By Dr. Mercola
Gout is one of the more than 100 different types of arthritis.1 Once called the “Disease of Kings” or “rich man’s disease,” the number of people suffering from gout is on the rise.
In England and New Zealand, the number of people evaluated at the hospital for symptoms of gout rose by 80 percent in the past decade.2 In the past 50 years the incidence of gout has nearly doubled in the U.S.3
Like a window into your metabolic health, gout is an outward sign of what’s happening on the inside of your body. Symptoms of the condition, and long-term treatment, are related to your lifestyle choices and nutritional habits. In other words, you have some degree of control over your condition.
In 2011, gout affected 8.3 million, or 4 percent of Americans.4 Although the numbers of people diagnosed are rising, it may not be an accurate representation of the number of people who experience the condition each year.
Many people suffer from an episodic gout condition, experiencing several occurrences over their lifetime.5 However, according to Dr. Allen Anandarajah, an associate professor of medicine and a rheumatologist at the University of Rochester Medical Center, many don’t see their doctor for these periodic occurrences.6
This means the number of people who have gout each year could actually be as high as 10 percent of the population. Symptoms include:7
✓ Pain, often in the big toe, starting at night
✓ Warmth, swelling and redness in the affected area
✓ Both fingers and toes or feet may be affected
✓ Extreme tenderness in the affected joint
✓ Red or purple coloring on the skin over the joint
✓ Joint may appear to be infected
✓ Limited movement in the joint
✓ Skin may itch or peel as the gout resolves
Symptoms Are Related to an End Product of Metabolism
These symptoms are the result of uric acid crystal deposits in the joint space. There is evidence that these deposits are related to metabolic syndrome,8 a constellation of health conditions characterized by insulin and leptin resistance, central or abdominal obesity, high blood pressure, and a fasting glucose greater than 100 milligram per deciliter (mg/dL).9
Purine, a compound found in certain foods, contributes to energy metabolism and is a component in some co-enzymes. All cells require purine for growth and survival. The final compound in the breakdown of purine is uric acid.
Only humans don’t have the enzyme uricase that converts uric acid to a compound easily excreted in the urine. It’s the buildup of serum uric acid that is associated with the severity of your gout.10
When your metabolic processes controlling serum uric acid don’t function effectively, it can result in an overproduction of uric acid and crystalline deposits in a joint space.11
Drugs Are Not an Ideal Long-Term Solution
Conventional treatment for gout includes the use of medications such as:
- Allopurinol, which reduces uric acid production
- Colchicine, which blocks inflammation caused by uric acid crystals and may be used for long-term prevention of recurring episodes
- Non-steroidal anti-inflammatory drugs (NSAIDs) used for pain control
In the short-term, these medications may effectively treat your symptoms. But gout may be a lifelong condition and the side effects from these drugs make them dangerous for long-term use.
Allopurinol is used during an episode of gout. Common side effects include nausea, diarrhea or drowsiness. Other side effects may include increased bleeding, signs of infection, kidney problems, yellowing skin or eyes, eye pain or vision changes and unexplained weight loss.12
Colchicine is used as a prophylaxis to prevent a recurrence. You may experience diarrhea, nausea, cramping and vomiting when you begin the medication.
Serious side effects include muscle weakness, numbness or tingling of your hands or feet, pale color to your lips, tongue or palms of your hands, unusual weakness, fast heart rate and shortness of breath.13
Side effects from long-term or consistent use of NSAIDs are well documented. Severe intestinal damage,14 increased risk of heart attack and stroke, increased risk of ulcers and reduced blood flow to the kidneys are some of the risks of NSAID use.15
Lifestyle Choices That May Limit or Prevent Gout
Gout is more common among men than women, and more often between the ages of 40 and 50.16 Although you may not have symptoms of gout today, it’s never too early to use a proactive approach to preventing illness. The preventive lifestyle choices to reduce your risk of gout will also help reduce your risk for other diseases.
✓ Exercise Daily
Regular exercise and consistent movement may help to normalize your insulin and leptin levels and reduce buildup of uric acid. If you suffer symptoms of gout you may want to limit your exercise to reduce the potential for permanent joint damage. For instance:
If you don’t have symptoms of gout, consider high-intensity interval training combined with strength training.
✓ Optimize Your Vitamin D Levels
Research has demonstrated the importance of vitamin D to your overall health and the prevention of many diseases, including diabetes, cancer and heart disease. Evidence also suggests it plays a preventive role in the development of metabolic syndrome.17
Sensible sun exposure is the best way to raise your vitamin D levels. This way your body naturally creates vitamin D3. You’ll know that you have accomplished this when your skin turns to the lightest shade of pink. Staying in the sun beyond this point will only promote burning and skin damage.
If you live in an area where sunlight isn’t abundant, you can take a vitamin D3 (25-hydroxyvitamin D3) supplement along with a vitamin K2 MK-7 supplement. Your ideal dosage is one that will help you reach and maintain a healthy vitamin D level of 40 to 60 nanograms per milliliter (ng/ml).
✓ Enough Sleep
Quality sleep each night benefits your overall health and reduces your risk of abdominal fat deposits. Sleep deprivation suppresses your immune system, increases your appetite and leads to premature aging.
How much sleep you need depends on several medical and physical factors unique to you. According to the National Sleep Foundation, young adults between 18 and 64 years need between seven and nine hours of sleep each night.18
✓ Practice Grounding
Grounding or earthing is the process of walking or standing barefoot on bare earth, permitting free electrons from the earth to enter your body. These powerful antioxidants combat free radicals in your system.
Grounding may reduce your risk of cardiovascular disease and may thin your blood, both good things when you want to reduce your risk for gout. If you want to try grounding, start by walking in a dewy, grassy area barefoot.
If you live near a large body of water, that’s a great location for walking barefoot, as seawater is a good conductor.
✓ Reduce Your Stress
Stress is almost inevitable in a fast-paced life. It may increase your release of cortisol, reducing your body’s sensitivity to the hormone and increasing the amount of inflammation in your system.
Inflammation reduces your ability to fight infections and is one factor in the development of several different diseases.
If you aren’t sure where to start reducing your stress, try the Emotional Freedom Techniques (EFT). This process works much the same as acupuncture, but using pressure and tapping to stimulate the energy meridian points in your head and chest.
Limiting Fructose Is Critical if You Have Gout
Uric acid is a byproduct of fructose metabolism. In fact, fructose is the ONLY type of sugar that will raise your uric acid levels and will typically generate uric acid within minutes of ingestion. The ideal range for uric acid is between 3 to 5.5 mg/dL. The connection between fructose consumption and increased uric acid is so reliable that a uric acid level taken from your blood can actually be used as a marker for fructose toxicity.
I became fully aware of the dramatic and devastating impact fructose has on your uric acid levels when I interviewed Dr. Richard Johnson on this topic. You can watch that interview above.
Sensible food choices are important to your overall health and wellness. Your cells produce energy and replicate based on the nutrition you feed them. The choices you make can increase or reduce your risk of experiencing a bout of gout. Fructose is at the very top of the list of foods to avoid if you have gout.
As a general rule, I recommend limiting your total fructose to 25 grams (g) per day. If you’re insulin resistant or have gout, you would be wise to limit fructose to 15 g per day or even less, until your symptoms have resolved.
Other dietary considerations that may be helpful include the following:
✓ Limit Fructose
According to Johnson's research, a quarter of the U.S. population consumes a whopping 134 g of fructose a day. This is a staggering amount of fructose when you consider the fact that you need to restrict your fructose intake to below 25 g a day in order to maintain good health.
If you have gout, this is extremely important, and you must take into account the fructose you consume from fruit and other foods. For instance, if you eat cherries for their therapeutic value, 10 sweet cherries or 1 cup of sour cherries contain about 4 g of fructose.
However, cherries are also high in fructose, one of the primary means of increasing your uric acid production and therefore your risk of gout. The key is to eat them in moderation and include the grams of fructose from your cherries in your daily allotment of fructose.
✓ Celery Seed Extract
Unique to celery is compound 3-n-butylphthalide, which gives celery a distinctive flavor. While still in early stages, research has found a positive association between 3-n-butylphthalide and a reduction in pain and inflammation.20 The results were statistically significant, with some participants achieving 100 percent pain relief.
✓ Eat Potassium-Rich Foods
Potassium citrate helps alkalize your urine and improves the excretion of uric acid. Potassium is widely available in fruits and vegetables. The most beneficial sources include broccoli, celery, avocado, spinach and romaine lettuce. If you want to supplement, consider using potassium bicarbonate, which is probably the best potassium source to use as a supplement.
✓ Avoid Soy
✓ Limit Alcohol
Regular alcohol use has a demonstrable association with the development of gout.22 Beer appears to have a slightly higher risk than hard liquor, while wine has very little effect on the development of gout.23
✓ Drink Enough Fluid
Liberal intake of water helps to reduce the concentration and promote the excretion of waste products in your urine. Diluting your urine also reduces the risk of kidney stones. Drink enough each day to keep your urine a light straw color, which indicates you’re well hydrated. When the color is darker you aren’t drinking enough and if your urine doesn’t have any color you may be drinking too much.
✓ Avoid Foods High in Purines
Organ meats, brewer’s yeast, sardines and tuna packed in oil, chicken livers and beef fillet all have over 100 mg of purine per 100 g of product.24 Foods high in purine will breakdown to uric acid.