Gout is a common type of arthritis that occurs when uric acid (sodium urate) builds up in the blood, tissues, and urine. The uric acid that accumulates ultimately crystallizes and takes on a needle-like shape, which is its natural crystalline form. This crystal can circulate through the body and attached to the joints; ultimately jabbing into them. The joints most commonly effected are the big toe, mid-foot, ankle, knee, wrist and fingers. Acute joint pain is usually the first symptom, then the joints become inflamed—red, hot, swollen and extremely sensitive to touch. Repeated gout attacks can eventually lead to joint damage.
The Biochemical Cause
The uric acid that accumulates is the end product of the metabolism of a class of compounds known as purines. If there is a physiological deficiency of the digestive enzyme uricase, then uric acid is not made sufficiently water-soluble and it accumulates and crystallizes, especially at lower temperatures, which may explain why joints in the extremities are most affected.
Approximately 70% of those who suffer from gout actually produce too much uric acid while the other 30% cannot properly make uric acid water-soluble via uricase and eliminate it. About 25% have a family history of gout. Poor kidney function can also play a role in the development of the disease.
The Dietary Relationship
Uric acid is the byproduct of certain foods, so there is a significant relationship between diet and the development of gout. Historical depictions of King Henry the VIII of England often illustrate him with his toe or foot bandaged and elevated, suffering the pain of gout.
Gout has been called the “rich man’s disease” since it is associated with obesity and the consumption of too much rich food and alcohol. However, it affects people from all walks of life, most commonly men (90%) between the ages of 40 and 50. Gout pain can be increased and induced by calorie-restrictive dieting, drinking, certain medications, overeating, stress, and surgery or injury to a joint. Uric acid kidney stones may also be related to the condition.
Several other diseases, including rheumatoid arthritis, infections and pseudogout, can mimic the joint symptoms of gout. Pseudogout is another form of arthritis that occurs in the larger joints—usually knees, wrists or ankles—caused by the development or deposition of calcium pyrophosphate dihydrate crystals. The best method for getting a definitive diagnosis of gout is by taking a joint fluid sample by needle aspiration and examining the joint fluid for the characteristic uric acid crystals.
Note: The dietary recommendations and considerations described below contain foods to which some individuals may have food allergies, intolerances and sensitivities. In those cases, those foods should be avoided. Dietary choices should be modified to meet your personal dietary needs. Consult with EZBalance for further information regarding nutrition and your individual medical condition and for a comprehensive gout prevention/management protocol.
The basic treatment goals involve:
- Dietary and herbal measures that maintain uric acid levels within the normal range
- Controlled weight loss in overweight individuals
- Avoidance of known precipitating factors (alcohol, diet, etc.)
- The use of nutritional substances to prevent further attacks
- The use of herbal and nutritional substances to inhibit the inflammatory process.
Urinary 24-hour uric acid levels can be used to monitor the effectiveness of dietary therapy.
- Avoid refined sugar, particularly sucrose and fructose, refined carbohydrates, and alcohol
- Avoid foods high or moderate in purines (organ meats and sweetbreads, meats, mincemeat, consommé, meat gravies and broths, shellfish, brewer’s and baker’s yeast, herring, sardines, mackerel, mussels, anchovies, legumes, peanuts, spinach, asparagus, fish, poultry and mushrooms). Thyme and thyroid extracts can also pose a problem if taken for extended periods of time.
- Increase complex carbohydrate and decrease fat ingestion. Protein intake should be moderate (not more than 25% of your overall intake of foods). Moderate consumption of cold-water fish as part of overall protein intake is indicated (see below). During an acute attack, rely on non-starchy vegetables for two weeks with moderate protein and healthy fats. Also, eating celery, dark leafy greens, blueberries, cherries and strawberries will help to neutralize the uric acid and are full of antioxidant nutrients and Vitamin C. Omega-3 essential fatty acids that are found in cold water fish like halibut, salmon and tuna, for example, are anti-inflammatory and likely beneficial in this condition.
- Liberal fluid (water) intake dilutes the urine, reduces the risk of kidney stones and increases the excretion of uric acid. Drink at least 64 oz. of water daily. Rule-of-thumb for water consumption: One half of your body weight in ounces, plus 8 ounces for each cup of coffee or black tea and 8 ounces for each half hour of exercise.