Gout
Gout
17 Coping Ideas
Gout is a type of arthritis that strikes like a bolt from the blue. Its excruciating, throbbing pain often hits at night, turning the skin red-hot and leaving the affected joint swollen and tender. Worse, an attack can last for days.
Once considered the domain of royalty, gout is caused by very plebeian uric acid. We all have it in our bloodstreams. But if you suffer from gout, "either you produce too much or you produce a normal amount and don't excrete enough," says Branton Lachman, Pharm.D., a clinical assistant professor of pharmacy at the University of Southern California School of Pharmacy. Either way, the excess turns into tiny, troublemaking crystals that inflame your joints.
Often the big toe is the prime target, but almost any joint can become a sore point. And while anyone can fall prey to gout, the typical victim is a middle-aged male, who may be overweight and may have a family history of the disease. If you're a current—or potential—sufferer, heed these dos and don'ts from the experts.
Get some R and R. During an acute attack, keep the affected joint elevated and at rest, says Alabama pathologist Agatha Thrash, M.D., co-founder of Uchee Pines Institute, a nonprofit health-training center in Seale, Alabama. You'll probably have little trouble following this advice because the pain will be so intense. During this phase, say doctors, most patients can't bear even the weight of a bed sheet on the tender joint.
Reach for ibuprofen. It is the tremendous inflammation around the affected joint that causes the pain. So when you need a painkiller, says Jeffrey R. Lisse, M.D., an assistant professor of rheumatology at the University of Texas Medical School at Galveston, make sure it's one that can reduce inflammation—namely ibuprofen. Follow bottle directions. But if those dosages don't give relief, he says, consult your doctor before increasing them.
The Alternate Route
The Power of Cherries and Charcoal Cherries. Although there is no hard scientific evidence that cherries help relieve gout, many people find them beneficial. It doesn't seem to matter whether they use sweet or sour varieties or whether the cherries are canned or fresh. Reported amounts vary from a handful (about ten cherries) a day up to 1/2 pound. People have also reported success with 1 tablespoon of cherry concentrate a day, says Agatha Thrash, M.D. Charcoal poultice. Dr. Thrash recommends charcoal poultice. Charcoal has the ability to draw toxins from the body. Mix 1/2 cup of powdered activated charcoal with a few tablespoons flaxseed (ground to a meal in a blender) and enough very warm water to make a paste. Apply to the affected joint. Cover with a cloth or plastic to hold in place. Change every 4 hours or leave on overnight. Charcoal produces stains, so be careful not to get any on clothes or bed linens. Charcoal bath. You may also mix charcoal into a bath for soaking your foot, says Dr. Thrash. Use an old basin that you don't mind staining. Mix 1/2 cup of charcoal powder with water to make a paste. Then gradually add enough hot water so your foot will be submerged. Soak for 30 to 60 minutes. Charcoal by mouth. Activated charcoal taken by mouth can help reduce uric acid levels in the blood, says Dr. Thrash. Take 1/2 to 1 teaspoon four times a day at the following times: upon rising, at midmorning, midafternoon, and at bedtime. |
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Avoid aspirin or acetaminophen. All pain relievers are not created equal. Aspirin can actually make gout worse by inhibiting excretion of uric acid, says Dr. Lisse. And acetaminophen doesn't have enough inflammation-fighting capability to do much good.
Apply ice. If the affected joint is not too tender to touch, try applying a crushed-ice pack, says John Abruzzo, M.D., director of the Division of Rheumatology at Thomas Jefferson University. The ice will have a soothing, numbing effect. Place the pack on the painful joint and leave it for about 10 minutes. Cushion it with a towel or sponge. Reapply as needed.
Avoid high-purine foods. "Foods that are high in a substance called purine contribute to higher levels of uric acid," says Robert Wortmann, M.D., an associate professor of medicine and co-chief of the Rheumatology Division at the Medical College of Wisconsin. So avoiding such foods is prudent.
Those foods most likely to induce gout contain anywhere from 150 to 1,000 milligrams of purine in each 3 1/2-ounce serving. They include high-protein animal products such as anchovies, brains, consomme, gravy, heart, herring, kidney, liver, meat extracts, meat-containing mincemeat, mussels, sardines, and sweetbreads.
Limit other purine-containing foods. Foods that may contribute to gout have a moderate amount of purines (from 50 to 150 milligrams in 3 1/2 ounces). Limiting them to one serving daily is necessary for those who suffer severe cases. These foods include asparagus, dry beans, cauliflower, lentils, mushrooms, oatmeal, dry peas, shellfish, spinach, whole-grain cereals, whole-grain breads, and yeast.
In the same category are fish, meat, and poultry. Limit them to one 3-ounce serving five days a week.
Drink lots of water. Large amounts of fluid can help flush excess uric acid from your system before it can do any harm. Robert H. Davis, Ph.D., a professor of physiology at the Pennsylvania College of Podiatric Medicine, recommends plain old H2O. "Most people just don't drink enough water," he says. "For best results have five or six glasses a day."
As a bonus, lots of water may also help discourage the kidney stones that gout patients are prone to.
Consider herbal teas. Another good way to take in sufficient liquid is with herb teas. They're free of both caffeine and calories, so large amounts won't make you jittery or pile on unwanted pounds. Colorado nutrition counselor Eleonore Blaurock-Busch, Ph.D., president and director of Trace Minerals International, especially recommends sarsaparilla, yarrow (milfoil), rosehip, and peppermint. Brew as usual and drink often.
Don't drink alcohol. "Avoid alcohol if you have a history of gout," says Gary Stoehr, Pharm.D., an associate professor of pharmacy at the University of Pittsburgh School of Pharmacy. Alcohol seems to increase uric acid production and inhibit its secretion, which can lead to gout attacks in some people. Beer may be particularly undesirable because it has a higher purine content than wine and other spirits, says Dr. Blaurock-Busch.
If you do tipple on special occasions, minimize your risk of a reaction by following this tip from Felix O. Kolb, M.D., a clinical professor of medicine at the University of California, San Francisco, School of Medicine. "Drink slowly and buffer wine with readily absorbed carbohydrates such as crackers, fruit, and cheeses."
Control your blood pressure. If you have high blood pressure in addition to gout, you have double trouble. That's because certain drugs prescribed to lower blood pressure—such as diuretics—actually raise uric acid levels, says Dr. Lachman. So taking steps to lower your blood pressure naturally would be wise. Try decreasing your sodium intake, losing excess weight, and exercising. But never discontinue any prescribed medication without consulting your doctor.
Beware of fad diets. If you are overweight, slimming down is imperative. Heavier people tend to have high uric acid levels. But stay away from fad diets, which are notorious for triggering gout attacks, says Dr. Lisse. Such diets—including fasting—cause cells to break down and release uric acid. So work with your doctor to devise a gradual weight-loss program.
Consult your doctor about supplements. Be careful when taking vitamins, says Dr. Blaurock-Busch, because too much of certain nutrients can make gout worse. Excess niacin and vitamin A, in particular, may bring on an attack, she says. So always consult a physician before increasing your vitamin intake.
Don't hurt yourself. For some unknown reason, gout often strikes a joint that's been previously traumatized. "So try not to stub your toe or otherwise injure yourself," says Dr. Abruzzo. "And don't wear tight shoes, which can also predispose your joints to minor injury."
PANEL OF ADVISERS
John Abruzzo, M.D., is director of the Division of Rheumatology and a professor of medicine at Thomas Jefferson University of Philadelphia, Pennsylvania.
Eleonore Blaurock-Busch, Ph.D., is president and director of Trace Minerals International, Inc., a clinical chemistry laboratory in Boulder, Colorado. She is also a nutrition counselor specializing in the treatment of allergy and chronic diseases at the Alpine Chiropractic Center there, and is the author of The No-Drugs Guide to Better Health.
Robert H. Davis, Ph.D., is professor of physiology at the Pennsylvania College of Podiatric Medicine in Philadelphia.
Felix O. Kolb, M.D., is clinical professor of medicine at the University of California, San Francisco, School of Medicine.
Branton Lachman, Pharm.D., is clinical assistant professor of pharmacy at the University of Southern California School of Pharmacy in Los Angeles. He is also vice president of clinical services of Lachman Medical in Corona, California.
Jeffrey R. Lisse, M.D., is assistant professor of rheumatology at the University of Texas Medical School at Galveston.
Gary Stoehr, Pharm.D., is associate professor of pharmacy at the University of Pittsburgh School of Pharmacy in Pennsylvania.
Agatha Thrash, M.D., is a pathologist who lectures worldwide. She is also co-founder of Uchee Pines Institute, a nonprofit health-training center in Seale, Alabama, and author of Charcoal.
Robert Wortmann, M.D., is associate professor of medicine and co-chief of the Rheumatology Division at the Medical College of Wisconsin in Milwaukee. He is also chief of medicine at the Clement J. Zablocki Veterans Medical Center there.
