A ROYAL PAIN...Out with Gout
Natural ways to prevent & treat an increasingly common condition
The only way to describe Wanda is with one word: exuberant. At 64, she still works as a therapist, spends much of her free time caring for her grandchildren, and actively volunteers in her community. She's had her share of health problems-a history of bad sinus infections, acne rosacea, a challenging menopause, and high blood pressure-yet I would describe her as someone in basically good health, with high vitality and a clear mind. Whenever I see her name on my patient roster, I smile.
This time, Wanda sought my help for a new complaint: gout. Gout is an extremely painful condition characterized by recurrent attacks of acute inflammatory arthritis. Usually one joint becomes swollen, red, tender and warm. About 50% of the time, it is the big toe, but other joints or the kidneys may be involved.
Gout occurs when uric acid (a natural waste product of metabolism that eventually gets excreted in the urine) builds up in the blood to an excessive level and starts to crystallize. It is these crystals that land in the joints, tendons, or surrounding areas and cause terrific pain and galloping inflammation. Sometimes crystals form in other places, such as under the skin or in the urinary tract (kidney stones).
Conventional care may include nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen, etc.), steroids, and colchicine to relieve pain and decrease inflammation. When a patient is no longer having an acute flare-up, the goal is to reduce uric acid levels in the blood with dietary and lifestyle changes. For those unable or unwilling to make these changes or for whom such changes are not sufficient to keep uric acid levels in the normal range, two main drugs, Allopurinol (a uric acid blocker), and Probenecid (which aids the kidneys’ in removing uric acid) are prescribed to prevent further flare-ups.
"Disease of kings"
Gout is one of the oldest known forms of arthritis, with evidence of it dating back more than 4000 years to ancient Egypt. Historically, gout was known as the “disease of kings” because it tended to afflict royalty and those who had the means to indulge in “rich” diets heavy on meat, alcohol, and fats.
In our time, the incidence of gout has been rising sharply, as might be predicted by certain risk factors. These include dietary issues (see sidebar on the next page), alcohol consumption, high blood pressure, the use of diuretic medication, being overweight*, metabolic syndrome** (high blood sugar, high triglycerides, low “good” cholesterol), osteoarthritis*, and chronic kidney disease. Up to 4% of people in the developed world will have an issue with gout at some point in their lives, and about 8 million people in the U.S. experience it. Men are more likely to have gout, but women become increasingly susceptible after menopause. About 20% of gout sufferers have a family history of gout and may be genetically predisposed to it.