Got Gout? Here's What You Need to Know

Dr. Mike: Hey, Dr. Mike here. Have you heard of the Disease of Kings? If not, stick around to learn if you are at risk.

Live Foreverish Introduction: You're listening to Live Forever-ish, a show dedicated to helping you live just a little longer. Here's your hosts, Dr. Mike and Dr. Crystal Gossard.

What Is Gout? 00:00:16

Dr. Mike: Alright. Welcome to Live Foreverish. Today we're talking about gout, Dr. Crystal.

Dr. Crystal: I'm happy we're talking about this.

Dr. Mike: That's interesting. Do you have gout?

Dr. Crystal: It runs in my family.

Dr. Mike: Oh, there you go.

Dr. Crystal: All right.

Dr. Mike: Yeah, the Disease of Kings, right? [For] most people in the old days, it [had to do with] meat consumption. It was the kings, queens and the royalty having those crazy parties! I don't know if they had crazy parties.

Dr. Crystal: Yeah, it was the meat. It was alcohol, and the poor people didn't have [all of that].

Dr. Mike: [Right], they didn't have all that stuff.

Gout is basically a form of arthritis. People need to know that: It's a crystalline type [of] arthritis. It happens because of the accumulation of urate crystals in the joints. Listen, [the attacks] are usually brief, but they can be debilitating when you have one.

Dr. Crystal: That's what I hear [from] my family members. You don't even want the covers to touch your feet!

Dr. Mike: Everything is overly sensitive, and it throbs. There's a lot of throbbing with this, and it occurs most often in men.

Dr. Crystal: And you're also seeing [it in] post-menopausal women! It's starting to increase in those individuals.

Dr. Mike: Interesting—a hormonal link. Something [is] going on there.

Basically, uric acid is the culprit here. And it comes from a specific type of metabolism called purine, which you find in certain meats, cheeses and alcohol.

Then, you end up getting hyperuricemia. Hyperuricemia in and of itself doesn't mean you have gout; it's just a risk factor for developing gout.

Dr. Crystal: Exactly.

Dr. Mike: It predisposes you to get those [uric] crystals in your joints.

Dr. Crystal: Building up.

What Are the First Signs of a Gout Attack? 00:02:10

Dr. Mike: Let's go through some of the initial signs of gout.

Dr. Crystal: Well, it's pain, immediate pain. It comes on really fast, not gradual. You wake up in the morning, or it comes on at night…

Dr. Mike: Early morning! I’ve heard early morning is kind of the key.

Dr. Crystal: [Yes], first thing [when] you wake up. Typically…the joint between the big toe and the ball of the foot is often affected—most often!

Dr. Mike: People think that's the only place. It's not.

Dr. Crystal: Correct…but it's usually one location.

Dr. Mike: Yeah.

Dr. Crystal: Especially [for] that first attack.

Dr. Mike: Most people with that first attack [of gout], that's where they're going to deal with it most of the time.

Dr. Crystal: Yes, and you also may have fever, some redness, you’ll have an elevation of white blood cells. Typically, I don't think it's very difficult to identify: I think this is gout.

Dr. Mike: Yeah, it’s pretty clear.

Dr. Crystal: …when it first comes on.

Dr. Mike: It’s so painful; it’s pretty clear. Most doctors don't have a problem diagnosing [gout].

We do know that the causes [are] probably linked to genetics and some lifestyle [factors], right?

Dr. Crystal: I think we have to take a pause for the cause [on] the genetics because…

Dr. Mike: A pause for the cause?

Dr. Crystal: A pause for the cause, because many people suffer in silence, or they may not go to their doctor, because they feel ashamed.

Sometimes it's from their family members, maybe it's [from] something that they are doing, but [it’s important to understand] that there is a genetic basis.

Can Gout Be Genetic? 00:04:21

Dr. Crystal: It's not the fault of the sufferer. Red meat is associated with [gout], [but it] doesn't mean that the person is consuming an overly large amount of red meat. It's just because of their genetics, they're more likely to…

Dr. Mike: Exactly.

Dr. Crystal: …build up uric acid.

Dr. Mike: Your purine metabolism [has enzymes and proteins]. It’s a metabolic pathway. You're going to be a little different than me, right?

Dr. Crystal: Right.

Dr. Mike: [It doesn’t] necessarily [mean] somebody has gorged themselves with meat and beer, but that's the stigma.

Dr. Crystal: But then, sometimes people [do].

Dr. Mike: Yes, sometimes it is [true]!

Dr. Crystal: That's something to consider, but we do see specific genes involved in gout’s inflammatory process.

Dr. Mike: Now, here’s what’s interesting—and I think this is very important point to bring out and talk a little bit about.

Even though gout usually has an [initial attack]…and then it’ll clear, and then you’ll have another one later, it can be very different for people. It’s kind of all over the place.

But what we're learning is in between those times [of] feeling pretty good, there's still some uric crystals floating around causing inflammation.

Gout and Uric Acid 00:05:49

Dr. Crystal: Right, and that's when you're seeing the elevated uric acid levels—that's the crazy part. When someone's in the middle of an attack, their uric acid levels may not be elevated.

Sometimes you have to confirm [the] elevated uric acid either before [or] 2 to 4 weeks after the attack. It’s really between the attacks is where you’re having that uric acid elevated, those crystals are forming and brewing up.

Dr. Mike: What are you…? If you watch on YouTube, you can see what [Dr. Crystal] is doing…

Dr. Crystal: So I thought that was interesting.

Dr. Mike: We're going to get into foods in a moment—the purine foods. But other common triggers [like] infection.

This [next one] is a big one. As a radiologist, we were always taught to watch out for contrast media.

When you're doing CT scans or MRI scans with contrast, one of the warnings is, if you have a bad joint [and] it gets pain, go see your doctor. That could be associated with [gout].

Dr. Crystal: Oh, that's what you tell someone?

Dr. Mike: Yes, you have to tell them that.

[Gout is associated with] acidosis, some trauma, chemotherapy and [even] psoriasis. There’s some link there as well. At the end of the day, this is a very painful type of arthritis. It can be debilitating.

It needs to be treated and controlled because you can get chronic gout, which is what you don't want. You start getting crystals all over the place, and that’s not good.

Dr. Crystal: True, and now you're damaging your joints and have chronic inflammation.

Dr. Mike: We always like to share…trending questions. One of the questions about gout is: Will it go away on its own?

Dr. Crystal: It can, in about two weeks.

Dr. Mike: And it does in most people. But remember, you want to control that inflammation [and] uric acid. That's why treatment is so important.

Dr. Crystal: Yes, because if you don't treat it, then the attack can reoccur.

Dr. Mike: Let's go into food.

What Foods Should You Avoid if You Have Gout? 00:08:13

Dr. Crystal: So, what are those high purine foods? We mentioned red meat, but also pork, lamb…and seafood.

Dr. Mike: Anchovies!

Dr. Crystal: Sardines, mussels, scallops, trout and tuna, alcoholic beverages. I know we weren't going to go into it, but specifically beer and liquor. And high-fructose corn syrup.

Dr. Mike: When it comes to beer, the beers that have more of the malt, the darker beers, heavier beers, IPAs—one of my favorites, Indian Pale Ale—those are going to have more carbs and sweetness in it. Those are probably more associated with [gout].

A low-calorie, low-purine diet [is recommended]. And one of the best you can do is…

Dr. Crystal: …a plant-based diet. A whole food plant-based diet—I do want to say that. We're not talking about eating a bunch of fake meat.

Dr. Mike: Because there may be stuff that you don't want!

Dr. Crystal: People think plant-based a.k.a. vegan, and that's not really what we're talking about. There was a study published in JAMA Network Open last year, and they reviewed over 122,000 participants, and found that men and women who had the highest adherence to a healthy, plant-based diet had a 21% lower risk of gout than those whose adherence was among the lowest.

Dr. Mike: Yeah.

The Best Foods for Gout 00:10:04

Dr. Crystal: We had some more context here that we didn't include, but they grouped the plant-based diets to those who were really following a healthy plant-based diet with fruit, vegetables and leafy greens, versus a plant-based where they were just taking out meat but still eating potatoes.

Dr. Mike: Well, don't knock potatoes too much! We're knocking everything here.

Let me back up, when you say plant-based. Is that 100% or is that like our 80-20 rule: 80% plant-based, 20% meats that aren't associated with purines?

Dr. Crystal: So, more of whole food plant-based, not having meat at all.

Dr. Mike: Not having meat at all? Okay, interesting.

Other people also talk about anti-inflammatory diets, but if you're following [a] plant-based [diet], a healthy one, that's anti-inflammatory.

Dr. Crystal: Yes, but you can have plant-based and go to…sugar, sweets, these plant-based desserts. There's a bakery around the corner where it's all plant-based.

Dr. Mike: But it’s still a lot of sugar!

Dr. Crystal: It's still a lot of sugar and refined carbs.

Dr. Mike: You still have to watch that.

Dr. Crystal: So when we say the anti-inflammatory diet, that means limiting pro-inflammatory foods.

Dr. Mike: We're going to get into the gist of what a lot of people want: How do we treat all this? There are conventional treatments we'll get into, but there's also nutrient add-ins we'd like to share with you, as well.

Let's first talk about when somebody has an acute attack, what's probably going to be prescribed by their doctor. [Likely] some form of an NSAID [non-steroidal anti-inflammatory drug] is going to be given …and likely some steroids.

What Are the Most Common Treatments for Gout? 00:12:08

Dr. Crystal: Yes. If it is an isolated area, they may even give you an intra-articular injection of a steroid—just to get it right in there!

Dr. Mike: And those are rough!

Dr. Crystal: Well, it can quickly get rid of that attack.

Dr. Mike: If you could get through it, about five minutes later, you're feeling 100% better.

Dr. Crystal: You deal with one pain or the other. Which one?

Dr. Mike: That’s for isolated [gout]. I don't know what percent that is. That's probably most people, I think, at least in the initial attack.

But again…it’s not the big toe [for everybody], it can be in other places. It could be multiple joints, and in those cases, it's probably oral or intramuscular.

Dr. Crystal: Yes.

Dr. Mike: And then colchicine, which [disrupts] your inflammatory process. That's a very common drug that's prescribed, as well.

That's acute, though. You're basically just helping it heal faster, resolve faster, because it probably will resolve on its own, but you don't want to be in pain like that for two weeks.

Dr. Crystal: Correct.

Dr. Mike: So, you're going to get treated this way. On the conventional side, what are we doing nowadays for long-term control?

Dr. Crystal: There are three main strategies: You can inhibit uric acid production, increase excretion of uric acid [or] give your body the enzyme to break down uric acid. We don’t have the enzyme to break down uric acid. The enzyme is available to [help you] degrade the purines.

Dr. Mike: …Inhibiting uric acid production is probably the most common approach. That's your allopurinol.

Dr. Crystal: Yes, first line treatment.

Dr. Mike: It is basically an inhibitor of one of these important enzymes in that metabolic process.

There are other ones, but speaking of kings, that's the king of gout medicine.

As you said, there's increased uric acid excretion. There are just choices there that might be helpful for some people. The recumbent one is interesting, I think.

Dr. Crystal: I think it's really cool. It's giving us enzymes that we don't have.

Dr. Mike: I wonder how they do it. If you could get that into your cell’s DNA, you could replicate better.

I know this is not that; this is just giving the enzyme. But imagine going to the next step, the genetic level.

Can Vitamins Help Manage Gout Naturally? 00:15:06

Dr. Crystal: That would be…what do they call it? Where you can now chop up your DNA and kind of…

Dr. Mike: Splice it and stuff.

Dr. Crystal: …splice it! That's on the horizon.

Dr. Mike: That’s genetic editing. It's on the horizon. It's really exciting. Those are going to be your classic [treatments], but there is good news on the natural side of things. There are nutrient add-ins that we’d like to share with you.

Talk to your doctor about [these], it’s not going to hurt to add [to your routine]. You’ve already talked about vitamin C when we did a reel…You got all excited about vitamin C!

Dr. Crystal: Because it’s just 500 mg of vitamin C, an average dose of vitamin C. We found that there was a 12% reduction in new gout diagnosis. This was an analysis [of] over 14,000 men enrolled in a study.

Dr. Mike: And that was oral, right?

Dr. Crystal: Yes.

Dr. Mike: Oral vitamin C. So simple!

Dr. Crystal: Yeah.

Dr. Mike: It's cheap, and we probably need it anyway.

Dr. Crystal: Just a daily add-in.

Dr. Mike: Yeah, a daily add-in [of] 500 mg.

Dr. Crystal: If you have gout, then that should be something that you take every day.

Dr. Mike: I like this one: coffee.

Dr. Crystal: Oh, yeah.

Dr. Mike: Another simple one. Let's first talk about what the study is, and then we'll talk about the add-in as a nutrient.

This [study] is just looking at coffee drinking…and this was a big meta-analysis too.

Dr. Crystal: But there was a lot of coffee involved. Stand-by for the dose!

Dr. Mike: This is a meta-analysis, we like those. Pooling the data of nine studies, including over 175,000 men and women. They concluded that if men drink between 1 to 3 cups per day…

Which, that’s not so bad. I mean, I [drink] two shots of my espresso…

Dr. Crystal: So, you're almost there!

Dr. Mike: You don’t. You only have one cup a day?

Dr. Crystal: One. Well, unless I'm really tired, [just] one cup.

Dr. Mike: Well, that's not good because…

Dr. Crystal: I don’t want heart palpitations!

Dr. Mike: …for women you need 4 to 6.

Dr. Crystal: I don't know if I could do that.

What the Study Says: Coffee and Gout 00:17:27

Dr. Mike: So men who drink 1 to 3 cups [daily] and women who drink 4 to 6 cups [daily], there was a lowering of the serum uric acid levels.

Another study looked at the same thing, saw the same association and claimed that this was a nice way to reduce the risk of gout.

Dr. Crystal: Let's go back to that coffee—realize that our average coffee cup is two servings. Maybe, I do drink more than [one cup]. Usually in these studies, one cup is typically about 5 or 6 oz. If you go and get like a 12 oz coffee, that's…

Dr. Mike: Oh, that's huge.

Dr. Crystal: That’s like a medium at Dunkin Donuts.

Dr. Mike: In the old days, I remember my grandma used to have her coffee cups and they were smaller.

Dr. Crystal: Right.

Dr. Mike: I don't know what size they were, but they were not the mugs most people use today.

Dr. Crystal: So when we say a cup, we're not talking about a true 8 oz cup. We’re talking about 5 oz.

Dr. Mike: Yes, the normal coffee serving. Maybe it's not so bad.

Dr. Crystal: So maybe it’s not so bad, that kind of what I'm thinking.

Dr. Mike: Again…we're fans of coffee. We’re also fans of standardized coffee add-ins, nutrient add-ins, because there are key compounds in coffee that are helpful for so many things, including sugar issues.

I wonder what's going on there. For instance, we know chlorogenic acid in coffee is good for sugar levels.

Dr. Crystal: And we know gout is associated with diabetes, overweight, obesity, metabolic syndrome…

Dr. Mike: So you think it’s a sugar issue?

Dr. Crystal: But coffee is also anti-inflammatory.

Dr. Mike: Oh, yeah.

Dr. Crystal: So maybe it's a multimodal approach.

Dr. Mike: In these studies, they drank coffee. But if you don’t want to do that—not everybody likes coffee—maybe [try] a nutrient add-in. It’s something to think about. They’re out there—good for your heart, good for sugar [levels]. Give it a shot!

Are There Herbal Remedies for Gout? 00:19:40

Dr. Mike: All right…we have a few more here. Chinese herbs, there’s some that have been used for quite some time to treat gout [and] inhibit the same enzyme as allopurinol does. Cinnamon, that’s a good one. Polygonum cuspidatum…

Dr. Crystal: Oh, yes.

Dr. Mike: Did I say that right? I think I got close. There are other ones in there if you want to try those.

Dr. Crystal: Well, the cinnamon for sure. The Polygonum, I think I've had that before. I need to brush up on my Chinese.

Dr. Mike: I think they all fall into the warming herbs and spices. That's why cinnamon's there. That would be my guess.

Dr. Crystal: But we do know, Terminalia bellirica, and then, to a lesser extent, Terminalia chebula. Both of these inhibit the enzyme involved in uric acid production. So, it helps to lower uric acid.

We have research [comparing] two groups: the active group and the placebo group in a randomized trial [of] 88 participants with high uric acid levels. They were [assigned] 250 or 500 mg of Terminalia bellirica twice per day for 24 weeks. [In the active group] there was a significant reduction in uric acid in as early as four weeks.

Dr. Mike: So, they started seeing results early, but they went out 12 weeks total?

Dr. Crystal: 24 weeks.

Dr. Mike: Okay, 24 weeks. That's great. There are some choices there now.

Next, hot off the press!

Dr. Crystal: When we say hot off the press, I want to clarify: We're filming this March 2025.

Dr. Mike: And this study was published on March 20th, 2025, on vitamin D.

Dr. Crystal: Now, you know what surprised me about this study? I guess we should tell them the details.

Vitamin D and Mortality Risk 00:21:48

Dr. Mike: Well, yeah.

Dr. Crystal: They really didn't increase vitamin D to levels that we would consider optimal! So, this study included 7,337 people with gout.

Those with serum vitamin D of at least 18 nanograms per milliliter had a 28% lower risk of all-cause mortality during an 11.4-year median follow up, compared to gout patients whose vitamin D levels were lower.

Dr. Mike: Right.

Dr. Crystal: So, we're seeing some promise here.

Dr. Mike: Yeah, I think it's good. Like vitamin C, vitamin D is not going to hurt you.

Dr. Crystal: Yes.

Dr. Mike: Go ahead and add it! And this is a consistent thing we see across the board with vitamin D studies. Either they don't look at blood levels, or when they do, they go with standard conventional blood levels. You are going to get better efficacy at…the higher blood levels we [support].

Dr. Crystal: It’s like, well, what were the levels of the other people?

Dr. Mike: If they're like average people, very low.

Dr. Crystal: Improvements at 18 nanograms per milliliter! Wow.

Dr. Mike: Anyways, there’s a list of some nice nutrient add-ins. If you are suffering with gout, talk to your doctor, of course. Hopefully this information was helpful.

Don't forget to go to LiveForeverish.com where you can download, like, share, comment, review…

Dr. Crystal: Yes!

Dr. Mike: …and subscribe so you never miss a show! There are tons of episodes there.

And then, our sponsor Life Extension wants to say thank you. Go to LifeExtension.com and use the discount code “PODCAST.” You get 10% off [a purchase of] $50 or more, plus free shipping and handling. That's code “PODCAST.”

Dr. Crystal: And we're looking for some fans! We could do fan of the week—send us a comment!

Dr. Mike: I like that.

Dr. Crystal: We will highlight your comments on our next show.

Dr. Mike: Okay, I'm Dr. Mike. That's…

Dr. Crystal: …Dr. Crystal.

Dr. Mike: Thanks for listening.