Gout

Gout is a fairly common type of arthritis, arthritis being a group of conditions characterised by joint inflammation. When we think of arthritis, we mostly identify with osteoarthritis, which is a gradually deteriorating degenerative condition of the joints often seen in older patients.

What is gout?

Gout is a fairly common type of arthritis, arthritis being a group of conditions characterised by joint inflammation. When we think of arthritis, we mostly identify with osteoarthritis, which is a gradually deteriorating degenerative condition of the joints often seen in older patients.

Gout symptoms

Think of a sudden, red, hot, swollen and painful joint with no warning – this is typically how gout presents. Although gout can affect any joint, one of the most common is the big toe. The key to identifying it is the suddenness of the onset and of course if you have a history of gout then there are previous events of similar joint pain attacks.

Other joints often affected include the elbows, knees, ankles, wrists and fingers. The pain usually comes on at night while sleeping and is most intense in the first 4-12 hours. The joint is usually hypersensitive to pressure, movement and touch and as mentioned is usually hot, red and swollen. Usually, the pain gradually decreases over the next few days, but the joint remains tender for up to 2 weeks.

What causes or triggers a gout attack?

Gout occurs when a substance called uric acid builds up in your joints and surrounding tissues in the form of crystals. These crystals are sharp and jagged and not only mechanically damage joints and their soft tissue, but they trigger the immune system to cause a painful inflammatory response, thus the redness, swelling, pain and heat.

We all produce uric acid but usually, our body keeps levels under control by efficiently eliminating (excreting) it through the kidneys and into our urine. Gout sufferers either make too much uric acid for the body to handle, or they make normal amounts but can’t excrete it properly via the kidneys, which is known as hyperuricaemia i.e., too much uric acid in the blood.

1. Making too much uric acid

Uric acid is the by-product of processing or breaking down purines, which are naturally occurring molecules found in the DNA and RNA of our cells. Most purines are produced naturally ‘in-house’ when old worn out cells die and are broken down. Since we constantly are breaking down and replacing old cells with new ones, our body must constantly process the unwanted purines and find a way of eliminating them.

Purines can also come from sources outside of our bodies, namely our diet. Yes, although all foods contain some purines, there are certain foods which are known to contain very high levels of purines which can further add to our purine levels. Eating excessive amounts of these foods could further add to the purine burden and ultimately increase uric acid levels. Gout sufferers who consume purine-rich food increase the risk of a gout attack by 5 times!

Although all foods contain purines, these typically contain higher amounts:

• Meat (all, but especially organ meat)
• Poultry (specifically chicken)
• Fish (specifically sardines and tuna)
• Seafood (especially mussels and crayfish)
• Legumes (beans, lentils, soya)
• Mushrooms.

Other foods which could increase the uric acid load, but not because they contain purines, include:

• Sweetened fizzy drinks
• Alcohol

2. Not excreting enough uric acid

Uric acid is mainly eliminated via the kidneys and less so through the gut. Usually, the kidneys are able to filter dissolved uric acid out of the blood and eliminate it as waste through the urine. If the kidneys are overloaded with too much uric acid or are too weak to filter the blood adequately, then levels build up in the body increasing the risk of a gout attack. Therefore, patients with chronic kidney disease are more prone to gout attacks. We also know that when urine is alkaline, it’s easier for the body to excrete uric acid. Acidic urine which is typical in someone following an ‘acidogenic diet’ i.e. too much meat, dairy, sugar and processed food reduces our ability to excrete uric acid in the urine.

The following factors can negatively affect uric acid excretion:

• Pre-existing weakened kidney function (e.g. diabetics, older patients)
• Alcohol, although it doesn’t contain purines, it inhibits the excretion of uric acid
• Acidogenic diet and low urine pH levels (acidic urine)
• Not drinking enough good quality filtered water daily (chronic dehydration).

Most gout sufferers will therefore tell you that they have their attacks when they combine a variety of factors such as eating purine-rich food and drinking alcohol.

What foods can be protective against gout?

Firstly, drink plenty of filtered, good-quality water daily (at least 1.5 to 2 litres), and if you exercise, you need even more. This will help to keep urine more alkaline and help to support healthy kidney function.

Interestingly, there is research which confirms the following foods may offer some protection against gout:

• Vitamin C
• Cherries and probably other berries containing antioxidants
• Coffee (good quality, no sugar) in moderate amounts only!
• A predominantly plant-based diet (more alkaline).

Besides dietary triggers, what puts you at risk of getting gout?

In addition to the potential triggers mentioned above, the following are also associated with an increased risk of getting gout:

• Medicines such as diuretics and aspirin and some blood pressure medicines
• Weakened kidneys
• Obesity
• Metabolic syndrome (obesity, high blood pressure, high cholesterol, sleep apnoea)
• Diabetes
• Trauma or surgery
• Family history.

Complications and more severe forms of gout

Although gout is not directly life-threatening, ongoing poorly managed gout can lead to long-term problems which involve the joints themselves as well as the kidneys.

The long-term build-up of uric acid in joints and soft tissue can form nodules called tophi. These can lead to joint damage, deformity, and further pain. When uric acid levels are high, uric acid can crystalise in the actual kidneys which can lead to a type of kidney stone called a uric acid stone. These deposits in the kidneys also damage the kidneys and lead to weakened kidney function.

The most effective ways to treat gout

1. Dietary and lifestyle changes

First and foremost, drink at least 2 litres of good quality, filtered water per day, check your diet and reduce your intake of purine-rich foods and alcohol. Alkalise your diet by eating more plant-based foods, vegetables, and unprocessed foods, and less sugar, fast foods and salt. If you are overweight, aim to sustainably lose 10% of your current body weight through diet and regular exercise.

Have your kidney function checked, and if you are diabetic, make sure you control your blood sugar as well as possible.

2. Pharmaceutical therapies

The orthodox therapy for acute attacks of gout usually consists of non-steroidal anti-inflammatory drugs (NSAIDS). Although useful in a gout crisis, these shouldn’t be used long-term as some can cause harm to the stomach and digestive system as well as weaken kidney function. Some of these are available over the counter such as ibuprofen.

Colchicine is a well-known anti-gout therapy used for many years which lowers inflammation in gout attacks. The other common drug used to lower uric acid levels is allopurinol which reduces the amount of uric acid production. This is used preventatively long-term in many patients. There are various other prescription medicines which either reduce the production of uric acid or force the body to eliminate more via the kidneys.

Before self-medicating with pharmaceutical drugs, talk to your pharmacist for advice or your doctor for an appropriate prescription taking your medical history and other medicine use into account.

3. Natural remedies

Usually, here the emphasis is on preventing the condition from re-occurring and treating gout at its root cause rather than simply eliminating the symptoms. Supporting healthy kidney function and the elimination of uric acid are some of the ways in which natural remedies assist with treating gout.

• • A.Vogel Nephrosolid – is a Western Herbal medicine which acts as a tonic to support the function of the kidneys, bladder and urinary tract. By promoting irrigation of the urinary tract, it assists with the maintenance of kidney and urinary tract health.

    It consists of 4 key herbs for the urinary system designed by famous Swiss Naturopath Dr Alfred Vogel who was a firm believer in preventative medicine. Nephrosolid is made in Switzerland from fresh plant extracts of well-known kidney herbs including Solidago, Silver birch, Restharrow and Horsetail and is a tonic to support the function of the kidneys.

Dr Vogel always taught that it was best to support both the kidneys and the liver simultaneously when either one called for support. He firmly believed that when one of these eliminatory organs was distressed, the other provided compensatory support. For this reason consider supporting liver function with kidney function for best results, in this regard he recommended additional A.Vogel Boldocynara.

• A.Vogel Boldocynara is a Western Herbal medicine which acts as a tonic to support the function of the liver, gallbladder, and digestive system, and is indicated for the relief of unhealthy liver symptoms such as indigestion, nausea, the sensation of fullness, bloating and flatulence.

  Systemic acidity causes low urine pH i.e., more acidic urine. We know from research that acidic urine is less able to carry uric acid out of our bodies thus increasing build-up in the blood. To increase urine pH i.e., make it more alkaline, drink more water and eat more alkaline foods such as vegetables and fruit which contain alkaline minerals such as calcium, magnesium and potassium.

• A.Vogel Multiforce Alkaline Powder – is a source of calcium, magnesium, phosphorus and potassium, as well as citrate and bicarbonate salts (alkalising minerals) and has a systemic alkalinising effect. It supports the body’s acid buffering mechanism by providing essential alkaline minerals required to combat a typical acidogenic diet (high in animal protein and low/deficient in fruit, vegetables and minerals) and lifestyle, thereby assisting in addressing the negative consequences thereof.

  Used daily, it may help to:

  • Support healthy uric acid levels by regulating acid/alkaline balance. Used in conjunction with conventional therapy may help relieve the symptoms associated with gout.
  • Maintain and support urinary tract function and health by increasing urine pH, thereby assisting to prevent complications such as kidney stone formation.
  • Assist in the relief of joint pain, lower back pain and reduced mobility/flexibility, which are common consequences of an acidogenic diet.
  • Improve symptoms of osteoarthritis and age-related joint discomfort and degeneration, such as pain and stiffness.

Other useful herbal teas include:

These largely support kidney elimination of uric acid and have anti-inflammatory effects. Consult a phytotherapeutic doctor for more information on these:

• Stinging nettle leaf tea (Urtica dioca)
• Celery seed tea (Apium graveolens)
• Birch leaf tea (Betula alba)
• Wild carrot tea (Daucus carota).

  Listen to the podcast here: Gout podcast

Reference

1. Abate, N., et al. 2004. The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance. Kidney Int. 65(2): p. 386-92.
2. Aihemaitijiang, S., et al. 2020. The Association between Purine-Rich Food Intake and Hyperuricemia: A Cross-Sectional Study in Chinese Adult Residents. Nutrients. 12(12).
3. Hoffmann, D., Medical Herbalism – The Science and Practice of Herbal Medicine. 2003, Rochester: Healing Arts Press. 666.
4. Kanbara, A. Hakoda, M., and Seyama, I. 2010. Urine alkalization facilitates uric acid excretion. Nutr J. 9: p. 45.
5. Kanbara, A., et al. 2012. Effect of urine pH changed by dietary intervention on uric acid clearance mechanism of pH-dependent excretion of urinary uric acid. Nutr J. 11(1): p. 39.
6. Roddy, E. and Choi, H.K. 2014. Epidemiology of gout. Rheum Dis Clin North Am, 40(2): p. 155-75.
7. Zhang, Y., et al. 2012. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis. 71(9): p. 1448-53