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Gout, Get Out!

by Dr. Susan Lark

Published 04/30/09

Gout is a type of arthritis that usually starts in a big toe and sometimes affects other joints, such as the ankles, knees, and wrists. It causes sudden flare-ups of extreme pain, plus "bumps" around the joints. The cause is excess blood levels of uric acid, which form shard-like crystals that stab the cartilage, tendons, and surrounding tissues, setting up an inflammatory reaction (June 2008, Arthritis Research & Therapy). Uric acid comes from the breakdown of purines, which are compounds found in most foods, the richest sources being meat, seafood, and alcohol. When purines are metabolized, blood uric acid levels rise unless the kidneys eliminate the excess in your urine. If there's too much uric acid produced, or too little removed, crystals start forming.

Gout becomes much more common in women after menopause. There's clearly a hormonal reason, but it hasn't been completely figured out. And another little-known fact about gout is that it is also a cardiovascular warning bell. A diagnosis of gout means a 60 percent increase in your risk of coronary artery disease. It even has the same risk factors: increased belly fat, elevated blood glucose, high triglycerides, and high blood pressure (February 2007, Arthritis and Rheumatology). The bottom line is that if you have gout, the discomfort in your big toe isn't your only concern.

Dealing with Gout

The conventional approach to treating gout is to prescribe anti-inflammatories such as steroids and a drug called colchicine, as well as allopurinol to lower blood uric acid levels. Patients are also told to steer clear of shellfish and alcohol. However, not only are the drugs fraught with side effects, but the dietary restrictions, while useful, are only part of the story because diet isn't the only source of purine. In fact, most of the uric acid in your bloodstream comes from your own body, which is chock-full of purine-rich tissues.

Millions of cells in your body die naturally every day. And if you're under excessive stress or suffering from a chronic inflammatory disease, there is even more cellular debris for your body to clean up. Uric acid is produced during the breakdown of the purines in that debris. How much depends in part on your liver, which directs the process with an enzyme called xanthine oxidase. If your liver is overtaxed or undernourished, xanthine oxidase activity can escalate, producing higher uric acid levels.

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