Gout

Gout, or gouty arthritis, is a common type of arthritis caused by an increased concentration of uric acid in the fluids of the body.

More than 2 million Americans suffer from gout each year, and it affects mostly middle-aged men.  Gout occurs when the kidneys cannot excrete excess uric acid in the urine, and crystals of uric acid form. These crystals accumulate at the joints, tendons, kidneys, and other tissue where considerable inflammation, pain, and arthritic-symptoms take place. The first step is to rid the body of uric acid, and that is by eliminating foods that are high in purines. When cells die and get recycled, the purines in their genetic material also get broken down.

In the 19th century, researchers discovered that the cause of gout was excessive uric acid production. Uric acid is the chemical formed when purines are completely broken down in the body. It’s normal for uric acid to be formed in the body from this process, for in our blood a certain amount of uric acid acts as an antioxidant and may reduce damage to our blood vessels.  However, the problem occurs when uric acid levels in the blood and other parts of the body become too high. When this happens uric acid accumulates and forms uric acid crystals that become deposited in one’s joints, tendons, kidneys (as invisible stones), and other organs.

With 20th century advances in understandings of the body’s urea cycle came effective treatments for gout.  The condition is now treatable, especially in acute cases, and when patients understand the importance of making healthy lifestyle choices.

Causes

Some examples of causes of gout and/or hyperuricemia (high uric acid levels):

• Nutrition, including high purine intake (see DIET below), high fructose consumption, alcohol and cola.
• Medications, including cytotoxic drugs, diuretics (Lasix, furosemide, Bumex), Vitamin B12
• Genetic factors, including Glucose-6-phosphate deficiency.
• Miscellaneous causes include obesity, alcohol consumption, psoriasis, high triglycerides, and excessive exercise.

Signs And Symptoms

Asymptomatic Hyperuricemia – In this stage there are no symptoms and only findings of a high uric acid level are revealed upon laboratory review.  High uric acid may actually be detected years before there is a gout attack. Most men who progress to having an attack have a serum urate level over 7.0 mg/dL (0.42 mmol/L).  This stage is sometimes referred to as “gout is like a match” because when uric acid accumulates near a joint, it sets off an attack that is like “setting the joint on fire.”

Acute/Recurrent Gout – This is the most common and most familiar stage of gout. During this stage acute inflammation often affects a single joint (usually the metatarsophalangeal joint of the big toe in 50% of cases.) This inflammation is self limited and often time extremely painful. Pain and inflammation peak within 24 hours, persists for several hours up to seven days, and often initially occurs at night time.

Intercritical Gout – In patients with established gout attacks, but are symptom-free for long periods in between attacks, they are referred to as being intercritical.  Hyperuricemia may persist. These patients must be educated on ways to reduce their uric acid levels so that the risk of an additional attack is minimized.

Chronic Gout – Patients who have long-standing gout develop tophi (deposits of urate, protein, and inflammatory cells) over many years of attacks. These tophi can mimic nodules and are sometimes mistakenly diagnosed as rheumatoid arthritis.  Patients with tophi may be prone to rupture or tearing of affected tendons, ligaments, or cartilage.

The criteria for the diagnosis of gout varies. Many times there is a presence of urate crystals in synovial fluid, or tophi that contain urate crystals.  Other symptoms include one attack of acute arthritis, maximal inflammation occurring within 24 hours, presence of joint redness, swollen joint on big toe, hyperuricemia, radiographic evidence of joint swelling, and/or negative synovial fluid culture during acute attack.

Diet

Most cases of gout can be treated and controlled by diet alone. Common advice is to avoid purines that might be a risk for gout. Purines are natural substances found in all the body’s cells and in virtually all foods. A relatively small number of foods, however, are concentrated forms of purines. High purine foods are akin to high protein foods, which include kidney, sardines, shell fish, wine, cheeses, herring, and asparagus.

The following dietary recommendations will help maintain a low-purine diet and help to rectify the occurrence and re-occurrence of gout attacks:

1. Eliminate alcohol, especially beer and wine, completely for the short-term, and then drink very moderately.
2. Organ meats are among the worst offenders. Eliminate red meats, chicken (especially goose and turkey), bacon, beef liver, kidney, gravy, veal, mincemeat, and game meats.
3. Eliminate high-carbonated drinks and drinks with phosphoric acid, including soft drinks, soda pop, and diet cola. Drink 6-8 glasses of water daily.
4. Minimize fish products that are high in purines, including herring, mackerel, mussels, scallops, sardines, anchovies, and shell fish.
5. Eat a lower protein diet.
6. Certain vegetables contain low amounts of purines and should be eaten moderately. They include asparagus, green peas, dried beans, mushrooms, celery, and spinach.
7. Achieve a more ideal body weight.
8. Eliminate excess refined sugar and restrict simple sugars (fructose, fruit juices, and honey.)
9. Consume a diet with more whole grains, legumes, nuts, seeds, berries, garlic, onions and vegetables. Eating the equivalent of ½ pound of fresh cherries (cherry juice) daily is an old nature remedy for gout.
10. Other foods that are allergic in nature and may lead to a more inflammatory response include:
    1. cow’s milk
    2. corn
    3. meat (beef)
    4. wheat
    5. eggs
    6. citrus
    7. nightshades (potatoes, tomatoes, peppers, eggplant)
    8. nuts
    9. coffee
    10. food additives.

Risks

If gout goes untreated, microscopic crystals of sodium urate can damage organs, especially the kidneys and the heart. This may lead to premature aging of the organ, and possible kidney stone formation. There is a heredity component; however, gouty arthritis is most likely a problem with acidic blood (due to lifelong acidic diets) and a too stressful a lifestyle.

Supplement Protocol

1. A POTENT MULTIPLE VITAMIN/MINERAL FORMULA
   A complete multi-vitamin/mineral formula is essential in boosting the immune system and lowering uric acid levels. Adding additional antioxidants, amino acids, and green foods would be more beneficial.  Dosage: As directed on label.
2. VITAMIN C with BIOFLAVONOIDS
   Vitamin C is a potent antioxidant that may reduce levels of free radicals that encourage gouty arthritis by destroying body tissues and may also lower serum uric acid levels. The favored bioflavonoid is QUERCETIN, which aids in vitamin C absorption, strengthening joints, and promotes cartilage repair. Dosage: Vitamin C 3,000-5,000 mg daily; quercetin 200-400 mg daily.
3. ESSENTIAL FATTY ACIDS (FLAXSEED, FISH OIL or BORAGE OIL)
   These omega fats help to repair tissues, aid in healing, decrease inflammation, and lubricate joints. Because an excess of saturated fats is often behind the implementation [I think you need a different word here, like development] of gout, restoring fatty acid balance with EFA’s is crucial. Dosage: 1000-4000 mg daily (flaxseed seems preferable to patients over 60 yrs).
4. CELERY SEED EXTRACT
   Celery extracts are effective in eliminating uric acid. This is a favorite herb of ethnobotanist Dr. James Duke who claims the self-dosing anecdotal results led him to believe in the effectiveness of the herb. Celery seed has high concentrations of flavonoids that inhibit the formation of xanthine oxidase. It has at least 26 anti-inflammatory compounds. Celery seed extract would be considered a natural alternative to the drug allopurinol. Dosage: 2-4 capsules daily, or as directed.
5. PANCREATIC/DIGESTIVE ENZYMES
   These enzymes (i.e., BROMELAIN, AMYLASE, PANCREATIN, WOBENZYM) have anti-inflammatory properties and may enhance the absorption of nutrients. Enzymes also help to break down proteins (purines), increase gastric emptying, and improve digestion. Dosage: 1-2 tablets 5-15 minutes before meals.
6. TUMERIC (CURCUMIN)
   One compound in tumeric inhibits the synthesis of prostaglandins that are involved in the release of pain and inflammation. Tumeric has pain-relieving qualities similar to aspirin and ibuprofen (without stomach upset and other side effects). Tumeric at higher doses also stimulates the adrenal glands to release cortisol, which is the body’s own cortisone that decreases inflammation. Dosage: 500-3,000 mg daily, or as directed.
7. COENZYME Q-10
   This enzyme has a high antioxidant effect and may protect against damage to organs. Dosage: 60-100 mg daily. It may be more effective if taken with HAWTHORN.
8. METHYLSUFONYL METHANE (MSM)
   MSM is a common supplement that may decrease pain and inflammation. It may be taken concomitantly with other anti-inflammatory herbs (BOSWELLIA, TUMERIC, DEVIL’S CLAW) and GLUCOSAMINE. Dosage: Take 2-6 tablets daily as needed.
9. GLUCOSAMINE and CHRONDROITIN
   Glucosamine with chrondroitin are highly effective for joint integrity. They help to build cartilage and hopefully reduce long-term problems with arthritis. They also have anti-inflammatory and pain-relieving properties. Dosage: 500-1,500 mg daily.
10. NON STEROIDAL ANTI-INFLAMMATORIES (NSAIDS)
    These may be used sparingly to reduce acute pain. COLOSTRUM may be of benefit in repairing NSAID side effects.
11. CAT’S CLAW
    This is an Amazonian herb used by natives to reduce inflammation. Dr. James Duke also recommends this herb when other better known products fail. Dosage: 2-6 capsules daily.
12. B COMPLEX VITAMINS
    These are essential for proper digestion and the functioning of all enzyme systems in the body. B vitamins also reduce stress and aid in protein metabolism. Dosage: 50-100 mg daily. There is some evidence that FOLIC ACID supplementation (a potent inhibitor of xanthine oxidase) may decrease uric acid, thus relieving gout symptoms and exacerbations. Dosage: 1,000 mcg daily.
13. MAGNESIUM and CALCIUM CITRATE
    These minerals help to reduce stress caused by the disorder. Dosage: Magnesium 500-750 mg daily; Calcium 1,000-1,500 mg daily.
14. UVA URSI
    This herb has a diuretic effect and can be supplemented to reduce edema due to gout. Dosage: 2-4 capsules daily for 3-4 weeks only.
15. DEVIL’S CLAW
    Several reports indicate that this herb lowers uric acid levels and has anti-inflammatory properties, both of which are useful in treating gout. Dosage: As directed.
16. ZINC
    Zinc is an important mineral in protein metabolism and tissue repair. Dosage: 40-80 mg daily.
17. VITAMIN E (d-alpha-tocopherol form)
    Vitamin E reduces oxidative damage and improves circulation. Dosage: 400-800 IU daily.
18. TOPICAL PAIN REMEDIES
    These include Arnica, Capsaicin, and MSM cream.
19. PYCONOGENOL or GRAPE SEED EXTRACT
    These powerful antioxidants function as natural anti-inflammatory agents and improve circulation. Dosage: as directed on label.

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