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Gout

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What is gout?
Gout is a painful, arthritic condition of the joints. It usually strikes the big toes, but it can also affect the ankles, heels, knees, wrists, fingers and elbows.

What are the symptoms of gout?
The pain associated with gout is often sudden and intense. Joints tend to swell, and can be warm to the touch. The skin around the joint may also take on a deep red or purple hue. People who have had gout for extended periods of time may develop nodules beneath the skin near joints; these are accumulations of uric acid crystals. Attacks can recur in the same joint over weeks, months or years, and repeated bouts of gout can damage the joint. Kidney damage can also occur.

What are the causes of gout?
Gout has a strong genetic component. The hallmark of gout is elevated blood levels of uric acid, a breakdown product of protein metabolism (a distinction should be made by a physician between true gout and pseudogout, a similarly painful, arthritic condition that occurs when calcium pyrophosphate dehydrate crystals are deposited in a joint). Uric acid comes from the metabolism of purines, a subclass of proteins that are abundant in human tissues and such foods as organ meats, sardines, anchovies, mushrooms, asparagus and lentils. Also, a number of drugs and supplements can increase uric acid levels in the blood and its tendency to form irritating crystals in joints. These include salicylates (the active component of aspirin), vitamin B3 (niacin), excess vitamin C and diuretics that may be prescribed for high blood pressure, edema or, cardiovascular disease. Others are Cyclosporine (used to prevent rejection of transplanted organs) and Levodopa for Parkinson's disease. Excess alcohol consumption, being overweight, and exposure to lead in the environment also increase the risk of gout in genetically susceptible individuals. Other risk factors include dehydration and acid conditions of the blood that can result from serious infections, surgery or ketogenic weight loss diets (such as the Atkins diet). The genetic component should not be underestimated, however. It is possible to have high levels of uric acid and never develop gout.

What is the conventional treatment of gout?
There is no known cure for gout, but it can be alleviated through a variety of conventional therapies. Physicians often prescribe non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to keep inflammation and pain under control. Corticosteriods can have a similar affect; these are administered via pills or injections. There are also medicines that can lower levels of uric acid, the best known is probably allopurinol (Zyloprim). All of these measures should be used only as a last resort, as all carry the risk of significant side effects.

What therapies does Dr. Weil recommend for gout?
Like so many diseases, gout is likely an artifact of inflammation and habits of lifestyle, which means following an anti-inflammatory diet and making changes in lifestyle should be the first line of defense. The following should be emphasized:

  • Avoid meats that are particularly rich sources of uric acid such as organ meats, sardines and anchovies. Physicians used to advise cutting back on purine-rich plant foods such as lentils, peas, beans, mushrooms, cauliflower and spinach; however, recent research has shown no correlation between eating such foods and incidence of gout attacks.
  • Eliminate coffee and all other caffeine sources from the diet.
  • Minimize alcohol consumption. Alcohol promotes dehydration and irritates the urinary tract.
  • Drink the full complement of eight eight-ounce glasses of water daily to flush uric acid from the system and prevent urate crystal deposition.
  • If you are overweight, lose the excess pounds.
  • Eat tart cherries in all forms - fresh, or as cherry juice, or in the form of tart cherry extract. Laboratory findings at Michigan State University suggest that ingesting the equivalent of 20 tart cherries inhibits enzymes called cyclooxygenase-1 and -2, which are the targets of anti-inflammatory drugs.
  • Take bromelain, a compound of digestive enzymes and other compounds extracted from pineapple stems.

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