Prevent a Gout Attack!

Will a gout attack cause you acute pain and cripple your daily activities? You can take effective preventative measures now even if you have had a past history of gout! Discover three natural remedies that could ease a gout attack.

What is Gout?

Gout is the most prevalent form of inflammatory arthritis and afflicts 8 million Americans.  Unfortunately, gout is associated with several chronic diseases and impaired quality of life.  Elevation of serum uric acid (UA) levels, hyperuricemia, is an essential prerequisite for the development of gout.  As blood uric acid levels rise and the physiological saturation threshold for uric acid is exceeded in body fluids, the formation and deposition of uric acid crystals occurs in and around joints.¹These crystals then trigger an immune response and inflammation.

How Common is Gout?

In the USA, 3.9% of adults have gout.The number of people suffering from gout attacks has increased in recent years. Epidemiological evidence from New Zealand, the USA, the UK, and China suggests that gout is becoming more prevalent. The findings of three similarly conducted successive surveys from New Zealand show an increase in the prevalence of gout. During the years between 1977 and 1996 the incidence of gout more than doubled. It increased from 20.2 to 45.9 per 100,000 people.²

What are the Symptoms?

Gout may manifest itself as an acute attack of severe pain and inflammation affecting peripheral joints, most commonly, the big toe and finger.³ The buildup of sharp uric acid crystals can lead to pain, swelling, redness, heat, stiffness, and may affect finger, elbow, knee, heel, ankle, and wrist joints. It is perhaps the most painful type of arthritis.  Deposits of uric acid (called tophi) can also form lumps under the skin. Then, too, kidney stones can form in the kidneys from uric acid crystals. Acute attacks of gout may be accompanied by low-grade fever, chills, and malaise. The majority of patients experience a second acute gout attack within 1 year of the first episode.⁴  A gout attack can be brought on by stressful events, alcohol, drugs, or another illness.

Where Does Uric Acid Come From?

Uric acid comes from the breakdown of substances called purines. Purines are found in all of your body’s tissues.  They are also in many foods, such as liver, dried beans and peas, and anchovies.  Normally, uric acid dissolves in the blood.  It passes through the kidneys and out of the body in urine.  But uric acid can build up in the blood when the body increases the amount of uric acid it makes; or the kidneys do not get rid of enough uric acid; or if a person eats too many foods high in purines. If uric acid stays chronically elevated, uric acid crystals may form in joints, triggering inflammation, and gout consequently develops. Not everyone who has elevated uric acid inflammation will develop gout.

What Other Problems with High Levels of Uric Acid?

We do need a certain amount of uric acid. It is actually an antioxidant.  Uric acid has excellent antioxidant capacity. It can be responsible for as much as 2/3 of the total plasma antioxidant capacity.⁵ When the level of uric acid is chronically elevated though, problems like gout and kidney stones increase.  Normal values for serum uric acid run between 3.5 and 7.2 mg/dL. Uric acid values higher than 7.0 mg/dl are a risk factor for the development of gout.  Not everybody with elevated uric acid will develop gout.  Probably, most individuals with any chronic degenerative diseases such as obesity, diabetes, and kidney disease would be wise to have their uric acid level tested. Why?

Elevated uric acid is also seen as a prognosticator of kidney disease, diabetes mellitus, metabolic syndrome, cardiovascular disease, and inflammation.⁶. Individuals with chronic kidney disease (CKD) are at increased risk for gout, and those with gout are at increased risk of CKD.^{7 8} Hyperuricemia increase is seen in 16% of all causes of mortality and 39% of total cardiovascular disease.^9,10 Either an excessive production of uric acid or a reduced clearance of uric acid, or both, cause the uric acid levels to rise.

How Serious is Gout?

Individuals with gout frequently have other concurrent chronic conditions such as hypertension, chronic kidney disease, cardiovascular disease, obesity, diabetes, and hyperlipidemia, all of which have a significant, adverse impact on public health. Elevated levels of uric acid may be a factor in these co-existent diseases. Chronic kidney disease contributes to the progression of hyperuricemia and/or gout. The evidence that gout and hyperuricemia contribute to the pathogenesis of their comorbidities creates greater urgency for appropriate gout management.¹¹ Accumulating evidence points to elevated UA as an independent risk factor for kidney dysfunction.¹² Whether or not hyperuricemia is a cause or effect for decline in kidney function remains to be seen. However, it would be prudent for anyone who has had gout to adopt a wise lifestyle regimen to reduce his risk for deterioration of his kidneys.

What Risk Factors for Gout?

Men are more prone to getting gout than are premenopausal women. Your genetics can increase the possibility of gout attacks also. If a family member is afflicted then you may also experience the same.

Medical Conditions:

Diabetes, kidney disease, injury to a joint, infection, and rapid weight loss may increase one’s risk for gouty arthritis. Metabolic syndrome (MetS) is characterized by at least three of the following: obesity, high glucose and triglycerides (blood fats), low HDL, hypertension, and inflammation.  The production of uric acid is often increased and its excretion is decreased in individuals with metabolic syndrome. An elevated level of triglycerides itself has been linked to a new synthesis of purines which accelerate UA production. Increased UA has been seen in individuals with insulin resistance. In this condition, the cells do not respond efficiently to insulin.  Elevated blood fats are also commonly seen in individuals who have insulin resistance.

Beverages:

Consumption of sweetened sodas and drinks, especially with high fructose corn syrup, has been linked to an increased risk for gout. Fructose leads to more production of uric acid.¹³  Juice lovers, listen up. Consuming orange juice can also increase one’s risk.¹⁴ However, fructose as it is packaged in fresh whole fruit, poses no harm because it is loaded with fiber and beneficial phytochemicals. Moderate, regular, or heavy use of alcohol, especially beer, has been linked to an increased risk for gout. Beer intake is an independent factor for elevated uric acid as it is rich in high-quality purine.  Alcohol consumption increases uric acid production and interferes with the removal of uric acid from the body.

Culprit Medications:

The regular use of aspirin and the vitamin niacin increase the risk for gout.  Diuretics are important medications that increase the output of urine and help hypertension, congestive heart failure, and edema,but  they can increase uric acid excretion through the kidneys.

What Dietary Factors Increase the Risk of Gout?

A plant-based diet is ideal. Most meats are high in purines.  Some of the highest are organ meats, poultry, shell fish, sardines, red meat, seafood, and wild game.  Beer is also very high in purines.  A twelve year study of 47,000 men conducted by Hyon Choi, MD, compared the effects of dietary intake of purine-rich foods in relation to the risk of having gout attacks. He reported that higher levels of meat and seafood consumption are associated with an increased risk of gout, whereas a higher level of consumption of dairy products is associated with a decreased risk of gout. Consumption of purine-rich vegetables was not associated with gout.¹⁵

The 1993-1998 Singapore Chinese Health Study examined 63,257 Chinese adults, ages 45-74, and explored the impact of diet on the risk for developing gout. The researchers found that, after adjusting for potential confounding factors, total protein intake (mainly contributed by poultry, fish, and shellfish) was associated with an increased risk of gout, while dietary intakes of soy and legumes were associated with a reduced risk of gout. In this particular study, red meat, eggs, dairy products, grains, nuts and seeds were not associated with an increased risk. (Please note: there may have not been enough red meat consumption in this study to determine its influence),Those who consumed legumes had 17% less risk of developing gout.¹⁶

What is Gout-Prevention Nutrition?

Studies have shown that vegetables high in purines do not increase the risk of gout or recurring gout attacks.¹⁷ A healthy diet based on lots of fruits and vegetables can include high-purine vegetables, such as asparagus, spinach, peas, cauliflower, or mushrooms. You can also eat beans or lentils, which are moderately high in purines but are also a good source of protein.¹⁸ It is recommended that individuals with hyperuricemia should not ingest a large amount of purine-rich food (for instance, veal, bacon, kid meat, mutton, turkey, pork, duck, goose, etc.) and limit (better yet, exclude) fish and meat intake.((Erick Prado de Oliveira. High plasma uric acid concentration: causes and consequences. Diabetol Metab Syndr. 2012; 4: 12)

The low-sodium DASH Diet emphasizes fruits, vegetables, whole grains, and legumes. It excludes red and processed meats but includes low-fat dairy and fish. This diet is protective against gout, reduces saturated fats and total fat intake, decreases elevated uric acid levels, and lowers the risk for cardiovascular disease, which is a common comorbidity of gout.¹⁹ Fiber and high consumption of vitamin C-rich foods may help to protect us from gout.²⁰ Vitamin C intake shows an inverse relation with uric acid.

Because hypertension, chronic kidney disease, diabetes, and cardiovascular diseases often accompany gout, the authors think that a well-balanced, a predominately whole plant food diet is the best option. Why? Studies show that healthful plant foods diets reduce the risks of these comorbidities and help improve them.^{21 22 23 24 25}

What are Treatment Options?

Early attacks usually get better within 3 to 10 days, even without treatment. Typically, a health care provider would prescribe nonsteroidal anti-inflammatory drugs (if there are no contraindications) which are usually sold over-the-counter. Colchicine is a medication that is designed to decrease uric acid deposits in the joints; however, it has serious side effects. Also, avoid alcohol and foods that trigger the attacks.

What About Cherries for Gout?

Studies show that cherry consumption may lower uric acid levels. Cherries combat inflammation. A study of 100 patients with recurrent gout, taking 15ml/day of cherry juice concentrate for 4-6 months, also revealed decreases in markers of inflammation. A greater than 50% reduction was also seen in the number of acute gout attacks for 92% of treated patients.²⁶ So cherries are worth a try.

Hydrotherapy for Gout

A contrast foot bath can help relieve gout. You will need two buckets (galvanized are the best), a container of ice, a pitcher of hot water, a few towels, and bath thermometer. Fill one bucket about 1/3 full of water, 102 to 106 degrees Fahrenheit. Fill the second bucket 1/3 full of cold water with some ice. Soak your feet in the hot water for 3 minutes.  Then place your feet in cold water for 30 seconds. Repeat this series three times. Add hot water to the foot bath periodically and make the tub of cold water colder each time you place your feet in it. In other words, you want a sharp contrast.  As a final step, plunge your feet in warm water. Please note:  if you have diabetes, poor sensation, edema in the lower leg or foot atherosclerosis in the extremities (peripheral vascular disease), or an open sore, you must consult with a doctor before trying a contrast bath.  Mild contrast baths may help in these conditions, but do check with your doctor first!

Any Herbs that Could Help Gout?

Ginger has a strong anti-inflammatory effect on joints and can be regarded as a useful tool for the treatment of acute gouty arthritis.²⁷. The shogaol (a ginger constituent) has strong anti-inflammatory and antioxidant effects and helps gout.²⁸

Curcumin from turmeric reduces the inflammation from needle-shaped uric acid crystals.²⁹. However, if one is taking a medicine, it is essential to consult with your pharmacist first before using ginger or any herb.  Individuals with bleeding disorders should not use ginger or curcumin.

One interesting observation in conclusion: The same lifestyle measures that help to prevent gout attacks are in many aspects the same that help to protect your kidneys and your heart!

 

1. Roddy E. Epidemiology of gout, Arthritis Research & Therapy. 2010 www.ncbi.nlm.nih.gov/pmc/articles/PMC3046529/↩
2. Arromdee E, Epidemiology of gout: Is the incidence rising? Journal of Rheumatology 2002; 29: 2403–2406.↩
3. Smith, R. US Pharmacist. The Diagnosis and Treatment of Gout. US Pharmacist, 2009:34(5):40-47↩
4. Smith, R. US Pharmacist. The Diagnosis and Treatment of Gout. US Pharmacist, 2009:34(5):40-47↩
5. Roddy, ibid↩
6. de Oliveira EP, Burini RC↩
7. https://www.kidney.org/atoz/content/gout/patient-facts ↩
8. High plasma uric acid concentration: causes and consequences. Diabetol Metab Syndr. 2012 Apr 4; 4:12↩
9. De Oliveira, ibid↩
10. Chen JH. Serum uric acid level as an independent risk factor for all-cause, cardiovascular, and ischemic stroke mortality: a Chinese cohort study. Arthritis Rheum. 2009; 61:225–232↩
11. Karis, E. Hyperuricemia, gout, and related comorbidities: cause and effect on a two-way street. South Med J. 2014 Apri: 107(4):235-41↩
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14. Choi, HK Fructose-rich beverages and risk of gout in women.  JAMA. 2010 Nov 24:304(20):2270-8↩
15. Choi, HK. Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men, NEJM 2004 March 11(50):1093-1103↩
16. Teng GG.Food sources of protein and risk of incident gout in the Singapore Chinese Health Study. Arthritis Rheumatol. 2015 Mar 25↩
17. Choi, HK. Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men, NEJM 2004 March 11(50):1093-1103↩
18. Gout Diet: What’s allowed; what’s not. mayoclinic.org/…/in-depth/gout-diet/art-20048524↩
19. Juraschek SP, Gelber AC, Choi HK, Appel LJ, Miller ER 3rd. Effects of the Dietary Approaches to Stop Hypertension (DASH) Diet and Sodium Intake on Serum Uric Acid. Arthritis Rheumatol 2016;68:3002-9.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423545/ ↩
20. www.lifeextension.com , Gout and Hyperuricemia, 2015↩
21. Miles FL, Lloren JIC, Haddad E, et al. Plasma, urine, and adipose tissue biomarkers of dietary intake differ between vegetarian and non-vegetarian diet groups in the Adventist Health Study-2. J Nutr. Published online February 15, 2019.↩
22. Chauveau P, Koppe L, Combe C, Lasseur C, Trolonge S, Aparicio M. Vegetarian diets and chronic kidney disease. Nephrol Dial Transplant. 2019 Feb 1;34(2):199-207. ↩
23. Świątek, Ł., Jeske, J., Miedziaszczyk, M. et al. The impact of a vegetarian diet on chronic kidney disease (CKD) progression – a systematic review. BMC Nephrol 24, 168 (2023). https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-023-03233-y↩
24. Wang T, Kroeger CM, Cassidy S, et al. Vegetarian Dietary Patterns and Cardiometabolic Risk in People With or at High Risk of Cardiovascular Disease: A Systematic Review and Meta-analysis. JAMA Netw Open. 2023;6(7):e2325658. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807597↩
25. McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. J Geriatr Cardiol. 2017 May;14(5):342-354. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/ ↩
26. Jancin B. Cherry Juice Flowing in Gout Treatment Pipeline.Family Practice News. 2010↩
27. Sabina, EP. 6-Shogaol inhibits monosodium urate crystal-induced inflammation–an in vivo and in vitro study. Food Chem Toxicol. 2010 Jan; 48(1):229-35↩
28. Grzanna R, Lindmark L, Frondoza CG. Ginger: An herbal medicinal product with broad anti-inflammatory actions. J Med Food. 2005;8:125–32. ↩
29. Chen, B., Li, H., Ou, G. et al. Curcumin attenuates MSU crystal-induced inflammation by inhibiting the degradation of IκBα and blocking mitochondrial damage. Arthritis Res Ther 21, 193, 2019↩