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All About Gout

All about Gout: Purine metabolism and why we need Uric Acid

All about Gout: Purine metabolism and why we need Uric Acid but at proper levels. Here is a Purine and Uric Acid Food Chart

Gout is often referred to as the "disease of kings." Gout has long been incorrectly linked to the kind of overindulgence in food and wine only the rich and powerful could afford. However, gout can affect anyone and involves a wide range of risk factors.

Today, many of our foods and modernistic diets increase the risk of gout. Modern diets consist of foods that are overly acidic to the system. They lack the minerals needed to buffer acids and maintain a proper pH of the system. For many, gout is precipitated by a combination of low-grade diet and lifestyle choices. Acidic diets, low water consumption, liver damage from foods and prescription drugs, unhealthy beverage choices, environmental toxins, and food additives all beget dangerous body imbalances. The over-production and under-excretion of uric acid is a direct result of these imbalances. Storages of uric acid in the blood and tissue yield the unpleasant consequence known as Gout. However, uric acid is an antioxidant that protects our DNA and is essential to our body's needs. Plasma uric acid levels correlate with longevity in primates and other mammals. This is presumably a function of the urate's antioxidant properties. Purines, which uric acid is metabolized from, is in every living human cell. In fact, there are health disorders such as MS that are directly associated with low levels of UA.

Our challenge is to maintain healthy levels in support our needs, while avoiding the storage that can lead to Gout. Fortunately, it is possible to treat gout and reduce/stop these acutely painful attacks by adjusting eating habits, increasing water intake, and adding supplements to our diet. Foods high in calcium are shown to have a favorable effect on uric acid within the blood supply. Reducing the ammonia load on the body, improving the digestive system, increasing both liver and kidney function also have very beneficial effects on the purine/uric acid metabolism.

What causes gout?

Gout occurs when excess uric acid (a normal waste product) collects in the body and needle-like urate crystals are deposited into the joints. This may happen because either uric acid production increases or, more often, the kidneys cannot remove uric acid from the body well enough. Certain foods and drugs may raise uric acid levels and lead to gout attacks. These include the following:

  • Foods such as shellfish and red meats (the source of these foods, what you eat them with, and the amounts you consume make a difference)

  • Alcohol in excess

  • Sugary drinks and foods high in fructose

  • Some medications like low-dose aspirin (but because it can help protect against heart attacks and strokes, we do not recommend that people with gout stop taking low-dose aspirin), certain diuretics (water pills) such as hydrochlorothiazide (Esidrix, Hydro‐D), immunosuppressants used in organ transplants such as cyclosporine (Neoral, Sandimmune) and tacrolimus (Prograf)

    Over time, increased uric acid levels in the blood may lead to deposits of urate crystals in and around the joints. These crystals can attract white blood cells, leading to severe, painful gout attacks and chronic arthritis. Uric acid deposits can also be found in the urinary tract, causing kidney stones.

    How your urine pH affects Gout Dissociation

    At a pH of 5, the urine is saturated at 60 mg/L (it will carry 60mg/L of uric acid in the form of urate). Conversely, at a urine pH of 6, the urine is saturated at 220mg/L, 160mg more of dissociated uric acid. You can drastically alter the solubility of uric acid simply by changing urinary pH. This is the basis of natural management.

    At a pH equal to the pKa, uric acid and urate exist in equivalent proportions as a consequence of the Henderson-Hasselbach equation. Hence, if 200mg of urate were introduced into a 1-L aqueous solution with a pH of 5.5 at 37 degree C, 100 mg would become uric acid, and the remainder would continue to be urate. In contrast, if 1200mg of urate were instilled into a similar volume at a pH of 6.5, 1100mg would remain in the soluble urate form. These relationships are based on the upswing of the uric acid dissociation curve at this pH, which plateaus at a pH of approximately 7.2.

    When food is metabolized in the body, the useable nutrients are removed, and we are left with an ash-like residue. The elements comprising the ash are either absorbed or eliminated. This ash can have an acidic, alkalic, or neutral effect on the body's chemistry. Alkaline ash leaves minerals the body can use to neutralize excess dietary acid. Alkalic ash is desired because our bodies must remain slightly alkaline. Acid ash, on the other hand, leaves behind minerals, that in excess can have a negative effect on our health. Foods elevated in sulfur, chloride, nitrogen, and phosphorus have an acidifying effect on the body. These foods also produce large amounts of ammonia. Proteins, notably animal protein, provide markedly higher levels of these acidic elements.

    Acidifying elements must be neutralized in order to maintain a healthy pH balance in the body. Alkaline minerals such as calcium, magnesium, potassium and sodium serve this very purpose. These elements are found most abundantly in plant foods. The body will store these minerals and release when necessary to maintain pH balance. Bones are the primary source of calcium, potassium, and magnesium. The body is capable of handling moderate amounts of acidifying foods. However, if most of the food we consume leaves an acid ash, the body will continually draw alkalizing elements from its reserves, depleting these vital minerals. The result is acidosis.

    Acidosis leads to loss of calcium and weakening of the bones (Osteoporosis), degeneration of joints (Arthritis), precipitation of calcium in body tissues (kidney stones and Gout), and the development of bone spurs. Body chemistry is constantly on the edge of its limitations, which creates tremendous stress. This stress facilitates the degeneration of body tissue and weakens the immune system; thereby increasing susceptibility to disease and affecting the overall day to day body functions.

    Food, Vitamins, Minerals, Probiotics and Uric Acid Production

    Approximately, 70% of your daily UA load comes from your own cells as they die. The other 30% (normal diet) is produced by the foods we eat. For these reasons, our food and vitamin/minerals choices play a large roll in maintaining a gout-free life. Healthy cells, as a matter of course, die off at a normal rate, while the death of unhealthy cells can take place at an alarmingly rapid rate. As we age, we naturally produce fewer cells. However, lifestyle choices directly affect the health of those cells. Stress, sickness, weight loss, and even extreme physical exertions can all cause premature cellular death. This cell death increases the uric acid loads on the system. Couple this with pH imbalances (food and lifestyle), and uric acid is drastically increased within the blood supply. These heightened levels can prove to be entirely too much for the kidneys and bowels to dispose of in a 24-hour time frame. This day in and day out process eventually culminates a gout attack, and if left unchecked can result in excessive acute attacks and joint damage.

    Gout sufferers tend to be deficient in several areas with regard to vitamins, minerals, and healthy bacteria levels. These are areas they can supply additional support to the cells by way of diet and supplementation. Those that work as antioxidants perform the useful function of squelching free radicals. Why is this helpful? Because during gout attacks, free radical levels rise.

    Pantothenic acid, B5, is known as the 'anti-stress vitamin' and is effective as a gout remedy because it can help break down the excess uric acid which causes gout. Folic acid is believed to help the body produce fewer enzymes that make up uric acid. Quercetin may inhibit xanthine oxidase, the enzyme required to convert purines into uric acid. This is the method used by the leading long term gout pharmaceutical, Allopurinol. Quercetin has done this in test-tube studies. Deficiencies in Vitamins A, E, B1, B2, B6, and B12 are rather prevalent in gout sufferers and should be included in your multivitamin, as well. Bromelain is a vitamin that assists the body in blocking inflammation. Because gout is a result of swollen joints, this vitamin can help relieve the symptoms. Lastly, do not sleep on the importance of healthy bacteria. Nutrient absorption, vitamin synthesis, and waste elimination through regularity are dependent upon a certain number of probiotics, or friendly bacteria, present and active in the intestines.

    Who gets gout?

    Gout affects more than 3 million Americans. This condition and its complications occur more often in men, women after menopause, and people with kidney disease. Gout is strongly linked to obesity, hypertension (high blood pressure), hyperlipidemia (high cholesterol and triglycerides), and diabetes. Some other types of arthritis can mimic gout; so proper diagnosis is the key. Health care providers suspect gout when a patient has swelling and intense pain in one or two joints, initially, followed by pain‐free times in between attacks. Early gout attacks often start at night. Diagnosis depends on finding the distinguishing crystals. The physician may use a needle to extract fluid from an affected joint and will study that fluid under a microscope to find whether urate crystals are present. Crystals also can be found in deposits (called tophi) that can appear under the skin. These tophi growths occur in advanced stages of gout. Uric acid levels in the blood are important to measure, but can sometimes be misleading, especially if measured at the time of an acute attack. Levels may be normal for a short time or even low during attacks. Some may have increased uric acid levels, without the presence of Gout. X-rays may show joint damage in gout of long duration.

    Points to remember

  • Bouts of arthritis that come and go are a sign of gout.

  • Finding the characteristic crystals in the fluid of joints allows health care providers to correctly diagnose gout.

  • There are natural ways to control gout.

  • People with chronic gout usually require lifetime management to maintain lower uric acid levels.

  • Lifestyle changes such as controlling weight, limiting alcohol, increasing water intake, and making better food choices by increasing those that are alkaline to the system, can help control gout.

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