Disease, Illness and Condition Library
Gout
than women. It most commonly affects the joint of the big toe. Gout is essentially the result of a breakdown in the body’s internal chemistry and is caused by uric acid crystals in the joints.
derive from the generic material of cells. It is normally filtered out by the kidneys and excreted in the urine. If an excess of uric acid is produced, it accumulates and forms tiny crystals in the joints and elsewhere. If the crystals enter the joint space, they cause inflammation, swelling, and joint pain. Gout most commonly affects the big toe, but it may affect other joints: the ankles, knees, hands, wrists, and elbows. It can also affect soft flesh of the ears, hands, and feet, where uric acid may crystallize in the form of small hard white lumps called tophi. The affected joint starts to ache, then quickly becomes swollen, red, very warm, and extremely painful. The attack usually lasts for a few days, dies down, and the joint gradually returns to normal. Gout affects four times as many men as women. When gout affects women it usually does so after menopause; for men it’s middle age. While gout is not curable it is controllable, but if left untreated, it can cause crippling arthritis, high blood pressure, and kidney damage, which may eventually prove fatal. Some people are more susceptible to gout than others. In some individuals the metabolism naturally controls uric acid slowly. Common gout triggers include infections, injury, antibiotics, diuretics, aspirin, and crash diets. There seems to be differing options amongst medical professionals as to the role food and drink pay in the onset of gout. Some doctors believe food and drink to be major contributing factors while others believe they play only a small role. Gout can be extremely painful and should always be taken seriously, despite its reputation for being a nuisance disease. It is important that an accurate diagnosis be made, although it symptoms may mimic other kinds of arthritis, the treatment for gout is specific.
The average adult male excretes 200 to 600 mg of uric acid daily, and another 100 to 300 mg is excreted in the bile and other gastrointestinal tract secretions. While diet is very important it may only contribute only 20 percent of the total. Nevertheless, purines and uric acid acquired through diet have been shown to increase crystal formation in tissue. As you may already know uric acid is a highly insoluble molecule, and at a pH of 7.4 and body temperature, the serum (blood minus blood cells) is saturated at 6.4 to 7.0 mg/100ml. Although higher concentrations do not necessarily result in uric acid crystals being deposited in tissues (some still unknown factors seem to inhibit crystal precipitation), the chance of an acute attack of gout is greater than 90 percent when the serum uric acid level is above 9 mg/100ml. Lower body temperatures decrease the saturation point of uric acid, which may explain why uric acid deposits tend to form in areas such as the top of the ear, where the temperature is lower than the average body temperature. Uric acid is insoluble at a pH level of 6.0 and can lead to kidney stones, as the urine is concentrated in the collecting ducts of the kidneys and passed to the bladder. Treatment for Gout There are four approaches to treatment. The first is caring for the pain with pain medication. The second is treatment for the inflammation with a course of anti-inflammatory drugs. You are advised to get plenty of rest, increase your fluid intake, especially water, and to greatly cut down on red meats and alcohol. The third treatment involves a combination of drugs, which you will have to take for the rest of your life. The first drug increases the excretion of uric acid by the kidneys and the second drug reduces the amount of acid produced by the body. The fourth is to limit the intake of purine rich foods combined with supplementation of herbal gout treatment formulas. This type of treatment would be considered a holistic approach. No matter what course action you decide to take limiting your intake of foods high in purines is probably a good idea. Limiting these types of food should reduce the amount of uric acid in your system. Purine rich foods include shellfish, oily fish, and legumes. It is very important not to take painkillers if you suspect you have gout, except those prescribed by your doctor. Asprin, for example, can actually slow the excretion of uric acid from the body, thereby aggravating the disease. Pseudo Gout This is a form of arthritis caused by deposits of calcium crystals, rather than the uric acid crystals of gout, in the joints of the body. Pseudo gout refers to the gout like attacks of joint inflammation that occur in many people suffering from this condition. The calcium containing crystal deposits that are found in the cartilage of the joints may be visible on X rays taken of the affected area. Pseudo gout is caused by deposits of crystals composed of calcium and pyrophosphate in the tissues of the body, especially in the cartilage. It is believed that an accumulation of pyrophosphate in the cartilage promotes the formation of the crystals. Pyrophosphate is a type of acid produced by the joint tissue. In most cases the crystals form without specific reason. Pseudo gout tends to run in families as does conventional gout. Acute attacks of pseudo gout often occur in the knee joints and can incapacitate the sufferer for weeks. Pseudo gout is not as serious, nor as painful as regular gout and is harmless unless the crystals become dislodged. If this happens they can set up inflammation in the joint. This is often treated by inflammatory drugs or by drawing off the fluid containing the crystals with a syringe. Only if treatment is neglected is pseudo gout likely to cause long term damage and pain. Pseudo gout, like gout, is controllable but not curable. It is very important that a correct diagnosis be made to avoid confusion with gout. Current wisdom suggests that gout can be controlled through diet, watching your weight and sometimes taking the right medications. Diet seems to be particularly important. Many foods contain purine which has been linked to gout.
Therapeutic Considerations for Gout The current standard medical treatment for acute gout is administration of colchicine, the anti-inflammatory drug originally isolated from the plant Colchicum autumnale (autumn crocus, meadow saffron). Colchicine has no effect on uric acid levels; rather, it stops the inflammatory process by inhibiting neutrophil migration into areas of inflammation. Three out of every four patients with gout show major improvement in symptoms within the first twelve hours after receiving colchicine. However, as many as eighty percent of patients are unable to tolerate an optimal dose because of gastrointestinal side effects, which may precede or coincide with clinical improvement. Colchicine may also cause bone marrow depression, hair loss, liver damage, depression, seizures, respiratory depression, and even death. Other anti- inflammatory agents are also used in acute gout, including: indomethacin, phenylbutazone, naproxen, and fenoprofen. Once the acute episode has been resolved, a number of additional measures are taken to reduce the possibility of recurrence: * Drugs or herbal remedies to keep uric acid levels within a normal range * Controlled weight loss in obese individuals * Avoidance of known triggering factors, such as heavy alcohol consumption or a diet rich in purines * Low doses of colchicine to prevent further acute attacks Several dietary factors are known to be causes of gout, including consumption of: * Alcohol * Foods containing large amounts of purines (organ meats, meat, yeast, poultry, etc.) * Fats * Refined carbohydrates * Excessive calories Those suffering from gout are typically obese, vulnerable to hypertension or diabetes, and at a greater risk for cardiovascular disease. Obesity is probably the most important diet related factor. In theory, the naturopathic approach for treating chronic gout does not diverge substantially from the customary medical approach: * Dietary and herbal measures are employed, instead of drugs, to keep uric acid levels within the normal range * Obese individuals are placed on a careful weight loss program * Known precipitating factors, such as heavy alcohol consumption and numerous dietary factors, are controlled * Nutritional substances are used to prevent further acute attacks Dietary Considerations The dietary treatment of gout involves the following guidelines: * Eliminating consumption of alcohol * Low purine diet * Achievement of ideal body weight * Liberal consumption of complex carbohydrates * Low fat intake * Low protein intake * Liberal fluid intake Alcohol: Alcohol increases uric acid production by accelerating purine breakdown. It also reduces uric acid excretion by increasing lactate production, which impairs kidney function. The net effect is a considerable increase in serum uric acid levels. This explains why alcohol consumption is often a trigger in acute attacks of gout. Elimination of alcohol is all that is needed to reduce uric acid levels and prevent gouty arthritis in scores of individuals. Low Purine Diet: A low purine diet has long been the foundation of dietary therapy for gout. However, with the introduction of potent drugs that lower uric acid levels, many physicians choose to simply write out a prescription rather than educate the patient how to control the gout by dietary measures. Foods with high purine levels should be entirely avoided. These include organ meats, meats, shellfish, yeast (brewer’s and baker’s), herring, sardines, mackerel, and anchovies. Foods with modest levels of protein should be limited as well. These include: dried legumes, spinach, asparagus, fish, poultry, and mushrooms. Weight Reduction: Excess weight is linked with an increased rate of gout. Weight reduction in obese individuals appreciably reduces serum uric acid levels. Weight reduction should entail the use of high fiber, low fat diet, as this type of diet will help manage the elevated cholesterol and triglyceride levels that are also common in obesity. Carbohydrates, Fats, and Protein: Consumption of refined carbohydrates, fructose, and saturated fats should be kept to a minimum. Simple sugars (refined sugar, honey, maple syrup, corn syrup, fructose, etc.) increase uric acid production, while saturated fats decrease uric acid excretion. The diet should focus on complex carbohydrates such as legumes, whole grains, and vegetables rather than on simple sugars. Protein intake should not be excessive (greater than 0.8 g/kg of bodyweight), as it has been shown that uric acid synthesis may be accelerated in both normal and gouty patients by a high protein intake. Adequate protein is necessary for good health (0.8 g/kg body weight), however, as amino acids decrease resorption of uric acid in the renal tubules, thus increasing uric acid excretion and reducing serum uric acid concentrations. Fluid Intake: Liberal fluid intake keeps the urine diluted and promotes the excretion of uric acid. Furthermore, dilution of the urine reduces the risk of kidney stones. Drink at least 6 eight ounce glasses of water each day. Nutritional Supplements Eicosapentaenoic Acid: Supplementation with omega-3 oils appears helpful in the treatment of gout. The omega-3 oil eicosapentaenoic acid (EPA) limits the production of the inflammatory leukotrienes, the key mediators of much of the inflammation and tissue damage observed in gout. Vitamin E: Vitamin E is suitable for the treatment of gout since it also (mildly) inhibits the production of leukotrienes and acts as an antioxidant. Selenium functions synergistically with vitamin E. Folic Acid: Folic acid has been shown to inhibit xanthine oxidase, the enzyme responsible for producing uric acid. In fact, research has established that a derivative of folic acid is an even greater inhibitor of xanthine oxidase than the drug allopurinol – the most widely used drug for gout – suggesting that folic acid at high dosages may be a valuable treatment in gout. Positive results in the treatment of gout have been reported, but the data are incomplete at this time. The dosage of folic acid required is in the range of 10 to 40 mg per day. Folic acid has been used at these high dosages with no reported toxicity and is certainly safer than current drugs used in gout. However, there have been reports of high dose folic acid interfering with some drugs that are used to treat epilepsy. High doses of folic acid may also mask the symptoms of a vitamin B12 deficiency. Because of these concerns, folic acid therapy should only be utilized under the supervision of a physician. Bromelain: There are no studies on the use of bromelain in the treatment of gout. However, this proteolytic enzyme complex of pineapple has been demonstrated to be an effective anti-inflammatory agent in both clinical human studies and experimental animal models. Bromelain is a suitable alternative to stronger prescription anti-inflammatory agents used in the treatment of gout. For best results, bromelain should be taken between meals. Quercetin: The flavonoid quercetin has demonstrated several effects in experimental studies that indicate its possible benefits to individuals with gout. Quercetin inhibits uric acid production in a similar fashion to the drug allopurinol, as well as inhibiting the manufacture and release of inflammatory compounds. Quercetin is widely found in fruits and vegetables, but supplementation can provide higher amounts for the treatment of gout. For best results, 200 to 400 mg of quercetin should be taken with bromelain between meals three times daily. Bromelain may help to improve the absorption of quercetin as well as exerting anti-inflammatory effects of its own. Alanine, Aspartic Acid, Glutamic Acid, and Glycine: These amino acids have been shown to lower serum uric acid levels, seemingly as a result of decreasing uric acid resorption in the renal tubule. This results in a boost in uric acid excretion. Probably the best way in which to take advantage of this research is to take supplemental minerals like magnesium and calcium bound to aspartate (aspartic acid). The dosage would be based on the level of the mineral (e.g., 1,000 mg of the combination of magnesium and calcium daily). Niacin and Vitamin C: High doses of niacin (greater than 50 mg per day) are in all probability contraindicated in the treatment of gout, as niacin competes with uric acid for excretion and vitamin C may increase uric acid production in a small percentage of people. Botanical Medicines
Cherries: Consuming one half pound of fresh or canned cherries per day has been shown to be very effective in lowering uric acid levels and preventing attacks of gout. Cherries, hawthorn berries, blueberries, and other dark red-blue berries are rich sources of anthocyanidins and proanthocyanidins. These compounds are flavonoid molecules that give these fruits their deep red-blue color, and are remarkable in their capacity to prevent collagen destruction. In addition, these flavonoids are first-rate antioxidants and inhibit the formation of leukotrienes. In addition to consuming anthocyanidin – and proanthocyanidins - rich berries, extracts of bilberry, grape seed, or pine bark can be used. Devils Claw: Devil’s claw has been used in folk medicine for the treatment of a variety of diseases, including gout and rheumatoid arthritis. Clinical research in Europe indicates that devil’s claw may be of benefit in the treatment of gout. In addition to relieving joint pain, clinical trials found that devil’s claw also reduced serum cholesterol and uric acid levels. Several pharmacological studies on animals have reported that devil’s claw possesses an anti-inflammatory and analgesic effect similar to the potent drug phenylbutazone. However, other studies have indicated that devil’s claw has little, if any, anti-inflammatory activity. The conflicting experimental results may reflect a mechanism of action that is different than current anti-inflammatory drugs or a lack of quality control (standardization) of the preparations used. Further clinical research is needed to clarify these inconsistencies. Devil’s claw may be useful in the short term management of gout. However, since gout can be effectively prevented and treated by following simple dietary changes in most instances, the use of devil’s claw in long term management of gout is probably unnecessary.
Standardized Milk Thistle Extract - Has been shown to contain anti-swelling properties. Turmeric Powder - Has been used in ancient cultures as a medicinal herb. Yucca Herb Stock Leaf - Is used to address joint discomfort and promotes liver health. Lead Toxicity An additional item of concern relates to lead toxicity. A secondary type of gout, sometimes called saturnine gout, can result from lead toxicity. Lead in the body can cause a decrease in uric acid secretion, contributing to gout. Historically, saturnine gout was due to the consumption of alcoholic beverages stored in containers containing lead. An unexpected and moderately common source of lead appears to be leaded crystal, as wine takes on lead when stored in a crystal decanter. Lead concentration increases with storage time, reaching toxic levels after several months. Even a few minutes in a crystal glass results in a quantifiable increase in the level of lead in the wine.
Encyclopedia of Natural Medicine
Gout-Gone - Homeopathic remedy relieves gout symptoms - swelling, inflammation and burning pain in small joints - Continue Uricinex - All natural uric acid support formula - On site review Uricinex helps promote healthy uric acid levels for healthy joint function . . . without negative side effects. Uricinex contains a proprietary blend of vitamins, minerals, and herbs designed for maximum results. Continue
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