Gout

Once called the disease of kings, gout was associated with lavish banquets and goblets overflowing with wine. Even today many people think gout is limited to rich old men who dine well and drink port after dinner. Today natural treatments and lifestyle changes can help relieve gout.

The reality of gout

Gout is actually a democratic medical condition affecting people from all socioeconomic backgrounds, though most sufferers are male. According to the Arthritis Society, about 2 percent of Canadian men over 30 and women over 50 have gout—and the incidence of gout has doubled in the last 20 years.

What is gout?

Gout is a form of inflammatory arthritis caused by a buildup of needle-like uric acid crystals in the tissues and joints of the body. Uric acid is a natural byproduct formed by the breakdown of purines, chemicals found in many foods. When our bodies can’t process uric acid, gout becomes chronic and progressive, permanently destroying affected joints.

Painful on its own, gout is often linked to heart disease and kidney stones.

Is it gout?

If your big toe throbs and is inflamed and swollen, it’s probably gout. As the condition progresses, it can affect other joints—ankles, knees, wrists, fingers, and elbows. Lumps of crystals may form in the soft tissue around fingers, elbows, the rim of the ears, and big toes.

Gout attacks are usually rapid. They begin with pain, followed by heat, swelling, redness, stiffness, extreme tenderness at the affected site, and sometimes fever and muscle ache.

Attacks generally last hours or days and usually affect only one joint at a time. Unfortunately, more than 75 percent of sufferers have future episodes, often with increasing frequency and affecting a wider range of joints. For a few, gout turns into chronic joint inflammation, similar to rheumatoid arthritis.

What causes gout?

In theory, gout is caused by an inherited abnormality in the body’s ability to process and eliminate uric acid. In reality it’s not that simple. While approximately 10 percent of American males have high levels of uric acid, a condition called hyperuricemia, most don’t develop gout. Equally, not everybody with low levels is safe either.

That’s where lifestyle and medical factors enter the equation by elevating levels of uric acid in the blood. Increased risk factors for developing gout, other than a family history, include

• obesity, particularly excessive weight gain during youth
• moderate to heavy alcohol consumption
• high blood pressure
• kidney dysfunction
• an organ transplant
• having diseases such as cancer, hemoglobin disorders, psoriasis, diabetes, and hypothyroidism
• the use of certain drugs, including some diuretics, low-dose aspirin, niacin, some immunosuppressants, and some medications for Parkinson’s disease and tuberculosis

Once the disease gains a foothold in the body, it attacks through flare-ups, which may become chronic. Everyday situations that can spark explosions of pain include

• dehydration
• joint injury
• fever
• overeating
• excessive drinking

Even recent surgery can trigger gout attacks, possibly because patients become dehydrated.

Conventional medical treatment

Treating gout involves both short-term measures for acute flare-ups and long-term management to prevent repeat attacks and joint destruction.

To correct the underlying problem of acid buildup, doctors prescribe drugs that increase the body’s ability to excrete or lower the amount of uric acid. For flare-ups, conventional medications include pain relievers and anti-inflammatory drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and corticosteroids to decrease joint inflammation.

Unfortunately, most of these drugs have side effects, ranging from gastrointestinal irritation and bleeding, diarrhea, nausea, and vomiting to kidney stones, severe rash, and liver damage. Plus, as uric acid metabolism is not constant, anyone taking these drugs needs to be monitored regularly by a qualified health care practitioner.

Lifestyle and natural treatments

You can’t change your genetics; you can change your lifestyle.

Purine
While purine is found in many foods, not all sources affect the body equally. With only an approximate 10 percent of the body’s uric acid coming from food, restricting purine-rich food is just a first step. At the top of the to-be-avoided list are

• shellfish
• meat, particularly organ meats such as liver, brains, kidneys, and sweetbreads
• dried beans and peas
• anchovies, herring, and sardines
• Dairy

For years researchers have known that low-fat dairy intake reduces the risk of gout. A recent New Zealand study indicated that enriched skim milk dramatically decreased the risk of flare-ups and lessened pain among people with poorly controlled gout.

Liquids
Alcohol—especially beer—and fructose in sweetened drinks increase uric acid levels, while water helps to flush uric acid out.

Coffee may also have a positive effect. Teams of Canadian and American researchers investigated 45,869 men and discovered that drinking four or more cups of caffeinated coffee a day, but not tea, significantly reduced the risk of gout. Later studies reported results for both men and women.

Diets and weight
While maintaining a normal weight reduces risk, quick low-carbohydrate weight loss diets and fasting have the opposite effect.

Vitamin C
Several studies have shown vitamin C to lower blood uric acid levels. One study found that men with the highest vitamin C intake from supplements or food were less likely to develop gout than those with the lowest intake—those taking 1,500 mg daily as supplements had a 45 percent lower risk. However, researchers warn that megadoses, as well as extra niacin and vitamin A, can increase uric acid, causing flare-ups, so consult a health care practitioner.

Cherry juice
Two small studies on cherry juice concentrate for reducing gout attacks have borne fruit; it appears to work by reducing inflammation.

Supplements
Numerous supplements and herbs are touted to cure or lessen the pain of gout, such as bromelain, turmeric, flaxseed oil, cat’s claw, and devil’s claw. Homeopathic remedies include aconite, arnica, belladonna, bryonia, colchicum, and ledum to reduce pain and swelling.

Currently, much of the evidence for these natural or traditional remedies remains anecdotal. As more scientific studies are done, some of these remedies may indeed pass the effectiveness test. For now, be a careful consumer and consult a health care practitioner.