What is gout and how can I prevent it?

This question was submitted by a friend of mine:

I suffer from Gout and have attacks on occasion. I have tremendously changed my eating habits and alcohol intake but still suffer from mild to moderate attacks from time to time. Diet, exercise and moderation can control gout – but what can be done to prevent it?

What is gout?

Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The joint at the base of the big toeis the most commonly affected (approximately 50% of cases). However, it may also present as kidney stones. It is caused by elevated levels of uric acid (UA) in the bloodwhich crystallizes and the crystals are deposited in joints, tendons, and surrounding tissues. (Source: Wikipedia)

Uric acid is an organic compound produced in the body by the liver and mainly excreted by the kidneys (65 to 75 percent) and intestines (25 to 35 percent). Uric acid is an antioxidant and it can be responsible for up to two-thirds of total plasma antioxidant capacity.

Who is at risk for developing gout?

The ratio of men to women is about 5:1 and the disease is rare in premenopausal women.

About 10 percent of people with high levels of uric acid develop gout at some point in their life.The risk, however, varies depending on the degree of elevation. When levels are between 415 and 530 μmol/L (7 and 8.9 mg/dL), the risk is 0.5% per year, while in those with a level greater than 535 μmol/L (9 mg/dL), the risk is 4.5% per year.1 (Gout: an update”. Am Fam Physician 76 (6): 801–8).

That said, people with normal level of uric acid can develop gout, and some people with high levels of uric acid levels will never develop.

What causes gout?

Studies have shown that diets high in sweetened drinks (fructose) can elevate levels of uric acid, contributing to the development of gout.

Alcohol and especially beer also elevate levels of uric acids.

Several studies suggest iron plays a role in triggering flares of gouty arthritis by increasing levels of uric acid. 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.).

How to prevent gout and flare-ups:

Phlebotomy (blood drawing) to reduce iron stores to near-iron-deficient levels was shown to improve flares of gouty arthritis in 12 hyperuricaemic patients with active disease. Relapse was prevented in 56 percent; the remaining patients had a reduction in the frequency and severity of attacks. The mechanism of this benefit remains unclear, but may be related to a decrease in urate-complexed iron, decreased oxidative stress or possibly an immunosuppressive effect of relative iron deficiency.* (Have your iron levels checked and if they are elevated, making a blood donation would likely be beneficial).

Eat a healthy diet. High uric acid is associated with metabolic syndrome and this is associated with chronic inflammation. Start with having a green drink in the morning, which will increase your body’s alkalinity. For lunch and supper, I recommend at least half your meal consist of vegetables (50 percent raw, such as a salad, 50 percent steamed). The other half of your meal should be unprocessed whole grains, sweet potato, brown rice, and protein. I believe that, in our culture, we eat too much protein so I also recommend exploring vegetarian meals on occassion (Chana Masala, Lentil soup) until you are comfortable with this. 

Take vitamin C (1.5 g). Vitamin C has been shown to increase uric acid excretion. Note: People with kidney disease should consult their doctor before taking vitamin C supplements. Vitamin C increases the absorption of some types of iron from foods, so people with hemochromatosis should not take vitamin C supplements. Vitamin C in doses over 2,000 milligrams per day may cause diarrhea, gas, digestive upset, or interfere with the absorption of vitamin B12.

Avoid eating too much fruit(remember fructose) and if you do eat fruit, go for the berries first and try to eat it between, not with, your meals.

Limit alcohol consumption, especially beer.

I recommend taking an anti-yeast supplement that contains caprylic acid. This substance controls yeast and their toxins. Yeast in the colon in the alternative medicine field has been thought to contribute to inflammatory states. The most effective formulations are the ones that are released in the colon where the fungus lives.

Christian

* Ghio AJ et al.Complexation of iron cation by sodium urate crystals and gouty inflammationArch Biochem Biophys1994;313:21521

*Facchini FS.Near-iron deficiency-induced remission of gouty arthritisRheumatology2003;42:15505.

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