Gout Is A Form Of Arthritis
Gout is regarded as a form of rheumatism and is one of the most painful forms of arthritis. There are different types of arthritis such as osteoarthritis, the “wear and tear” arthritis of the larger joints like hips, knees, back, etc. Then there is rheumatoid arthritis which is the inflammatory (heat) arthritis affecting the smaller joints generally like the writs, fingers, etc. And then there is gout, what I call the “red-blooded male’s arthritis”. I can remember reading a book awhile ago about the era of the large ocean going vessels such as the Endeavour during the golden age of discovery. Many officers on board such vessels suffered terribly from gout. Mind you, they were the commanding men who drank plenty of rum and ate plenty of beef with lashings of gravy. So what has changed? Blokes still like to command, drink rum and coke or cold beer, and eat hot steaks and what red-blooded guy doesn’t? I have never seen a committed vegetarian suffering with gout, and very much doubt they even exist in this country.
Signs and Symptoms of Gout
- Recurrent, acute attacks of pain, tenderness, redness, inflammation and swelling around the smaller joints – especially the joint of the big toe. Why the big toe you ask? Common sense – because it is the joint at the lowest point of the body, the area where deposits of uric acid and other wastes tend to form due to gravity. If you are right-handed, the right big toe joint will be more likely affected than you left, and vice versa. This is because you step off and lead with your right foot as you walk, and is will have therefore a slightly better circulation of nutrients (and therefore also a little more deposition of wastes) than your left foot. Reflexologists often talk about “crystals” forming around the toe joints, and you can feel “crunching” sensations if you prod firmly under your toes or wiggle the toe joints at times.
- Swelling, inflammation and a feeling that the joint may be very hot and/or throbbing.
- A red discolouration around the joint.
- Definite tenderness which can be so intense that even a blanket touching the skin can be absolutely unbearable!
- Chills or fever in some cases, see your doctor if this is the case.
Here are a few gout statistics
- Gout afflicts approximately up to 0.5% of the population of the western world.
- Over 95% of gout sufferers are men aged 30 or over.
- Gout is twenty times more likely in males than women.
- Gout is strongly associated with being overweight and having high blood pressure.
- Gout can also occur in women, more commonly after menopause.
- Maori and Pacific Islander peoples in particular tend to have high uric acid levels and are predisposed to gout, especially the Maori (indigenous New Zealand population)patients I see who love typically love to consume paua (abalone), kina (sea urchin), mussels (shellfish), roe (fish eggs) and crayfish (like lobster).
- The type of individual most commonly affected by gout is an overweight man who drinks large amounts of alcohol, is a regular meat-eater and who may have high cholesterol and high blood pressure.
Causes Of Acute Gout Attacks
- Certain medications, such as some types of diuretics, can cause gout. Aspirin and niacin (Vitamin B3) can also raise uric acid levels.
- Certain diseases can lead to an excessive production of uric acid in the body, including some leukaemias, lymphomas and some haemoglobin (blood) disorders.
- Some studies have indicated an increased prevalence of low thyroid function (hypothyroidism) in people with gout.
- Dehydration (alcohol & caffeine dehydrates).
- Injury to a joint.
- Excessive intake of purine-containing foods (see list below).
- Heavy alcohol intake.
- Recent surgery (this may be related to changes in the body fluid balance because of fasting before surgery).
- Family history – hereditary.
Approximately 70% of gout patients have an overproduction of uric acid, the remaining 30% of gout patients have a poor elimination of uric acid, therefore it makes sense to eat fewer foods which help to produce uric acid, and improve uric acid elimination by way of the kidneys. Uric acid is a by-product of the breakdown of certain foods in the body, and gout was once considered to be closely related just to diet. It is now understood that inheriting a problem with uric acid excretion from the body is probably one of the most common reasons for gout to occur. Improving a person’s kidney function as much as possible has helped many gout sufferers I have seen over the years. Uric acid is the end product of the metabolism of chemicals called purine that are found in many foods. Purines are also found naturally in the body, and normally, the body disposes of excess uric acid via the urine, but in people with gout uric acid accumulates in the body. This can be due to reduced excretion of uric acid by the kidneys or to overproduction of uric acid by the body. This accumulation of uric acid may also cause kidney stones, and it doesn’t take a rocket scientist to work out that you need to improve the kidney function as much as is possible to help the patient overcome gout.
Gout Is Pain
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Medical Treatment of Gout
Preventing Gout Attacks
- Reduction or elimination of alcohol consumption, this is the BIG one in my opinion. Alcohol causes uric acid levels to rise and has a diuretic effect that can add to dehydration and bring on gout attacks
- Make sure you drink plenty of water to promote the excretion of uric acid;
- Weight reduction, is often necessary. This can be achieved by reducing dietary fat and calorie intake, which should be combined with a regular (walking) programme.
- “Crash diets” should be avoided as this can lead to an increase in uric acid levels through lowered uric acid excretion, you put more pressure on the kidneys and liver when you try to lose weight too quickly and end up with more problems than you can solve!
- Dietary changes to reduce uric acid levels in the blood. Avoid purine-rich foods such as shellfish, organ meats (liver, brains, kidney etc.), and fish roe, paua, crayfish, anchovies and sardines.
- Limit the intake of dried beans and peas and yeast products like beer and bread.
- Try an ice pack on the affected area, sometimes a foot spa can help as well.
- Reflexology has helped many patients and is well worth a try.
Eric’s Gout Recommendations
- Drink at least six glasses per day and make sure that you have one of the glasses before you go to sleep – it helps get rid of uric acid. The more you pee the more uric acid you get rid of.
Reduce serum uric acid levels.
- Vitamin C. Doses of 4000 up to 8000mg/day increased urinary excretion of uric acid and lowered serum uric acid levels in many trials. This effect would presumably reduce the risk of gout. However, it has been argued that rapid mobilisation of uric acid could trigger a gout attack; although such an effect of vitamin C supplementation has not been reported. To minimise this theoretical risk, I recommend the gout patient to start vitamin C at lower doses and build up gradually.Eat cherries: Black cherries are the best (fresh or canned) up to 250gr a day or the equivalent amount of cherry juice, has been reported to relieve acute attacks, prevent recurrences, and reduce serum uric acid levels. Sweet yellow and red sour cherries were also effective. I have seen major improvements in more than a few males who stepped their intake of cherries up with acute attacks and have major pain relief (drug-free) within a week.
- Folic acid. Doses of up to 10mg/day, when combined with unspecified doses of vitamin C, has been reported to reduce serum uric acid levels.
- Reduce fructose intake. High consumption of fructose (fruit sugar) may increase the risk of gout due to the ability of fructose to increase the body’s production of uric acid.If you have bad gout, avoid these high fructose food items: Honey, dates, raisins, figs.
- Alcohol. Daily drinking habits, lack of exercise, and dehydration enhance the increase in plasma concentration of uric acid induced by alcohol, and it is important to pay attention to these factors, as well as to the ingested alcohol volume and type of alcoholic beverage. An excess of alcohol should be avoided. Total abstinence and avoidance of alcohol may be required in severe cases. The worst alcohols to consume with gout are the ones you “can’t see though” like whiskey, bourbon, rum, beer, etc. The alcohols which don’t seem as bad are the “clear” ones like vodka and gin. You should avoid ALL alcohol if you have bad gout. See now why guys don’t tend to come back to the naturopath now if they have bad gout? One male gout patient called me the “fun police”, when I made the recommendations of abstinence.
- Protein. Consume a moderate amount of protein. Limit meat, fish and poultry to 100 – 120 grams per day. Try other low-purine good protein foods such as low fat dairy products, tofu and eggs.
- Body weight. Maintenance of, or gradual reduction to, ideal body weight could prove helpful. Your blood pressure will drop, so will your cholesterol and not only your likelihood to avoid gout attacks, but you will reduce your chances of most chronic diseases.
- Avoid as much as possible: anchovies, crayfish, shellfish, lobster, albaone, fish roe or fish eggs like caviar, herring, mackerel, meat extracts, beef in general, kidney or organ meats, lamb, pork, mussels, paua, roe, sardines, yeast (baker’s and brewer’s, taken as supplement) coffee, tea and ALL alcoholic beverages, chocolate, cocoa, caffeine containing soft drinks, wheat germ, pastry, high fat biscuits and cakes, whipped cream, fried potato, potato chips, broth, bouillon, consommé, meat stock soups and gravies.
- Eat these foods with caution: Asparagus, dried beans lentils, meat, mushrooms, dried peas, spinach (silver beet)
- To have in your diet: Milk and milk drinks, carbonated beverages, cereal/grain beverages. All breads and cereals, low fat biscuits, cakes, and puddings. Fat in moderation only, fruit juices such as cherry, blue berry are particularly good. Eat cherries and blue berries. Fish is ok, but stick with tarakihi, snapper, gurnard and younger fishes. Chicken and ham, soups, most all the common vegetables, condiments, herbs, nuts, olives, peanut butter, pickles, popcorn, relishes, salt.
- Krause’s Food, Nutrition, & Diet therapy, 10th edition (Mahan LK, Escott-Stump S)
- Broadhurst, C. L. Ease gout pain. Nutrition Science News. July 1999.
- Flouvier, B., et al. Folic acid and uric acid. Ann Intern Med. 88(2):269, 1978.
- Henry, R. R., et al. Current issues in fructose metabolism. Ann Rev Nutr. 11:21-39, 1991.
- Hoi, H. K., et al. Alcohol intake and risk of incident gout in men: a prospective study.
- Lancet. 363 (9417):1277-1281, 2004.