Eliminate Gout by Optimizing Health

Yesterday Raul and I attended "The Georgia Show" body building competition by NPC to promote healthy food and a healthy lifestyle. We met many amazing people including trainers, gym owners, body builders, models, radio show hosts, and many other interesting people ( and of course the bikini models).  While at the show I met a man who had gout and he asked for my help. Gout is a serious issue so I decided to write this blog so that people can educate themselves and make informed choices.

What is gout? 

Gout is a form of arthritis where EXCESS uric acid (monosodium urate in the body) is present in the blood, tissues, and urine.   This excess uric acid crystallizes and accumulates in the joints causing pain, swelling, tenderness, and loss of function.  Uric acid often accumulates in the big toe (aka Podagra) and is extremely painful to the point where it is hard to walk.  


Gout is typically more common in men (95% of gout patients are men aged 30+) and is 20 times more prevalent in men than in woman. Gout afflicts approximately 0.3% to 0.4% of the "western world".  Gout is potentially hereditary but this mostly pertains to susceptibility to the condition. However, other factors such as diet and overall health affect whether or not the condition forms.  


Typical recommendations for alleviating gout include avoiding Fish, Red meats, organ meats, Alcohol ( especially beer) as well as other forms of nutritional yeast (Brewers or Torula), Tea, Coffee(due to caffeine but sometimes beneficial), chocolate, caffeine.  All of the latter are high in uric acid or are broken down into uric acid easily in the body.

These are good recommendations because the body is already overloaded with uric acid so extra intake doesn't help the situation but these foods are often not the CAUSE of the problem.  Let me explain.

Uric acid is actually beneficial and very important in normal amounts, People afflicted with multiple sclerosis(neuro-muscular degenerative disease) for example often have low uric acid levels and some doctors recommend strategies to increase uric acid levels in some of these cases.   Uric acid is produced in the body naturally through protein metabolism and acts as a potent antioxidant. Therefore, optimal amounts are essential.   

• Anti-oxidants bind to various types of free radicals and neutralize them.  
• Free radicals are destructive byproducts of metabolism that bind to things easily (due to an extra free electron) and cause damage to the body when not kept in check.  

The real problem:

Approximately 70 percent of Gout Patients have an overproduction of uric acid, the remaining 30 % of gout patients have defective elimination of uric acid.  

While giving up dietary sources of purines can help in short term it is essential to find the cause of the problem that is causing uric acid to be produced too fast, in excessive amounts, or not be eliminated properly.  

In one way or another most conditions, especially gout, are a symptom of poor health.  Individuals effected with obesity have much higher rates of gout. Obesity, in itself, is a symptom of an unhealthy lifestyle in most cases.

Also, those who consume large amounts of refined fructose sugar either as sucrose(refined table sugar), crystalline or purified fructose(sports drinks and processed foods), high fructose corn syrup (soft drinks, sodas, fruit juices), and even fruit if in extreme excess (mostly highly processed fruits and dried fruits) can increase uric acid levels and cause problems.

Note: Meat products are more often suggested as a trigger for gout attacks. However, fructose is a significant factor as well, if not more so than animal products.  There are many cases of Vegans with gout.  It is much more rare but it happens.

Note: Fructose has to be processed by the liver and converted into glucose (blood sugar) to be used by the body.  The conversion is stressful so many experts recommend limiting total fructose consumption to 25 grams per day (you would need to eat a whole sack of apples to go over this naturally).  The most common source of refined fructose is packaged and processed foods, sports drinks, processed fruit juices, sodas, and refined pastries.  High fructose corn syrup  is in everything now because it is sweeter (fructose is much sweeter than glucose or sucrose), it is subsidized by tax dollars (worst idea ever), and highly profitable for manufactures (due to subsidies).

Do no be deceived by the whole its "fruit sugar" or its "nutritionally the same as sugar" nonsense. It's not.  I can touch on this in another article later on.  Lets get to the useful stuff!

Action Steps:


The goal is to prevent gout and create a healthy body and an internal environment that allows the body eliminate extra uric acid thus alleviating the symptoms of gout.

Step one:  Stay hydrated and maintain proper fluid balance.  Most people drink way too many juices, sodas, and other sweetened beverages the excess sugar and salt can create imbalances that can exacerbate gout. Spring water is always my first preference, then Distilled (rain water), or reverse osmosis.  Use findaspring.com to find good water near you, Beyond Organic Spring water, or find other local sources near you. I use a Reverse Osmosis filter in my house and get spring water from a local spring as a fun day trip and Beyond Organic Spring Water when I travel or I am in a rush.  You want your water to be as pure as possible.  Water is measured by TDS - total dissolved solids.  The lower TDS the better.  Distilled should be 0 or 1.  Reverse osmosis should be close to that as well.  High quality spring water can vary.  We like Beyond Organic because its gets as low as 3 TDS (Fiji Water ranges from 40-50).  Functional beverages such as kombucha, coconut water, and cultured whey are also useful for hydration and health.

Step two: Switch to a diet consisting of real, fresh food.  Organic, local, seasonal products are always best but don't stress out too much about if these are not available to you.  If you have to make a choice what to buy organic first look up the clean 15 and dirty dozen lists that are published each year which states the least sprayed and most sprayed conventionally farmed foods.  Avoid foods that are sprayed heavily (or at least wash them very well, soak in vinegar solution or veggie wash, etc).

If I had to make a choice between organic animal products and organic vegetables I would choose organic animal products first.  For example if i was low on cash i would spend the extra money on healthy animal products, pasture raised organic eggs, meat, etc before spending extra to get organic broccoli (which isn't sprayed too often).

This recommendation is based on the law of bio-accumulation.  The higher something is up on the food chain the more toxins it has accumulated and will pass on to you.  Remember, You are not what you eat, you are what you ate, ate.  If you eat conventionally farmed beef loaded with antibiotics, hormones, GMO corn feed sprayed with large amounts of pesticides that toxicity can potentially be passed on to you. We recommend Beyond Organic Beef, US wellness meats, Local farmers near you,  and Whole Foods.  These companies provide sources of higher quality animal products.  Other health food stores are good sources too.  Check out the side bar for links and other resources. Check out Eatwellguide.org for other healthy food establishments near you.  

Step three: Eliminate purine(uric acid) rich foods. Also, eliminate foods that break down into them (or at least cut down consumption significantly). Eliminating these foods can be beneficial, specifically short term until levels of uric acid normalize.

• Fish
• Red meats 
• Organ meats (liver etc.)
• Alchohol (ethanol itself may prevent excretion of uric acid)
• Beer (specifically because of the DNA and RNA in yeasts containing purines and uric acid)
• Other nutritional yeasts (torula, brewers) and breads
• Milk, especially homogenized milk (increases xanthine oxidase enzyme and uric acid formation). 
• Homogenization makes the fat toxic! Avoid!  
• Methylxanthine group chemicals - caffeine, theobromine (chocolate), theophylline (chocolate, coffee, tea) - these substances break down (are oxidized) into uric acid easily in the body

Side Note about dairy and gout: Homogenization is a process that breaks down the large fat particles in milk and dairy products into smaller ones in order to suspend the fat and spread it evenly through the product. Milk fat, when homogenized releases an enzyme called xanthine oxidase which increases uric acid production and retention and can exacerbate gout.   Because of this low fat milk products (referring to conventional store bought milk) have been found to be better for those with gout.

Homogenization is not a health related issue and is done strictly for consumer appeal purposes so buy non-homogenized milk whenever possible (in non-homogenized milk the fat floats to the top). Assuming the animals are healthy, pasture raised animals and the product is non-homogenized I believe that dairy has the potential to be very healthy for those who are no allergic in some way. Check out RealMilk.com or Beyond Organic Amasai or Cheese, and stick to other non-homogenized products in your local grocery store or health food store.

Step four: Eliminate substances that are stressful for the liver. As stated earlier excess sugars can be problematic.  Most everyone agrees fructose in its refined form is toxic in one way or another.  In relation to gout specifically it has been found to increase uric acid levels.   Fructose has also been blamed in part for the obesity epidemic. Obesity in itself can promote a situation in the body that allows uric acid to accumulate (poor circulation, etc.).  Eliminate all refined sugars and limit carbohydrate consumption to fruits, vegetables, and healthier grains such as rice, millet, and grain-like fruit kernels such as buckwheat or quinoa.  Also avoid unnatural and toxic fats and oils such as canola, sunflower, safflower, cottonseed,  peanut, anything partially or fully hydrogenated.   These fats clog your cells promote insulin resistance (diabetes) and cause significant amounts of inflammation and hormonal dysfunction in the body.   Stick to real whole foods and fats including healthily raised animal products, nuts, seeds, avocados, coconut, olives, and derivative butters and oils.  Avoid anything in excess. 

In regard to alcohol beer is worse because of the extra sources of uric acid. However, Alcohol (ethanol) itself has been found to decrease the rate of exertion of uric acid.  This can potentially lead to an accumulation of uric acid in the blood which can cause or exacerbate gout.

I hope this helps!  Much Love!


Feel free to leave a comment if you have questions, would like further reading, or have topic requests.  

Sources:  

1. Yamamoto, T., et al. Effect of ethanol on metabolism of purine bases (hypoxanthine, xanthine, and uric acid). Clin Chim Acta. 356(1-2):35-57, 2005.
2. Broadhurst, C. L. Ease gout pain. Nutrition Science News. July 1999. 
3. Olak-Bialon, B., et al. [Does coffee drinking influence serum uric acid concentration?] Wiad Lek.57(Supplement 1):233-237, 2004. 
4.  Hooper, D. C., et al. Uric acid, a peroxynitrite scavenger, inhibits CNS inflammation, blood-CNS barrier permeability changes, and tissue damage in a mouse model of multiple sclerosis. FASEB J. 14(5):691-698, 2000. 
5. Sevanian, A., et al. Serum urate as an antioxidant for ascorbic acid.American Journal of Clinical Nutrition. 54:1129S-34S, 1991. 
6. Choi, H. K., et al. Gout: epidemiology and lifestyle choices. Curr Opin Rheumatol. 17(3):341-345, 2005.
7. Choi, H. K., et al. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. British Medical Journal. 2008. 
8. Henry, R. R., et al. Current issues in fructose metabolism. Ann Rev Nutr. 11:21-39, 1991.