Uric acid salts may deposit in the tissue around the joints, especially in the fingers and the toes. It can also occur in the heel, knee, hand, ear, or any joint in the body. When it irritates the joint, it causes inflammation or an “attack” of gout.
The first attack of gout is characterized by intense pain, usually involving only one joint. The first joint of the big toe is affected in nearly half of the first attacks. The affected part feels as if cold water were poured over it. If the attack progresses, fever and chills will appear. The first attacks usually occur at night. Subsequent attacks are common with the majority occurring within one year. Chronic gout is rare due to the advent of drug and dietary therapies.
This condition is closely related to diet. Uric acid is a by-product of certain foods. Other factors such as obesity, alcohol, a large meal, and increasing age add to an individual’s susceptibility to gout. Any physical or emotional stress may also bring on an attack of gout. In some patients, gout appears to be hereditary. Individuals with gout are prone to diabetes, high blood pressure, and cardiovascular disease.
If you think you may have gout, be tested. The best method of diagnosis is for the doctor to insert a needle into the affected joint and aspirate the fluid. He then examines the fluid under a microscope for the characteristic uric acid crystals to verify an elevated serum uric acid level.
Royal Recommendations for Prevention and Treatment
1. Avoid processed foods (e.g., white flour products), refined foods (e.g., white sugar products), animal fats, fried foods, and heat-processed oils. Junk food should be eliminated altogether as sugar can raise blood levels of uric acid.
2. A low-purine diet is important in treatment. Purines are constituents of nucleoproteins from which uric acid is derived. Avoid purine-rich foods such as anchovies, asparagus, beans, cauliflower, chicken, herring, meats and meat gravies, mushrooms, mussels, all organ meats, sardines, shellfish, whole grains and yeast. Alcohol should be avoided as well since it inhibits the excretion of uric acid from the kidneys.
3. Increase your consumption of complex carbohydrates in the form of fresh fruits and vegetables. This will help reduce total protein intake. Emphasizing a high-fiber diet will help with weight loss by lowering blood fat levels of cholesterol and triglycerides. Oat bran, guar gum, pectin, and psyllium husk are all good sources of fiber. (See “Constipation.”)
4. Increase your fluid intake to 6-8 glasses. This can be in the form of distilled, reverse osmosis, or spring water, vegetable juices, broth, and herb teas. Increased liquid helps to decrease the concentration of solutes in the blood and prevent the buildup of gout-producing crystals in the kidneys.
5. Cherries, hawthorn berries, blueberries, and other dark-red berries in any form are rich sources of anthocyanidins and other flavonoids which have been shown to be effective in lowering uric acid levels, inhibiting tissue destruction, and preventing attacks of gout.
6. Avoid weight loss diets with severe restrictions or fasts of longer than three days as this may result in increased uric acid levels. (See “Obesity.”)
7. Allopurinol is the drug frequently prescribed for long-term control of gout. However, this may result in skin eruptions and liver toxicity and should be taken with caution by patients with kidney problems. Other drugs to use with caution include aspirin compounds and thiazide diuretics that inhibit the excretion of uric acid from the kidneys. Also, be aware that excess vitamin A and niacin may bring on an attack of gout.
8. Colchicine, a potent anti-inflammatory drug used for acute gout attacks, has no effect on uric acid levels. Rather, it stops the inflammatory process by inhibiting the migration of white blood cells into areas of inflammation. Most patients show initial improvement after receiving colchicine but the optimal dose often causes gastrointestinal side effects. If this occurs, Indomethacin is an alternative medication.
9. Pharmaceutical grade DMSO may be helpful in relieving pain as a scavenger of hydroxyl radicals. (See “Arthritis.”) This may be used topically. However, once absorbed through the skin, it tends to produce a garlic odor.
10. Heat from hot tubs and baths provide relief because this increases circulation to the joints. Lack of oxygenation secondary to poor circulation may be a contributing factor in gouty arthritis. For some reason, gout often strikes a joint that’s been traumatized. Do your best to avoid injuring your feet or wearing tight fitting shoes that might irritate.
11. Check your food allergies. (See “Allergy—Foods.”) The allergy evaluation should include screening for foods. At the very least, you can begin eliminating some of the foods that you tend to eat repetitively. Eliminate products containing food coloring, dyes, MSG, and aspartame as well.
12. Check your hormone levels. This includes estradiol, thyroid, and DHEA. Estrogen increases under conditions of stress and interferes with thyroid function. DHEA, an adrenal hormone precursor, is often low in older patients, when a degenerative condition is present, and as a result of prolonged stressful conditions. Natural hormones made from plants are available without the side effects of synthetic medicines. These natural hormones can be obtained by prescription from a compound pharmacy.
13. Check your thyroid function by measuring your basal body temperature. This is done by placing a thermometer under your arm for 10 minutes before arising from bed on two consecutive days. For menstruating women, this is best done at the beginning of the menstrual cycle. The average basal body temperature should be greater than 97.8 degrees. If not, a trial of natural thyroid should be considered. A low body temperature decreases the saturation of uric acid in the blood and causes deposits to form. (See “Hypothyroidism.”)
14. Consider evaluating your body burden level of environmental pollutants such as lead, aluminum, and cadmium. (See “Chelation Therapy.”) Chronic lead intoxication is known to decrease renal clearance of uric acid from the kidneys. All heavy metals can act as free radicals in the body and be a possible source of joint destruction. Mercury should also be evaluated if you have amalgam fillings in your teeth. If elevated, heavy metal detoxification therapy is indicated.
15. Heart rate variability testing, an assessment of heart rhythm, can reveal if an imbalance in the autonomic nervous system exists. The ANS controls non-conscious bodily functions. An imbalance in the ANS can now be treated with non-cognitive biofeedback (i.e., recycling of heart rate variations).
16. Supplements recommended include the antioxidant vitamins C and E. B-complex with additional folic acid and B5 (also known as “pantothenic acid”") plays an important role in purine metabolism. The mineral zinc is known to be helpful for tissue repair. The mineral magnesium plays an important role in protein synthesis and pH balance. Essential fatty acids (such as fish oils, flax seed oil, and borage oil) promote the production of prostaglandins in the body that inhibit inflammation. The amino acid L-Methionine nourishes the cartilage and acts as a natural anti-inflammatory. Amino acids Alanine, Aspartic acid, Glutamic acid, and Glycine have been shown to lower serum uric acid levels. Bioflavonoid compounds, such as quercitin, have a similar effect. Proteolytic enzymes, such as Bromelain, are natural anti-inflammatory agents and should be taken between meals for best results. Glucosamine Sulfate stimulates the synthesis of new cartilage and actually inhibits deterioration of the joints.
17. Herbs known to be beneficial are birch, burdock, hyssop, juniper, peppermint, rosehip, sarsaparilla, and yarrow.
18. Homeopathic medicines found to be helpful for this condition are: Colchicum (if large toe is inflamed and you cannot bear to have it touched), Ferrum Phosphoricum (when inflammation is present), Ledum (if sharp pains ascend upwards), Rhododendron (for pains in the small joints), and Rhus Toxicodendron (if pain is better with motion). Ribes Nigrum and Vaccinium Myrtillus contain anthocyanidins and are available as gemmotherapy products.
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