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GOUTVisit The Healthy Living Bookshelf:
Gout is a form of arthritis that occurs when crystals of uric acid accumulate in a joint, leading to the sudden development of pain and inflammation. People with gout either overproduce uric acid or are less efficient than other people, at eliminating it. The joint of the big toe is the most common site to accumulate uric acid crystals, although other joints may be affected. Checklist for Gout
 What are the symptoms of gout? The pain of gout can arise suddenly and is often very intense. The affected joint is usually red, swollen, and very tender to the touch. A low-grade fever may also be present. How is it treated? Acute gout attacks are typically treated with colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (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. Dietary changes that may be helpful: Foods that are high in compounds called purines raise uric acid levels in the body and increase the risk of gout. Restricting purine intake can reduce the risk of an attack in people susceptible to gout. Foods high in purines include anchovies, bouillon, brains, broth, consommé, dried legumes, goose, gravy, heart, herring, kidneys, liver, mackerel, meat extracts, mincemeat, mussels, partridge, fish roe, sardines, scallops, shrimp, sweetbreads, baker’s yeast, brewer’s yeast, and yeast extracts (e.g., Marmite, Vegemite). Avoiding alcohol, particularly beer, or limiting alcohol intake to one drink per day or less may reduce the number of attacks of gout.1 2 Refined sugars, including sucrose (white table sugar) and fructose (the sugar found in fruit juice), should also be restricted, because they have been reported to raise uric acid levels.3 According to a 1950 study of 12 people with gout, eating one-half pound of cherries or drinking an equivalent amount of cherry juice prevented attacks of gout.4 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. Lifestyle changes that may be helpful: People who are overweight or have high blood pressure are at greater risk of developing gout.5 However, weight loss should not be rapid because restriction of calories can increase uric acid levels temporarily, which may aggravate the condition. Nutritional supplements that may be helpful: Large amounts of supplemental folic acid (up to 80 mg per day) have reduced uric acid levels in preliminary research.6 However, other studies have failed to confirm the effectiveness of folic acid in treating people with gout.7 In one small study, people who took 4 grams of vitamin C (but not lower amounts) had an increase in urinary excretion of uric acid within a few hours, and those who took 8 grams of vitamin C per day for several days had a reduction in serum uric acid levels.8 Thus, 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. Despite this concern, some doctors recommend vitamin C supplementation (sometimes starting with one gram per day) as a method for reducing elevated uric acid levels. In test tube studies, quercetin, a flavonoid, has inhibited an enzyme involved in the development of gout.9 10 However, it is not known whether taking quercetin by mouth can produce high enough quercetin concentrations in the body to achieve these effects. Although human research is lacking, some doctors recommend 150–250 mg of quercetin three times per day (taken between meals). Herbs that may be helpful: Autumn crocus (Colchicum autumnale) is the herb from which the drug colchicine was originally isolated. Colchicine, a strong anti-inflammatory compound, is used as a conventional treatment for gout. Both the herb and the drug have significant toxicity and should only be used under the guidance of a physician. References: 
1. Ralston SH, Capell HA, Sturrock RD. Alcohol and response to treatment of gout. BMJ 1988;296:1641–2. 2. Scott JT. Alcohol and gout. BMJ 1989;298:1054. 3. Emmerson BT. Effect of oral fructose on urate production. Ann Rheum Dis 1974;33:276–80. 4. Blau LW. Cherry diet control for gout and arthritis. Tex Rep Biol Med 1950;8:309–11. 5. Loenen H, Eshuis H, Lowik M, et al. Serum uric acid correlates in elderly men and women with special reference to body composition and dietary intake (Dutch Nutrition Surveillance System). J Clin Epidemiol 1990;43:1297–303. 6. Oster KA. Xanthine oxidase and folic acid. Ann Intern Med 1977;87:252–3. 7. Boss GR, Ragsdale RA, Zettner A, Seegmiller JE. Failure of folic acid (pteroylglutamic acid) to affect hyperuricemia. J Lab Clin Med 1980;96:783–9. 8. Stein HB, Hasan A, Fox IH. Ascorbic acid-induced uricosuria: a consequence of megavitamin therapy. Ann Intern Med 1976;84:385–8. 9. Bindoli A, Valente M, Cavallini L. Inhibitory action of quercetin on xanthine oxidase and xanthine dehydrogenase activity. Pharmacol Res Commun 1985;17:831–9. 10. Busse W, Kopp D, Middleton E. Flavonoid modulation of human neutrophil function. J Allergy Clin Immunol 1984;73:801–9. |
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