The Offal Truth

The Jakarta Post ,  Jakarta   |  Sat, 05/24/2008 11:10 AM  |  Health

In the West, it’s considered a disease of times gone, or at most an old man’s affliction. Here, it remains a relatively common problem, especially among men. Vivi Anggrainy takes a closer look at gout.

 

A typical lunch for Ferdy used to consist of chowing down on amazingly tasty animal parts – the innards, lungs and other offal -- that some people consider to be disgusting and better thrown away.

Two years ago, the 31-year-old Jakarta marketing officer experienced pain in his joints and extremities. After an initial doctor’s consultation failed to improve his condition, he went in for a blood test. It revealed a uric acid level of 11 mg/dL and he was diagnosed with gout.

“That was a frightening experience for me,” he says. “I am a young man with a chronic condition which was probably triggered by my previous eating habit.”

Simply put, gout is a form of arthritis. The problem is caused when the body cannot effectively metabolize uric acid, a waste product that naturally occurs in the body. Gout usually attacks the big toes as they are the coolest and farthest extremity from the body. It also can affect other joints such as the ankle, heel, instep, knee, wrist, elbow, fingers and spine. Sufferers describe the pain as excruciating.

"The process begins with the metabolism of purines, which are nitrogen containing compounds that are important for energy,” according to the Health and Age website. “Humans are the only mammal that breaks downs down purines into uric acid which is not as easily eliminated from the body as humans lack an enzyme called uricase. Thus explain the build up of uric acid in body tissues."

"Normally, the body keeps a health level of purines which is below 6.8 mg/dL. When the concentrations of uric acid reach 7 mg/dL and above, the blood becomes supersaturated and crystals of a salt cold monosodium urate form thus causing inflammation and pain."

Uric acid is produced from purines in the liver. Most passes through the kidneys and is excreted in urine. The rest is disposed of in the intestines, where it is processed and broken down by bacteria.

Gout is most common in men over 40, and doctors say women have a much lower risk for the condition, possibly because of the action of estrogen in facilitating the excretion of uric acid. However, about 85 percent of cases in females occur in post-menopausal women.

A study done by the Indonesian Rheumatic Centre in Jakarta in North Sulawesi, found that alcohol consumption and certain food habits were associated with gout. A family history of gout and being overweight were also significant risk factors.

Dr. Mardiana, who has been in general practice for 30 years, said that one out of 100 male patients she sees is diagnosed with gout. She said that she very rarely had a female patient with gout.

Aside from a hereditary predisposition, she said the consumption of animal organs and offal contributes to the disease’s high prevalence here. “Many of my patients with Makassar, Padang or Manado backgrounds have gout,” she says. “Their diets include a lot of offal. We consume the inner parts of animals when it is practically junk.”

Fund manager Agus has a family history of gout but is an admitted food lover. The 26-year-old fund manager ate whatever and however much he wanted, until he was diagnosed with gout.

“My first gout attack was back in 2002 when I was 20, which is quite young and it was quite scary in a way,” he says. “I was given medication but I chose not to depend on medication because I think that lifestyle changes are more important to prevent the disease to deteriorate my state of health.”

A quick Internet search revealed all the foods barred from his plate.

“For a foodie like me, it was a tough choice to make. Almost all the food I like is basically on the list. For example, it turns out that seafood contains high levels of purines. And finding out that ‘good food’ such as oatmeal, beancurd and tempeh have significant amount of purines was a little bit disappointing.

He says he finds the situation a bit “funny …I can focus on my heart and cholesterol levels and eat lots of oatmeal, salmon and beancurd. On the other hand, this will exacerbate and speed up my gout flare-ups.

“So what am I supposed to do?”

Dr. Mardiana says portion control is very important in controlling gout.

“Food in the nut and beans family, including soybeans, actually have a moderate amount of purines. You can eat this food but you must control your portions. For example, a quarter cup of beans accompanied by vegetables.”

She adds that by controlling the amount of purines consumed, it gives the body a chance to metabolize them properly.

“In my experience, a lot of patients with gout also come from poor families,” she says. “They cannot afford medications and therefore, the only option is a strict diet to prevent attacks. However, they usually tend to forget the rules and often, when they feel better, they will go back to their old eating habits and then come back to me with the same complaint.”

Sonny, a 36-year-old gout sufferer, agrees that food choices play a significant role in preventing gout attacks.

“I used to loathe healthy food and until I was diagnosed I preferred to eat fried food, soto (Indonesian chicken soup) and satay. I read books on gout and then modified my lifestyle. I don’t have as many attacks per year anymore although, I do get more attacks when I start to slack off and not take care of my body properly,” he says.

“You know, our eating habits in Indonesia are crazy, we eat organs considered rubbish. I used to like fried cow’s lungs but now I don’t even dare to have a tiny bite of lungs and emping (bitter nut crackers) which I love.”

He says he has learned his lesson the hard way.

“Once you know that you are at risk, like me, don’t even think about eating what you are not supposed to. The pain from gout attacks is so bad that even the wind blowing causes excruciating pain when your joint is inflamed.”

The writer is the manager of International Medical Insurance at PT. Global Asistensi Manajemen Indonesia a.k.a. Global Health and Assistance

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