Natural Approach for the
Relief of Gout

Introduction

With the increased popularity of the “low carb” diet, there has been a rather dramatic increase in the prevalence of gout – more than twice as many people suffer from gout now compared to ten years ago. Gout is a common type of arthritis caused by an increased concentration of uric acid (the final breakdown product of purine—one of the units of DNA and RNA) in biological fluids. In gout, uric acid crystals are deposited in joints, tendons, kidneys, and other tissues, where they cause considerable inflammation and damage. Gout may lead to debilitation from the uric acid deposits around the joints and tendons, and kidney involvement may result in kidney failure.

Gout is the result of either increased synthesis of uric acid; reduced ability to excrete uric acid; or both over production and under excretion of uric acid. Several dietary factors are known to trigger gout, including consumption of high-purine content foods (such as organ meats, meat, yeast, poultry), fats, excessive alcohol,and refined carbohydrates. Obesity is also associated with an increased rate of gout. Weight reduction in obese individuals significantly reduces serum uric acid levels. Hydration is also important as a liberal fluid intake keeps the urine diluted and promotes the excretion of uric acid.

Food Prescriptions for Gout

The dietary treatment of gout involves the following guidelines, each of which will be briefly summarized:

1. Low-purine diet
2. Elimination of alcohol intake
3. Achievement of ideal body weight
4. Elimination of refined carbohydrates
5. Low-fat intake
6. Avoid high-protein, high-fat foods
7. Liberal fluid intake
8. Liberal consumption of cherries or flavonoid-rich extracts

A low-purine diet has long been the mainstay of dietary therapy for gout. Foods with high purine levels should be entirely omitted. These include: organ meats, yeast (brewer’s and baker’s), herring, sardines, mackerel, and anchovies. Intake of foods with moderate levels of protein should be reduced to 1 serving every 2-3 days as well. These include: dried legumes, spinach, asparagus, fish, poultry, and mushrooms. Low-purine foods may be eaten in small amounts daily.

Table 1. Purine Content Ranking of Selected Foods

High-Purine Foods:

• Anchovies
• Consommé
• Herring
• Mackerel
• Meat extracts
• Organ meats (including brain, kidney, and liver)
• Roe
• Sardines
• Yeast, including Baker’s and Brewer’s

Moderate-Purine Foods:

• Asparagus
• Fish
• Legumes
• Meat
• Mushrooms
• Peas (dried)
• Poultry
• Shellfish
• Spinach

Low-Purine Foods:

• Eggs
• Fruit
• Grains
• Milk
• Noodles
• Nuts
• Olives

Alcohol increases uric acid production by accelerating purine breakdown. It also reduces uric acid excretion by increasing lactate production, which impairs kidney function. Elimination of alcohol is all that is needed to reduce uric acid levels and prevent gouty arthritis in many individuals.

Obesity is associated with an increased rate of gout. Weight reduction in obese individuals significantly reduces serum uric acid levels. Weight reduction should involve the use of a high-fiber, low-fat diet, as this type of diet will help manage the elevated cholesterol and triglyceride levels that are also common in obesity.

Refined carbohydrates and saturated fat intake should be kept to a minimum. Simple sugars, such as refined sugar, honey, maple syrup, corn syrup, and fructose, increase uric acid production, while saturated fats decrease uric acid excretion. The diet should focus on complex carbohydrates, such as legumes, whole grains, and vegetables rather than on simple sugars.

High-protein and high-protein foods are usually foods that are high in purines. High- fat animal foods also promote inflammation and should be avoided, regardless of purine content. High protein foods that are not high in purines should be eaten only in small amounts to avoid taxing the kidneys, which are burdened with excreting excess uric acid.

Liberal fluid intake keeps the urine diluted and promotes the excretion of uric acid. Furthermore, dilution of the urine reduces the risk of kidney stones. Drink at least 48 ounces of water each day.

The most popular natural approach to gout has been consuming the equivalent of one-half pound of fresh cherries per day. This approach has proved useful in lowering uric acid levels and preventing attacks of gout. The flavonoid compounds in cherries have been shown to inhibit the production of uric acid as well as prevent destruction of joint structures. Flavonoid rich extracts like grape seed extract or pine bark extract may be effective substitutes for cherries. The typical dosage for these extracts is 300 mg per day.

Celery Extract for Gout

Though not as popular as the cherry cure for gout, celery seed extract appears to offer even greater benefit. Specifically, a special celery extract has been shown to produce significant benefits in the treatment of “rheumatism” – the general term used for arthritic and muscular aches and pain. The extract is standardized to contain 85% 3nB (3-n-butylpthalide) - a compound unique to celery that is responsible for the characteristic flavor and odor of celery as well as its medicinal effects. In these clinical studies the efficacy of celery seed extract was evaluated by well-established clinical protocols used to measure the effectiveness of conventional drugs used in arthritis and muscular pain. Study participants included patients suffering from osteoarthritis, osteoporosis or gout.

In the first study, the subjects had joint pain present for approximately 10 years in a remittent or continual form and it led to a lack of joint mobility and pain that prevented the carrying out of household duties, hobbies and activities involved in employment of these subjects. The subjects were given only 34 mg of the celery extract twice daily. Nonetheless, the results of the study were extremely positive and quite statistically significant. The chance that such a positive effect in reducing pain in these subjects was a placebo effect was less than 1 in 1000. Subjects experienced significant pain relief after 3 weeks of use with the average reduction in pain scores of 68% and some subjects experiencing complete 100% relief from pain. Most subjects achieved maximum benefit after six weeks of use although some did notice improvements the longer the extract was used.

In a second study, a similar group of patients received 75 mg of the celery extract twice daily for three weeks. At this higher dosage, the subjects reported even better results than in the first study. Statistically and clinically significant reductions were noted in pain scores, mobility, and quality of life. Like the first study, no side effects were noted other than a diuretic effect (celery seed extract also exerts significant blood pressure lowering action).

When the data on the subset of patients with gout was analyzed it was clear that they responded extremely well. Subsequent evaluation to explain the benefits noted in these patients indicates that 3nB lowers the production of uric acid by inhibiting the enzyme xanthine oxidase. Eventually celery seed extract lowers blood uric acid levels, however, quite interestingly the initial blood uric acid measurements may increase in people with gout as uric acid crystals begin to dissolve – a very good sign.

The proper dosage of a celery seed extract standardized to contain 85% 3nB and other phthalides for joint and muscle complaints based on the information now available from trials as well as clinical experience are the following:

• For the relief of join and muscle pain (including pain due to osteoarthritis, rheumatoid arthritis, and fibromyalgia): 75 to 150 mg daily.
• For gout: 75 to 150 mg twice daily.

Key References

• Blau LW. Cherry diet control for gout and arthritis. Texas Rep Biol Med 1950; 8: 309–311
• Jacob RA, Spinozzi GM, Simon VA, et al. Consumption of cherries lowers plasma urate in healthy women. J Nutr 2003;133(6):1826-9.
• Soundararajan S and Daunter B: Ajvine: Pilot biomedical study for pain relief in rheumatic pain. School of Medicine, The University of Queensland, Brisbane, Queensland, Australia, 1991-92.
• Venkat S, Soundararajan S, Daunter B and Madhusudhan S. Use of Ayurvedic medicine in the treatment of rheumatic illness. Department of Orthopaedics, Kovai Medical Center and Hospitals, Coimbatore, India, 1995.
• Hu D, Huang XX and Feng YP: Effect of dl-3-n-butylphthalide (NBP) on purine metabolites in striatum extracellular fluid in four-vessel occlusion rats. Yao Hsueh Hsueh Pao 1996;31:13-7

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Michael T. Murray, N.D., is widely regarded as one of world's leading authorities on natural medicine. A prolific author, Dr. Murray has written over 20 books on health and nutrition including the best-selling Encyclopedia of Natural Medicine and his latest book The Encyclopedia of Healing Foods. Dr. Murray is also Director of Product Development and Education for Natural Factors one of the leading manufacturers of natural products.