Gout is a type of arthritis – particularly affecting the big toe and foot but it can also impinge upon ankle, knee, hand and wrist. It is much more prevalent in men than women but post-menopausal women are at risk. It is not a condition of wear and tear but rather is caused by an excess of uric acid (urates) in the bloodstream – formed from the breakdown of cells and poorly metabolized foods, sometimes a side effect of certain medications and also treatment regimens such as chemotherapy.
A diminished ability for the kidneys to remove excess urates can be a genetic trait but the build up is generally dietary in nature and simple changes can have a big impact upon prognosis. Excess urates tend to crystalize and gather around the joints thus agitating inflammation and pain. Gout is acutely painful, and although it may resolve rapidly with a combination of anti-inflammatory and urate eliminating medications, recurrent attacks or the progression to chronic gout is very likely without lifestyle change.
Occasionally, stones will form in the kidneys and in some circumstances the urate crystals can migrate and adhere under the skin – visible as small white pimples, medically know as tophi. Gout is increasing being recognized as a comorbidity with other conditions – notably alcoholism, diabetes, obesity, high blood pressure, poor circulation and kidney disease.
How does winter affect it – In the past gout has been referred to as the King’s disease or Bishop’s disease – those two professions having a greater exposure to rich foods and plenty of wine and thus a higher level of purines that breakdown into uric acid. A diet rich in meats and alcohol is no longer the preserve of certain socio-economic allegiances but a staple of the everyday meals of many. The typical Christmas fayre and the switch to more consistent comfort and convenience eating that often occurs in winter is a diet rich in purines and also table sugar, corn syrup, and high fructose corn syrup which prompt uric acid formation and retention.
How to minimize it – In the acute phase (the flare up of pain) your GP may prescribe painkillers and non-steroidal anti-inflammatory drugs. Affected joints are best temporarily immobilized and elevated. Ice packs offer some relief. drink more water – the recommendation is often 8-10 glasses of water each day – which will help with reducing uric acid build up and assist the passing of stones (where implicated).
With recurrent/chronic gout, diet and lifestyle changes are required to lower uric levels and instances of flare ups. Cut back on units of alcohol, sugary and carbonated drinks, and processed meals or snacks. Avoid foods that are rich in purines – that’s red meat, offal, poultry, fish and seafood but also note asparagus, cauliflower, spinach, peas, beans, lentils, oatmeal, mushrooms, yeast containing foods and beverages.
If you are overweight, your medical practitioner might suggest you shed a few pounds but follow a sustainable pattern of healthy eating and gradual weight loss as crash dieting can actually trigger uric acid retention in the kidneys and only complicate your condition. And while it is firmly a metabolic condition, stress can exacerbate both flare ups and pain threshold – so perhaps mindfulness, music or moments to yourself.
Herbal help – Burdock Root in a tea or soup (or tincture form) is a go to for gout attacks, it helps detox the bloodstream, is a natural anti-inflammatory and by prompting urination it helps eliminate some excess uric acid. Devil’s Claw ( Harpagophytum procumbens) is a potent anti-inflammatory but it has the great capacity to dissolve urate crystal and purge uric acid from the bloodstream – Check it doesn’t clash with current meds . Nettle as tea and potherb has long repute to dissolve uric acid deposits and a supplement of evening primrose oil or other supplements/foods containing gamma linolenic acid (GLA) de-inflames and also reduces urate crystal-forming. All of these will help with kidney stones too – as will the dietary changes listed here.
Dietary changes – So while it advised to avoid the purine-rich foods listed above, there are foods that have a beneficial impact upon lowering uric acid in the blood stream and in part dissolving crystals. Apples and apple Cider Vinegar contain malic acid which disarms uric acid and helps the body expel it. Citrus fruits and in particular fresh lemon or lime juice contains citric acid which also helps expel uric acid and dissolves crystals. Sour cherries and cherry juice concentrate (local health store will stock) help lessen uric acid production and help break up crystals into small easier removed strata. Eating more fibre also binds to and removes uric acid. Fibre also helps balance blood sugar and insulin levels which is often implicated in gout.