About five years ago, the New York Times published an article chronicling the rising tide of gout in America. The paper took great pains to point out that this erstwhile “disease of kings” is no longer limited to the kingly, i.e. the wealthy. Now that the poor and middle classes have access to plentiful rich foods and copious alcohol, gout is well within the reach of the rest of us. And even among the thin, young, and clean-living, gout appears to be on the rise.
Ain’t egalitarianism grand?
We get gout when a substance called uric acid, normally dissolved in the blood, crystallizes out of solution on and near the joints. These crystals are sharp. One of the first goals of gout sufferers, then, is to reduce uric acid in the blood.
We produce uric acid as we metabolize compounds called purines, which we get from food. So it stands to reason, less food with purines would mean less uric acid, which would lead to less gout. For decades, this is what we were all told. And for decades, people who followed this advice had fewer and less severe attacks of gout. It seemed pretty clear-cut.
It turns out, however, that it was never quite so simple, because not all purines are created equal. A recent study tracked 47,120 men for 12 years, charting their incidence of gout versus what they ate, and found that while purine-rich animal foods were associated with a higher risk of gout, purine-rich plant foods were not. The original research never made that distinction[i]. It’s not entirely clear – at least not to me – why purine-rich animal foods are so much worse than purine-rich plant foods…
Anyways, purines are components of RNA, DNA, and a variety of other compounds involved in cell division and cellular metabolism. So it stands to reason, cells that are very metabolically active tend to have the highest levels of purines. For example, organ meats like liver, brain and kidneys are extraordinarily rich in purines, because livers, brains, and kidneys are always working. Animals with incredible growth rates are also very purine-rich. Think anchovies, sardines, and shrimp (and nutritional yeast). Also, wild animals are higher in purines than farm-raised animals, because they run around more.
Milk, on the other hand, is almost purine-free, because it doesn’t do anything in the animal.
Foods that are moderately high sources of purines include “regular” meat and poultry, larger fish, asparagus, mushrooms, beans and peas; and foods made with yeast, such as bread and beer.
So even if you cut back on all purines, you can still enjoy nuts and seeds, fruits, and most vegetables, grains, potatoes, eggs and dairy.
Two other things tend to make gout worse: alcohol and obesity.
Turns out, we produce more uric acid when we drink alcohol. A glass of wine with dinner is probably no great tragedy, but three or four glasses with dinner might be.
And obesity… well, that might be too strong of a word. You don’t have to be that overweight to be at an increased risk. Even an extra 20-30 pounds can make gout worse.
So, how do we treat gout with natural medicine?
As a daily practice, plenty of fresh water is a good start, to flush out excess uric acid. Or drink a few nice cups of nettle tea, which tastes pleasant hot or cold, is reasonably rich in minerals, and is a mild, kidney-strengthening diuretic that ought to help us excrete uric acid. I’m unaware of any formal clinical trials here, but it is a traditional remedy, and one with almost no downside.
There was a large, well-designed trial which showed that only 500 mg of vitamin C a day for two months lowered blood uric acid slightly but significantly.
Reducing a predisposition towards inflammation with fish or borage oil probably won’t stop an attack from developing. However, it ought to make the eventual attack less painful. And quick-acting anti-inflammatory herbs ought to help damp down an acute attack. Some of those herbs are boswellia, white willow bark, devil’s claw, turmeric… the list goes on and on – and formulas are often more effective than single herbs. Once you’ve established you don’t react to any of them, you might find that relief begins at a dose higher than what’s recommended on the back of the bottle.
And then there’s cherry juice. When it comes to treating an acute attack, cherry juice is a great place to start. Over the years I’ve heard countless people swear that cherry juice (and fresh cherries, and dried cherries, and frozen cherries, and cherry extract in capsules and tablets) have worked for them. It’s one of those rare bits of folk medicine that has become common knowledge, acknowledged by practitioners of traditional and mainstream medicine alike. So I was surprised, when I sat to research the subject: there hasn’t been a single decent prospective clinical trial on the subject. Not one.
Research aside, here’s what I know: dark cherries work better than Rainier cherries, and tart (Montmorency) cherries work the best. A cup of juice a day is a good daily practice to prevent attacks. At the very least, the black cherry juice sure beats O.J. on taste. (There’s also been research where daily cherry intake reduces soreness after working out.) During an acute attack, you might want to down a quart or more of cheer juice a day. Or you can get cherry juice concentrate and add it to sparkling mineral water to make a therapeutic, refined sugar-free “soda.” I like Gerolsteiner mineral water for flavor, and I like the fact that it also kicks in some natural calcium.
I’ve never really known how many fresh cherries to recommend, but I’m all for eating a lot. For the cherry pills, I usually find the dose recommended on the back of the bottle is good enough for prevention, although you may want to triple or quadruple it during an acute attack.
Cherries are pretty safe, so you should feel free to experiment with doses that work for you. They’re a wonderful antioxidant fruit, too, good for you in all sorts of ways. Oh, and I almost forgot to mention: they’re delicious.
Another folk remedy to consider is celery seed. Dr. James Duke, who manages the USDA Phytochemical Database, places celery seed in his “Duke’s Dozen” herbs for good health. He says that celery was the one he was most skeptical about to begin with. Now, he says, it’s the only one he takes every single day.
Duke like to talk about how he took allopurinal daily for nearly two decades to control his gout; how he switched to celery seed five years ago, and hasn’t had an attack since. How he danced barefoot and drank Peruvian rum and still didn’t get gout. James Duke is always a storyteller.
Anyways, he says he does well on two 500 mg capsules a day, each with 450 mg of standardized extract. That’s where I’d start. We see this again and again and again: the broad conclusions we’re fed about dietary heroes and villains are based on research that fails to draw fundamental distinctions. First, we were taught that all fats were bad. Then that all saturated fats were bad, but unsaturated fats were actually good. Now, researchers admit that some saturated fats (short- and medium-chain) are actually good for us, while some unsaturated fats (trans-fats) are actually bad for us.
And that isn’t the end of it. It’s now becoming increasingly clear that “unhealthy” long-chain saturated animal fats are less the villains than often co-occurring compounds such as preservatives, carcinogens created from charring, and another unhealthy fat called arachidonic acid found in high levels in poorly-raised, poorly-fed meat…
Beware the sweeping conclusions!!!
… Adam Stark