Gout = Inflammatory Arthritis
Gout is a painful inflammatory arthritis caused by uric acid crystals
forming in the joints. Attacks of gout often start suddenly during sleep and
feel like a joint is "on fire."
Uric Acid Crystals Cause Inflammation
The pain and swelling of gout are caused by uric acid crystals that form in
the joint. Uric acid is a waste product of purine metabolism. Uric acid is
dissolved in the blood and is excreted through the kidneys into the urine. In
people with gout, the uric acid level increases and uric acid crystals are
deposited in joints and other tissues. These needle-shaped crystals trigger an
immune response that produces intense local inflammation with severe pain,
tenderness and swelling. After several years of increased serum uric acid, uric
acid crystals can build up in the joint(s) and surrounding tissues. They form
deposits that are sometimes apparent as firm lumps (tophi) under the skin. Tophi
often are found in or near severely affected joints, on or near the elbow, over
the fingers and toes, and in the outer edge of the ear. Uric acid crystals can
also form stones in the kidneys, in the ureters and in the bladder. Stones form
when the uric acid concentration in the urine is too high - this is cause by low
water intake, diuretics, and overly acidic urine. A diet rich in purines may be
Uric Acid Production
Uric acid substance is a product of the chemical breakdown of the purine
bases that compose the genetic material, DNA and RNA. As cells die and release
DNA from their chromosomes, purines are converted into uric acid which is
excreted in the urine and, to a lesser extent, the intestinal tract. The
concentration of uric acid in the blood is related to the balance between uric
acid production and excretion. The normal level in children is about 2 mg/dl. At
puberty, the level increases in males by 1 mg/dl, but it does not increase in
females; the normal range is 3 to 7 mg/dl in adult males and 2 to 6 mg/dl in
adult females. At concentrations greater than 6.5 to 7.0 mg/dl in water, urate
precipitates in the form of sodium urate crystals. When blood levels are above
10 mg/dl, the chance of an acute attack of gout is greater than 90 percent.
Only 10% of people with hyperuricemia are over-producers of uric acid caused
by diseases of the blood and bone marrow, inherited enzyme abnormalities and
metabolic alterations due to obesity. In patients who overproduce uric acid
because of a deficiency of hypoxanthine-guanine phosphoribosyltransferase, gout
attacks may begin before puberty.
Increased destruction of body cells leads to increased uric acid production;
examples are malignancies, particularly lymphoreticular cancers, hemolytic
anemia, polycythemia, leukemias and nonmalignant conditions of increased
cellular proliferation (e.g., psoriasis). Uric acid production will also
increase with the accelerated breakdown of adenosine triphosphate (ATP) in
glucose-6-phosphatase deficiency, tissue ischemia and myophosphorylase
Decreased urinary excretion of urate most often contributes to
hyperuricemia. Patients with urate clearances of 6 to 7 ml per minute are more
likely to have hyperuricemia after a purine load than those with clearances of
12 to 14 ml per minute. The assessment of renal handling of urate may be part of
medical investigation designed to provide information about urate production,
renal function, urine flow and the contribution of dietary purine intake to
serum and urine urate.
Gout medications are used to:
- Relieve the pain and swelling of an acute attack: nonsteroidal
anti-inflammatory drugs (NSAIDs), colchicine, codeine, Demerol, corticosteroid
- Prevent future episodes: colchicine, probenecid, sulfinpyrazone, and
- Prevent or treat tophi: probenecid, sulfinpyrazone, and allopurinol.
- Prevent the formation of uric acid kidney stones: allopurinol
Gout Rescue-Alpha Nutrition Program
Gout can be controlled by diet revision.
Usually, a combination of medication and diet revision will achieve the best
control. Attacks of Gout are exceedingly painful experiences and most
victims are motivated to implement preventive measures.
The purine content of food is only a contributing cause to gout. Other factors in the
flood supply influence uric acid metabolism and also influence the kidneys ability to
excrete uric acid. Acidic foods and beverages such as tea, coffee usually have to be avoided. If blood uric acid levels are high, several cups
of coffee can tip the balance by acidifying the blood and urine and an attack of gout can
Many gout suffers will feel minor symptoms as their tissue uric acid levels rise-
aching and tenderness in susceptible joints - for many days before an acute attack. If
they heed the warning and stop all risky foods, the uric acid levels will subside and the
painful attack is averted. The highest purine content is found in animal foods, especially
meats and some seafoods. The total consumption of meat should be reduced and organ meats avoided. The
only vegetable foods with high purine content are legumes, especially kidney beans.
The Alpha Nutrition Program has
features that are helpful to gout sufferers, especially if gout accompanies
other food-related diseases such as obesity, atherosclerosis and diabetes.
The goal in an overweight person is to make a permanent diet change
following Alpha Nutrition principles. We usually recommend combing diet
revision with the preventive medication such as probenicid.
A food holiday on Alpha ENF will
reduce uric acid levels while establishing the foundation for a new, healthier diet
regimen. Phase 1 of Alpha Nutrition works well to reduce uric acid levels and can be used
as a retreat strategy when warning symptoms appear. There are four
conditions in phase 1
to reduce uric acid concentrations:
Maximum portion size of poultry 3 oz/day
Smaller portions of peas and green beans (never both on the same day)
Add baking soda to
alkalinize the urine: 1/2
teaspoon two to four times a day
Increase water intake - 8 x 8 ounce glasses per day.