Gout

The ache in your toe may be enough to knock you off your feet. Gout, a form of arthritis, often strikes without warning. According to research or other evidence, the following self-care steps may help kick the pain:

Check out cherries
Soothe symptoms and prevent new attacks by eating a half a pound of cherries or drinking an equivalent amount of cherry juice per day

Rest for relief
During acute attacks, rest the affected part to reduce pain and inflammation

Pass up high-purine foods
To keep uric acid levels low, eat fewer purine-containing foods, such as liver, shrimp, and dried pulses

Put a limit on alcohol
To help prevent new attacks, avoid drinking more than one alcoholic drink a day

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full gout article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About gout

Gout is a form of arthritis that occurs when crystals of uric acid accumulate in a joint, leading to the sudden development of pain and inflammation.

People with gout either overproduce uric acid or are less efficient than other people at eliminating it. The joint of the big toe is the most common site to accumulate uric acid crystals, although other joints may be affected.

Product ratings for gout

Science Ratings	Nutritional Supplements	Herbs
	Vitamin C
	Folic acid Quercetin	Colchicine from autumn crocus
See also: Homoeopathic Remedies for Gout
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

The pain of gout can arise suddenly and is often very intense. The affected joint is usually red, swollen, and very tender to the touch. A low-grade fever may also be present.

Medical options

Over-the-counter analgesics, such as aspirin (Genuine Bayer®, Ecotrin®, Bufferin®), ibuprofen (Motrin IB®, Advil®), and naproxen (Aleve®), might provide temporary pain relief.

Acute gout attacks are typically treated with the prescription drug colchicine and prescription strength nonsteroidal anti-inflammatory drugs (NSAIDs) such as celecoxib (Celebrex®), indomethacin (Indocin®), meloxicam (Mobic®), and naproxen (Naprosyn®, Anaprox®). Occasionally corticosteroids, such as prednisone (Deltasone®), are used to treat inflammation.

Individuals with gout are often prescribed allopurinol (Zyloprim®) to prevent future acute attacks. Probenecid (Benemid®) and sulfinpyrazone (Anturane®) are available, yet less frequently used, to treat gout.

Healthcare practitioners recommend resting the affected joint during acute gout attacks.

Dietary changes that may be helpful

Foods that are high in compounds called purines raise uric acid levels in the body and increase the risk of gout. Restricting purine intake can reduce the risk of an attack in people susceptible to gout. Foods high in purines include anchovies, bouillon, brains, broth, consommé, dried pulses, goose, gravy, heart, herring, kidneys, liver, mackerel, meat extracts, mincemeat, mussels, partridge, fish roe, sardines, scallops, shrimp, sweetbreads, baker’s yeast, brewer’s yeast, and yeast extracts (e.g., Marmite, Vegemite).

Avoiding alcohol, particularly beer, or limiting alcohol intake to one drink per day or less may reduce the number of attacks of gout.¹ ² Refined sugars, including sucrose (white table sugar) and fructose (the sugar found in fruit juice), should also be restricted, because they have been reported to raise uric acid levels.³

According to a 1950 study of 12 people with gout, eating one-half pound of cherries or drinking an equivalent amount of cherry juice prevented attacks of gout.⁴ Black, sweet yellow, and red sour cherries were all effective. Since that study, there have been many anecdotal reports of cherry juice as an effective treatment for the pain and inflammation of gout. The active ingredient in cherry juice remains unknown, but a study in healthy volunteers found that eating about half a pound of cherries per day for four weeks decreased levels of C-reactive protein (a measure of inflammation).⁵

Lifestyle changes that may be helpful

People who are overweight or have high blood pressure are at greater risk of developing gout.⁶ However, weight loss should not be rapid because restriction of calories can increase uric acid levels temporarily, which may aggravate the condition.

Vitamins that may be helpful

Large amounts of supplemental folic acid (up to 80 mg per day) have reduced uric acid levels in preliminary research.⁷ However, other studies have failed to confirm the effectiveness of folic acid in treating people with gout.⁸

In one small study, people who took 4 grams of vitamin C (but not lower amounts) had an increase in urinary excretion of uric acid within a few hours, and those who took 8 grams of vitamin C per day for a few days had a reduction in serum uric acid levels.⁹ Thus, supplemental vitamin C could, in theory, reduce the risk of gout attacks. However, the authors of this study warned that taking large amounts of vitamin C could also trigger an acute attack of gout by abruptly changing uric acid levels in the body. Another study showed that taking lower amounts of vitamin C (500 mg per day) for two months significantly reduced blood levels of uric acid, especially in people whose initial uric acid levels were elevated.¹⁰ For people with a history of gout attacks, it seems reasonable to begin vitamin C supplementation at 500 mg per day, and to increase the amount gradually if uric acid levels do not decrease.

In test tube studies, quercetin, a flavonoid, has inhibited an enzyme involved in the development of gout.¹¹ ¹² However, it is not known whether taking quercetin by mouth can produce high enough quercetin concentrations in the body to achieve these effects. Although human research is lacking, some doctors recommend 150–250 mg of quercetin three times per day (taken between meals).

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Autumn crocus (Colchicum autumnale) is the herb from which the drug colchicine was originally isolated. Colchicine, a strong anti-inflammatory compound, is used as a conventional treatment for gout. Both the herb and the drug have significant toxicity and should only be used under the guidance of a physician.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References

1. Ralston SH, Capell HA, Sturrock RD. Alcohol and response to treatment of gout. BMJ 1988;296:1641–2.

2. Scott JT. Alcohol and gout. BMJ 1989;298:1054.

3. Emmerson BT. Effect of oral fructose on urate production. Ann Rheum Dis 1974;33:276–80.

4. Blau LW. Cherry diet control for gout and arthritis. Tex Rep Biol Med 1950;8:309–11.

5. Kelley DS, Rasooly R, Jacob RA, et al. Consumption of Bing sweet cherries lowers circulating concentrations of inflammation markers in healthy men and women. J Nutr 2006;136:981–6.

6. Loenen H, Eshuis H, Lowik M, et al. Serum uric acid correlates in elderly men and women with special reference to body composition and dietary intake (Dutch Nutrition Surveillance System). J Clin Epidemiol 1990;43:1297–303.

7. Oster KA. Xanthine oxidase and folic acid. Ann Intern Med 1977;87:252–3 [letter].

8. Boss GR, Ragsdale RA, Zettner A, Seegmiller JE. Failure of folic acid (pteroylglutamic acid) to affect hyperuricemia. J Lab Clin Med 1980;96:783–9.

9. Stein HB, Hasan A, Fox IH. Ascorbic acid-induced uricosuria: a consequence of megavitamin therapy. Ann Intern Med 1976;84:385–8.

10. Huang HY, Appel LJ, Choi MJ, et al. The effects of vitamin C supplementation on serum concentrations of uric acid: results of a randomized controlled trial. Arthritis Rheum 2005;52:1843–7.

11. Bindoli A, Valente M, Cavallini L. Inhibitory action of quercetin on xanthine oxidase and xanthine dehydrogenase activity. Pharmacol Res Commun 1985;17:831–9.

12. Busse W, Kopp D, Middleton E. Flavonoid modulation of human neutrophil function. J Allergy Clin Immunol 1984;73:801–9.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires August 2007.