Thursday, December 9, 2010

What Is Gout and What Are the Symptoms?

A read asks, "Do I have gout? I thought that only gourmets and rich people got this disease." Gout was once considered a rich man’s disease. In the twenty-first century, gout is more of a poor person’s disease, becoming more and more common among the same populations that are developing type 2 diabetes.

It's hard to imagine, but the high-protein, high-fat foods we now consider cheap and of very little nutritional value, such as Spam and hot dogs, were once luxury items. The fresh fruits and leafy green plant foods that help sufferers avoid new attacks take a little more effort to obtain and cost a little more at the checkout counter, but they are still vastly less expensive than medication.

What is gout? Gout is a form of arthritis. It results from the accumulation of the metabolic byproducts of uric acid in joints. The condition causes sudden attacks of pain and tenderness in joints. The most frequently affected joint is the metarsophalangeal joint of the big toe, but sometimes gout strikes other joints, such as the ankles, hands, knees, and wrists.

The first attack usually occurs at night. Joints quickly become warm, red, and tender. The skin over the joints often appears as if it had been infected. Untreated, the subsequent pain and swelling usually continue for at least 3 and up to 10 days.

The pain of gout  is triggered by the accumulation of needle-sharp crystals of a salt of uric acid known as monosodiumurate. These crystals build up in a joint and find their way into surrounding tissues during an acute attack. So much monosodiumurate can accumulate in the synovial fluid in the joint that it takes on a chalky color. The immune system fills the joint with neutrophils to break up injured tissue. The massive inflow of neutrophils makes pain and swelling worse. Over time, this misguided immune process can destroy a joint.

The body makes uric acid by breaking down purines, one of the two types of components of DNA, RNA, and ATP. How purines are recycled depends on xanthine oxidase, an enzyme that generates a potent free radical known as superoxide. Over consumption of gout-causing foods that are rich in purines, such as meat, eggs, fish, beans, and peas, can generate more uric acid than the xanthine oxidase system can process. Excessive alcohol consumption, surgery or serious illness, or withdrawal from ACTH, steroid medications, or even gong off the medications prescribed for the treatment of gout can disable the xanthine oxidase system. When this happens, xanthine oxidase cannot process even the normal levels of purines generated by the digestion of food. Byproducts accumulate and precipitate an attack.

Gout is most commonly a disease of men over the age of 50. Women only represent 5 to 17 percent of all cases of gout, and the condition is almost never seen in women before menopause except in women with a strong family history of the condition.

How to prevent gout. The standard medical intervention for gout pain relief is colchicine. This potent anti-inflammatory drug was originally isolated from a flower, the autumn crocus, the same plant that is the source of saffron. It is extremely effective at controlling inflammation. There's no doubt colchicine works. Up to 75 percent of patients show major improvement in symptoms within the first 8-12 hours of taking the drug.

Unfortunately, using colchicine for gout control has serious side effects. It can cause bone marrow dysfunction. It can cause depression, hair loss, and liver damage. Users of colchicine may suffer respiratory problems and seizures. Even more problematic is that fact that taking a dose of colchicine low enough to avoid these side effects doubles risk of death from congestive heart failure, and the way to avoid increased risk of death from congestive heart failure is to increase the dose of colchicine, increasing the risk of painful but non-fatal side effects. Moreover, colchicine is only an anti-inflammatory. It does nothing to prevent future attacks of gout.

A natural approach to treating gout aims to keep uric acid within normal levels. Considerable personal discipline is required to overcome the condition, but the combination of dietary changes and nutritional supplementation usually prevents further attacks.

What foods cause gout? Overconsumption of protein foods is usually the culprit behind recurrent gout attacks. Whether it's filet mignon or tripe, pork loin or pork snout, homemade tofu or beans out of the can, most high-protein foods are unfriendly to gout sufferers. Fortunately, you only need a little protein each day to keep your body well-supplied.

It's absolutely essential to remember that step number one in controlling uric acid is lowering your intake of foods that contain purines. These are the foods that increase uric acid production. You must also avoid alcohol, since alcohol accelerates the breakdown of purines into forms that become uric acid and impairs kidney function. You need to reduce consumption of sugary refined carbohydrates and also of saturated fats. These foods likewise trigger uric acid retention. And you can't go on an Atkins or South Beach style high-protein diet, since the amino acids high protein diets provide displace uric acid in the cleansing apparatus of the kidneys. When the kidneys cannot clear purines, they go back into the bloodstream where it eventually circulates to the joint.

The next step in controlling uric acid is reducing insulin resistance, the inability of muscle cells to accept sugars. The simplest ways of reducing insulin resistance are vigorous exercise and weight loss. Vigorous exercise is not recommended for sufferers of gout since it may precipitate uric acid crystals in the kidneys. In some cases, a deficiency of the enzyme HGPRTase may cause excessive release of hypoxanthine in muscles being exercised.

Limitations on exercise leave diet as the principal means of reducing insulin resistance in gout. A clinical study at the University of Witwatersrand in South Africa enrolling 13 men with gout found that following a calorie-restricted diet for four months normalized uric acid levels in a majority of participants in the trial.

The diet consisted of 1600 calories a day, 40 percent derived from carbohydrate, 30 percent from protein, and 30 percent from fat, simple sugars replaced with complex carbohydrates and saturated fats replaced with polyunsaturated fats. Participants lost an average of 15 pounds (7.7 kilos), and the frequency of attacks was reduced from average of two per month to one attack every other month.

Better relief for gout. Until recently, researchers thought that nearly the only food gout sufferers can eat as much as they want is cherries. Consuming one-half pound (250 grams) of cherries, fresh or canned, every day is widely recognized as lowering uric acid levels and preventing attacks of gout. Cherries, along with blueberries, and other dark and red-blue berries are rich sources of joint-healthy flavonoids. Consuming pineapple, on the other hand, won't stop the accumulation of uric acid crystals, but it may help break them down.

Diabetics, of course, need to limit the amount of fruit they eat any given meal. If you have both diabetes and gout, then you need to (1) space out your consumption of fruit through each of your three meals a day, (2) strictly limit your consumption of other starchy and sugary foods and (3) test your blood sugars to make sure the extra fruit is not making your blood sugar levels run high. However it turns out that there is an alternative that also works if you can't tolerate all the natural sugars in fruit.

Leafy greens, especially spinach, are the answer. In 2010, Japanese scientists reported that alkalizing the urine is the key to getting rid of the uric acid that forms the crystals that cause gout. It is not important--or possible--to "alkalize the body." Your kidneys keep the pH of your body in a constant, narrow range. They do this by making your urine more or less acidic or alkaline. If your urine is alkaline, then it can carry off the uric acid. And you make your urine alkaline by eating more alkalizing foods than acidifying foods.

The strongest alkalizing food that's commonly consumed is spinach. A serving of spinach can neutralize two or three servings of meat--which is more than you should be eating! It's best not to overindulge in leafy greens, either, especially if you tend to get kidney stones. And it's also important not to consume soft drinks. A liter of Diet Coke, for example, is harder for your body to neutralize than half a pound (220 grams) of turkey.

The best of all natural cures for gout. But cherries and berries are in a class to themselves. They don't just alkalize. They also contain natural healing agents that have the ability to cross-link the proteins in collagen, reinforcing the collagen matrix of cartilage and tendons. They also prevent the formation and release of the compounds that cause the intense pain of gout, namely, prostaglandins, leukotrienes, and histamine. In combination with strictly limiting your consumption of protein foods, fruit and vegetables may give you a drug-free way to get rid of gout for good. Try the diet for several weeks.

Selected Reference:

Kanbara A, Hakoda M, Seyama I. Urine alkalization facilitates uric acid excretion.Nutr J. 2010 Oct 19;9:45.

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