Gout is a caused by an excess of uric acid and crystal deposition in a joint space. It most commonly affects the great toe, but can occur in the ankle, knee, wrist, and finger joints as well. Although gout is often considered as an acute inflammatory arthritis it is really a systemic disease that is associated with serious health comorbidities.
Gout (hyperuricemia) is associated with:
Coronary Artery Disease
The Framingham Heart Study demonstrated an independent 60% risk of increased coronary artery disease in men with gout. Other studies show that men with gout are at a 55% increase risk of fatal myocardial infarction, and a 38% increase of death due to cardiovascular disease. Gout is an independent risk factor for death of all causes!
The typical treatment for gout consists of anti-inflammatory drugs and steroids. While effective in treating symptoms these drugs carry potentially harmful side effects and do not address the root cause of the disease.
Aggressive lifestyle counseling centering on weight loss, exercise, and dietary modification dramatically lowers all cause morbidity associated with gout. Patients should avoid red meat in the forms of beef, pork, lamb, and seafood as these foods raise uric acid levels associated with gout. Sugary beverages should also be avoided. Patients should increase the intake of vegetables, legumes, nuts, and vegetable proteins. Beer and liquor consumption is associated with increasing gout attacks, while wine and coffee consumption are not.
Integrative Approach to Gout
Weight loss. Adiposity is associated with hyperuricemia, so achieving an ideal weight is paramount to the treatment of gout.
Nutrition. It is very important for gout patients to follow a strict diet that eliminates beef, pork, lamb, and seafood. Increase plant sources of omega-3 fatty acids found in flaxseed, walnuts, and leafy greens. Increase intake of vegetables, legumes, and vegetable proteins. Experts no longer recommend limiting purine rich vegetables once thought to contribute to gout. Meat consumption appears to raise uric acid levels, while vegetables do not. Decrease sugary drinks, like soda and juice that contains fructose (fruit juice). Alcohol intake is associated with gout, with beer having the strongest association, followed by liquor. Wine does not seem to have an affect on gout. Low fat dairy consumption is helpful, specifically milk and yogurt. Drink plenty of water, as adequate hydration helps the kidneys to eliminate uric acid. Proper water consumption is ½ of your weight in pounds as ounces of water needed daily. (150 lb person needs 75 oz of pure water daily). Coffee consumption at no more than 2 cups per day does not seem to affect gout. Bing sweet cherries have shown to improve plasma urate levels and increase uric acid excretion by the kidneys.
Supplements. Supplements and botanicals can be useful in treating gout. Consult a integrative practitioner for the right supplements to suit your body. You do not need all of the following recommendations!
Vit C: 1000-2000 mg a day
Cherry extract: 1000-3000 mg a day
Green coffee extract: 400-1200 mg a day
L-methylfolate: 1000 mcg daily
Quercetin: 250-500 mg daily
Grape see extract: 100-200 mg daily
Olive leaf: 500-1000 mg daily
Milk thistle: 750 mg daily
Fiber: 30-40 grams of fiber daily
Fish oil: 1400 mg EPA and 1000 mg DHA daily
Curcumin: 400-800 mg daily
Trans-resveratrol: 250-500 mg daily
Acupuncture. Acupuncture appears to be an effective treatment for acute gout. In some trials acupuncture was superior to allopurinol and indomethacin. The acupuncture group as did not suffer medication side effects.
Pharmaceuticals. Pharmaceuticals fall into the categories of; Non-steroidals, Steroids, Pain medications, and Preventative medications. While it is not the scope of this article to review these medications, keep in mind that each of them has potential and serious side-effects. Remember if dietary correction reduces uric acid levels naturally, medications are not necessary.
If you or someone you know suffers from gout, please take it as a sign of severe metabolic imbalance and a marker for serious life threatening heart disease. Lifestyle changes that facilitate whole body heath are the best long-term treatment plans.