GOUT

IT'S THE STUFF OF LEGEND, an old-fashioned disease that supposedly afflicts only the elderly, the rich and the over-indulgent. But gout isn't humorous - it's painful. Imagine shards of ground glass inside your joints. Only the shards aren't glass, but crystals of uric acid, a byproduct of the breakdown of old cells and the construction of new ones.

Uric acid is usually filtered out of the body by the kidneys. But when there's too much of the acid in the bloodstream, it begins to accumulate in the joints.

Uric acid crystals inflict intense joint pain, often in night-time attacks that come without warning. The big toe is most often affected, but other joints, including knees, ankles, elbows and fingers, can be involved. Swelling, inflammation, a sensation that the joint is on fire, and chills or fever can also result.

Nine out of ten people with gout are middle-aged men; over half of those with gout have a genetic predisposition to the ailment. People who are overweight and those prone to high blood pressure, heart disease or diabetes are likely candidates.

Gout has traditionally been thought of as a disease of the affluent who dine on fatty meats, wines and rich dairy products, but newer research points to a different culprit: beer. One study found that the major dietary difference between 61 men with gout and a group of men who didn't have it was that 41 per cent of the gout group drank more than a dozen cans of beer - two and a half litres - a day.

SUPPLEMENTS TO EASE THE PAIN
You can take a number of supplements to alleviate the pain of gout and help ward off future attacks, but they aren't a substitute for improving your diet. (Also be aware that niacin supplements may precipitate an attack of gout, as nicotinic acid competes with uric acid for excretion from the kidneys. If you're currently taking niacin for heart disease, high cholesterol or other conditions, ask your doctor about gout and this supplement.)

1. olic acid. This nutrient is important in the breakdown and metabolism of proteins; it also inhibits the action of an enzyme responsible for the production of uric acid. Typical dosage: 200 to 400 milligrams per day.

2. Alpha-lipoic acid (ALA), vitamin E and selenium. This terrific trio helps to suppress the production of leukotrienes, chemicals that play a role in joint inflammation. ALA and selenium help vitamin E fight damaging free radicals more effectively. Typical dosage: 50 to 800 milligrams of ALA per day; 200 to 400 IU of vitamin E per day; and 200 micrograms of selenium per day.

0. Omega-3 and omega-6 fatty acids. You can get these in fish oil, flaxseed oil or evening primrose oil, but the source doesn't matter. What matters is that these fatty acids inhibit the production of the inflammatory agents released in gout in several ways. Typical dosage: 1,200 to 2,000 milligrams of fish oil per day plus 500 to 1,500 milligrams of omega-6 fatty acids per day (sunflower, safflower, olive and soya oils contain omega-6 fatty acids).

0. Bromelain. This enzyme is found in the pineapple plant and functions as an effective anti-inflammatory. Typical dosage: 500 to 1,500 GDUs (gelatin digestion units) per day; or just eat plenty of fresh pineapple.

Beer drinkers aside, the reason certain people are prone to gout remains somewhat of a mystery. Researchers have linked the disease to prior joint injuries, periods of stress, and alcohol or drug consumption. Certain diuretics and antibiotics can trigger gout; studies have also shown that gout can result from the presence of tumours, kidney disorders, lead poisoning and enzyme deficiencies. Mild cases of gout may be completely controlled by dietary changes. Continuing attacks may need more intensive care because they can cause permanent joint and kidney damage.

GET A DOCTOR'S DIAGNOSIS

Because several other disorders can mimic the symptoms of gout, it is important to see a doctor for an accurate diagnosis of any persistent joint pain. Blood and urine tests may or may not show a high level of uric acid. Your doctor may want to take X-rays or draw fluid from the synovial sac that cushions the joint to find out if what's ailing you is really gout.

DRUG TREATMENT

Non-Steroidal Anti-Inflammatories (NSAIDs)

Indometacin (Indocid), ibuprofen, naproxen (Naprosyn, Nycopren, Synflex). Function: decrease inflammation and pain. Side effects: abdominal pain, indigestion, dizziness, stomach ulcers, stomach bleeding, nausea, nightmlares.

 

Other Drugs

Colchicine (many products). Function: inhibits inflammation and decreases pain. Side effects: diarrhoea.

Allopurinol (Zyloric). Function: reduce the formation of uric acid.
Side effects: nausea, vomiting, diarrhoea, numbness, skin rashes, cataracts, drug interactions.

Probenecid (Benemid), sulfinpyrazone (Anturane). Function: decrease the amount of uric acid in the body by acting on the kidneys. Side effects: stomach and intestinal irritation, skin rash.

 

A GENTLER-ON-JOINTS DIET

Gout is among the most food-instigated disorders described in this book. Luckily, mild cases are also easily treated by changes in diet. And at least you know the enemy: uric acid.

But how do you fight it? One way is to withhold compounds that the body breaks down into uric acid. One of these compounds, purine, occurs in many foods. A low purine diet is essential in treating and preventing gout.

Try to avoid the following foods.

0. Alcohol • Lunch meats

1. Anchovies • Oatmeal

2. Asparagus • Offal

3. Cauliflower • Mushrooms

4. Dried beans and lentils • Mussels

5. • Herring • Peas

6. Poultry • White flour

7. Sardines • White sugar

8. Saturated fat • Yeast products

9. Spinach

After that list, you might ask what's left? Try eating plenty of the following foods.

0. Fresh vegetable juices (carrot, celery, parsley)

1. Grains, seeds and nuts

2. High-fibre foods and complex carbohydrates

3. Plenty of water to facilitate excretion of uric acid

4. Raw fruits and vegetables

5. Vegetable broths

HERBAL REMEDIES

Grapeseed (Vitis vinifera)

You've probably seen commercial products that include grapeseed or pine bark extracts. These contain powerful antioxidants called procyanidins that neutralise damaging free radicals in joints and work as natural anti-inflammatory agents. Typical dosage: 50 to 200 milligrams of procyanidins per day.

Turmeric (Curcuma longa)

This spice, familiar to anyone who enjoys Indian food, contains a compound called curcumin. Like grapeseed, turmeric is antioxidant and anti-inflammatory. It's also effective at easing the stiffness and pain that come with gout. Turmeric is especially effective when combined with boswellia (see below). Typical dosage: 300 to 900 milligrams per day of a product standardised to 95 per cent curcumin.

Boswellia (Boswellia carterii)

This resin, also known as Indian frankincense, contains an acid that in animal studies has shown an ability to control arthritis. It also inhibits inflammation and improves circulation to affected joint tissues. Typical dosage: 300 to 400 milligrams per day of an extract containing 65 per cent hoswellic acid.

Devil's Claw (Harpagophytum procumbens)

This herb has an extensive history of use as an anti-inflammatory, pain reliever and digestive stimulant. Because improper digestion of protein plays a role in gout, causing the uric acid build-up that leads to those shard-like crystals, this is a remedy tailor-made for people with gout. Typical dosage: 600 to 800 milligrams per day of product standardised to 1.5 per cent harpagoside. Caution: do not use if you have gastric or duodenal ulcers. Do not use if you are pregnant or breastfeeding. If you have heart disease, use only with a doctors supervision.

 

Yucca (Yucca schidigera)

Another digestion-improving herb, yucca has been found in some studies to treat arthritis pain, swelling and stiffness. Although those studies were controversial, yucca has seen continued use for joint pain. Typical dosage: 1,000 to 1,500 milligrams two or three times per day.

Celery Seed (Apium graveolens)

If you like this seed as a seasoning, here's another reason to appreciate it. An extract of celery seed has the ability to calm inflammation and neutralise the harmful effects of uric acid. Typical dosage: 2 to 4 tablets of celery seed extract per day.

 

CHEER FOR CHERRIES AND BERRIES

Not all good things are off limits to people with gout. In studies, cherries (especially black cherries), blueberries and strawberries have proven their ability to reduce levels of uric acid in studies. Black cherry juice is probably the most effective. Drink 30 to 60 millilitres of pure juice per day.