Gout

Gout is one of those conditions which can be aided considerably with a change in diet and lifestyle, and is a form of arthritis which is normally associated with “high living”. This condition causes a rather painful accumulation of crystals of uric acid around the joint.

I have seen many male gout patients over the years, but recall only one or two women over the years in my clinic complaining of this rather painful condition. Do you suffer from gout, or are you a woman reading this who has a partner suffering? Then read on, I have some good hints and tips which are sure to help.

I can still remember the first gout patient I ever saw, I was practicing in the student clinic in the 90’s. A male aged mid forties came in complaining of a very painful right ankle and big toe. He was a mechanic who enjoyed a beer, in fact he said: “Eric, I’ll do anything you suggest, I won’t be stopping my beer however, but I can’t live with this pain anymore”.

A gout attack of pain usually strikes unexpectedly, but generally subsides in a few days with treatment. However, some guys can experience pain for several weeks with gout attacks often re-occurring and without the correct management the attacks of pain may become more frequent and can be very debilitating indeed. You should contact your doctor if really severe pain in a joint recurs or lasts more than a few days, especially if the pain is accompanied by chills or fever.

Now let’s have a closer look at gout, what it is and what causes it and more importantly, how we can help the gout patient with some good natural medicine suggestions.

Gout is 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 wrists, 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 your 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.
• Sudden, intense and sharp pain in a joint.
• 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.

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 patients I see who love paua, kina, mussels, roe and crayfish.
• 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.

Uric acid

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

How come gout hurts, where does all that pain come from? Simple, when the uric acid accumulate in the blood and tissues it can crystallise out into a joint, forming a multitude of tiny, jagged, needle-shaped crystals. This triggers an intense inflammatory response that causes a painful arthritis attack called a gout attack.

Have you ever stood on a pin or a needle, perhaps some broken glass and got annoyed and irritated by this? Then you will know how a gout sufferer will feel – they can be most irritated and annoyed like a child who has just stood on a pin cushion. Pain has a way of bringing out the worst in many people!

As I mentioned, gout commonly strikes the big toe, but other joints can be affected, including the instep, ankle, knee, wrist, elbow and fingers. Acute pain is generally the first symptom and then the affected joint becomes inflamed (almost infected-looking): red, swollen, hot and extremely sensitive to the touch. I have many times seen a case of gout in the clinic that the patient’s doctor referred to as “osteoarthritis”, when in fact it had all the makings of gout. Signs and symptoms such as a needle-like pain affecting the small joint, male patient who enjoys alcohol drinker, crayfish and roe (fish eggs), enjoys barbeques and steaks, etc. Common things happen to people commonly, I have often said.

The funny thing with guys is, you see them once then you don’t tend to see them again in the clinic. I believe that it is purely the pain that brings them ultimately to see the practitioner. This is especially so for some larger blokes I have seen where the pain was not helped to a large degree by the standard gout drugs, and then there is much more urgency to that appointment.

I have often said that there is nothing more than a high degree of pain to bring a guy to your room as a patient. If you are a regular reader of my column, you may recall that I have often said that males belong to the “John Wayne School of Health”: “I’ll be alright, there’s nothing wrong with me, and I’ll just get right back on that horse and keep on riding”. I can recall in one Western that even John Wayne himself went to see a doctor when the pain of a rather large shotgun blast in his shoulder was preventing him from actually getting on his horse, and even then the doctor’s visit seemed was under duress!

Good thing that, the pain, it may be nature’s way of getting guys off their horses and into clinics. If a woman experiences pain, let’s say one out of a scale of ten – then she is off to get it investigated. She tends to be much more proactive, is it any wonder a woman will live longer than a man?

Males tend to wait until the pain moves from four to five out of ten, and even then, the visit is seen as an “inconvenience”. If a man would only start to improve his gout when he experiences the pain at a level of one out of ten, then he will find it a lot easier to turn gout around than when the pain is nine out of ten. This is because at low occasional pain levels, gout is not quite a disease process yet, it is a functional disturbance which can be much more easily corrected.

An appointment with the naturopath at this stage will reveal that the man will probably be eating and drinking the wrong foods contributing to the progression of his gout, all he needs at this stage is a change of diet and an improvement in his kidney function to help the clearance of uric acid. Better still, if his blood can be cleansed with appropriate treatment such as a detox process, he will feel much better, reducing and even possibly eliminating his chances of developing full-blown gout.

A visit at high pain levels will only be sought in terms of pain relief, and there will be pathology or disease present. And the stronger the pain, the more urgent will be the pain relief naturally. Seriously bad gout pain can make the biggest blokes cry like the biggest babies, I have seen this on one occasion when a tough Aussie male burst into tears as he told me that even the thin sheet at night on his big toe was excruciatingly painful. This guy was into cold beer and hot pies and had plenty of both, the tears were real and no laughing matter folks!

These cases are harder to turn around because all the focus is purely on strong pain control. Supplements may work, but are not as powerful as pharmaceutical drugs when it comes to pain control, hence the reason why we only see the gout patient once. The drugs which control pain wreck the person’s digestion in time, that’s the real problem and the stark reality. And the underlying problem is not really sorted either: the offending ways continue and so does the gout. So convenient, just switch off that pain.

Interesting if we compare the recent financial crisis which was due to “extending credit”, I think medicine is going down the same path until we end up with the upcoming “health crisis” globally which will be due similarly to extending credit of a different nature. You temporarily solve a problem by taking away the pain but create the long term crisis and avoid treating the real underlying causes. I have to admit, this is one area in which natural therapists fail – strong pain control. We are the preventative medicine experts.

Acupuncture will have some benefit here, but many patients are just not keen on the needles. Herbs or supplements? Not really, drugs do work well but why wait until you need strong pain relief is my question, why not address conditions like gout BEFORE you require the strong solution?

Medical Treatment of gout

Allopurinol is the pharmaceutical drug of choice used in long-term prevention of gout and decreases the body’s production of uric acid. People experiencing gout attacks should, however, avoid medications containing aspirin as these can make gout worse. Pain relievers such as paracetamol or other more powerful analgesics, are often used to manage the pain.

Anti-inflammatories, such as non-steroidal anti-inflammatory drugs (NSAIDs), are used to decrease joint inflammation and reduce the pain. If NSAIDs cannot be given because of an ulcer, your doctor may use colchicine may be used to settle an attack. I have found the homeopathic colchicines (30c) can be very useful for the gout patient instead of this drug.

Do you take a “water tablet” or a diuretic? Pharmaceutical diuretics may cause gout in people who are genetically predisposed to gout by increasing the accumulation of uric acid within the body.

Resting the joint, possibly in a splint, and applying ice packs may help. Ice is a great acute gout treatment which I highly recommend.

Preventing gout attacks

Prevention is the thing which you need to focus your attention to, and in my opinion is equally as important as treating the gout.

• 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 remedies

• Water
  • 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 in 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 in doses of 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.
• 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.
• Diet
  • 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.
  • Avoid as much as possible: anchovies, crayfish, shellfish, paua, kina, fish roe, 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 (silverbeet)
  • 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 ok, but stick with tarakihi, snapper, gurnard and younger fishes.
    • other: chicken and ham, soups, most all the common vegetables, condiments, herbs, nuts, olives, peanut butter, pickles, popcorn, relishes, salt