Gout

---

Overview

Gout is associated with a build up of uric acid which is a breakdown product of purines. It is usually a harmless substance excreted in the urine, and therefore causes no problems. However, people who suffer from gout have a build up of uric acid in the bloodstream. Changes in urate levels tend to trigger an attack (hence why an attack may follow over consumption of purine-rich foods). Urate crystalizes to form monosodium urate monohydrate crystals, which accumulates around the joints (as the cooler temperatures makes the crystals less soluble), causing them to become extremely painful, inflammed and swollen. 1,2

Gout has a number of causes including an hereditary predisposition; diet and excess alcohol (which increases the synthesis of urates and inhibits their secretion); some medicines, e.g. some chemotherapy drugs can increase urate levels; obesity; being male increases your risk if getting gout as men tend to have higher urate levels than women; other health conditions such as psoriasis and reduced kidney function also increase your risk of developing gout. 1,2,3

The initial attack often lasts for 3-10 days, but afterwards you may be more prone to future attacks, which may be more frequent and longer lasting. When we think of gout we think of the swollen big toe - although this joint is primarily affected, other joints such as the fingers, ankles, knees and elbows are also susceptible.  The initial attack tends to be preceded by an event which changes urate levels and subsequent attacks are common. 4
​

Self Help

 Decrease
1) Purine rich foods which should be avoided include:

• Meats - kidney, liver, veal, turkey and venison.
• Fish - anchovies, herring, mackerel, sardines, fish roes, mussels and scallops.
• Veg/pulses - asparagus, peas, beans     4, 2

2) Reduce alcohol intake - especially beer, wine and port 5
3) Foods containing oxalic acid: rhubarb, sorrel, spinach. Oxalic acid interferes with your body's ability to excrete uric acid 8

INCREASE
1) Drink water - this will help your body to excrete uric acid and help to prevent urate crystals from forming. Try to drink 6-8 glasses per day (or more if you exercise or in hot weather). 4
2) Cherries, blueberries. Cherries have been shown to reduce plasma urate levels in clinical trials.
Red-blue berries contain anthrocyanosides which prevent the breakdown of collagen in the connective tissues (collagen the main protein of connective tissue and is important for healthy tendons and ligaments. Collagen is broken down in inflammatory conditions such as arthritis and gout). Eat approx half a pound of fresh or canned cherries a day. 7
3) Following an alkaline diet may be helpful  as it increases the solubility of uric acid. - a diet high in fruit (ideally red/blue berries for their flavonoid content) and vegetables 8

You can apply a bag of frozen peas to the joint during an attack for up to 5 mins at a time. This will help to ease the inflammation. Do not apply ice directly to the joint and wait until the joint has returned to its normal temperature before reapplying.
​
If you are overweight, losing weight gradually may help to reduce the risk of gout. Weight loss should be sensible - ask a health care professional for advice 6

Top Tip - Cherries

Cherries, blueberries. Cherries have been shown to reduce plasma urate levels in clinical trials.
Red-blue berries contain anthrocyanosides which prevent the breakdown of collagen in the connective tissues (Collagen is the main protein of connective tissue and is important for healthy tendons and ligaments. Collagen is broken down in inflammatory conditions such as arthritis and gout). Eating approx. half a pound of fresh or canned cherries a day can help. 7

Research

Consumption of Cherries Lowers Plasma Urate in Healthy Women.l

Abstract
To assess the physiologic effects of cherry consumption, we measured plasma urate, antioxidant and inflammatory markers in 10 healthy women who consumed Bing sweet cherries. The women, age 22–40 y, consumed two servings (280 g) of cherries after an overnight fast. Blood and urine samples were taken before the cherry dose, and at 1.5, 3 and 5 h postdose. Plasma urate decreased 5 h postdose, mean ± sem = 183 ± 15 μmol/L compared with predose baseline of 214 ± 13 μmol/L (P < 0.05). Urinary urate increased postdose, with peak excretion of 350 ± 33 μmol/mmol creatinine 3 h postdose compared with 202 ± 13 at baseline (P < 0.01). Plasma C-reactive protein (CRP) and nitric oxide (NO) concentrations had decreased marginally 3 h postdose (P < 0.1), whereas plasma albumin and tumor necrosis factor-α were unchanged. The vitamin C content of the cherries was solely as dehydroascorbic acid, but postdose increases in plasma ascorbic acid indicated that dehydroascorbic acid in fruits is bioavailable as vitamin C. The decrease in plasma urate after cherry consumption supports the reputed anti-gout efficacy of cherries. The trend toward decreased inflammatory indices (CRP and NO) adds to the in vitro evidence that compounds in cherries may inhibit inflammatory pathways.

Herbal Medicine

A medical herbalist uses a range of plants to treat gout - these include Celery seed, Burdock and Gravel root. The herbs chosen are suitable for the individual, thus there is no standard prescription for gout.

A therapeutic treatment strategy may involve:
Diuretics to flush urates from the body (supporting the liver can also help to reduce urates)
Anti-inflammatories (salicilate-rich anti-inflammatories may not be suitable)
​Alteratives

Treatment is designed to treat the individual and their presenting symptoms and therefore no two precriptions will be the same.

See disclaimer

References

1. Kumar, P., & Clark, M. (2002) Clinical medicine (5th ed.). Philadelphia, PA: Saunders.

2. Rothschild, B.M. (2015). Gout and pseudogout. Retrieved from: http://emedicine.medscape.com/article/329958-overview
​
3. Ryan, L.M. (2015). Gout. Retrieved from: http://www.msdmanuals.com/en-gb/professional/musculoskeletal-and-connective-tissue-disorders/crystal-induced-arthritides/gout

4. Pizzorno, J.E., Murray, M.T., & Joiner-Bey, H. (2008). The clinician’s handbook of natural medicine (2nd ed.). St. Louis, MO: Churchill Livingstone.

​5. Choi. H.K., Atkinson, K., Karlson, E.W., Willett, W., & Curhan, G. (2004). Alcohol intake and risk of incident gout in men: a prospective study. The Lancet, 363(9417), 1277–1281. doi:10.1016/S0140-6736(04)16000-5

​6. Hechtman, L. (2012). Clinical naturopathic medicine. Chatsworth, Australia: Elsevier.

7. Murray, M., Pizzorno, J., & Pizzorno. L. (2005). The encyclopaedia of healing foods. London, UK: Atria Books. 
 
8. ​Murray, M.T., & Pizzorno, J.E. (1993c). Gout. In: Pizzorno, J.E., & Murray, M.T. (Eds.). Textbook of natural medicine (2nd ed.) (pp.1253-1259). London, UK: Churchill Livingstone.