The ache in your toe may be enough to knock you off your feet.
Gout, a form of arthritis, often strikes without warning. According to research or other
evidence, the following self-care steps may help kick the pain:
- Check out cherries
- Soothe symptoms and prevent new attacks by eating a half a pound
of cherries or drinking an equivalent amount of cherry juice per day
- Rest for relief
- During acute attacks, rest the affected part to reduce pain and
inflammation
- Pass up high-purine foods
- To keep uric acid levels low, eat fewer purine-containing foods,
such as liver, shrimp, and dried beans and pulses
- Put a limit on alcohol
- To help prevent new attacks, avoid drinking more than one
alcoholic beverage a day
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full gout article for more
in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and
lifestyle changes that may be helpful.
About gout
Gout is a form of arthritis that occurs when crystals of uric acid accumulate in a joint,
leading to the sudden development of pain and
inflammation.
People with gout either overproduce uric acid or are less efficient than other people at
eliminating it. The joint of the big toe is the most common site to accumulate uric acid
crystals, although other joints may be affected.
What are the symptoms?
The pain of gout can arise suddenly and is
often very intense. The affected joint is usually red, swollen, and very tender to the touch.
A low-grade fever may also be present.
Medical options
Over-the-counter analgesics, such as
aspirin (Genuine Bayer®, Ecotrin®, Bufferin®), ibuprofen (Motrin IB®, Advil®), and naproxen (Aleve®), might provide temporary pain
relief.
Acute gout attacks are typically treated with the prescription drug colchicine and prescription strength nonsteroidal anti-inflammatory drugs (NSAIDs) such as
celecoxib (Celebrex®), indomethacin (Indocin®), meloxicam (Mobic®),
and naproxen (Naprosyn®, Anaprox®).
Occasionally corticosteroids, such as
prednisone (Deltasone®), are used to treat inflammation.
Individuals with gout are often prescribed
allopurinol (Zyloprim®) to prevent future acute attacks. Probenecid (Benemid®)
and sulfinpyrazone (Anturane®) are available, yet less frequently used, to treat
gout.
Healthcare practitioners recommend resting the affected joint during acute gout
attacks.
Dietary changes that may be helpful
Foods that are high in compounds called purines raise uric acid levels in the body and
increase the risk of gout. Restricting purine
intake can reduce the risk of an attack in people susceptible to gout. Foods high in
purines include anchovies, bouillon, brains,
broth, consommé, dried legumes, goose, gravy, heart, herring, kidneys,
liver, mackerel, meat extracts, mincemeat,
mussels, partridge, fish roe, sardines, scallops,
shrimp, sweetbreads, baker’s yeast,
brewer’s yeast, and yeast extracts
(e.g., Marmite, Vegemite).
Avoiding alcohol, particularly beer, or limiting alcohol intake to one drink per day or
less may reduce the number of attacks of gout.1 2 Refined sugars, including sucrose (white table sugar)
and fructose (the sugar found in fruit juice), should also be restricted, because they have
been reported to raise uric acid levels.3
According to a 1950 study of 12 people with gout, eating one-half pound of cherries or drinking an equivalent amount of cherry
juice prevented attacks of gout.4 Black, sweet yellow, and red sour cherries were
all effective. Since that study, there have been many anecdotal reports of cherry juice as an
effective treatment for the pain and
inflammation of gout. The active ingredient in cherry juice remains unknown.
Lifestyle changes that may be helpful
People who are overweight or have high blood pressure are at greater risk of developing
gout.5 However, weight loss should not be rapid because restriction of calories can
increase uric acid levels temporarily, which may aggravate the condition.
Vitamins that may be helpful
Large amounts of supplemental folic acid
(up to 80 mg per day) have reduced uric acid levels in preliminary research.6
However, other studies have failed to confirm the effectiveness of folic acid in treating
people with gout.7
In one small study, people who took 4 grams of
vitamin C (but not lower amounts) had an increase in urinary excretion of uric acid within
a few hours, and those who took 8 grams of vitamin C per day for several days had a reduction
in serum uric acid levels.8 Thus, supplemental vitamin C could, in theory, reduce
the risk of gout attacks. However, the authors of this study warned that taking large amounts
of vitamin C could also trigger an acute attack of gout by abruptly changing uric acid levels
in the body. Another study showed that taking lower amounts of vitamin C (500 mg per day) for
two months significantly reduced blood levels of uric acid, especially in people whose initial
uric acid levels were elevated.9 For people with a history of gout attacks, it
seems reasonable to begin vitamin C supplementation at 500 mg per day, and to increase the
amount gradually if uric acid levels do not decrease.
In test tube studies, quercetin, a flavonoid, has inhibited an enzyme involved in the
development of gout.10 11 However, it is not known whether taking
quercetin by mouth can produce high enough quercetin concentrations in the body to achieve
these effects. Although human research is lacking, some doctors recommend 150–250 mg of
quercetin three times per day (taken between meals).
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
Autumn crocus (Colchicum autumnale) is the herb from which the drug colchicine was originally isolated. Colchicine, a
strong anti-inflammatory compound, is used as a conventional treatment for gout. Both the herb
and the drug have significant toxicity and should only be used under the guidance of a
physician.
Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.
References:1. Ralston SH, Capell HA, Sturrock RD. Alcohol and response to treatment
of gout. BMJ 1988;296:1641–2.
2. Scott JT. Alcohol and gout. BMJ 1989;298:1054.
3. Emmerson BT. Effect of oral fructose on urate production. Ann
Rheum Dis 1974;33:276–80.
4. Blau LW. Cherry diet control for gout and arthritis. Tex Rep Biol
Med 1950;8:309–11.
5. Loenen H, Eshuis H, Lowik M, et al. Serum uric acid correlates in
elderly men and women with special reference to body composition and dietary intake (Dutch
Nutrition Surveillance System). J Clin Epidemiol 1990;43:1297–303.
6. Oster KA. Xanthine oxidase and folic acid. Ann Intern Med
1977;87:252–3 [letter].
7. Boss GR, Ragsdale RA, Zettner A, Seegmiller JE. Failure of folic acid
(pteroylglutamic acid) to affect hyperuricemia. J Lab Clin Med
1980;96:783–9.
8. Stein HB, Hasan A, Fox IH. Ascorbic acid-induced uricosuria: a
consequence of megavitamin therapy. Ann Intern Med 1976;84:385–8.
9. Huang HY, Appel LJ, Choi MJ, et al. The effects of vitamin C
supplementation on serum concentrations of uric acid: results of a randomized controlled
trial. Arthritis Rheum 2005;52:1843–7.
10. Bindoli A, Valente M, Cavallini L. Inhibitory action of quercetin on
xanthine oxidase and xanthine dehydrogenase activity. Pharmacol Res Commun
1985;17:831–9.
11. Busse W, Kopp D, Middleton E. Flavonoid modulation of human
neutrophil function. J Allergy Clin Immunol 1984;73:801–9.