Getting on the Right Foot With Gout

Overview

While it certainly presents as an acute inflammatory arthritic condition, gout is more of a metabolic disease.¹  Like diabetes, it is heavily related to lifestyle and diet, and truly lifestyle education and determination on the part of the patient can reduce risk of morbidity in the long term.¹

Purines are in abundance in the body as they form part of the building blocks of DNA and RNA.¹  Uric acid is what is produced when purine metabolizes.  This is typically excreted through the kidneys, however buildup can occur when there is too much uric acid, or the kidneys are not able to excrete well, or a combination of the two.¹  These uric acid crystals are then deposited in various joints in the body, often times in the big toe, causing the pain and inflammation we know as gout².

Gout is linked to cardiovascular disease, hypertension, obesity, insulin resistance and dyslipidemia.¹  In fact, a study of 51,529 men had a 55% increased risk of myocardial infarction and a 38% risk of death from cardiovascular disease.³   It is more likely to affect men than women.²

The excessive consumption of meat, alcohol, and sugary beverages increase the risk for gout.^1,2,4  In fact, those that have a higher intake of beef, pork, and lamb have a 41% increased risk of gout.⁵ Interestingly, where meat and seafood seem to elevate uric acid levels, those who drank milk daily showed a decrease in uric acid levels.⁶  Moderate intake of coffee, also, appears to reduce uric acid levels.¹

Therapeutic Foods

The Mediterranean diet could be one diet to consider in the treatment of gout as it focuses primarily on increased intake of omega 3 fatty acids, like those from fish, but also from plant sources like flax, walnuts, and leafy greens.¹  Its perceived benefits in gout are due to the long studied benefit of preventative and cardio supportive benefits of omega 3 fatty acids.¹ 

The diet favors intake of vegetables, legumes, olive oil, nuts, and vegetable proteins rather than on animal products known to be implicated in risk of gout.⁷   Increased intake of vegetable proteins were associated with a 27% lower incidence of gout.⁵

Participants in a 2013 study of gout and the Mediterranean diet showed a decrease in uric acid levels 9.12 to 6.2 over an 8 week use of the diet.⁷

Specifically, cherries and tart cherry juice should be encouraged, with studies showing that 280 grams of Bing sweet cherries lowers plasma and urine urate levels.⁸  Cherries may also inhibit inflammation and reduce C reactive protein, commonly elevated in acute inflammation.¹

Hibiscus tea, is also shown to be beneficial at 1.5g two to three times a day, showing to increase uric acid excretion, as well as to reduce blood pressure.⁹

Supplements to Consider

Vitamin C  - Where once thought to worsen symptoms of gout, recent studies have shown vitamin C as most likely to lower uric acid levels and increase uric acid clearance.¹⁰ Supplementation with 1500mg of vitamin C daily showed a 45% reduced incidence of gout.¹⁰  There may be additional benefits to Vitamin c simply be increasing the intake of citrus foods, but there is speculation that it may be due to the presence of a bioflavonoid called hesperidin, which showed positive correlation to reduction of symptoms of gout in animal models.¹¹  There are no known contraindications to this method at this time.

Quercetin – In addition to the pronounced benefits in the treatment and prevention of cardiovascular disease, quercetin additionally exhibits anti-inflammatory properties and may thus show some benefit with symptoms of gout.  Human trials have not been conducted, but animal studies show a positive correlation.¹²  Quercetin can be found in apples, onions, berries, grapes, citrus fruits and green leafy vegetables.  One can be sure to increase these foods regularly, or consider supplementing with 500mg twice daily.¹  There are no reported contraindications.

Conclusion

While gout is truly painful, lifestyle management and nutrition is at the forefront of its therapy, and thus, in the power of each individual sufferer to make positive change in their experience.  Weight loss, exercise, limiting alcohol and meats and increasing vegetation can get your feet on the right track.

References:

1. Rakel D. Integrative Medicine. In: Integrative Medicine. 4th ed. Elsevier; 2018:320-333.
2. Stump SE. Nutrition and Diagnosis Related Care. 8th Editio. (Klein EM, ed.). Wolters Kluwer Health/Lippincott Williams and Wilkins; 2015.
3. Choi HK, Curhan G. Independent impact of gout on mortality and risk for coronary heart disease. Circulation. 2007;116(8):894-900. doi:10.1161/CIRCULATIONAHA.107.703389
4. Ross K. Inflammation. (c):1-20.
5. Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004;350(11):1093-1103. doi:10.1056/NEJMOA035700
6. Choi HK, Liu S, Curhan G. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2005;52(1):283-289. doi:10.1002/ART.20761
7. Vedder D, Walrabenstein W, Heslinga M, et al. Dietary Interventions for Gout and Effect on Cardiovascular Risk Factors: A Systematic Review. Nutrients. 2019;11(12). doi:10.3390/NU11122955
8. Selloum L, Reichl S, Müller M, Sebihi L, Arnhold J. Effects of flavonols on the generation of superoxide anion radicals by xanthine oxidase and stimulated neutrophils. Arch Biochem Biophys. 2001;395(1):49-56. doi:10.1006/ABBI.2001.2562
9. Prasongwatana V, Woottisin S, Sriboonlue P, Kukongviriyapan V. Uricosuric effect of Roselle (Hibiscus sabdariffa) in normal and renal-stone former subjects. J Ethnopharmacol. 2008;117(3):491-495. doi:10.1016/J.JEP.2008.02.036
10. Choi HK, Gao X, Curhan G. Vitamin C intake and the risk of gout in men: a prospective study. Arch Intern Med. 2009;169(5):502-507. doi:10.1001/ARCHINTERNMED.2008.606
11. Martínez AL, González-Trujano ME, Chávez M, Pellicer F, Moreno J, López-Muñoz FJ. Hesperidin produces antinociceptive response and synergistic interaction with ketorolac in an arthritic gout-type pain in rats. Pharmacol Biochem Behav. 2011;97(4):683-689. doi:10.1016/J.PBB.2010.11.010
12. Huang J, Zhu M, Tao Y, et al. Therapeutic properties of quercetin on monosodium urate crystal-induced inflammation in rat. J Pharm Pharmacol. 2012;64(8):1119-1127. doi:10.1111/J.2042-7158.2012.01504.X