A Functional Medicine Perspective on Gout

By Michal Cooling, CNTP

Gout is very much a lifestyle-based condition; however, there can be some deeper issues at hand. For example, people who have had gout have an increased risk of developing kidney stones, high blood pressure, kidney disease, diabetes, high levels of triglycerides, and atherosclerosis. My goal is to offer general information on nutrition and lifestyle principals as well as clinical considerations.

Here’s the scenario…

When your body is filled with toxic acidity from:

Foods and drinks
Poor breathing habits
Breathing in poor-quality air
Toxic chemical exposure (both from breathing and contact with your skin)
Metabolic acidity that is created by chronic stress

… then the uric acid is just one more assault on your hard-working kidneys! So the answer to “what is gout?” lies in the lifestyle you’re living.

Ask Yourself:

What am I eating today?
What am I drinking today?
Am I breathing as well as I could be?
What’s in this air I’m breathing?
What am I putting on my skin?
What am I thinking today?

By asking yourself these questions you’ll start to get a whole new perspective about gout symptoms and the causes – and it will change the way you go about your day. Ask yourself these questions every day, because as soon as you get over the gout attack you’re having now, you’ll stop thinking about gout altogether . . . until the next gout attack hits.

Risk Factors:

Family history of gout
Kidney issues (found on a blood test)
High levels of triglycerides (found on blood test)
Drinking too much alcohol
Eating foods rich in purines, such as meat, shellfish, and sweetbreads
Exposure to environmental toxicity
Surgery
Metabolic syndrome and impaired gut function (found on blood test)
Hidden food sensitivities and infection (found on a blood test)
Autoimmunity (found on a blood test)

Conventional medical treatment suppresses inflammation to manage symptoms. However, simply suppressing it will not address the underlying causes, but it does point us in an important direction – find the inflammatory triggers and promote inflammatory relief. The most common causes of inflammation are food sensitivities, hidden infection, poor gut function, environmental chemicals, stress and autoimmunity. The following are some key clinical pieces to identifying the underlying triggers and causes for gout.

Identifying and addressing the above risk factors.
Identifying and eliminating potential food allergens, including dairy, wheat (gluten), soy, corn, nightshades, preservatives, and food additives. This can be done through proper food sensitivity testing (conventional testing is incomplete), elimination diets, and muscle-response testing.
Identifying and addressing hidden infection, leaky gut, toxicity, breakdown of stress mechanisms (such as adrenal fatigue), and autoimmunity.
A lesser-known gout origin is low blood oxygen saturation. This can be identified through symptom analysis and blood testing. Strong, well-developed breathing habits should correct this. However, some individuals need additional supplemental support.
Identifying and addressing inconsistent sleep or rest and lack of simple exercise. Well-planned sleep and exercise habits help to keep the body systems in good working order and minimize the incidence of gout. Exercise at least 30 minutes daily, 5 days a week.
Possibly the most overlooked of all gout sources is stress. Stress is just as much of a trigger as food. Strong emotions and negative thinking create powerful acidic chemistry in the internal environment of the body. The stress hormones adrenaline and cortisol add to the overall acidic load that has to be managed by the kidneys. This adds to the strain of maintaining the pH balance and helps to provide the right conditions for gout to flourish. Aiding the body with stress-buffering nutrients as well as stress relieving exercises helps tremendously.

Nutrition for Gout:

Eat antioxidant foods, including fruits (such as blueberries, blackberries), and vegetables (such as squash, spinach).
Consume foods high in potassium like celery, broccoli and mixed greens (like kale and chard).
Some nutritionally oriented doctors promote a low fructose diet to treat gout. In fact, they have seen such promising improvements from eliminating sugar from the diet, that they promote purine-rich foods in the absence of sugar.
Another theory states that one half pound of cherries per day (fresh or frozen) for 2 weeks lowers uric acid and prevents attacks. Cherry juice (8 – 16 oz. per day) is also helpful as well as Bing cherries.
Include more high fiber foods, including apples, sweet potato skins, berries, root vegetables (such as yams and turnips), and psyllium seed.
Eat foods rich in magnesium and low in calcium, such as brown rice, avocado, and banana.
Lemon and apple cider vinegar help balance pH. Lemons are a very effective liver stimulant and dissolvent of uric acid. Lemon helps to liquefy bile making digestive juices flow much more freely. You can also support bile with supplements.
Use healthy cooking oils, such as coconut oil, avocado oil, and olive oil.
Drink 8 glasses of filtered water daily to help flush uric acid from the body. Dehydration often triggers a gout attack. If water is being poorly absorbed, add mineral drops to the water. Drinking water before bedtime helps keep things from concentrating overnight.

Foods to Avoid:

Refined foods, such as white breads, pastas, sugar, high fructose corn syrup, and MSG.
Nightshades (potatoes, tomatoes, eggplant, peppers, tobacco). Everybody reacts differently so this may be helpful, it will be a matter of just seeing if there is a reaction after eating any of these plants.
Eat fewer red meats and more lean meats, coldwater fish, and/or beans for protein.
Cut down on foods containing oxalate, such as rhubarb, beets, nuts, chocolate, black tea, wheat bran, and strawberries.
Restrict purines in your diet. Foods with a high purine content include beef, goose, organ meats, sweetbreads, mussels, anchovies, herring, mackerel, and yeast. Foods with a moderate amount of purines include meats, poultry, fish, and shellfish not listed above. Spinach, asparagus, beans, lentils, mushrooms, and dried peas also contain moderate amounts of purines.
Limit intake of caffeine.
Avoid roasted nuts and any foods containing (or cooked with) oil that has been heated. Oils become rancid when heated and rancid fats quickly destroy Vitamin E, which results in the release of increased amounts of uric acid.
Reduce or eliminate trans fatty acids, found in commercially baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid alcohol, and tobacco.
Avoid sugar sweetened soft drinks.

Supplements to Help with Gout:

A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc and selenium. Magnesium specifically is helpful.
Quercetin with bromelain. Papaya supplements are also beneficial, or eating lots of fresh pineapple.
Curcumin is one of the most effective anti-inflammatory nutrients on the market.
Omega-3 fatty acids, such as fish oil. Take 1- 2 capsules or 1 tablespoon of oil daily to help decrease inflammation and promote general health. Coldwater fish, such as salmon or halibut, are good sources. Essential fatty acids inhibit leukotriene production, which are fatty molecules of the immune system that contribute to inflammation.
N-acetyl cysteine, 200 mg daily, for antioxidant effects.
Vitamin C, 500 – 1,000 mg daily, for antioxidant support. In one study, higher vitamin C intake was independently associated with a lower risk of gout.
Acidophilus (Lactobacillus acidophilus), 5 – 10 billion CFUs (colony forming units), when needed for maintenance of gastrointestinal and immune health.
Methylsulfonylmethane (MSM), 3,000 mg twice a day, to help decrease inflammation.

Herbs to Consider for Gout

Cranberry (Vaccinium macrocarpon) for kidney health. You may also take 8-16 ounces of unsweetened cranberry juice daily.
Green tea (Camelia sinensis) for antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
Devil’s claw(Harpagophytum procumbens) for pain and inflammation. Devil’s claw may increase the blood thinning effect of certain medications such as aspirin and Coumadin.
Cat’s claw (Uncaria tomentosa) standardized extract, 20 mg 3 times a day, for inflammation, immune, and antibacterial/antifungal activity. Cat’s claw may worsen certain conditions, such as leukemia or some autoimmune disorders and may also interact with many different medications. Talk to your doctor before using.
Bromelain (Ananus comosus) and Turmeric (Curcuma longa), inflammation. Both can increase the blood thinning effect of certain medications such as aspirin and Coumadin.
Bilberry extract
Celery Seed
Yuca and chamomile

Helpful Tips for Gout:

Make a paste with cayenne powder and wintergreen oil to relieve local inflammation and some pain. Sometimes it will sting at first, but with persistent use it will subside.
Nettle tea compress, applied externally. Use 1 – 2 tsp. per cup of hot water.
Avoid taking extra niacin and vitamin A. Both may play a role in some attacks of gout.
Avoid baby aspirin since it may increase the chances of a person developing gout.
Soaking the gout-affected joint in warm water and Epsom salts is very alkalizing in a localized way. Alternating an Epsom salt soak with towel-wrapped ice-packs is a fast topical gout treatment.

Homeopathy:
Some of the most common remedies used for gout are listed below. A common dose is 3 – 5 pellets of a 12X to 30C remedy every 1 – 4 hours until your symptoms improve.

Aconite for sudden onset of burning pain, anxiety, restlessness, and attacks that come after a shock or injury. Also take if your joints are swollen and painful.
Belladonna for intense pain that may be throbbing, if pain is made worse by any motion and better by pressure, or if the joint is very hot.
Berberis vulgaris for spasms of pain in joints or twinges made worse by walking. There may be back pain and a tendency to develop kidney stones.
Bryonia for pain made much worse by any kind of motion, or if pain is better with pressure and with heat.
Colchicum for pain made worse by motion and changes of weather, especially if there is any nausea associated with the attacks.
Ledum when joints become mottled, purple, and swollen, or if the pain is much better with cold applications and is worse when overheated.
Rhus toxicodendron for stiff, swollen joints that are hot and painful, or if the pain is worse with cold applications and better with heat.

Sources

Nutrition Therapy Institute, Clinical Nutrition Course

Baby Aspirin and Gout: https://umm.edu/health/medical/reports/articles/gout

Gout and Milk: https://usatoday30.usatoday.com/…/Enriched…/52824366/1

SUPPORTING RESEARCH:

Choi HK. A prescription for lifestyle change in patients with hyperuricemia and gout. [Review]. Curr Opin Rheumatol. 2010;22(2):165-72.
Choi HK. Diet, alcohol, and gout: how do we advise patients given recent developments? Curr RheumatolRep. 2005;7(3):220-6.
Choi HK, Curhan G. Coffee consumption and risk of incident gout in women: the Nurses’ Health Study. Am J Clin Nutr. 2010;92(4):922-7.
Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. 2008; [Epub ahead of print].
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):502-7.
Dubchak N, Falasca GF. New and improved strategies for the treatment of gout. Int J Nephrol Renovasc Dis. 2010;3:145-66.
Eggebeen AT. Gout: an update. Am Fam Physician. 2007;76(6):801-8. Review.
Falasca GF. Metabolic diseases: gout. Clin Dermatol. 2006;24(6):498-508.
Gagnier JJ, Chrubasik S, Manheimer E. Harpgophytum procumbens for osteoarthritis and low back pain: a systematic review. BMC Complement Altern Med. 2004 Sep 15;4:13.
Hak AE, Choi HK. Lifestyle and Gout. Curr Opin Rheumatol. 2008;20(2):179-86.
Jana S, Shekhawat GS. Critical review on medicinally potent plant species: Gloriosa superba. [Review]. Fitoterapia. 2011;82(3):293-301.
Kang EH, Lee EY, Lee YJ, Song YW, Lee EB. Clinical features and risk factors of postsurgical gout. Ann Rheum Dis. 2008;67(9):1271-5.
Lee SJ, Terkeltaub RA, Kavanaugh A. Recent developments in diet and gout. Curr Opin Rheumatol. 2006;18(2):193-8.
Li EK. Gout: a review of its aetiology and treatment. Hong Kong Med J. 2004;10(4):261-70.
Li S, Micheletti R. Role of diet in rheumatic disease. [Review]. Rheum Dis Clin North Am. 2011;37(1):119-33.
Pascual E, Sivera F. Therapeutic advances in gout. Curr Opin Rheumatol. 2007;19(2):122-7.
Peterson DM. Nonsteroidal anti-inflammatory drugs and colchicine to prevent gout flare during early urate-lowering therapy: perspectives on alternative therapies and costs. J Pain Palliat Care Pharmacother. 2010;24(4):402-4.
Rakel & Bope: Conn’s Current Therapy 2009, 1st ed. Philadelphia, PA: Saunders Elsevier. 2008.
Richette P, Bardin T. Gout. Lancet. 2010;375(9711):318-28.
Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. ArthritisRes Ther. 2006;8 Suppl 1:S2.
Schelesinger N. Over