Everything You Need to Know About Gout

Gout is often considered solely as a form of inflammatory arthritis, but it truly is a systemic disease that comes along with significant comorbidities. Treatment of gout isn’t just about relieving pain, it also reduces the risk of kidney damage, high blood pressure, heart disease and diabetes. Read on for everything you need to know about it and how to treat it naturally. 

What is gout?

Gout is the most common form of inflammatory arthritis that affects adults. It causes pain and swelling in joints, typically starting in the first metatarsophalangeal joint, which is just a really long word describing the big toe! 

What causes gout?

The cause of gout is hyperuricaemia, defined as elevated uric acid levels in the bloodstream. Uric acid is a waste product that forms when the body breaks down purines. Purines are made within the body and are found in many foods. 

Normally, the kidneys filter out excess uric acid, however, hyperuricaemia (high uric acid) occurs when the kidneys don’t adequately eliminate uric acid if there is an overproduction of uric acid or a combination of both. 

Uric acid forms small, sharp crystals in and around the joints (ouch!) causing severe pain, swelling and tenderness to the affected areas and activating inflammatory processes within the body. 

But it’s not just joints that are affected, urate crystals can also be deposited throughout the body in the skin, soft tissues and kidneys. 

Signs and Symptoms of Gout

The signs and symptoms of gout almost always occur suddenly, and often at night. They include:

• Intense joint pain- gout usually affects the large joint of your big toes, but it can occur in any joint. 
• Inflammation and redness- the affected joint or joints become swollen, tender, warm and red.
• Limited range of motion- as gout progresses, you may not be able to move your joints normally.
• Low grade fever- may occur because of the body-wide inflammatory response. 
• Elevated uric acid levels on blood test. 

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Gout is typically diagnosed using clinical criteria from the American College of Rheumatology. One test that is typically done is a blood test to measure uric acid. Identifying elevated uric acid levels early is really important because your uric acid levels may be elevated long before gout develops.

Chronically elevated uric acid levels may cause crystal deposits in joints and tissues. These urate deposits may be asymptomatic to begin with and can continue silently before symptoms such as gout are noticed. Early identification means early intervention which may prevent things like gout, kidney stones or kidney damage from occurring. 

During an acute gout attack, uric acid levels may fall below those normally seen between gout attacks so levels should also be measured when you’re not having an acute flare of your gout. 

Generally speaking, your uric acid level is high when:

• For females, it’s over 6mg/dL (0.36mmol/L)
• For males, it’s over 7mg/dL (0.41mmol/L)

For people with gout, lower target uric acid levels may be recommended.

A word on uric acid

As I mentioned, uric acid is a natural waste product that’s created when the body breaks down purines. 

Hyperuricaemia isn’t just responsible for gout so when I’m talking about lowering uric acid to treat gout that’s not the only benefit, it’s also incredibly important to reduce the risk of other systemic diseases like kidney disease, heart disease, high blood pressure and diabetes. 

Ok, back to gout!

Risk factors for developing gout

There are a number of risk factors and contributing factors to the development of gout. Some of these we can’t change but the great thing is that there are many that we can! 

As you may have heard me say before, the CAUSE of your disease is the KEY to your healing. This means that if you can identify what’s causing or contributing to your elevated uric acid levels (and gout symptoms), then you can identify what you need to do to heal it. 

Risk factors for gout include:

• Genetics
• Age- prevalence increases with age.
• Sex- more common in males. 
• Being overweight.
• Alcohol- particularly beer and spirits.
• Foods high in purines such as red meat, processed meats, organ meats, shellfish/crustaceans, yeast and oily fish. 
• Sugary beverages such as sodas sweetened with high fructose corn syrup, fruit juices or other sugar containing drinks.
• Medications- these include aspirin, diuretics (eg. furosemide and hydrochlorothiazide), immunosuppressant agents (eg. tacrolimus and cyclosporine), testosterone and chemotherapy. 
• Medical conditions that increase uric acid levels include high blood pressure, diabetes, heart disease, kidney disease and metabolic syndrome.

Medical treatment of gout

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Current medical treatment for gout is sub-optimal which is clear when we see that the incidence of gout is increasing worldwide and that for many people, it is a recurring problem despite conventional treatment. 

Conventional medical treatments include:

• Drugs for acute attacks (non-steroidal anti-inflammatory drugs [NSAIDs], corticosteroids, colchicine).
• Drugs to reduce hyperuricaemia (xanthine oxidase inhibitors like allopurinol to decrease production of uric acid, uricosuric drugs to increase excretion of uric acid).

Medications to treat gout come with their own problems and side effects. Common side effects from Colchicine include nausea, vomiting and diarrhoea and caution should be used in people with renal impairment. NSAIDs are well known to cause kidney damage and corticosteroids raise blood sugar levels and can lead to diabetes. 

Gout and Kidney disease

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Uric acid is excreted mainly by the kidneys and because of this, any reduction in kidney function is accompanied by retention of uric acid. 

Hyperuricaemia is not only a result of kidney disease but also a risk factor for the development and progression of CKD. There are a few ways that this happens. Firstly, uric crystals can settle in the glomeruli of the kidneys causing direct damage, secondly high uric acid levels are also associated with high blood pressure, heart disease and diabetes which can all contribute to kidney damage and finally elevated uric acid causes inflammation and oxidative damage throughout the body and the kidneys. 

Now to the most important part…

How do you lower uric acid levels and treat gout naturally?

The foundation for treating gout lies in making some changes with your diet, keeping physically active and losing weight if you are overweight. Weight loss has been linked to a decrease in uric acid levels and leads to reductions in gout incidence and exercise is a strong preventor of gout.

The great thing is that making these changes won’t just lower your risk for gout but also every other metabolic disease that is associated with elevated uric acid levels including kidney disease, heart disease and diabetes.

The use of supplements can also be of assistance, but dietary and lifestyle changes really are key here. 

Dietary Advice

• Eliminate alcohol- all types of alcohol cause more uric acid to be absorbed by the kidneys, raising blood uric acid levels, but beer has its own high purine level and so contributes to uric acid elevation in two different ways.

• Eliminate sugar-sweetened beverages, particularly those that contain high fructose corn syrup.

• Avoid animal-derived purine-rich foods such as seafood, red meat and organ meat as these foods have been shown to increase the risk of gout. 

• Avoid foods high in saturated fat as these are highly inflammatory in the body and are undesirable when there is gout (or any time really!). 

• Increase intake of vegetables, legumes, nuts and vegetable proteins. Purine rich vegetables, which were once thought to contribute to gout, are now understood to have no impact. Furthermore, increased intake of vegetable protein is actually associated with up to 27% lower incidence of gout.

• Make sure you’re drinking enough water- being dehydrated will concentrate uric acid and may lead to precipitation of urate crystals. 

• Consume 225 grams (half a pound) of Cherries each day for two weeks. This will help lower uric acid levels naturally. You may use either fresh or frozen cherries. Alternatively try 250mls of unsweetened cherry juice a day instead. After the two weeks, lower the dose to 100mls for maintenance and prevention. 

• Follow an alkaline diet- increases uric acid excretion in urine and decreases blood uric acid levels. Also beneficial for kidney function. 

Nutritional and herbal supplements

• Bromelain is a proteolytic enzyme that may assist in reducing pain, swelling and inflammation associated with gout. Take between meals.
• Quercetin has been suggested to be beneficial because of its ability to inhibit xanthine oxidase which is the enzyme needed to make uric acid. Quercetin also reduces inflammation and has antioxidant properties.
• Vitamin C- vitamin C supplementation was once thought to exacerbate gout however recent data has reversed that belief. In saying that, megadoses of vitamin C should be avoided as it may increase uric acid levels in a small number of people. Vitamin C has been clinically proven to reduce serum uric acid levels in relatively low doses. 
• Fish oil- reduces inflammation. 
• Folic acid- is an inhibitor of xanthine oxidase so may be of assistance in lowering uric acid levels.
• Couch grass (Agropyron repens) is a diuretic and has been used traditionally for its effects on renal secretion in gout. Couch grass, through its action as a diuretic promotes the removal of toxic build-up via the kidneys.
• Turmeric (Curcuma longa)- assists in the control of inflammation and pain. Has also been shown to lower uric acid concentrations.
• Nettle leaf- a gentle diuretic that helps the body process and flush away toxins, reduces inflammation and may help reduce the symptoms of gout. 

So there you go. Hopefully this article has given you a better understanding of what gout is and the relationship between gout and kidney disease and also impressed upon you the importance of lowering uric acid levels, not just in the prevention of gout but also other metabolic diseases and kidney damage. If you are suffering from gout, there are plenty of things you can do to lower uric acid levels and manage your condition. Your joints (and your kidneys) will definitely thank you for it!

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