Gout

Excess Uric Acid

Gout is caused by an excess of uric acid in the body. Uric acid is a chemical which is a natural part of the normal breaking down and building up of food and body tissues. The excess can be caused by:

• an increase in production by the body
• by under-elimination of uric acid by the kidneys
• by increased intake of foods containing purines which are metabolized to uric acid in the body.

What Causes Gout Pain ?

The condition of raised blood uric acid is called hyperuricaemia. When this is present the uric acid which is normally dissolved in the blood may, from time to time, form microscopic crystals in the joints leading to acute Gout attacks. Uric acid may also collect under the skin as tophi (chalk coloured nodules) or in the urinary tract as kidney stones.

Why Higher Uric Acid?

It follows that Gout may develop in persons whose uric acid is higher than normal, caused any of the following:

• Certain meats
• Seafood
• Dried peas and beans and other high purine foods
• Alcoholic beverages may also significantly increase uric acid levels
• Some of the drugs used to treat high blood pressure
• Less commonly, long-standing kidney disease may result in high blood levels of uric acid

Acute attacks are typically treated with colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethicin (Indocin® ) or naproxen sodium (Aleve® , Anaprox® ), and corticosteroids. Resting the affected joint is commonly recommended. For long-term treatment, doctors may prescribe medications such as allopurinol (Lopurim® , Zyloprim® ) to decrease uric acid production, or probenecid (Benemid® ) or sulfinpyrazone (Anturane® ) to increase the excretion of uric acid from the kidneys.

Nutrition

• Folic acid - A few studies indicate that large amounts of supplemental folic acid may reduce uric acid levels; the research is mixed.
• Vitamin C According to one small study, supplemental vitamin C could, in theory, reduce the risk of gout attacks. However, the authors of this study warned that taking large amounts of vitamin C could also trigger an acute attack of gout by abruptly changing uric acid levels in the body.
• Quercetin(150-250 mg three times per day [taken between meals]): This flavonoid inhibits an enzyme which controls the rate of uric acid synthesis. Quercetin also has shown anti-inflammatory effects in test tube studies but this may not be effective in oral quercetin.

Diet

• Purines Restrict purines: Foods that are high in compounds called purines raise uric acid levels in the body. Foods high in purines are generally protein-rich foods.
• Alcohol Avoid alcohol: Limiting alcohol intake, particularly beer, to one drink per day or less can reduce the number of attacks of gout.
• Sugar Avoid sugar: Refined sugars, including sucrose and fructose, should be restricted, because they raise uric acid levels.
• Cherries & Cherry Juice According to a 1950 study of 12 individuals with gout, eating one-half pound of cherries or the equivalent amount of cherry juice prevented attacks of gout. Black, sweet yellow, and red sour cherries were all effective. Since that study, there have been many anecdotal reports of cherry juice as an effective treatment for the pain and inflammation of gout. The active ingredient in cherry juice remains unknown.
• Avoid Yeast Avoid nutritional yeast and brewer's yeast: These foods can raise uric acid levels.

Lifestyle

• Weight loss: Individuals who are overweight are at greater risk of developing gout.
• High blood pressure: Individuals who have high blood pressure are at greater risk of developing gout.

Studies

See the following for footnote references.

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