It has been called a disease of overindulgence. But not everyone with gout fits the image of a beer-drinking, beef-eating, overweight middle-aged man with an exquisitely aching toe. “I simply seem to be sensitive to meats, especially red meat, and to gravies and other fatty, rich foods,” says Frances George of Cusick, Washington. She blames bad genes, not bad habits. “My father had gout, and so does my son,” she says. In fact, it wasn’t until her son was diagnosed with gout as a teenager that she realized that her long-standing ankle pain has the same cause. “I’ve never had it in my toe, so that misled me for a while,” she says.
A form of arthritis, gout causes the same symptoms: joint pain and swelling. Usually, the pain is limited to the first joint of the big toe, other joints in the foot, the knee and sometimes the wrist and elbow.
The pain occurs when sharp crystals of uric acid form in the fluid surrounding a joint. That happens when blood levels of uric acid become too high—or, paradoxically, drop too quickly. Alcohol, rich foods, drugs that reduce blood pressure, lead poisoning, even inherited metabolic disorders can cause gout. Uric acid can also crystallize in the kidneys and other soft tissues, causing damage. So staving off attacks is important for reasons that go beyond pain prevention.
A gout attack often starts at night, as a joint becomes increasingly hot, swollen and painful. “It can come on fast,” George says. “It usually doesn’t wake me up at night, but I can go to bed fine and wake up in the morning with a stiff, swollen ankle.” For her, that attack might come after eating meat for a few days in a row or chowing down at a favorite local restaurant with an all-you-can-eat buffet that features prime rib. “I don’t eat any more than anyone else, but I’m the only one who ends up with gout,” she laments.
George knows that if she sticks with low-fat vegetarian fare, her symptoms will subside. So that’s what she does when her ankle acts up.
Indeed, most cases of gout respond very nicely to dietary changes, says Joseph Pizzorno, Jr., N.D., a naturopathic physician and president of Bastyr University in Seattle. “Dietary changes are all that many people need to control their symptoms,” he says. For some, avoiding alcohol is all that’s necessary. Others may need to cut back on both alcohol and certain foods, such as meats. These foods are rich in purines, protein components that are converted to uric acid in the body.
Ironically, gout can also be induced by very low calorie diets—starvation diets, for example—which also increase blood levels of uric acid as the body begins to break down tissues, explains Jeffrey Lisse, M.D., associate professor of medicine and director of the Division of Rheumatology at the University of Texas Medical Branch at Galveston.
Although individual nutrients are not the main dietary treatments for gout, there are a few that can prove helpful.
| Prescriptions for Healing Dietary changes and drugs, not vitamins, are considered the primary strategies for preventing gout attacks. But some experts believe that these vitamins may provide an additional edge. Nutrient Daily Amount
Folic acid 10,000-40,000 micrograms Vitamin E 400-800 international units Plus a supplement containing the Daily Values of all of the B-complex vitamins
MEDICAL ALERT: If you have symptoms of gout, you should see a doctor for proper diagnosis and treatment. This dosage of folic acid is way beyond the Daily Value of 400 micrograms and is available only by prescription. Take this much folic acid only under medical supervision. Large doses of folic acid can mask symptoms of pernicious anemia, a vitamin B12deficiency disease. If you are considering taking more than 600 international units of vitamin E, it's a good idea to discuss it with your doctor first. If you are taking anticoagulant drugs, you should not take vitamin E supplements. |
Folic Acid Dissolves Crystals
Some doctors recommend folic acid, a B vitamin that in large doses inhibits xanthine oxidase, the enzyme responsible for the body’s production of uric acid. In fact, one prescription drug used to treat gout, allopurinol (Zyloprim), also inhibits this enzyme.
“I wouldn’t use folic acid alone, but it may be helpful to some people as part of a complete package of dietary changes and nutritional supplements,” says Dr. Pizzorno. The vitamin won’t resolve an acute attack, when uric acid crystals have already formed in a joint. But it may help ward off further attacks.
The recommended dosage, 10,000 to 40,000 micrograms of folic acid a day (25 to 100 times the Daily Value of 400 micrograms), is far more than is available from even the best food sources. “People must take supplements to get this large amount,” Dr. Pizzorno says. And supplements in this large amount are available only by prescription. So if you’d like to try folic acid as a preventive, you’ll have to discuss it with your physician.
Here’s another good reason for taking large doses only under medical supervision: Not all studies find side effects at large doses, but in one that did, people taking 15 milligrams (15,000 micrograms) of folic acid a day complained of nausea, bloating, problems sleeping and irritability. Large doses of folic acid can also mask symptoms of pernicious anemia, a vitamin B12–deficiency disease.
Since some experts contend that large doses of any one of the B-complex vitamins can cause shortages of others, your doctor probably will also have you take a supplement containing the entire B-complex.
| Food Factors Even if drugs control your gout, some doctors believe that it's wise to change your eating habits to avoid future attacks. That way, you can avoid taking drugs, with their unpleasant side effects. Plus you'll be eating heart-healthy fare. In most cases, gout responds well to dietary changes. Here's what many doctors recommend. Purge purines from your platter. Liver, beef, lamb, veal, shellfish, yeast, herring, sardines, mackerel and anchovies are all high in purines, protein components that break down to form uric acid. Doctors recommend avoiding these foods during a gout attack and limiting your intake of them between attacks. Say good-bye to booze. Drinking alcohol causes a buildup of uric acid in the body because it increases uric acid production at the same time that it reduces uric acid excretion. That's why so many gout sufferers pay the price for a single episode of overindulgence. "Eliminating alcohol is all many people need to do to avoid attacks," says Joseph Pizzorno, Jr., N.D., a naturopathic physician and president of Bastyr University in Seattle. If you do drink occasionally, stick to hard liquor or wine, both of which have fewer purines than beer. Try cherries. Many people with gout swear that eating cherries helps quickly resolve attacks. Only one study, though, published in 1950, found that eating about a half-pound of fresh or canned Royal Ann or black Bing cherries a day helps lower uric acid levels. But it's worth a try. "Cherries, hawthorn berries, blueberries and other dark red-blue berries are rich sources of anthocyanidins and procyanidins," Dr. Pizzorno explains. These compounds apparently help strengthen and prevent the destruction of the connective tissue that forms joints as well as inhibit tissue-destroying enzymes secreted by immune cells in the course of inflammation, he explains. Go for the H2O. Drinking lots of water keeps urine dilute and promotes the excretion of uric acid, says Jeffrey Lisse, M.D., associate professor of medicine and director of the Division of Rheumatology at the University of Texas Medical Branch at Galveston. Drinking lots of nonalcoholic fluids during a bout of gout is particularly important. It prevents your kidneys from forming uric acid crystals, which can lead to damage and kidney stones. Peel off the pounds. If you're overweight, reducing will lower uric acid levels, Dr. Pizzorno says. "A high-fiber, low-fat diet--fruits, vegetables, whole grains, beans and the like--is the best way to go," he says. Gradual weight loss is mandatory, however. Losing weight too fast also increases uric acid levels and can trigger an attack, says Dr. Lisse. |
Vitamin E Adds Anti-inflammatory Power
Some doctors add vitamin E to their gout-relieving prescriptions. While there are no studies to show that vitamin E alone can abort or prevent a gout attack, this vitamin has properties that may help dampen inflammation, Dr. Pizzorno says. He suggests 400 to 800 international units daily, both during and between attacks. (If you are considering taking more than 600 international units of vitamin E daily, it’s a good idea to discuss it with your doctor first.)
Vitamins to Banish
Two vitamins that you’ll want to avoid in excess during a bout of gout are vitamin C and niacin. “Both increase uric acid levels in the body,” Dr. Pizzorno says. By the way, low doses of aspirin, a commonly used anti-inflammatory drug, also increase blood levels of uric acid, says Dr. Lisse. So you’ll want to avoid using it to relieve gout pain. “Any other nonsteroidal pain reliever is safe,” he adds.
