Gout is caused by uric acid depositing in the joint space. Uric acid is produced by the metabolism of purines by xanthine oxidase. Purines are everywhere in our diet and body as they are the amino acids that are the building blocks of our DNA and RNA. For some reason the portions obtained from red meat cause the most conversion into uric acid. Studies show that the plant derived proteins don't have the same deleterious conversion. The most common place we see gout is in the big toe joint and it usually occurs in one joint at a time, unless the disease has been around a long time. Uric acid is excreted by kidneys and a bit by the small intestine and builds up either by:
10% caused by overproduction
90% caused by under-excretion
How do I get tested for Gout? Your doctor will need to get some fluid from the afflicted joint during a flare-up to test for certain crystals in the joint. This is also done to make sure that you don’t have an infection of the joint or other medical problem. A blood level can be done, but is non-specific. We can do a 24-hour urine assay to test why you have elevated levels of uric acid in your blood.
Newer studies can distinguish gout patients from their gut flora and this may be more sensitive than a blood uric acid level! There appears to be distinct microbiota patterns in patients suffering from gout:
Certain Bacteroides species are more prevalent
Bifidobacterium and Faecalibacterium species are deficient compared to normal
Gout was first written about by the ancient Egyptians. Hippocrates also describes the condition and labeled it a “Disease of Kings” as he determined its association with heavy foods and alcohol, available to the nobles at that time.
Why is Gout such a big deal? Well, in addition to the pain and swelling that can be quite debilitating, Gout is also a risk factor for and associated with the following conditions:
Metabolic syndrome
Cardiac disease
Dyslipidemia
Increased mortality from all causes
Hypertension
So what can you do? Gout is preventable and treatable by Lifestyle and Nutritional changes. The following is a list of things that you can do to reduce your flare-ups and even to eliminate and reverse the disease:
Losing weight can help reduce the pressure on joints in the feet
Exercise program will help mobility at the joints
Hydration with help dilute the uric acid and help with renal elimination
High-fiber foods feeds the good bacteria in the gut
Potassium-rich foods aids in dieresis and renal excretion
Decrease or eliminate red meat consumption heavy in protein and purines that are converted to uric acid
Avoid most seafood Except small cold water fish like sardines
Increase omega 3 fatty acids
Plant based proteins– flaxseed, walnuts leafy greens
Nuts and legumes have no impact on gout despite their high purine content
Avoid sugars and especially fructose laden drinks
Whole fruits are okay, Contain Vitamin C and Hesperidin Soft drinks are very bad
Limit alcohol - One beer increases risk by 50%, Spirits are also not great, but Wine appears to be okay in light moderation
Coffee – decaf too is okay and may help
Supplements to consider
Vitamin C now considered to be a great treatment - Lowers uric acid levels by increasing urinary excretion. 1500 mg a day
Fatty acids - EPA 500 mg, GLA – omega 6 fatty acid 3000 mg
Evening primrose oil, borage oil, black currant see oil
Quercetin - Anti-inflammatory, Inhibits xanthine oxidase, Decreases Blood Pressure and LDL cholesterol - 500 mg twice a day
Bromelain - Found in pineapples and supplements
Ginger and Turmeric - Anti-inflammatory
Magnesium - Aids in alkalization
Apple Cider Vinegar - Alkalinizes the urine
Celery Seed Extract, Nettles - Anti-inflammatory phytonutrients - Available as a tea
Chinese Herbs - Si Miao – 3 to 7 pills 3 times a day - Increases excretion
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