Gout and Hyperuricemia
Gout is a form of arthritis in which excess uric acid forms crystals in joints and other tissues causing painful inflammation. Vitamin C, cherries, and other integrative interventions have been shown to decrease uric acid levels and the frequency of gout attacks.
Risk Factors for Gout
Several risk factors promote a high uric acid level and gout attacks:
- Increasing age and being male
- Intake of high-purine foods, including red meat, fish and shellfish
- Alcoholic beverage intake, specifically beer and spirits
Diseases Associated with Gout/High Uric Acid
Along with gout, elevated blood levels of uric acid have been associated with other diseases:
- Heart disease
- Heart failure
- Metabolic syndrome and type 2 diabetes
- Kidney stones or other kidney disease
Diagnosis and Conventional Medical Treatments
Blood tests can determine whether a patient is hyperuricemic (above 7 mg/dL in males and 6 mg/dL in females), but the most definitive feature in the diagnosis of gout is the identification of monosodium urate crystals in joint fluid or aspirates of tophi. Once gout has been diagnosed, conventional medical treatments include:
- Drugs for acute attacks (non-steroidal anti-inflammatory drugs [NSAIDs], corticosteroids, colchicine)
- Drugs to reduce hyperuricemia (xanthine oxidase inhibitors like allopurinol to decrease production of uric acid, uricosuric drugs to increase excretion of uric acid)
Most mammals are able to convert uric acid to allantoin with the enzyme uricase and then easily excrete it through the kidneys. Humans and primates do not have this enzyme, but recently injectable drugs have been made available that will break down uric acid into allantoin in the blood.
- Rasburicase (Elitek) and pegloticase (Krystexxa), which is approved by the Food and Drug Administration to lower uric acid levels in patients with gout
Lifestyle and Dietary Changes
- Exercise daily and reduce weight as excess adiposity is associated with increased uric acid levels
- Limit red meat intake (beef, pork, lamb); consume low-fat dairy products since they are inversely associated with gout risk; and consume vegetable protein, nuts, and legumes as they are not associated with gout risk.
- Reduce alcohol intake and limit intake of sugar-sweetened beverages
- Vitamin C: Significantly reduces uric acid by inhibiting the enzyme xanthine oxidase.
- Cherries: A traditional gout treatment rich in polyphenol antioxidants, cherries have been shown to reduce the number of acute gout attacks.
- Coffee: Contains both caffeine and polyphenol antioxidants that may have independent roles in the reduction of gout risk.
- Fiber: There is a significant association between higher fiber intake and lower risk of gout and hyperuricemia.
- Folate: A dietary folate intake of at least 51.5 mcg/day showed a 70% reduction in gout risk compared to those who consumed less than this amount.