GOUT aka KAUTI - "The Rich Man's Disease" Part I

"Tokanga na'a langa ho kauti he fo'i kai ko ena!"  (Watchout with that meal, it might set off your gout!)  "Oku 'ikai ke lava mai he oku langa hono kauti.  Fk'ofa 'auptio!"  (He can't make it because he's having a gout attack.  Feel bad for him!)  How often have you heard these exclamations?  Gout has got to be one of the most (if not the most) debilitating disease out there.  Whether the man is 6'5" or 5'2", Gout, without a doubt, will always put him on his back for days.
MUCH have or is being SAID about KAUTI among our community.   "Fu'u lahi e kai puaka" or "Fu'u lahi e fakapikopiko moe fa'a kai".  But very little (in my humble opinion) has been or is being DONE.  It is ALMOST accepted that GOUT/KAUTI is a part of who we are.  I guess in a way, such notion has some truth to it.  It has been found that if you are a Pacific Islander, you are pre-dispose to HYPERURICEMIA (abnormal high level of uric acid in the blood-more on this later) which eventually can cause GOUTY attack (Simmonds et al., 1994; Zimmet et al., 1978)..  In a sense, we can blame our ancestors for not weeding out those that had the genetic mutations that leads to this deal.  I guess that's enough warming up and complaining.  It's time to sink our teeth into the subject matter and really try to get a working definition and understanding.  To overcome our enemies, we must understand everything about them.

WHAT IS GOUT or KAUTI?
GOUT has been known as the "Rich man's Disease" because it was only common in wealthy and privileged people who had more access to meats in their diets.  It is simply an inflammation of the joint due to crystallized uric acid that aggregate at the joints.  You can envision it as 'momo'i nge'esi hina sio'ata oku lingi'i ki he hokotanga hui!"  It is most often first manifested (~50%) in the big toe joint of the foot.  The reason being is because it is farther away from the core and therefore the temperature is lower.  The lower temperature is necessary for the crystallization process.  This is why most GOUTY attack happens during cold season.  However, it is important to note that it can happen anytime.
If you couldn't envision it, check out the pictorial depiction below:

(image retrieved from http://www.graphicshunt.com/health/images/gout-35.htm)










WHAT IS THE CAUSE/PATHOPHYSIOLOGY OF GOUT?
As mentioned above, it is due to aggregation of uric acid crystals in the joint and the associated tissues and tendons.  Abnormally high level of uric acid (hyperuricemia) will lead to accumulation in the joints and turning into crystals.  High level of uric acid can be due to three reasons: (1) either your body is making too much uric acid or (2) your body is not being able to get rid of the uric acid and (3) mixed of the first two.  It is important to note that having hyperuricemia doesn't mean that you have gout.  It is only when the uric acid crystallizes that one will have a gout attack.
The crystallization of uric acid is initiated when the (1) temperature at the joint is low enough and (2) the acidity (pH level) is at the threshold level.
How does 'kai puaka' and diet contributes to kauti then?  Studies have shown that diet contributes to 12% of gouty attacks (Chen LX, Schumacher HR (October 2008). "Gout: an evidence-based review". J Clin Rheumatol 14 (5 Suppl): S55–62.). Foods that are high in purines and proteins have been associated with hyperuricemia and gout.  Alot of these food not only contribute to high level of uric acid but they also lowers the pH level (increasing acidity) and therefore allowing for the formation of the crystals!  Here's a list of the acid forming foods  and substances:
Artificial sweeteners, Carbonated soft drinks & fizzy drinks , Cigarettes , Flour (white wheat), Goat, Lamb, Pastries & cakes from white flour, Pork, Sugar, Beer, Brown sugar, Deer, Chocolate, Coffee , Custard with white sugar, Jams, Jellies, Liquor , Pasta,  Table salt refined & iodized, Tea black, Turkey, Breads White / Wheat, White rice, commercial vinegar.


To wrap it up, we see that as Pacific Islanders, we are genetically predisposed to HYPERURICEMIA (high level of uric acid in the blood) and with the abundance of the foods and substances listed above and cold weather, gout will continue to plaque us UNLESS we do something about it.  In the next portion of the GOUT/KAUTI blog, we will explore how to combat this disease and address how dangerous the "Kai koe kae toki folo ha fo'i akau" attitude is.  TONGA MA'A TONGA!