Gout

Gout – Symptoms, Causes & Treatment

Gout is a type of arthritis that occurs when uric acid builds up in the blood due to disordered purine metabolism, which is deposited as monosodium urate crystals in a joint, causing inflammation and sudden severe pain.

Symptoms usually occur in a single joint and are episodic. Attacks are usually preceded by dietary excess, alcohol ingestion, trauma or medication use.  90-95% of patients are men over the age of 30.

Causes of Gout

Gout is caused by higher than normal levels of uric acid in the body. Uric acid results from a breakdown of purines in food.  Hyperuricemia may be due to the body making too much uric acid (e.g. high purine diet) or the reduced ability of the body to get rid of uric acid (e.g. reduced kidney function, poor methylation, SIBO, gut dysbiosis).

Risk factors

• Increased uric acid synthesis from high purine diet (organ meats, meat, shellfish, poultry, yeast)
• Family history: inherited enzyme deficiency causing excess production of uric acid
• Excess alcohol or coffee: decreases uric acid excretion from kidneys
• High fructose diet
• Obesity
• Stress (increases uric acid)
• Dehydration
• Hypertension
• Hypothyroidism
• Certain medications: diuretics, low-dose aspirin, some antibiotics, insulin
• Certain diseases causing increased uric acid: diabetes, anemia, leukemia, lymphoma
• Kidney disease or renal failure
• Lead toxicity: can cause a secondary type of gout known as saturnine gout

Signs and symptoms of Gout

• Symptoms usually involve only one or a few joints – most often affects big toe.
• Pain starts suddenly, often during the night, and is throbbing and excruciating
• Warmth, redness and tenderness of affected joint
• Possible fever
• Attack usually subsides in hours or days

Differential diagnosis

• Pseudo gout: arthritis caused by deposition of calcium salt crystals rather than uric acid crystals
• Rheumatoid, osteoarthritis or infectious arthritis
• Sarcoidosis
• Multiple myeloma
• Hyperparathyroidism

TREATMENT STRATEGY FOR GOUT

Treatment strategy is aimed mostly at decreasing length and frequency of attacks, underlying factors such as gut dysbiosis, SIBO, methylation and nutrient deficiencies need addressing to stop gout from reoccurring.

• Investigate and balance gut dysbiosis
• Investigate and address SIBO if present
• Balance folate and other methylation pathways
• Modify dietary risk factors
• Decrease pain and inflammation
• Decrease uric acid production / encourage removal
• Encourage hydration
• Reduce weight
• Manage stress

Diet plan guidelines for Gout

Reduce or eliminate:

• Alcohol: slows down excretion of uric acid as well as causing dehydration; often a precipitating factor for attacks of gout.
  • High purine foods: shellfish, organ meats, commercially produced red meat and poultry, beer, yeast should be limited to 150-300 g/day
  • High-fructose corn syrup e.g. soft drinks: fructose is the only carbohydrate known to increase uric acid
  • Pro-inflammatory foods: sugar, refined carbohydrates, trans fats, omega-6 fatty acids, caffeine and alcohol

·     Increase:

• Fruit and vegetables (70%) and plant-based proteins
  • Anti-inflammatory foods: cold-water oily fish, berries, nuts and seeds, turmeric, ginger, green tea, olive oil
  • Cherries, blueberries and other anthocyanoside-rich berries or extracts. During an acute attack, eat one jar of cherries daily. For prevention, 2 cherries daily can assist.
  • Water: minimum 2.5 L daily to keep uric acid in solution and promote excretion
• Weight loss diet if indicated

 Supplements that Support Gout

• Decrease serum uric acid levels
• Vitamin C + bioflavonoids – high dose
  • Folate – inhibits xanthine oxidase which is required for uric acid production
  • Magnesium
  • Zinc

* Avoid niacin in doses greater than 50 mg/day – may precipitate an attack of gout by competing with uric acid for excretion

** There is some concern that elevated retinol levels may play a role in some attacks of gouty arthritis

Herbal Medicine Treatment for Gout

• Analgesic and anti-inflammatory – devil‘s claw, turmeric, ginger, celery seed (preventative)
• Flavonoid-rich extracts – bilberry, grape seed, pine bark
• Support kidney function – buchu, couch grass, celery, corn silk

Lifestyle / Physical measures

• Hot and cold compresses provide pain relief and increase circulation to the joint
• Cayenne powder mixed with wintergreen oil applied topically
• Bed rest for 24 hours after acute attack – however prolonged bed rest may exacerbate the condition

Functional Medicine Treatment of Gout

Gout is a condition that often reappears for many patients.  Basic management of the condition can be achieved with the guidelines listed above.  To reverse the reoccurrence of gout requires thorough investigation into the patient, investigating biochemical pathways, optimizing detoxification, investigating and correcting gut dysbiosis and digestive function.

At our Perth clinic of Advanced Functional Medicine we have experience with Gout.

If you or a family member are suffering from gout we would love to hear from you.  What are you best remedies to overcome an acute attack of gout?  Have you managed to become totally gout free, if so, what worked for you?

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