Gout 101: Understanding the Cause and Treatment
If you’ve ever been awakened at night to find your big toe is the painful reason, you might be having a gout flare-up. This common inflammatory condition often sneaks up on you without warning, but take it as a sign that your diet, kidney function, or perhaps both, need to be evaluated.
What is Gout?
Gout is a type of inflammatory arthritis that causes swelling and pain in the joints. It often affects one joint at a time; the big toe typically falls victim to gout first, but it can spread and get progressively worse without proper intervention.
According to the National Kidney Foundation, an estimated 8.3 million adults in the US are dealing with gout. And worldwide, gout is now the most common form of inflammatory joint disease (1).
Historically, gout was known as ”rich man's disease” or “king’s disease” because the wealthy could routinely indulge in the lavish foods that contribute to gout - copious amounts of red meat, shellfish, sweets, and alcohol.
What Causes Gout?
Gout is caused by high levels of uric acid in the blood, medically known as hyperuricemia. As a common waste product of metabolism, uric acid is removed by the kidneys and leaves the body through urine. But if uric acid levels remain elevated, the compound forms needle-shaped crystals in and around the joints, causing pain and inflammation. High levels of uric acid also contribute to kidney stones.
Uric acid is a byproduct of purines breaking down. Purines are naturally occurring substances found in certain foods and are also present in every human body cell. Digesting foods and the routine process of cell turnover create uric acid. If the body makes too much uric acid or it can’t be removed efficiently, usually due to impaired kidney function, uric acid levels build up in the blood.
Certain factors increase your risk of developing gout (2, 3).
- Gender: Males are three times more likely than females to develop gout.
- Age: Risk increases with age, with significant increase for males over age 40 and females after menopause.
- Family history of gout.
- Alcohol consumption: Risk increases with regular consumption of beer and hard liquor.
- Diet: Risk increases with regular consumption of foods high in purines such as red meat, organ meats, and seafood.
- Being overweight.
- Having a metabolic syndrome: High blood pressure, high blood sugar, or high cholesterol.
- Having chronic kidney disease.
- Taking diuretics.
- Taking low-dose aspirin.
- Taking large amounts of niacin (vitamin B3).
- Taking cyclosporine: An immunosuppressant drug given after receiving an organ transplant or to treat some autoimmune diseases.
There are four stages of gout:
1. Hyperuricemia: When you have elevated blood levels of uric acid and crystals are forming but you have no gout symptoms.
2. Gout flare: When you experience an attack of intense pain and swelling in the joints.
3. Intercritical gout: The time between gout attacks when you do not have any symptoms.
4. Tophi: Defined as late stage gout when uric acid crystals form hard masses under the skin or other areas of the body. Depending on their location, tophi can permanently damage your joints and other internal organs such as the kidneys. Proper treatment can prevent the development of tophi.
Gout Symptoms
The most common symptom of gout is pain at the affected site. Often, the first hint of gout presents as pain in the big toe, but it can occur in other joints in the body. The pain can be intense and may be accompanied by swelling, redness, and stiffness in the joints.
Gout flares can be triggered by eating certain foods (high in purines), drinking alcohol, taking certain medications, and by physical trauma. Flares usually get better on their own, with or without treatment. Recurring gout attacks may become more frequent and more severe over time, even if you experience no symptoms between flares.
Diagnosing Gout
Because gout symptoms are similar to other conditions, a diagnosis can be difficult. After discussing your symptoms and medical history with your doctor, he/she will examine the affected joint.
For a deeper look into the cause of your symptoms your doctor may order a serum uric acid test to check blood levels, take a sample of the fluid from the affected joint, or order an imaging test such as an ultrasound or x-ray to check for uric acid crystals in the joints.
Gout Treatments
While there is no cure for gout, it can be effectively managed with ongoing treatment and adherence to certain lifestyle changes.
Your doctor can recommend a treatment plan based on your symptoms and the underlying cause of your gout. Over-the-counter anti-inflammatories can help reduce joint pain and swelling. Various prescription medications, including injectables, may be given to manage pain and inflammation, lower uric acid production, or break down uric acid for easier removal from the body.
Natural Gout Treatments
If your gout symptoms have not progressed enough to the point of needing pharmaceutical intervention, there are changes to both diet and lifestyle that can prove to be effective in managing gout. These changes can also complement medications recommended by your doctor for a more well-rounded gout treatment plan.
To reduce gout flare-ups and manage symptoms, consider the following:
1. Make dietary changes that reduce uric acid levels.- Limit alcohol.
- Limit sweetened beverages, especially soda.
- Stay hydrated with water to help the kidneys remove uric acid.
- Limit foods made with high-fructose corn syrup.
- Avoid animal proteins high in purines such as red meat, organ meats, sardines, anchovies, herring, mackerel, and shellfish.
- Eat lean meats, low-fat dairy products, and plant-based protein sources.
- Eat complex carbohydrates such as fruits, vegetables, and whole grains.
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Increase your consumption of cherries and/or cherry products.
Cherries are rich in plant-based compounds called anthocyanins, which have antioxidant and anti-inflammatory properties that help to reduce uric acid levels in the blood and also lowers the body’s inflammatory response (4). Anthocyanins have been compared to aspirin, ibuprofen, and naproxen for their anti-inflammatory qualities, but don’t have adverse side effects (5). Tart cherry products are widely used to treat gout naturally.
2. Take natural anti-inflammatories to prevent gout symptoms.
- Turmeric and curcumin
- Quercetin
- Bromelain
- Citric Acid
- Omega-3 Fatty Acids
- MSM
- Vitamin C
3. Treat gout flare-ups when they occur.
- Apply ice to the affected joint to reduce pain and swelling.
- Elevate the affected limb.
- Rest the affected joint. Avoid activities that require moving the affected joint until the pain and swelling have gone down.
How Kidney Health Affects Gout
As mentioned previously, kidney health plays a crucial role in managing your uric acid levels and, ultimately, your risk of developing gout.
Your kidneys have the very important and never-ending job of filtering your blood supply. Roughly 50 gallons of blood pass through the kidneys each day. Excess fluids, toxins, and waste products, like uric acid, are removed from the blood before it starts to recirculate through the body again.
Even healthy kidneys remove only 10% of the total uric acid in the blood. The remaining 90% gets reabsorbed, which makes you think we’re all going to get gout eventually. But if you have good kidney function and consume purines in moderation, your uric acid levels could remain stable enough to not cause problems.
Those with impaired kidney function, however, cannot effectively filter out uric acid, causing elevated blood levels and increased risk of uric acid kidney stones and gout.
That’s why it is so important to treat your kidneys well with a healthy diet and periodic kidney cleansing. Promoting kidney health not only helps to reduce your gout risk but reduces your kidney stone risk as well.
In summary, there may be no cure for gout, but managing your symptoms is attainable if you put in the work to prevent flare-ups and stop further progression of the disease. And it all starts with promoting kidney health.
Sources:
1. https://www.kidney.org/atoz/content/gout/patient-facts
2. https://www.niams.nih.gov/health-topics/gout
3. https://www.arthritis.org/diseases/gout
5. https://www.macrothink.org/journal/index.php/jfs/article/view/1927/1790