What to do about Gout?
Nutritional Focus

The prevalence of gout is increasing in Western countries. It is six times more common in men than in women but can affect anybody over the age of 30. Read about some effective natural remedies and lifestyle changes that can reduce the frequency of ‘attacks’ and may make a significant difference if you suffer from this painful ailment.
What to do about Gout?

Gout, which was once commonly called ‘Gouty arthritis’ is a condition that can affect adults from middle age onwards. Gout can cause sudden and severe joint pain, usually this is in your big toe, but it can be in other joints in your feet, hands, wrists, elbows or knees. It is characterised by hot, swollen, red skin over the affected joint during what is known as an ‘attack.’ The prevalence of gout is increasing in Western countries. It is six times more common in men than in women but can affect anybody over the age of 30. Although there are few scientifically proven cures, there are some effective natural remedies and lifestyle changes that can reduce the frequency of ‘attacks’ and may make a significant difference if you suffer from this painful ailment.

It is thought that genetics may play a significant role in its development, but there are some risk groups too. Consumption of a diet that is high in purines seems to predispose individuals to the development of gout. Purines are organic compounds that are found widely in nature and are present in many foods. However, it appears that on the whole, only meat and fish sources are a problem for gout sufferers. Purines are normally consumed from foods and then metabolised by the body, with the by-product uric acid being excreted in your urine via your kidneys. However, in some individuals this process is not done efficiently. In these individuals, the uric acid levels in the blood become elevated, a condition called hyperuricaemia. In people with gout, this then crystallizes into microscopic crystals of monosodium urate. These crystals deposit in joints, tendons and surrounding tissues, triggering an immune response that causing swelling and inflammation and an episode or flare up – commonly called an ‘attack’ of Gout ensues.

During an attack, which may last for a few days or in the worst cases a couple of weeks, the swelling can be accompanied by redness and stiffness and acute pain in the joint. In about half of all gout cases, the joints of the big toe are affected, but as stated above it can also affect the ankles, heels, knees, wrists, fingers and elbows. In around 98% of patients with hyperuricaemia and gout the high uric acid concentration is the result of under-excretion of uric acid, rather than over-production of it, but reducing your consumption of high purine foods can help to reduce attacks.

Dietary and lifestyle changes

Foods such as red meat, poultry, organ meat and oily fish (such as salmon, sardines, and herring) are particularly rich in purines, so it is essential to stop or at least reduce consumption of these foods. A high intake of sugary foods is also linked to frequency and severity of attacks. Obesity is a risk factor for gout, so if you are very overweight then it is a good idea to try and lose a few pounds.

For all gout sufferers, it is important to drink plenty of water, as this enables your body to flush out the uric acid. Urate crystals can form more readily in a dehydrated body, and dehydration is commonly seen in people with gout, so try to drink a couple of litres of mineral or filtered water every day. It appears that unfortunately, gout never ‘just goes away.’ Lifestyle changes and treatments are essential to managing it, and with good management many sufferers can dramatically reduce the frequency of attacks. The inverse also appears to be true, and it is a simple fact that if dietary changes and treatment regimens are not implemented, attacks tend to occur with increasing frequency.

Gout and alcohol – does it really do any harm?

The consumption of alcohol is often debated but according to a 2014 study by Tuhina Neogi, et al. (1), if you already have gout, you are highly likely to trigger gout attacks through drinking too much beer (and to an extent all types of alcohol). This is because, unfortunately for gout sufferers, brewer’s yeast, used in the production of beer, is considered a high-purine food. In addition to the high purine levels, there is also a significant amount of sugar in beer (found naturally in the grains used to make it such as barley and wheat) and in other alcoholic drinks, which makes them  unhelpful, and alcohol also causes dehydration as well. Finally, some studies have shown that not only does alcohol increase uric acid production, it also makes it more difficult for the body to excrete excess uric acid. These three effects — increased uric acid, decreased excretion, and dehydration — compound to heighten the risk of recurrent gout attacks even further. If you are a heavy drinker and suffer from gout, then it is important to try and reduce your drinking.

If you think that you are suffering your first attack of gout, you should see your GP who may refer you to a rheumatologist who will do tests to determine how much uric acid you have in your blood and may take a sample from the affected joint. It is also important to note that an attack of gout usually lasts around 5 – 7 days and will usually then get better. The NHS website advises that you call 111 if the pain from your gout attack gets worse, you also have a high temperature (you feel hot and shivery) or you feel sick and can’t eat. These symptoms may indicate an infection, so you need urgent medical help. In any diagnosed case of gout, it may be that conventional medication is necessary in the short term, but alongside the dietary changes mentioned here, many natural remedies, if given time, can make a real difference too.

Vitamin C

Vitamin C supplementation may increase the body’s ability to rid itself of uric acid, which could make it helpful to people with gout. In one small scientific trial, subjects who took 4g of vitamin C had an increase in urinary excretion of uric acid within just a few hours (2). In another study, taking just 500mg per day for two months significantly reduced blood levels of uric acid, especially in people whose initial uric acid levels were elevated (3). Because there is a possibility that taking large amounts of vitamin C in one dose could actually trigger an attack of gout, it is advisable to take a low dose of just 500mg per day, and to gradually increase this over time if uric acid levels are not elevated.

Sour Cherris

 

Montmorency Cherry

The Montmorency cherry is a variety of sour cherry that is widely grown in Europe, Canada and the U.S. Traditional use of tart cherry juice for relieving the symptoms of gout stretches back centuries, and there has been much anecdotal evidence for its benefits, but modern research has now demonstrated that its folkloric use is justified. Elevated uric acid levels are known to be involved in the onset and progression of gout. In a 2003 study conducted at the University of California in the United States, healthy women aged 20-40 years old saw a 15% decrease in uric acid levels after consuming just two 280g servings of cherries after an overnight fast (4). This was followed by further pilot studies in 2012 that indicated potential benefit during gout attacks (5). It is thought that anthocyanins, antioxidants that are present in many red and purple foods, may inhibit some of the inflammation pathways that are involved in the progression of gout. Tart Montmorency cherries are proven to be extremely rich in these and several other plant compounds that possess anti-inflammatory and antioxidant properties. Gout attacks are known to respond to anti-inflammatory medication, so this makes sense of the anecdotal evidence from gout sufferers that after ingesting Montmorency cherries, the negative effects of their condition were reduced.

In September 2014, researchers at Northumbria University in the UK, conducted a small study on healthy participants using a Montmorency cherry concentrate. Study participants drank either 30ml or 60ml of the concentrate mixed with 100ml of water. Final results showed that uric acid levels in urine increased (more uric acid was being excreted) whilst the levels in blood decreased (less uric acid being reabsorbed by the kidneys) as a result of consuming the cherry juice. Inflammation was also seen to have decreased. This small study is further evidence of possible positive benefit for gout sufferers in using Montmorency cherry as a preventative remedy (6). A systematic review of research and further articles published in medical journals in 2019 were positive in their conclusions too (7,8), but large-scale clinical trials have yet to be made. Some studies have shown that cherries may have a beneficial anti-inflammatory effect on individuals with other forms of arthritis such as osteoarthritis too (9), but more research is needed to show quite why cherries appear to be so helpful to gout sufferers. In the meantime, Montmorency cherries are a completely safe and potentially very helpful remedy worth trying. It can be hard to get hold of the fresh juice easily in the UK, but Optima Sour Cherry Juice Concentrate provides a potent alternative and contains no artificial colours or flavours. It can be taken directly from the bottle or diluted to taste. If you don’t like the idea of drinking cherry juice daily, try Nature’s Aid CherryXtra, made using freeze dried Montmorency cherries (take 1-2 capsules per day).

Celery Seed, Burdock & Nettle

Celery seeds contain nearly 20 different types of anti-inflammatory agents, and as a result they can be very effective for reducing inflammation during a gout attack. Some compounds present in the seeds can also impact on the production of uric acid, and it contains vitamin C which has been proven to increase uric acid excretion and reduce uric acid levels in the blood (2). As a source of calcium, magnesium and especially potassium they may help to maintain a more alkaline state in your body that can prevent urate crystal formation in your joints. Celery seeds are a diuretic too, meaning that they help to increase urine flow. In this way they can help to flush more uric acid out of your body.

Three compounds have been most heavily researched for their role in inflammation and uric acid production, which is a driving force behind the severity of gout attacks – luteolin, 3-n-butylphthalide and beta-selinene. In one study, researchers investigated the impact of the flavonoid luteolin on nitric oxide produced from uric acid. In large amounts nitric oxide can produce oxidative stress and trigger inflammation. The researchers found that luteolin from celery seeds reduced the production of nitric oxide from uric acid (10). This suggests that luteolin might provide some protection from uric acid-induced inflammation in gout. Luteolin may also directly reduce uric acid production. Some research has indicated that luteolin can inhibit xanthine oxidase (11), an enzyme which produces the by-product of uric acid. Reducing uric acid levels with luteolin might reduce the frequency of gout attacks. Researchers have discovered that exposing certain cells to 3-n-butylphthalide (3nB) reduced both oxidative stress and inflammation making it another crucial compound from celery that may have benefits against gout inflammation (12). A study on the medicinal herb Varbenaceae examined the antioxidant properties of beta-selinene, which is also present in celery seed. The results showed that beta-selinene demonstrated a wide variety of antioxidant and anti-inflammatory properties (13). These benefits may also be found in the beta-selinene in celery seed, but this study didn’t test celery specifically. Finally, there are a handful of other compounds in celery seed that may exhibit other antioxidant and anti-inflammatory properties. These properties may be especially beneficial in reducing inflammation in conditions such as gout (14).

If you choose to take celery seeds it is important to drink plenty of water due to their diuretic action. There are also a couple of important cautions – research has shown that celery seed may be dangerous to pregnant women, as it may cause miscarriage when taken in large doses. You should therefore avoid taking celery seed extracts and supplements if you are pregnant or trying to conceive. It can also be dangerous if you have an allergy to the seed, but if neither of these cautions apply, try adding the seeds to your diet. Celery seed is also found in some excellent herbal formulas for gout such as Nature’s Aid Celery Seed Complex, which provides 200mg celery seed alongside burdock root, nettle and Montmorency cherry. Burdock’s has anti-inflammatory properties (15) and may help to prevent uric acid induced inflammation in gout attacks. Additionally, burdock is a blood purifier that may help to push uric acid out of the body. Finally, burdock, like celery seed, is a natural diuretic that may help you to expel more uric acid out in your urine. Nettle has a natural anti-inflammatory action – it’s a very effective antihistamine – which helps to relieve inflammation, swelling and the agonizing pain brought on by gout flares, some research has also linked the stinging nettle to reduced uric acid levels too. The benefits of Montmorency cherries have been discussed above. Nature’s Aid Celery Seed Complex is available in tablets. Take 2 tablets per day with food.

Quercetin

Quercetin is a bioflavonoid that is found in small amounts in leafy green vegetables and beans, and in larger concentrations in onions and apples. It is also found in both green tea and black (‘normal’) tea. Quercetin is most commonly used for hayfever symptoms as it is a natural anti-histamine, but some preliminary scientific studies have shown that it may also be able to inhibit the production of one of the enzymes that is involved in the development of gout (16). Although these test tube studies do not prove that quercetin supplements will work in the body, some doctors recommend taking 150–250 mg of quercetin three times per day (taken between meals). Quercetin is a useful antioxidant too, so it is well worth trying. Try Higher Nature Quercetin & Bromelain. Take 3 tablets per day.

Quebra Pedra

Quebra pedra, also known as chanca piedra, is a plant that is native to the Amazon rainforest in Brazil. It is popularly used in South America as a remedy for both kidney and gall stones, and following some scientific research in Europe, it is now more widely available in the UK. Although quebra pedra is best known for its action against kidney and gall stones, it is an immensely complex plant with many important actives that make it useful for a number of other conditions. It is traditionally used in South America to treat excess uric acid, and although only preliminary scientific studies and no human trials have been conducted as yet, the research results have supported its historical use as a remedy for gout (17). Try drinking 3 cups of Rio Trading Quebra Pedra Tea per day.

 

 

REFERENCES:
1. Tuhina Neogi, Clara Chen, Jingbo Niu et al. Alcohol quantity and type on risk of recurrent gout attacks: An internet-based case-crossover study. Am J Med. 2014 Apr; 127(4): 311–318. Published online 2014 Jan 17.
2. Stein HB, Hasan A, Fox IH. Ascorbic acid-induced uricosuria: a consequence of megavitamin therapy. Ann Intern Med 1976;84:385-8.
3. Huang HY, Appel LJ, Choi MJ, et al. The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial. Arthritis Rheum 2005;52:1843-7.
4. Jacob RA, Spinozzi GM et al. Consumption of cherries lowers plasma urate in healthy women. Journal of Nutrition. 2003;133:1826-1829.
5. Schlesinger N, Rabinowitz R, Schlesinger M et al. Pilot Studies of Cherry Juice Concentrate for Gout Flare Prophylaxis, J Arthritis 2012.
6. Phillip G, Bella David C. et al. Montmorency tart cherry (Prunus cerasus L.) concentrate lowers uric acid, independent of plasma cyanidin-3-O-glucosiderutinoside. Journal of Functional Foods, Volume 11, November 2014, Pages 82-90.
7. Pei-En Chen, Chia-Yu Liu, Wu-Hsiung Chien et al. Effectiveness of Cherries in Reducing Uric Acid and Gout: A Systematic Review. Evid Based Complement Alternat Med. 2019.
8. Marcum W. Collins, Kenneth G. Saag, and Jasvinder A. Singh. Is there a role for cherries in the management of gout? Ther Adv Musculoskelet Dis. 2019; 11.
9. Tall JM, Seeram NP et al. Tart cherry anthocyanins suppress inflammation-induced pain behavior in rats. Behavioural Brain Research. 2004;153: 181-188.
10. James M. Pauff, Russ Hille. Inhibition Studies of Bovine Xanthine Oxidase by Luteolin, Silibinin, Quercetin, and Curcumin. J Nat Prod. 2009 Apr; 72(4): 725–731.
11. Dolati K, Rakhshandeh H, Golestani M, Forouzanfar F et al. Inhibitory Effects of Apium graveolens on Xanthine Oxidase Activity and Serum Uric Acid Levels in Hyperuricemic Mice. Prev Nutr Food Sci, 2018 Jun;23(2):127-133.
12. Chang-Yun Liu, Zhen-Hua Zhao, Zhi-Ting Chen et al. DL-3-n-butylphthalide protects endothelial cells against advanced glycation end product-induced injury by attenuating oxidative stress and inflammation responses. Exp Ther Med. 2017 Sep; 14(3): 2241–2248.
13. Chandra M, Prakash O, Kumar R et al. β-Selinene-Rich Essential Oils from the Parts of Callicarpa macrophylla and Their Antioxidant and Pharmacological Activities. Medicines (Basel). 2017 Sep; 4(3): 52. Published online 2017 Jul 10.
14. W. Kooti, Nahid Daraei. A Review of the Antioxidant Activity of Celery (Apium graveolens L) Chemistry, Medicine. Journal of Evidence-based Complementary & Alternative Medicine. 2017.
15. Maghsoumi-Norouzabad L, Alipoor B, et al. Effects of Arctium lappa L. (Burdock) root tea on inflammatory status and oxidative stress in patients with knee osteoarthritis Randomized Controlled Trial. Int J Rheum Dis. 2016 Mar;19(3):255-61.
16.Bindoli A, Valente M, Cavallini L. Inhibitory action of quercetin on xanthine oxidase and xanthine dehydrogenase activity. Pharmacol Res Commun 1985;17:831-9.
17. Vikneswaran Murugaiyah, Kit-Lam Chan. Mechanisms of antihyperuricemic effect of Phyllanthus niruri and its lignan constituents Journal of Ethnopharmacology, Volume 124, Issue 2, 15 July 2009, Pages 233-239.

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