the gout, historical illustration

“The Gout” by James Gillray. Published May 14th 1799

About a year ago, the New York Times printed 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 fat, old, alcoholic and wealthy.  Now, the skinny, young, clean-living, and impoverished can get it, too.

Ain’t egalitarianism grand?

Gout used to be considered the disease of kings because it is (often, but not always) linked to rich foods, alcohol, and obesity, all of which used to be the sole province of the upper classes, but now well within the grasp of us all.

We get gout when a substance called uric acid, normally dissolved in the blood, crystallizes on and near the joints.  These crystals are microscopic, and 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, if we ate fewer purines, we’d get less gout.  For decades, that’s what we were told.  And for decades, people who followed this advice had less gout fewer attacks, less severe.  It seemed pretty clear-cut.

It turns out, however, that the issue was never quite so clear-cut, and 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[1].  I can’t promise everyone is going to respond the same way, of course, but 47,120 people in a clinical trial is pretty compelling.

At any rate, purines are components of RNA, DNA, and a variety of other compounds involved in cell division and cellular metabolism.  You find purines in the highest concentrations in tissues that are most metabolically active.  For example, organ meats, like liver, brain and kidneys (because the livers, brains, and kidneys are always working); or animals with incredible growth rates, like 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 it’s inert.  Foods that are moderately high sources of purines include meat, poultry, larger fish, asparagus, mushrooms, beans and peas; and foods made with yeast, such as bread and beer.

Cutting back on purines still leaves you nuts and seeds, all fruits and many vegetables, (unleavened) 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 might be.  Cutting back on alcohol, then, can make a big difference.

And obesity… well, that might be too strong of a word.  Even an extra 20-30 pounds can make gout worse.  I’m not entirely sure why.  Perhaps the extra weight on the bones of the feet and toes produces conditions in which uric acid is more likely to crystallize?

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.  It 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.

(There are dozens of diuretic herbs out there: parsley, dandelion leaf, buchu, horsetail, oatstraw, juniper berries, cornsilk…  Personally, I still like nettles best for daily use).

Reducing a predisposition towards inflammation with fish or borage oil, or anti-inflammatory herbs, will make your gout hurt less, but probably won’t stop the disease from progressing.  Taking anti-inflammatory herbs and herbal formulas during an acute attack should lessen the severity.  Herbs like boswellia, white willow bark, devil’s claw, turmeric… the list goes on and on.  And 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.

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 down in front of PubMed to look for research on the subject, and couldn’t find a single decent research trial.

Research aside, here’s what I know: dark cherries are said to work better than Rainier cherries, and tart (Montmorency) cherries are said to work the best.  A cup of juice a day is a good daily practice to prevent attacks.  At the very least, it beats O.J. if you’re accustomed to a cup of juice with breakfast.  There’s also been research where daily cherries reduce soreness after working out.  During an acute attack, you might want to down a quart or more 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 tend to think that three cups of them would be roughly equivalent to one cup of the juice.  I could be wrong.  Likewise, I imagine that a half-cup of dried cherries would be equivalent to one cup of juice.  For the cherry pills, I usually find the dose recommended on the back of the bottle is good, although you may want to triple or quadruple it during an acute attack.

Cherries are (obviously) safe, so you should feel free to experiment with doses that work for you.  They’re a wonderful antioxidant fruit, good for you in all sorts of ways.  Oh, and I almost forgot to mention: they’re delicious.

Another folk remedy out there a lot less well known, but with indications it can be every bit as effective 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.

I have a lot less experience with celery seed than I do with cherry juice.  I don’t think I’ve known more than 4-5 people who have used it.  But it’s pretty compelling to hear Duke talk about it.  How he took allopurinal daily for nearly two decades to control his gout; how he switched to celery seed three 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.

[1] 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!!!