Gout is a common form of arthritis. This is where crystal deposition where monosodium urate crystals form in the joints and tissues. Painful inflammation is caused in one or more joints in the extremities and nodules in the soft tissues –tophi. Hyperuricemia increases the risk of gout as well as other diseases, such as hypertension, kidney disease and metabolic syndrome.
Frequently Asked Questions
- 1What is Uric Acid Metabolism?
- 2What causes Gout?
- 3What are some lifestyle tips for preventing hyperuricemia?
- 4What are the Risk factors for Gout?
- 5How does gout increase my risk of heart disease?
- 6Why is there a connection between Sleep apnea and Gout?
- 7Why is gout so painful?
- 8How can you control Hyperuricemia and help reduce gout?
- 9How is gout diagnosed?
- 10If I already have high uric acid levels during an acute attack, how can I bring my levels down quickly without using prescription drugs?
In humans it is the final product of purine metabolism, which are components of nucleosides (building blocks of DNA and RNA. Purine molecules are important for survival for vertebrates and humans, who have developed excellent systems for making sufficient purine nucleosides for their metabolisms by using materials available like glucose, glycine and glutamine. Excess purine’s are removed from the body as it gets broken down in the liver and excreted from the kidneys.
Purines are converted into intermediate uric acid and then gets metabolised by the enzyme uricase into allantoin. This is a soluble compound that flows easily through the blood stream, and filtered by the kidneys, and then excreted. Levels of uric acid depend on 2 factors:
The rate uric acid is made in the liver and the determent of blood uric acid levels from the kidneys. Humans are able to preserve blood levels of uric acid, by increasing antioxidant capacity in the blood. This is due to the fact that uric acid is an important antioxidant in the body fluids, which are responsible for neutralising free radicals in the blood stream. Humans cannot produce vitamin C, thus the reason we have the ability to preserve uric acid to compensate for that. Low blood uric acid levels may risk neurological disorders such as Amyotrophic Lateral Sclerosis, Multiple sclerosis, Huntington’s, Parkinson’s and Alzheimer’s.
The underlying cause of gout is hyperuricemia, the buildup of excess uric acid in the blood.
Uric acid is produced during the metabolism of purines, which are compounds found in high amounts in certain foods and beverages such as meats, poultry, seafood and beer. There are two ways to get purines, one is from your diet and the other is produced in the body. Purines are important for the synthesis of nucleic acids, the building blocks of DNA. However, your body doesn’t need dietary purines; it can produce them on its own. Just about all dietary purines are converted to uric acid. Hyperuricemia results either from excess production of uric acid, not enough excretion, or a combination of both. Under excretion is the primary cause of hyperuricemia in about 90% of cases, while overproduction is the cause in less than 10%. High blood levels of uric acid don’t necessarily mean you’ll develop gout. It only increases the risk based upon varying degrees of hyperuricemia. When blood levels are between 7 and 8.9 mg/dL, the risk of gout is less than 1% per year, but when uric acid levels are greater than 9 mg/dL, the risk of developing gout is 6 times higher. All of this is why the mainstay of gout treatment is preventing hyperuricemia. Unfortunately for a lot of us, this can be tough, because gender, menopause and genetics play a role. Men and post-menopausal women produce the most uric acid. If you fall into one of these two groups, you might consider taking preventative measures. Research also shows that hyperuricemia is a genetic trait. Lifestyle is a driving force behind the development of hyperuricemia and gout.
Avoid excessive alcohol. Drinking too much can interfere with the removal of uric acid from the body. Remember, under excretion is the primary way it builds up.
Limit dietary purines. This includes red meats, pork, lamb and seafood.
Maintain a healthy weight. Obesity increases the risk of gout. One theory is that excess body weight causes rapid turn-over of body tissues, increasing the need for purines and nucleic acids. The end result is more uric acid production.
Optimize kidney health. As under excretion causes 90% of hyperuricemia cases, improving and maintaining kidney function is important.
Optimize thyroid function. Hypothyroidism is associated with gout.
Optimize blood pressure. Hypertension is associated with gout.
Lower lead in your body. Chronic exposure has been linked to some cases of gout.
Minimize use of prescription diuretics. Medications that increase urine flow are associated with gout. Talk to your doctor if you’re at an increased risk for gout and discuss alternatives for treating high blood pressure.
Treat sleep apnea. A recent study in Arthritis & Rheuma-tology has found that sleep apnea is an independent risk factor of gout.
Increases with age, and is more common in men. Its Associated with other medical disorders such as hypertension, obesity, renal insufficiency, early menopause, Hypercholesterolemia and surgery. Some medications increase the risk of gout, such as diuretics, ant tuberculosis drugs, cyclosporine and levodopa. Aspirin taken in low doses inhibit excretion and increase blood levels. Higher doses will reduce these levels. Dietary influences that increase the risk of gout are high-purine foods, such as red meat, fish and shellfish, as well as pork and lamb. Alcoholic beverages higher the risk of gout, but wines does not affect this at all. Fructose that’s found in orange juice for example can higher the risk for gout.
Gout is bad for your heart, because it’s associated with diabetes and obesity, which are two independent risk factors of heart disease. The odds of developing gout are almost 4 times higher for diabetics than non-diabetics. Reports indicate that the underlying cause of gout, hyperuricemia, may in fact be an independent risk factor of cardiovascular disease. And the likely culprit is chronic inflammation.
Uric acid’s crystalline structure appears to activate the immune system and trigger a robust inflammatory reaction. Detailed analysis of uric acid’s role in initiating inflammation reveals a complex and powerful interaction between uric acid crystals, immune cells, multiple chemical signals, and eventual production of a powerful inflammatory protein, interleukin-1-beta. Once released into circulation, interleukin-1-beta signals the activation of more and more immune cells and inflammatory proteins, resulting in a destructive inflammatory response. Chronically elevated, inflammation can damage cells and tissues throughout the body, making it the common denominator of age-related disorders, including heart disease.
Sleep apnea and gout is linked to decreases oxygen levels in the blood which increases the uric acid levels. Sleep apnea can be triggering gout attacks as most attacks occur at night. Sleep apnea decreased the oxygen levels, then the uric acid levels rise with the increased carbon dioxide in the blood and then you have the potential of suffering from a potential painful gout attack.
Gout is painful because needle-like crystals of uric acid are piercing joint tissues. And, as if that weren’t enough, the crystals also initiate a powerful inflammatory response that causes redness, swelling and heat. This occurs within tight joint spaces with little ability to expand and relieve pressure. 23% compare the pain to shattered glass piercing their skin, 28% to breaking a bone, 34% to a severe burn and 37% to a stubbed toe, 69% describe the pain of an attack as “miserable”, 73% reported limited physical activity, 27% of gout patients say the disease causes them to take time off from work, 43% said they had canceled social plans because of a gout attack and 36% said they would leave their homes more often if they did not have gout.
This is why people suffering from acute gout are willing to ingest large quantities of prescription and over-the-counter pain medications, but the possibility of severe side effects has some patients searching for safer ways to control the pain. Cherries can help - Several studies provide strong evidence that the anthocyanins from cherries relieve pain and reduce inflammation.
Korean angelica is another alternative to side-effect prone pain medications. Used in traditional herbal medicine as a pain reliever, Korean angelica fights pain through its effects on the brain.
This makes it useful for many types of pain, including the painful inflammation characterizing gout. Curcumin and Boswellia are additional alternatives simply because they are so effective at inhibiting powerful inflammatory pathways that are activated during acute gout.
1. Good diet
- Limit red meat intake
- Limit your fish intake
- Drink skim milk and other low fat dairy products
- Consume vegetable protein, nuts, and legumes
- Decrease alcohol intake
- Decrease intake of sugar sweetened beverages
- Vitamin C
- Chinese herbs – cinnamon
2. Exercise daily
3. Do a sleep study to ensure that you don’t have Sleep apnea.
Classically, hyperuricemia and podagra (swollen, red big toe) are enough to make the diagnosis of gout. Just about any joint can be involved.So that leaves hyperuricemia (uric acid level greater than 8.6 mg/dL in men and 7.1 mg/dL in women) and severe pain in at least one joint as the criteria for most clinicians to call it gout. But keep in mind that gout occurs without hyperuricemia and many people with raised uric acid levels never develop gout.In cases with normal uric acid levels, synovial fluid analysis should be considered.
Although some doctors might treat for gout without one, the presence of large needle-shaped crystals within the joint fluid confirms the diagnosis and can be used to differentiate gout from pseudo gout or septic arthritis.
Book a consultation with our Health Renewal doctors for Gout.
During an acute attack, lowering uric acid isn’t beneficial. Instead, focus on quickly reducing inflammation. Start by icing and resting the affected joint. Talk with your doctor about conventional medications such as no steroidal anti-inflammatory drugs (NSAIDs), colchicine, glucocorticoids, and biologic agents that inhibit interleukin-1 beta. They might be appropriate for you, but they also have the potential for severe side effects. Although not as effective in reducing inflammation from gout individually, natural extracts when taken together can be safe and effective at reducing acute inflammation. However, the quick progression and resolution of acute gout may make it less amenable to nutrient “interventions,” many of which have only been tested for their long-term effects on inflammation. But there are specific nutrients that target joint inflammation and inflammatory signals, including interleukin-1-beta.
Curcumin, omega-3 fatty acids and resveratrol may be especially suited for this purpose.