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Battling Gout. One Canadian’s Story

The above image. 1

“People wish their enemies dead—but I do not; I say give them the gout, give them the stone!” (Thomas Sydenham, 1683)

OUCH!

It happened at the tender age of 61. In June 2013, at about 4:00 A.M., in a small hotel in Nordegg, Alberta, Canada. I suddenly awoke feeling the most excruciating pain I have ever experienced in the left toe joint. It was as if someone had taken a sledgehammer and smashed it down on my big toe. Every time the bed cover brushed against my toe, I almost hit the ceiling.

I was bewildered by what was happening. I finally did some reading and realized what was ailing me. These four letters stared back at me:

GOUT

This is my story of battling gout over the last ten years. Why do I write about it here, even though countless articles have been written about it? Because if I can help at least one person avoid or even alleviate the pain of this form of inflammatory arthritis, by telling my story of what measures I took to battle it, then writing this blog is well worth the effort.

A swollen toe from gout. Not a pretty sight. But even uglier on the inside. 2gNEDw&biw=1083&bih=504&dpr=1.22#imgrc=TPT7MxD4ERa3KM))

What is Gout?

Gout is a type of inflammatory arthritis that causes pain and swelling of the joints. In my case, it usually occurs in the big toe joint and occasionally in my ankles. Flareups can last for a week or two. Any longer and there would be a lot more suicides.

Gout is caused when high levels of serum urate build up in the body. If your kidneys do not flush these urates out then in some people they form needle-shaped crystals in and around the joint. Many people, however, have high levels of serum urate but never get gout.

Gout is a worldwide phenomenon. An estimated one million Canadians get it. And more men (about 4%) than women (about 1%) get gout. It is more common in older people. The highest prevalence of gout worldwide occurs in Taiwanese Aboriginals and Maori people. In these populations more than 10% have gout. Gout is rare in former Soviet Union regions, Guatemala, Iran, Malaysia, the Philippines, Saudi Arabia, rural Turkey and African countries. 3

What Causes Gout?

Purines 4 are the enemy. They are found in your body’s tissues and in many foods. When they break down, they become urate. Normally, urate is removed from your body in urine. However, if too little urate is removed, it builds up in your blood. And eventually, these needle-shaped crystals form in your joints, causing inflammation or gout flares that cause pain and swelling.

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The risk factors behind gout are complex and not always under our control. They include hyperuricemia, 6 genetics, dietary factors, medications, comorbidities, 7 and exposure to lead.

How I Battled Gout

When I had the first few gout ‘attacks’, I went to my doctor for help like most people. He recommended Colchicine, one of a number of drugs used to treat gout. Whenever I felt an attack coming on I took these pills which seemed to help but like many drugs, there were side effects.

Eventually, after some research, instead of just waiting for the next attack and then popping more pills, I decided to change three things in my diet that might help prevent or at least reduce the severity of gout attacks: 1) reduced intake of foods high in purines; 2) increased intake in foods containing vitamin C; and, 3) increase in foods with natural probiotics and probiotic supplements.

1. Foods High in Purines

Some foods are high in purines and should be avoided if you are suffering from gout. 8 Even some vegetables such as dried beans, peas, and lentils are high in purines.

I can live without or eat these foods in moderation. Yes, I like my seafood, steaks, or headcheese. But I don’t necessarily need them. Eating them occasionally doesn’t seem to be a problem.

But, I happen to really like beer and the occasional bottle of wine. And alcohol is high in purines. All alcohol — including beer, wine, and hard spirits — affect processes in the kidneys that in turn impact how uric acid is eliminated in urine. They substantially increase blood uric acid levels.

How do the different types of alcoholic beverages rate in terms of purine content? Wine and spirits have the lowest purine content. Beers contain the highest amount of purines. But not all beers are equal. According to some research, British beer, home-brewed beer, and lager beer each contain many different types of purines, such as adenine, hypoxanthine, adenosine, and guanosine. Japanese beer contains greater amounts of purines than other types of beer. 9

“Among the different types of alcohol, the strongest association to risk of gout is that of beer, followed by spirits, according to more recent literature. In a widely accepted study by Choi et al. wine was not associated with an increased risk of gout.” 10

After reading about purines in alcohol, I changed tactics. No, I didn’t become a teetotaler. Instead, I dropped my regular consumption of all beers, although occasionally I still drink some. I drank more spirits and wine.

I also drink considerable amounts of carbonated water daily with a chunk of lemon and lime in it. Water is thought to flush out uric acid in our bodies. Lemon and lime are high in Vitamin C.

2. Increased Intake of Vitamin C

Any foods high in Vitamin C lower uric acid levels in our bodies. Grapefruit, oranges, lemons, limes, pineapples, and strawberries are all great sources of Vitamin C.

I try to eat some of these foods every day, especially oranges, lemons and limes (in my carbonated water). I also take Vitamin C supplements every day. However, if you read the literature, the verdict is still out on whether Vitamin C helps reduce uric acid and therefore reduces or prevents gout attacks. 11 And according to some studies: “Fructose-rich fruit juices (especially orange juice) and sweet fruits (e.g. oranges or sweet apples) should be particularly avoided.” 12 These fruits and juices raise SUA 13 levels.

3. Increased Intake of Probiotics

Lastly, I increased my intake of probiotics found in natural foods and taken as supplements. Probiotics are live microorganisms found in yogurt and other fermented foods. Fermented foods are a type of food that is preserved with the help of these microorganisms. Foods high in probiotics include yogurt, kefir, kombucha, sauerkraut, pickles, miso, tempeh, kimchi, sourdough bread and some cheeses.

Probiotics influence how purine is absorbed by the body. This in turn helps reduce inflammation. 14

I regularly eat yogurt, sourdough bread and occasionally kimchi, sauerkraut, miso and pickles. And I take probiotic supplements every day. There’s a mind-boggling number of probiotic supplement brands to choose from. However, most research suggests that probiotics derived from natural fermented foods are the most effective.

My Results

After changing my diet in these three basic ways for two years, I have suffered no major gout attacks and only several minor flareups. After what I’ve experienced before changing my dietary intake, I consider this a large victory.

I don’t know which of the three changes helped. If it was only one or a combination of all three? I care only about the outcome. I’m virtually gout-free. Nor can I say with any certainty that some other factor, than these, was responsible for the reduction in gout attacks. I can’t think of any. But, it seems highly coincidental that as soon as I did these three things, my gout attacks decreased and then virtually disappeared.

Are my remedies to get rid of gout for you? I don’t know. We’re all different and what works for me may not for others. But, one thing I would strongly advise. If you’re suffering from this terrible malady, don’t just sit there and do nothing. Read about the subject. Educate yourself. Experiment with foods and safe products. Get professional advice. Sitting there, waiting for the inevitable, and then popping pills will rarely change things.

The literature on gout is enormous. Often you will find contradictions. That’s the nature of research. For example, my orange-a-day intake supposedly raises SUA levels (a no-no) but adds Vitamin C (a good thing). Trial and error is the only way forward.

Here is a recent 2022 update on the latest research about gout and gout-related issues. It is science-based and cites the most recent research about gout. It ends with ten basic recommendations to battle gout. If you’re suffering from gout, it is well worth reading:

Judith Sautner, Gabriela Eichbauer-Sturm, Johann Gruber, Raimund Lunzer, Rudolf Johannes. 2022. 2022 update of the Austrian Society of Rheumatology and Rehabilitation nutrition and lifestyle recommendations for patients with gout and hyperuricemia. In Wien Klin Wochenschr (2022) 134:546–554. Puchnehttps://link.springer.com/article/10.1007/s00508-022-02054-7

According to the Sautner et. al 2022 study cited above, these are the ten basic recommendations to deal with gout.

Gout is an ancient disease as witnessed by the many poems and words of wisdom, or gloom, written about it for centuries. I’ll leave you with one of many I believe sums up how to deal with this dreadful ‘Hell on Earth:

“Be persuaded, then, of one invaluable truth: even if you begin to weary of Gout’s society, the only safe way of dismissing him is by allowing him to dismiss himself. Inscribe in letters of gold on the cornice of your chamber, “Gout is the only cure for Gout.” You may turn yourself inside out, like a glove, with purgatives; you may deaden your nerves with quack narcotics, without advancing a step in the right direction.” Charles Dickens, 1858 15

Footnotes:
  1. courtesy of: https://creakyjoints.org/about-arthritis/gout/gout-symptoms/what-gout-pain-feels-like/[↩]
  2. From: https://www.google.com/search?client=firefox-b-d&sca_esv=557642428&sxsrf=AB5stBhmbTbFeLzZQt3B7Pt1_okL4KqUOA:1692235305019&q=images+of+gout+in+big+toe&tbm=ischsource=univfir=Ui3PzDLJcK4GM%252CHoXFzIc3ozlbM%252C_%253BDnUDk_9u3bYuPM%252CrQBJoG83fLD2JM%252C_%253BPyLj7FiMxFJBEM%252CsYf8_yXyq6HCKM%252C_%253BMvvM21gjZBrDGM%252CMeAhZe4xi4Z0MM%252C_%253BbaY8pd8Au1U0VM%252C7fJXlZBF9L3fnM%252C_%253BddgM-LXW_9kyLM%252CHj0KWjj7WGd1M%252C_%253BYdbWIgCSlb8HM%252CTqD4qZ_NTjJm9M%252C_%253BVw0Xf3YRSBR_dM%252Coxhov8kP5WXmzM%252C_%253BTPT7MxD4ERa3KM%252CcFemDm3RZDPeuM%252C_%253Bn3EjEnJJ_1RxM%252Crv4VSehWhxnVM%252C_%253ByZxye5P6MHwZYM%252CMeAhZe4xi4Z0MM%252C_%253BJFna0Vc98PzFM%252CYz3Uft_5w7yqBM%252C_usg=AI4_kQY5w_tUPKYRQZWMxC6Ca3DvoRDpg&sa=X&ved=2ahUKEwiBoe3hw-KAAxWvATQIHegbC84Q7Al6BA[↩]
  3. From HPC Live Network, Mark L. Fuerst. 2015. How Common is Gaut in the United States, Really? https://www.hcplive.com/view/how-common-gout-united-states-really[↩]
  4. a colourless crystalline compound with basic properties, forming uric acid on oxidation[↩]
  5. from: https://www.google.com/search?q=images+of+uric+acid+crystals+in+human+joints&tbm=isch&ved=2ahUKEwjNueepwuKAAxXhIzQIHdNxBWYQ2-cCegQIABAA&oq=images+of+uric+acid+crystals+in+human+joints&gs_lcp=CgNpbWcQAzoECCMQJzoFCAAQgARQnxZYxz5g-EZoA3AAeACAAXKIAYAMkgEEMTYuMpgBAKABAaoBC2d3cy13aXotaW1nwAEB&sclient=img&ei=p3TdZI3KAuHH0PEP0-OVsAY&bih=504&biw=1083&client=firefox-b-d#imgrc=JobhjEpLUBrcWM[↩]
  6. Hyperuricemia is an elevated uric acid level in the blood. This elevated level is the result of increased production, decreased excretion of uric acid, or a combination of both processes.[↩]
  7. Comorbidity occurs when a person has more than one disease or condition at the same time. Conditions described as comorbidities are often chronic or long-term conditions.[↩]
  8. Sugary drinks and sweets; high fructose corn syrup; alcohol; organ meats; game meats; certain seafood, including herring, scallops, mussels, codfish, tuna, trout and haddock; red meats, including beef, lamb pork and bacon; turkey.[↩]
  9. Gibson, T, A. V. Rogers, H. A. Simmonds, P. Toseland. 1984. Beer Drinking and Its Effect on Uric Acid. Rheumatology 23:203-09.[↩]
  10. From Judith Sautner, Gabriela Eichbauer-Sturm, Johann Gruber, Raimund Lunzer, Rudolf Johannes. 2022. 2022 update of the Austrian Society of Rheumatology and Rehabilitation nutrition and lifestyle recommendations for patients with gout and hyperuricemia. In Wien Klin Wochenschr (2022) 134:546–554. [Puchnehttps://link.springer.com/article/10.1007/s00508-022-02054-7][↩]
  11. For more information about the Vitamin C controversy, consult this article: https://www.healthline.com/health/vitamin-c-gout.[↩]
  12. Ayoub-Charette S, Liu Q, Khan TA, et al. Important food sources of fructose-containing sugars and incident gout: a systematic review and meta-analysis of prospective cohort studies. BMJ Open. 2019;9(5):e24171.

    Ebrahimpour-Koujan S, Saneei P, Larijani B, Esmaillzadeh A. Consumption of sugar-sweetened beverages and dietary fructose in relation to risk of gout and hyperuricemia: a systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2020;60(1):1–1.[↩]

  13. Serum Urate Level[↩]
  14. The effectiveness of probiotics to reduce gout attacks is no longer merely anecdotal. It’s science-based. For more information about the subject, read this article: Rodríguez JM, Garranzo M, Segura J, et al. 2023. A randomized pilot trial assessing the reduction of gout episodes in hyperuricemic patients by oral administration of Ligilactobacillus salivarius CECT 30632, a strain with the ability to degrade purines. Front Microbiol. 2023;14:1111652. https://www.hcplive.com/view/probiotic-linked-reduced-gout-episodes-need-treatment[↩]
  15. Good Qualities of Gout. In All the Year Round: A Weekly Journal, conducted by Charles Dickens, 1859 May 28th.[↩]