Health Tips / Gout

You don’t forget your first gout attack. Pain wakes you up in the middle of the night. Of all things, it’s your big toe that hurts. You try to go back to sleep, but the pain keeps getting worse and by morning, your poor toe can’t even stand the pressure from the bed sheet. Gout, which affects mainly middle-aged men, begins with unusually high blood levels of a waste product called uric acid. Normally uric acid is excreted in the urine, but in a gout-prone person, it precipitates as crystals in certain joints (the big toe, knees, elbows, fingers). The result is a local (and painful) inflammation. The crystals can also accumulate in the skin and in the kidneys (where they can cause kidney stones or even kidney failure).

Conventional medications are available that work well to stop an acute attack of gout as well as prevent additional attacks. But conventional medicines may have side effects and can be toxic to the liver. The nutritional and lifestyle suggestions from WholeHealth Chicago can help keep your gout at bay, and they’ll even make you a healthier person in the process.

What is Gout?

Gout is a condition in which too much uric acid (a substance primarily created by the breakdown of protein in certain foods) builds up in the blood. Normally uric acid is excreted through the urine, but in some people the body simply produces too much of this substance or can’t get rid of it efficiently. The excess uric acid then builds up in the bloodstream and eventually collects in the joints and other tissues. Gout’s characteristic inflammation and severe pain is the result of needle-shaped crystals that precipitate from the high concentration of uric acid. Gout tends to be a man’s disease, affecting more than one in a hundred males over age 40. Though women are less prone to this condition, their likelihood of suffering from gout increases after menopause. Gout is an intermittent disease: It may produce no symptoms much of the time, but then a painful attack can arrive without warning. Uric acid may accumulate in the blood for years without symptoms, then when levels reach a certain point (which varies among individuals), attacks of gout can suddenly begin.

Key Symptoms

  • Excruciating, sudden pain, most often in the big toe, heel, ankle, or instep at onset. Later, the knees, wrists, elbows, fingers, and other areas may be affected.
  • Swollen, red joints
  • Occasionally kidney stones with fever, extreme low-back pain, abdominal swelling, nausea, or vomiting

What Causes Gout?

Scientists don’t yet know the precise cause of gout but they have identified some risk factors:

Family history. One in four gout sufferers has relatives who have gout as well.

Triglyceride levels. Three in four gout sufferers have elevated triglyceride levels.

Weight gain. Men who put on many pounds between the ages of 20 and 40 are especially prone to gout.

Alcohol. Drinking too much alcohol, especially in “binge” patterns of several drinks at a time, appears to play a role in contracting gout.

Purine-rich foods, such as shellfish, liver, anchovies, kidneys and sweetbreads may cause flare-ups in some people. Other risk factors for gout include those as diverse as high blood pressure, kidney disease, crash diets, lead exposure and taking certain medicines, including antibiotics, diuretics and cancer chemotherapy drugs.

Treatment and Prevention

Over the centuries, people with gout slowly discovered that certain foods were able to relieve the misery of gout attacks and even to prevent attacks from occurring. Among the food remedies are several pleasant solutions, including fresh or canned cherries (though you need to eat an entire half pound per day). Experts now know that cherries reduce uric acid levels. Some people prefer cherry fruit extract pills, which are found on health-food store shelves. Strawberries, blueberries, and celery (or celery seed extracts) also seem to help keep gout at bay.

Today, the most effective treatments for acute gout attacks are conventional medications, which are both safe and effective. Most doctors prescribe one of the nonsteroidal anti-inflammatory drugs (NSAIDs) for an acute attack. Patients usually begin to feel relief within 24 hours. An older remedy for both an acute attack of gout, as well as prevention of future attacks, is the prescription drug colchicine, which is derived from an herb, the autumn crocus. Although effective, the oral version has the unpleasant side effect of inducing rather severe diarrhea, so for an acute attack, some doctors give colchicine in an intravenous injection.

For prevention (but not for acute attacks), most doctors prescribe allopurinol, which reduces the production of uric acid altogether. Some doctors prefer probenecid, with or without a little colchicine added. Probenecid increases the urinary excretion of uric acid.

In addition, one alternative therapy that has been used to relieve gout is acupuncture, which can be very effective in the treatment of inflammatory joint conditions.

Just a reminder: If you have a serious medical condition or are taking medication, it’s always a wise idea to talk with your doctor before beginning a supplement program.

How Supplements Can Help

Although conventional drugs are the best bet for treatment of gout, natural supplements may help by easing the pain of attacks as well as possibly preventing subsequent flare-ups. All of the supplements listed here are safe to use long-term, and some (cherry extract, vitamin C) are easier to stick with than others.

The enzyme bromelain is the supplement that seems to help most during an attack, and it should be taken every three hours to help relieve pain. Derived from pineapples, bromelain is widely used to fight all types of inflammation. Lower the frequency to twice a day once the current flare-up has subsided, and continue to take bromelain to help prevent future attacks. (Bromelain should be taken between meals to aid its effectiveness.)

Quercetin is a flavonoid that reduces levels of uric acid. It’s a good preventive and is more efficiently absorbed when taken with bromelain.

Eating cherries is an age-old remedy for preventing gout attacks, because the fruit is rich in flavonoids, which appear to help reduce uric acid levels. Health-food stores often carry cherry fruit extract. Real cherry or blueberry juice often has the same effect.

Celery extract is another food substance that helps lower uric acid levels (you can also eat raw celery). Herbal teas made from cat’s claw, devil’s claw, or olive leaf act either as anti-inflammatory agents or to reduce uric acid, as does the herb nettle.

Vitamin C helps release uric acid from the body’s tissues and then speeds its excretion through urine. This vitamin is best taken in doses spaced throughout the day, however, because a single high dose can free up so much uric acid that a kidney stone may form.

Borage or evening primrose oil can be very useful. These oils interferes with the formation of inflammatory substances in white cells that play a key role in gout attacks. Flaxseed oil and fish oils also have anti-inflammatory properties.

Get supplement dosages and tips in our WholeHealth Chicago Supplement Recommendations for Gout.

Self-Care Remedies

To dilute the urine and reduce uric acid levels, drink eight or more glasses of water a day.

Avoid alcohol, which may precipitate gout pain.

Maintain a normal weight. People who are obese are more likely to have gout.

Avoid fats, refined carbohydrates, and excess protein in the foods you eat.

Avoid purine-containing foods such as organ meats, shellfish, anchovies, legumes, oatmeal, spinach, asparagus, cauliflower, and mushrooms if you think you may be sensitive to them.

When to Call a Doctor

  • If you suffer pain that meets the description of a gout attack. (A doctor can prescribe pain-relieving medications.)
  • If you believe you are passing a kidney stone, which is excruciatingly painful.

Supplement Recommendations

From David Edelberg, M.D. at WholeHealth Chicago: With gout, you’ve actually got two separate situations: acute attacks and life between attacks. Your goal is to minimize the first, and keep the length of the second as long as possible.
You’ll easily recognize an attack of gout: Your big toe suddenly becomes the focal point in your life, and you simply can’t believe how much pain can gather there. Even the pressure of a bed sheet may be too much to bear. Let’s see what can help.

How to Take the Supplements

To treat an acute attack. You’re better off with conventional medications for an acute attack of gout. Call your doctor for some indomethacin, colchicine, or a good nonsteroidal anti-inflammatory drug (NSAID).

If you’re in a pinch, however, just start over-the-counter NSAIDs, such as Alleve or Naproxen, and add the bromelain. Take two tablets of the NSAIDs every three to four hours and double the recommended dose of the bromelain for one or two days (up to 3,000 MCU four times a day); it’s a very safe supplement.

To prevent recurrent attacks. The supplement list is well suited to help forestall acute episodes of gout. The quercetin, cherry fruit extract (as well as fresh or canned cherries), and vitamin C are useful for lowering elevated uric acid levels. A safe long-term anti-inflammatory agent, the fish oils can reduce some of the damage from long-standing deposits of uric acid crystals.

On a long-term basis, I’d opt for the quercetin/cherry/vitamin C/fish oils combination. You can actually start with the amount of vitamin C found in your basic multivitamin and daily antioxidant complex.

In addition, when cherries are in season, you can skip the cherry extract capsule for a while and just enjoy the fruit and the juice. Also remember that other members of the berry family are helpful: Fresh blueberries, strawberries, and blackberries (and their juices) are all effective at lowering uric acid.

Drinking herbal teas made from nettle, devil’s claw, and celery seed may be useful as well; all these natural remedies might help to keep your uric acid at acceptably low levels. You might also try them during an acute attack.

Additional tips:

Keep yourself well hydrated. Try to drink two to three quarts of fluid a day–but not just water. The herbal teas and fruit juices noted above should be consumed as well. Get your uric acid blood level checked periodically. If the levels remain very high, you may need medication to lower them in order to prevent kidney stones or damage to the kidneys themselves. Important:

We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.

Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions.

For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.

Be well,
David Edelberg, MD