Gout and gout prevention

Hyperuricemia (excess of uric acid in the blood) is the precursor of gout, which is the most common inflammatory arthritis in men. Excess uric acid builds up in the blood and is deposited as crystals rather than being excreted by the kidneys. These crystals typically form in the toe joints and can graduate to other joints. I [the author] have suffered from mild gout since 2013. I say mild but it was still excruciating, my left toe felt like it was broken and it wasn't diagnosed as gout in a UK hospital (quite how a swollen big left toe that wasn't broken, on a man in his 40's wasn't spotted baffles me). Many hours of research seemed to point to food, beer and hydration. Not drinking enough water and sweating from hard exercise seemed to been the trigger for me. The healthcare advice seems to blame eating too many "purines" and drinking alcohol.  But I actually now, 5 years later, believe that gout coverage in the media and on the internet is deliberately misguiding (blaming shellfish and liver!).

Gout

The literature seems to suggest not eating high purine containing healthy foods (shellfish, oily fish, organ meats) and completely ignores the utter poison that is fructose, added sugar and HFCS. The doctors and "health professionals" conveniently never mention fructose. You could ask 100 gout sufferers and not one would mention fructose. But they would all know about Allopurinol (the drug doctors put you on for life). The causes of gout are not the same as the triggers for gout. Vegetables and fruits also have "high" purines such as raisins, broccoli, brussel sprouts, banana and spinach. Only a fool would exclude these from their diet... forget the purines, ditch the sugar!

Purines

Gout attacks can be avoided (drug free) by:

  • Constant hydration (especially if you exercise heavily or go on a ski holiday or an activity break).
  • NO FRUCTOSE: Stay away from sugary drinks (cola, orange juice, tonics, fruit juices) and processed food. Fruits contain fructose, but they digest slowly and don't overload the liver.
  • Drink lemon water regularly (the citric acid will help).
  • Take apple cider vinegar daily. Apple cider vinegar (ACV) is one the oldest and most effective remedies for gout.
  • Moderating or changing your alcohol consumption (switch away from beers heavy in brewers yeast, add ice or soda water to your drinks).
  • Good electrolyte intake (salt, potassium, magnesium, calcium, zinc). Eat More potassium-rich foods: Potassium deficiency is sometimes seen in people with gout, and potassium citrate, which is known to alkalize your urine, helps your body to excrete uric acid. Gerolsteiner mineral water is a great option as it's very high in magnesium.
  • Eating some gout friendly foods See below).
  • Eat lots of celery (see below).
  • Take an anti-inflammatory curcumin supplement (see below).
  • Drink aronia juice (see below).
  • Drink dandelion tea.
  • Supplement with L-Glutamine.
  • Eat vitamin A and vitamin C rich foods
  • Lose some weight and control insulin. When people are overweight or obese, their bodies produce more insulin. Higher levels of insulin circulating throughout the body inhibit uric acid elimination by the kidneys. This excess uric acid can lead to gout. An elevated serum uric acid is also one of the best independent predictors of diabetes and commonly precedes the development of both insulin resistance and diabetes. So if you are eating and drinking sugary foods and processed carbs, you will have high levels of insulin and get fat. A 2010 Oxford study also documented that weight reduction leads to a considerable reduction of serum uric acid levels.
  • Correct your vitamin and mineral intake (see below).
    • Antioxidant and anti-inflammatory foods
    • Promoting liver and kidney health.
    • Promoting circulatory health.
    • Promoting joint health. Gout is serious and it can escalate to debilitating arthritis.

How much uric acid is in the blood?

Uric acid levels can vary based on sex. Normal values for women are 2.5 to 7.5mg/dL  and for men 4.0 to 8.5 mg/dL. Because only some purines are taken in from diet, someone with a high score of 9 would only drop to an eat eating a perfect low purine food diet.

Hyperuricemia

Hyperuricemia is also associated with several metabolic and other conditions, including diabetes and coronary artery disease. Serum uric acid levels and the frequency of gout have been rising during past decades (along with obesity and metabolic syndrome). This ties in with rising sugar-sweetened soft drinks and added sugar (high fructose corn syrup, HFCS) into processed food over the last few decades.

White sugar is 50% glucose and 50% fructose. Glucose can be absorbed throughout the body for use as energy, but fructose is targeted like a guided missile to the liver. It's the only place fructose can be metabolised. HFCS in soft drinks and many foods is the HFCS55 variety that contains 55% fructose. Alcohol and fructose are both metabolised in the liver. Fructose has been described as "alcohol without the buzz". The fuctose content of drinks is even worse than you think. Popular beverages made with HFCS have a fructose-to-glucose ratio of approximately 60:40, and thus contain 50% more fructose than glucose. Some pure fruit juices have twice as much fructose as glucose.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197219/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197219/

Shocking fructose levels in soft drinks and juices

Actual fructose consumption levels are difficult to estimate because of the unlabeled quantity of fructose in beverages. A 2014 study shows fructose levels way higher than was thought. Popular beverages made with HFCS have a fructose-to-glucose ratio of approximately 60:40, and thus contain 50% more fructose than glucose. Some pure fruit juices have twice as much fructose as glucose. Shocking!!!

    Fructose %       Glucose %      Fructose g/litre
 Coca-cola  59.4%  39.6%  62.5g (total sugars: 105.2g)
 Pepsi  60% 40%  65.7g (total sugars: 109.5g)
 Dr Pepper  60.2%  38.8%  61.4g (total sugars: 102.0g)
 Sprite  60%  39%  62.5g (total sugars: 104.2g)
 Mountain Dew  59.5%  39.6%  72.3g (total sugars: 121.5g)
 Iced Tea  59.4%  39.6%  59.3g (total sugars: 99.8g)
 Tonic Water  55%  45%  49.0g (total sugars: 89.0g)
 Red-Bull  55%  45%  55.0g (total sugars: 100.0g)
 Tropicana Orange Juice  52%  48%  52.4g (total sugars: 99.5g)
 Apple Juice (Minute Maid)  67%  33%  73.4g  (total sugars: 109.6g)
 Oceanspray Cranberry Juice    58.4%  41.6%  59.0g (total sugars: 99.4g)

There are 4g of sugar in a sugar lump. So drinking 1 litre of Pepsi equates to 27 sugar lumps (the equivalent of 18 lumps are  fructose which would go straight to the liver).

If a gout attack strikes...

  • Drink large amounts of water (with some hydration salts + sea salt).
  • Eat lots of celery.
  • Drink aronia berry juice.
  • Take L-glutamine
  • Take baking soda.
  • No alcohol.
  • No fructose (sodas, processed foods, sugar). With the exception of dark berries (aronia, blue berries etc which are not too sweet).
  • Cleanse your liver.
  • Visit a hospital or clinic, you can get either an anti-inflammatory injection (fast acting relief) or take anti-inflammatory tablets.
  • Gently massage the affected area (promotes the absorption of uric acid deposits around the affected joint).

Vitamins A & C

There have been lots of studies looking at the role of vitamin C and gout. It turns out that Allopurinol (the drug you need to take for the rest of your life) works a bit better that taking vitamin C. The vitamin C route seems far more sensible.

Studies do show that vistamin C has a positive effect upon gout. Some studies show that vitamin C can help lower uric acid levels in people who have gout. A 2009 study showed that the more vitamin C men took, the less likely they were to get gout.

A-C Carbamide is a big selling gout reducing supplement, however it just contains vitamin C and vitamin A. It's much easier and cheaper to get these two from your diet.

Vitamin deficiency, especially B5, A and E can increase uric acid.

Turmeric (or Curcumin)

Curcumin has received worldwide attention for its multiple health benefits, which appear to act primarily through its anti-oxidant and anti-inflammatory mechanisms. Curcumin is the active ingredient in Turmeric root.

Celery

Celery is a super food, as well as being potassium rich and low in calories. Luteolin, a major component of celery, blocks the enzyme Xanthine oxidase that leads to uric acid formation. Xanthine oxidase (XO) catalyses hypoxanthine and xanthine to uric acid in human metabolism. Overproduction of uric acid will lead to hyperuricemia and finally cause gout. Luteolin is one of the major components of celery and green peppers. A Vietnamese study even found that luteolin was more potent than allopurinol i.e. had a 2 times lower IC50 (The IC50 is the concentration of an inhibitor where the response is reduced by half).

Dark berries - Aronia

Aronia berry (or chokeberry) has many health benefits, with the most notable being its extremely high antioxidant properties fruits. Anthocyanins are plant pigments that give fruits, leaves, flowers, stems and roots their rich and deep red, purple and blue color. About 560 different anthocyanins have been identified. Out of all berries aronia (chokeberries) appear to have the highest concentrations of anthocyanins - 1,480 mg/100 g of fresh weight.  You can buy 3 litres of aronia juice from Amazon.

If you buy cartons of supermarket berry juice (containing added HFCS/sugar) you will make the gout worse.

Dandelion

Dandelion root is traditionally used in Chinese medicine to treat gout, kidney disease and urinary tract disorders. The increase in urination also helps to eliminate salt and water from your kidneys, so it's important to take plenty of electrolytes.

Pineapples

Pineapples are high in bromelain has also been found to reduce blood uric acid levels and therefore prevent gout. It is best to eat a very ripe pineapple where some of the stem can be eaten. The balance can be used in a smoothie. If you want to get a higher amount of bromelain then you could consider a supplement. The vitamin C content of pineapples will also help with gout.

Omega-3 and gout

Omega-3 is an excellent anti-inflammatory. A diet rich in omega-3 (sardines, sock-eye salmon etc) will give long term benefits.

Anti-oxidants

A 2007 study found that "Independent of age, sex, and total energy, protein, and vitamin intake, circulating uric acid levels were inversely associated with total carotenoids, in particular, α-carotene, lycopene, lutein, and zeaxanthin and with the mineral selenium". So the higher these anti-oxidants are, the lower uric acid levels go. Watermelons and tomatoes (puree especially) have lots of lycopene. Spinach and eggs are super sources of lutein, and zeaxanthin.

Astaxanthin & lobster

Gout literature say not to eat seafood, but in reality the purine levels are not too high. Lobster contains loads of astaxanthin which is an incredibly powerful antioxidant (also in trout, krill and shrimp). The recommended dosage of astaxanthin is 2-4mg. Astaxanthin is 295 μg/g of lobster protein (roughly 60μg/g in the meat). So 100g of lobster meat would give a whopping 6mg.

Beetroot / Glutamine supplementation

Beetroot is very low in saturated fat and cholesterol. It is also a good source of Vitamin CMagnesium, and Potassium. Red beetroots are one of most potent antioxidants and are also one of the richest sources of glutamine which is an amino acid essential to the health. L-glutamine supplementation is good for gout as it's a superb antacid. In studies, 2000mg of Glutamine produced a quick increase in plasma bicarbonate, which elevates alkaline reserves. Glutamine is used in the liver & kidney to make urea & ammonia which are normal breakdown products of protein, which are then excreted. Glutamine is important for the synthesis of glutathione (an essential anti-oxidant) in the liver. Studies have shown that L-Glutamine supplementation can minimize breakdown of muscle and improve protein metabolism.

Intermittent fasting and gout

Intermittent fasting is not a diet. You do not control calories or have any restrictions on what you eat. You not will be starving yourself because your body has a lot of fat reserves to live off. Intermittent fasting means having a fixed window of time that you do all your eating and drinking in. The rest of the time you either sleep or drink water. Typically people have an 8 hour eating window each day. Benefits:

  • You will gain control of insulin production, helping to relieve gout.
  • You will lose weight, helping to relieve gout.
  • You drink lots of water, helping to relieve gout.
  • You typically will eat more nutrient dense foods, helping to relieve gout.
  • Reduces inflammation.
  • Gives your liver a rest.

Medical tests

  • Uric acid level tests. Uric acid levels are tested at most hospitals or medical centres. You can even buy test strips or meters for home use).
  • Liver tests. Commonly used tests to check liver function are the alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), albumin, and bilirubin tests.
  • Kidney tests. Your kidney numbers include 2 tests: ACR (Albumin to Creatinine Ratio) and GFR (glomerular filtration rate). GFR is a measure of kidney function and is performed through a blood test. ACR is a urine test to see how much albumin (a type of protein) is in your urine.

Purines

Purines can be found in the nucleus of any plant or animal cell. Purines are molecules made up of carbon and nitrogen atoms, and these molecules are found in cell DNA and RNA. Purines are the building blocks of all living things. In the human body, purines can be divided into two categories:

  • Endogenous purines that are manufactured by the body.
  • Exogenous purines that enter the body via food. High purine foods are (mg/100g):
    • Beef or pig liver (400-500mg)
    • Kidney (400mg)
    • Scallops (70-140mg, actually quite low)
    • Anchovies (240mg)
    • Mackerel (170mg)
    • Prawns (70-120mg)
    • Lobster (102mg)
    • Sardines (210mg)
    • Yeast (680mg)
    • Brewers yeast (1800mg)
    • Mushrooms (490mg)

Uric acid is a product of purine metabolism. Purine is dynamically present in  every active multiplying cell (plant and animal). All these high purine foods are also full of anti-inflammatory compounds and micro-nutrients, they should NOT be avoided.

Most websites that cover gout give bad advice

Our advice is to:

  • Eat all these high purine (nutritious) foods as they are also full of anti-inflammatory compounds and micro-nutrients.
  • Avoid fructose.
  • Switch from beers (heavy in brewers yeast) to other drinks.
  • Eat gout friendly foods.
  • Follow the avoidance tips listed above.
drsvenkatesan.com/2011/10/06/what-is-the-relationship-between-serum-uric-acid-and-pulmonary-hypertension
drsvenkatesan.com/2011/10/06/what-is-the-relationship-between-serum-uric-acid-and-pulmonary-hypertension

Advanced stages of gout

If your gout attacks become more frequent and the location is spreading from the toes to the ankles, knees and other joints, then it's time to take severe action.

  • All the dietary options need to be implemented.
  • Vitamin K2, vitamin A and vitamin C intake should be high.
  • Antioxidant and anti-inflammatory rich foods and supplements should be taken.
  • You need to be super hydrated with a good dose of electrolytes.
  • Alcohol (especially beer) should be minimised or even eliminated.
  • Frequent monitoring of uric acid needs to take place.
  • You need to lose weight and have control of insulin levels. You need to reverse your pre-diabetic state or if you have been diagnosed with type 2 diabetes, you need to address the fundamental causes. Try our "belly to height" test to get a quick indication of your state of health.
  • Kidney and liver function needs to be assessed by a specialist doctor.
  • Discuss gout with a health professional that fully understands gout (some medication may be needed if all dietary routes have failed).

IF GOUT IS ONLY IN YOUR TOE, CONSIDER YOURSELF LUCKY THAT YOU HAVE HAD A LIFESTYLE WAKE UP CALL.

Gout preventing foods

Gout preventing micro-nutrients

Acid & alkaline foods

When a food is ingested each component will present itself to the kidneys as either an acid-forming compound or am alkali-forming compound. When the sum total of all the acid producing and the alkali producing foods are tabulated,  we’re left with a calculated acid load. If the diet provides more acidic components, it will obviously manifest as a net-acid load on the body. If it provides more alkaline components, it will show as a net-base load on the body.

  • Acidic food components include chlorides, phosphates, sulfates and other organic acids (they are free to pair up with H+ to make an acid solution).
  • Alkaline cations in food include sodium, potassium, calcium, and magnesium (they pair up with OH- to make alkaline solutions).

Our ancestors evolved eating a diet that was very alkaline and therefore very low acid. We are now eating a diet that is high in acidity.

PRAL (potential renal acid loads)

Acid excretion in the urine can be estimated by a formula described by Remer (sulfate + chloride + 1.8x phosphate + organic acids) minus (sodium + potassium + 2x calcium + 2x magnesium). Foods can be categorized by the potential renal acid loads (PRALs).

  • A positive PRAL score indicates the food is acidic.
  • A score of zero indicates the food is neutral.
  • A negative PRAL score indicates the food is alkaline.

 

PRAL Scores

Parmesan cheese  34.2
Processed cheese plain  28.7
Cheddar reduced fat  26.4
Eggs yolk  23.4
Hard cheese  19.2
Corned beef  13.2
Brown Rice  12.5
Fresh cheese (quark)  11.3
Trout brown  10.8
Rolled Oats  10.7
Luncheon meat canned  10.2
Turkey  9.9
Veal  9
Cottage cheese plain  8.7
Peanuts  8.3
Eggs chicken whole  8.2
Lean beef  7.8
Spaghetti whole meal  7.3
Cod fillets  7.1
Walnuts  6.8
Frankfurters  6.7
Spaghetti white  6.5
Cornflakes  6
Rice white  4.6
Bread rye flower  4.1
Lentils green and brown  3.5
Bread whole wheat  1.8
Yogurt whole milk  1.5
Eggs white  1.1
Beer pale  0.9
Ice Cream  0.8
Whole milk  0.7
Butter  0.6
Buttermilk  0.5
Coca-Cola  0.4
Olive oil  0
Sugar white  -0.1
Beer draft  -0.2
Honey  -0.3
Margarine  -0.5
Cucumber  -0.8
Grape juice unsweetened  -1
Broccoli  -1.2
Wine white  -1.2
Coffee infusion  -1.4
Apples or apple juice unsweetened  -2.2
Wine red  -2.4
Orange juice unsweetened  -2.9
Tomato  -3.1
Green beans  -3.1
Eggplant  -3.4
Apricots  -4.8
Celery  -5.2
Banana  -5.5
Black currents  -6.5
Spinach  -14
Raisins  -21

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