Gout's painful clout
Fit for life - Sunday, 15 September, 2002
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The first experience with gout leaves you writhing in pain. Subsequent encounters do not get any better. Welcome to the world of gout sufferers, where excruciating pain and joint disfigurement are the order of the day.

In effect, gout is more than just an arthritic condition. It is a meta­bolic disorder where the uric acid level becomes elevated in the bloodstream, either because of a high intake of purine (a type of amino acid) or because the uric acid cannot be excreted from the body. The excess uric acid crystallises and is deposited in the joint spaces, connective tissue, tendons and other tissues resulting in inflammation, pain and subsequent tissue damage.

Gout usually affects one joint at a time. The joint of the big toe is the prime target, but almost any other joint, such as the knee, ankle, foot, hand, wrist and elbow, can become a sore point. Deposits of uric acid, called tophi, can appear as lumps under the skin around the joints and at the rim of the ear. In addition, uric acid crystals can also accumulate in the kidneys resulting in kidney stones.

While anyone can fall prey to gout, the typical victim is a middle-aged person, who may be overweight and have a family history of the disease. Once horribly painful and debilitating, gout can now be easily controlled with proper diet management and lifestyle modifications as well as nutritional supplementation and herbal remedies.

Case study
Mr KH Lee, a 56-year-old retiree, suffers from severe gouty tophi in several fingers. Because of his condition, he could neither grip any object properly nor drive a car safely. He was on several medica­tions to lower his uric acid level in the blood and to relieve the pain and swelling in his fingers. Despite his condition, he continued with his seafood and alcohol intake. This went on for several years, and he sought alternative treatment recently when his condition did not seem to improve.

Herbal remedies
Lee was put on the following herbal preparation:
Celery Seed (Apium graveolens) Guaiacum (Guaiacum officinale) Sarsaparilla (Smilax ornata) Celery seed is a traditional
diuretic, well suited for arthritis and gout. It promotes the elimination of uric acid through the kidneys to lessen toxin build-up that may aggravate gout. Celery seed is usually found in combination with Guaiacum and Sarsaparilla. The combination acts primarily to soothe the pain of inflammation involving the joints.

Dietary factors
Lee was also advised to adhere to the following dietary and lifestyle changes.

A low-purine diet continues to be the mainstay of dietary therapy for gout. Avoid the purine-rich foods such as offal (liver, kidneys, tripe, heart, tongue), red meat (beef, lamb), shellfish, fish roe, herring, sardines, mackerel, scallops, mussels and anchovies, peas, lentils and beans, mushrooms, spinach, asparagus, cauliflower and yeast (brewer's and baker's).

As refined carbohydrates increase uric acid production and saturated fats reduce uric acid elimination, these foods should also be kept to a minimum.

Excessive protein intake may also accelerate uric acid synthesis in both normal and gouty patients. It should therefore be eaten in moderation.

Increase consumption of flavonoids, namely the antho­cyanidins and proanthocyanidins. These are found abundantly in cherries, hawthorn berries, blue berries and other dark red-blue berries. These fruits have also been shown to be very effective in lowering uric acid levels and preventing attacks of gout.

Self help
A simple yet effective regime could help gout sufferers find some relief. Elimination of alcohol from the diet is all that is needed to reduce uric acid levels and prevent gouty arthritis in many individuals. Drink more water as fluid intake keeps urine dilute and promotes the excretion of uric acid. A large amount of fluids can also help flush excess uric acid from the system to reduce the risk of kidney stone formation.

Achieving an ideal body weight is the most important dietary goal in gout treatment. Controlling body weight through a well­planned exercise and dietary programme can help reduce uric acid levels in those people who are overweight or obese.

Exercise is always important to maintain and achieve health and wellness. Go for exercises that do not aggravate the condition, such as walking or swimming. Light exercises are helpful in maintaining a normal range of motion, keeping the joint cartilage well­lubricated and strengthening the muscles around the joints.

After four weeks, Lee started to show some improvement. His fingers were less painful and the swelling had slightly reduced in size. His uric acid level had reduced but was still above the normal range. He confessed that he did not do much to his dietary and lifestyle modifications.

Nutritional considerations
In addition to the steps taken above, Lee was also put on a supplement that combines marine fish and evening primrose oils. These fatty acids have anti-inflammatory and analgesic effects that help reduce swelling and pain.

Anti-free radical nutrients such as beta-carotene, vitamins C, E and zinc were also recommended. Adequate intake of these nutrients prevents collagen destruction through their potent free radical scavenging action and reinforces the collagen matrix of connective tissues, thus maintaining supple, healthy joints.

Overall improvement was observed after 12 weeks. Only a slight swelling remained, although the fingers remained painful at times. He could grip objects without any difficulties: Diet wise, he had totally cut out seafood and alcohol from his diet. Lee was encouraged to continue on the herbal remedies as well as supplements that were previously mentioned. Last but not least, a healthy diet and lifestyle approach is mandatory to prevent recurrence.

Chronic gouty arthritis affecting the joint of the middle finger.