Nutritional Support for Gout

Nutritional Support for Gout

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. These crystals are VERY sharp and irritate the joint and surrounding tissues causing inflammation.

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.  The white blood cells that circulate to the site of injury during inflammation can actually get popped by these sharp crystals sending signals to the body to increase inflammation and send even more white blood cells to the site of injury.  This vicious cycle cascades worsening pain and injury. Repeated gout attacks can eventually lead to permanent 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. Gout occurs when you either consume too many foods high in purines, bringing your uric acid levels up or when your liver and kidneys can’t effectively eliminate normal levels of uric acid. The liver needs to metabolize the uric acid before the kidneys can pass it out of the body through the urine. If there is a physiological deficiency of the digestive enzyme uricase, then uric acid is not made sufficiently water-soluble to be expelled by the kidneys and urine causing it to accumulate and crystallize.  This happens 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.

Diagnosing Gout

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.

The basic treatment goals involve

(1) dietary and herbal measures that maintain uric acid levels within the normal range

(2) controlled weight loss in overweight individuals

(3) avoidance of known precipitating factors (alcohol, diet, etc.)

(4) the use of nutritional substances to prevent further attacks

(5) 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.

Dietary Recommendations

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.

• 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.
• Ensure you are eating molybdenum (a trace mineral) rich foods as the body uses molybdenum to break down uric acid. when molybdenum is low, it decreases the bodies ability to excrete uric acid in the urine, so it builds up in the tissues. Molybdenum rich foods are beans, lentils and peas (therefore if you are eating a paleo diet you could be risking an increase in gout pain).

Supplemental Support

• Reduce inflammation
  • Short term = Devils Claw, Yucca Root, non-steroidal anti-inflammatory drugs
  • Long term = Omega-3 fatty acids (like cold processed fish oils), CBD, Turmeric
• Reduce Uric Acid
  • Tart Cherry and Turmeric have been shown to remove purines from the body
  • Chanca Piedra (“stone breaker” Phyllanthus niruri L.) and Celery seed remove uric acid from the blood, liver, and kidneys

Just to provide a little more information, I have gout. I’ve only had three flares in my life, but man were they memorable! The first time it happened was after a birthday celebration where I drank and had a ton of seafood. I also had an attack due, I think, to too much plyometric (jumping) exercises. The last one I had was after a liver and colon detox and luckily that was the last one I ever had. I do drink celery juice often, take milk thistle daily and now do gentler exercise like walking, hiking and yoga.

Resources

1. Balch, Phyllis and James. Prescriptions for Nutritional Healing, 3^rd edition. 2000. Avery.
2. Murray, Michael and Pizzorno, Joseph. Encyclopedia of Natural Medicine, Revised 2^nd edition. 1998. Prima Health.

Erin Williams, MSN CN LMP, is the founder of EZBalance.com, a health and wellness company established in 2001. Erin has a bachelor’s degree in Chemistry from Purdue, a master’s degree in Nutrition from Bastyr University, and is currently studying to become a Functional Medicine Practitioner. Erin enjoys sharing her love of natural health and wellness with people through lectures, blogs, and consultations.