Gout is one of those conditions which can be aided considerably with a turn in diet and lifestyle, and is a form of arthritis which is regularly linked with “high living”. This health causes a rather painful accumulation of crystals of uric acid colse to the joint. I have seen many gout patients over the years, and I think I have seen one or two a women over the years in my clinic complaining of this rather painful condition.
I can still remember the first gout outpatient I ever saw, I was practicing in the trainee clinic in the 90′s. A male aged mid forties came in complaining of a very painful right ankle and big toe. He was a mechanic who enjoyed a beer, in fact he said: “Eric, I’ll do anything you suggest, I won’t be stopping my beer however, but I can’t live with this pain anymore”.
Neuropathy
A gout assault of pain regularly strikes unexpectedly, but generally subsides in a few days with treatment. However, some guys can experience pain for several weeks with gout attacks often re-occurring and without the definite supervision the attacks of pain may become more frequent and can be very debilitating indeed. You should experience your doctor if undoubtedly severe pain in a joint recurs or lasts more than a few days, especially if the pain is accompanied by chills or fever. Now let’s have a closer look at gout, what it is and what causes it and more importantly, how we can help the gout outpatient with some good natural rehabilitation suggestions.
Gout is arthritis
Gout is regarded as a form of rheumatism and is one of the most painful forms of arthritis. There are different types of arthritis such as osteoarthritis, the “wear and tear” arthritis of the larger joints like hips, knees, back, etc. Then there is rheumatoid arthritis which is the inflammatory (heat) arthritis affecting the smaller joints generally like the writs, fingers, etc. And then there is gout, what I call the “red-blooded male’s arthritis”. I can remember reading a book awhile ago about the era of the large ocean going vessels such as the Endeavour while the golden age of discovery. Many officers on board such vessels suffered terribly from gout. Mind you, they were the commanding men who drank plentifulness of rum and ate plentifulness of beef with lashings of gravy. So what has changed? Blokes still like to command, drink rum and coke or cold beer, and eat hot steaks and what red-blooded guy doesn’t? I have never seen a committed vegetarian suffering with gout, and very much doubt they even exist in this country.
Signs and Symptoms of Gout
Recurrent, acute attacks of pain, tenderness, redness, inflammation and swelling colse to the smaller joints - especially the joint of the big toe. Why the big toe you ask? common sense – because it is the joint at the lowest point of the body, the area where deposits of uric acid and other wastes tend to form due to gravity. If you are right-handed, the right big toe joint will be more likely affected than you left, and vice versa. This is because you step off and lead with your right foot as you walk, and is will have therefore a slightly best circulation of nutrients (and therefore also a wee more deposition of wastes) than your left foot. Reflexologists often talk about “crystals” forming colse to the toe joints, and you can feel “crunching” sensations if you prod firmly under your toes or wiggle the toe joints at times. The outpatient can also feel quite a sharp and rather intense pain in a small joint, particularly the toe or wrist. The affected joint can be red, hot, swollen and even throbbing. It may feel “on fire”. As earlier mentioned, the pain can be so unbearable that even a bed sheet can cause excrutiating pain.
Gout statistics
· Gout afflicts almost up to 0.5% of the people of the western world.
· Over 95% of gout sufferers are men aged 30 or over.
· Gout is twenty times more likely in males than women.
· Gout is strongly linked with being overweight and having high blood pressure.
· Gout can also occur in women, more generally after menopause.
· Maori (New Zealand indigenous peoples) and Pacific Islander peoples in single tend to have high uric acid levels and are predisposed to gout, especially the Maori patients I see who love abalone, mussels, roe (fish eggs like caviar) and crayfish (like lobster). I would expect that indigenous American or African peoples would similarly be affected by gout, particulary when they live in the developed Western countries and eat foods high in purines.
· The type of individual most generally affected by gout is an overweight man who drinks large amounts of alcohol, is a regular meat-eater, loves rich foods and who may have high cholesterol and high blood pressure.
What causes an acute gout attack?
· obvious medications, such as some types of diuretics, can cause gout. Aspirin and niacin (Vitamin B3) can also raise uric acid levels.
· obvious diseases can lead to an inordinate output of uric acid in the body, including some leukaemias, lymphomas and some haemoglobin (blood) disorders.
· Some studies have indicated an increased prevalence of low thyroid function (hypothyroidism) in people with gout.
· Dehydration (alcohol & caffeine dehydrates).
· Injury to a joint.
· inordinate intake of purine-containing foods (see list below).
· Heavy alcohol intake.
· recent surgery (this may be linked to changes in the body fluid equilibrium because of fasting before surgery).
· family history – hereditary.
What is Uric acid?
Approximately 70% of gout patients have an overproduction of uric acid, the remaining 30% of gout patients have a poor elimination of uric acid, therefore it makes sense to eat fewer foods which help to yield uric acid, and heighten uric acid elimination by way of the kidneys.
Uric acid is a by-product of the breakdown of obvious foods in the body, and gout was once thought about to be intimately linked just to diet. It is now understood that inheriting a problem with uric acid excretion from the body is probably one of the most common reasons for gout to occur. Improving a person’s kidney function as much as potential has helped many gout sufferers I have seen over the years.
Uric acid is the end product of the metabolism of chemicals called purine that are found in many foods. Purines are also found simply in the body, and normally, the body disposes of excess uric acid via the urine, but in people with gout uric acid accumulates in the body. This can be due to reduced excretion of uric acid by the kidneys or to overproduction of uric acid by the body. This accumulation of uric acid may also cause kidney stones, and it doesn’t take a rocket scientist to work out that you need to heighten the kidney function as much as is potential to help the outpatient overcome gout.
Gout can be very painful indeed
How come gout hurts, where does all that pain come from? Simple, when the uric acid fetch in the blood and tissues it can crystallise out into a joint, forming a multitude of tiny, jagged, needle-shaped crystals. This triggers an intense inflammatory response that causes a painful arthritis assault called a gout attack. Have you ever stood on a pin or a needle, maybe some broken glass and got vexed and vexed by this? Then you will know how a gout sufferer will feel – they can be most vexed and vexed like a child who has just stood on a pin cushion. Pain has a way of bringing out the worst in many people! As I mentioned, gout generally strikes the big toe, but other joints can be affected, including the instep, ankle, knee, wrist, elbow and fingers. Acute pain is generally the first symptom and then the affected joint becomes inflamed (almost infected-looking): red, swollen, hot and extremely sensitive to the touch. I have many times seen a case of gout in the clinic that the patient’s doctor referred to as “osteoarthritis”, when in fact it had all the makings of gout. Signs and symptoms such as a needle-like pain affecting the small joint, male outpatient who enjoys alcohol drinker, crayfish and roe (fish eggs), enjoys barbeques and steaks, etc. common things happen to people commonly, I have often said.
The funny thing with guys is, you see them once then you don’t tend to see them again in the clinic. I believe that it is purely the pain that brings them ultimately to see the practitioner. This is especially so for some larger blokes I have seen where the pain was not helped to a large degree by the suitable gout drugs, and then there is much more of an urgency to that appointment. I have often said that there is nothing more than a high degree of pain to bring a guy to your room as a patient. If you are a regular reader of my column, you may recall that I have often said that males belong to the “John Wayne School of Health”: “I’ll be alright, there’s nothing wrong with me, and I’ll just get right back on that horse and keep on riding”. I can recall in one Western that even John Wayne himself went to see a doctor when the pain of a rather large shotgun blast in his shoulder was preventing him from undoubtedly getting on his horse, and even then the doctor’s visit seemed was under duress!
Good thing that, the pain, it may be nature’s way of getting guys off their horses (or out of their cars) and into clinics! If a woman experiences pain, let’s say one out of a scale of ten – then she is off to get it investigated. She tends to be much more proactive, is it any wonder a woman will live longer than a man? Males tend to wait until the pain moves from four to five out of ten, and even then, the visit is seen as an “inconvenience”. If a man would only start to heighten his gout when he experiences the pain at a level of one out of ten, then he will find it a lot easier to turn gout colse to than when the pain is nine out of ten. This is because at low occasional pain levels, gout is not quite a disease process yet, it is a functional disturbance which can be much more undoubtedly corrected. An appointment with the naturopath at this stage will relate that the man will probably be eating and drinking the wrong foods contributing to the progression of his gout, all he needs at this stage is a turn of diet and an correction in his kidney function to help the clearance of uric acid. best still, if his blood can be cleansed with suitable rehabilitation such as a detox process, he will feel much better, reducing and even maybe eliminating his chances of developing full-blown gout.
A visit at high pain levels will only be sought in terms of pain relief, and there will be prognosis or disease present. And the stronger the pain, the more urgent will be the pain relief naturally. Seriously bad gout pain can make the biggest blokes cry like the biggest babies, I have seen this on one opening when a tough Aussie male burst into tears as he told me that even the thin sheet at night on his big toe was excruciatingly painful. This guy was into cold beer and hot pies and had plentifulness of both, the tears were real and no laughing matter folks!
These cases are harder to turn colse to because all the focus is purely on strong pain control. Supplements may work, but are not as marvelous as pharmaceutical drugs when it comes to pain control, hence the hypothesize why we only see the gout outpatient once. The drugs which operate pain wreck the person’s digestion in time, that’s the real problem and the stark reality. And the fundamental problem is not undoubtedly sorted either, the offending ways continue and so does the gout. So convenient, just switch off that pain. Involving if we correlate the recent financial urgency which was due to “extending credit”, I think rehabilitation is going down the same path until we end up with the upcoming “health crisis” globally which will be due similarly to extending reputation of a different nature. You temporarily solve a problem by taking away the pain but generate the long term urgency and avoid treating the real fundamental causes. I have to admit, this is one area in which natural therapists fail – strong pain control. We are the prophylactic rehabilitation experts. Acupuncture will have some benefit here, but many patients are just not keen on the needles. Herbs or supplements? Not really, drugs do work well but why wait until you need strong pain relief is my question, why not address conditions like gout Before you need the strong solution?
Conventional rehabilitation of gout Allopurinol is the pharmaceutical drug of selection used in long-term arresting of gout and decreases the body’s output of uric acid. people experiencing gout attacks should, however, avoid medications containing aspirin as these can make gout worse. Pain relievers such as paracetamol or other more marvelous analgesics, are often used to manage the pain. Anti-inflammatories, such as non-steroidal anti-inflammatory drugs (Nsaids), are used to decrease joint inflammation and sell out the pain. If Nsaids cannot be given because of an ulcer, your doctor may use colchicine may be used to rule an attack. I have found the homeopathic colchicines (30c) can be very useful for the gout outpatient instead of this drug. Do you take a “water tablet” or a diuretic? Pharmaceutical diuretics may cause gout in people who are genetically predisposed to gout by addition the accumulation of uric acid within the body.
Resting the joint, maybe in a splint, and applying ice packs may help. Ice is a great acute gout rehabilitation which I extremely recommend.
Preventing supplementary gout attacks
Prevention is the thing which you need to focus your attentiveness to, and in my belief is equally as leading as treating the gout.
· reduction or elimination of alcohol consumption, this is the Big one in my opinion. Alcohol causes uric acid levels to rise and has a diuretic follow that can add to dehydration and bring on gout attacks
· Make sure you drink plentifulness of water to promote the excretion of uric acid;
· Weight reduction, is often necessary. This can be achieved by reducing dietary fat and calorie intake, which should be combined with a regular (walking) programme.
· “Crash diets” should be avoided as this can lead to an growth in uric acid levels through lowered uric acid excretion, you put more pressure on the kidneys and liver when you try to lose weight too quickly and end up with more problems than you can solve!
· Dietary changes to sell out uric acid levels in the blood. Avoid purine-rich foods such as shellfish, organ meats (liver, brains, kidney etc.), and fish roe, abalone, lobster or crayfish, crabs, anchovies and sardines.
· Limit the intake of dried beans and peas and yeast products like beer and bread.
· Try an ice pack on the affected area, sometimes a foot spa can help as well.
· Reflexology has helped many patients and is well worth a try, so is aromatherapy.
Eric’s gout recommendations
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Water
This is the Big one, drink at least six glasses per day and make sure that you have one of the glasses before you go to sleep – it helps get rid of uric acid. The more you pee the more uric acid you get rid of.
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Reduce serum uric acid levels.Vitamin C in doses of 4000 up to 8000mg/day increased urinary excretion of uric acid and lowered serum uric acid levels in many trials. This follow would presumably sell out the risk of gout. However, it has been argued that rapid mobilisation of uric acid could trigger a gout attack; although such an follow of vitamin C supplementation has not been reported. To minimise this theoretical risk, I recommend the gout outpatient to start vitamin C at lower doses and build up gradually.Eat cherriesBlack cherries are the best (fresh or canned) up to 250gr aday or the equivalent number of cherry juice, has been reported to relax acute attacks, preclude recurrences, and sell out serum uric acid levels. Sweet yellow and red sour cherries were also effective. I have seen major improvements in more than a few males who stepped their intake of cherries up with acute attacks and have major pain relief (drug-free) within a week. Folic acid in doses of 10mg/day, when combined with unspecified doses of vitamin C, has been reported to sell out serum uric acid levels.
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Reduce fructose intake. High consumption of fructose (fruit sugar) may growth the risk of gout due to the ability of fructose to growth the body’s output of uric acid.If you have bad gout, avoid these high fructose food items: Honey, dates, raisins, figs,
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Alcohol Daily drinking habits, lack of exercise, and dehydration heighten the growth in plasma attentiveness of uric acid induced by alcohol, and it is leading to pay attentiveness to these factors, as well as to the ingested alcohol volume and type of alcoholic beverage. An excess of alcohol should be avoided. Total abstinence and avoidance of alcohol may be required in severe cases. The worst alcohols to consume with gout are the ones you “can’t see though” like whiskey, bourbon, rum, beer, etc. The alcohols which don’t seem as bad are the “clear” ones like vodka and gin. You should avoid All alcohol if you have bad gout. See now why guys don’t tend to come back to the naturopath now if they have bad gout? One male gout outpatient called me the “fun police”, when I made the recommendations of abstinence. I expect his pain levels were not high enough, believe me, Any male will do anything it takes to get rid of that pain!
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Diet Consume a moderate number of protein. Limit meat, fish and poultry to 100 – 120 grams per day. Try other low-purine good protein foods such as low fat dairy products, tofu and eggs.
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Body weightMaintenance of, or gradual reduction to, ideal body weight could prove helpful. Your blood pressure will drop, so will your cholesterol and not only your likelihood to avoid gout attacks, but you will sell out your chances of most lasting diseases.
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Diet Avoid as much as possible: anchovies, crayfish or lobster, shellfish, abalone, fish roe (or eggs live caviar), herring, mackerel, meat extracts, beef in general, kidney or organ meats, lamb, pork, mussels, paua, roe, sardines, yeast (baker’s and brewer’s, taken as supplement) coffee, tea and All alcoholic beverages, chocolate, cocoa, caffeine containing soft drinks, wheat germ, pastry, high fat biscuits and cakes, whipped cream, fried potato, potato chips, broth, bouillon, consommé, meat stock soups and gravies. Eat these foods with caution: Asparagus, dried beans lentils, meat, mushrooms, dried peas, spinach (silverbeet) To have in your diet: Milk and milk drinks, carbonated beverages, cereal/grain beverages. All breads and cereals, low fat biscuits, cakes, and puddings. Fat in moderation only, fruit juices such as cherry, blue berry are particularly good. Eat cherries and blue berries. Fish ok, but stick with younger fishes. Chicken and ham, soups, most all the common vegetables, condiments, herbs, nuts, olives, peanut butter, pickles, popcorn, relishes, salt.
Do You Have Gout?
