Gout

            Gout is associated with raised uric acid (or urate) levels. Although some people have a genetic susceptibility to gout, foods can make a major difference as they can increase or decrease uric acid levels. Supplements can also decrease uric acid.

            Gout was a rare disease in many parts of the world until they changed to a western diet. The major reason is sugar. In one study people with gout had double the sugar intake compared to those without gout. Sugar is made up of fructose and glucose. This causes a double-whammy as fructose causes uric acid to rise and glucose stops it being excreted by the kidney. High fructose corn syrup (in a lot of processed food) also contains both fructose and glucose and is a major hazard for those with gout. Cutting out sugar is one of the most important steps in controlling gout (most sugar in the diet is hidden sugar (see leaflet for metabolic syndrome to find where it’s hidden).

            Sugar is particularly likely to be the main culprit in those with metabolic syndrome (which causes abdominal obesity, high triglycerides, low HDL and sometimes hypertension). A blood test for lipids will reveal this syndrome.

Other Foods to Reduce

Meats, poultry and fish (especially anchovies and sardines) contain purines which can increase uric acid. Beans and lentils are also high in purines.

Alcohol can worsen gout. Dark alcohols and beer may be the worst.

Sugars, especially fructose can raise uric acid. Avoid high fructose corn syrup (in a lot of processed food) which can worsen gout. In one study people with gout had double the sugar intake compared to those without gout.

Foods to Increase

Most berries (except gooseberries) reduce uric acid.

Cherries can markedly reduce uric acid and cherry juice has been marketed for this purpose. Dr Blau published research in the 1950s showing that cherry juice can relieve an attack of gout. He found that taking 12 cherries daily or the equivalent in juice brought uric acid levels down to normal. Try taking cherries or drinking cherry juice at the first sign of an attack – the more the better.

Cider vinegar may help. Try a tablespoonful daily.

Large quantities of water (at least 2 litres a day) can relieve attacks of gout.

Coriander – 20 sprigs of coriander daily reduced uric acid levels by half in two months in one study.  

Vitamin C is known to increase uric acid secretion (it works in a similar way to the drug probenecid). However large doses are needed, Start with one grams twice daily, gradually increasing to 3 grams daily then reducing to 2 grams after improvement. Four grams of Vitamin C daily has been shown to reduce uric acid levels threefold. (This dose can sometimes cause loose stools and bloating).

Folic acid in very large doses inhibits the enzyme xanthine oxidase that produces uric acid. Folic acid will work on its own but works well with Vitamin C. The dose is 50mg twice daily (ten 5mg tablets twice daily). Large doses of folic acid can interfere with anti-epileptic drugs and vitamin B12 levels should be checked if this is used for any length of time.

Uric Acid

In recurrent gout it is usual to use drugs like allopurinol to control uric acid levels. Guidelines in the UK suggest lowering the uric acid level to 300 µmol/l. However I am a little wary of this as I often seen very low levels in patients treated for gout. Uric acid is a key brain anti-oxidant and low levels have been linked with Alzheimer’s disease, stroke, Parkinson’s disease and multiple sclerosis. I think the best plan is to lower it enough to control the gout but no more.