Roger  is a sports enthusiast, exercising strenuously even at age 65. Several times per year he goes on week-long skiing or bicycling trips. After returning from some trips, Roger gets severe gout pain in his big toe. Roger uses no medications and doesn't alter his diet, but he does take daily supplements and avoids alcohol. During acute attacks he rests the toe, drinks water and fruit juices, doubles his antioxidant supplement dose, takes three to four grams of vitamin C per day and avoids peanuts. 

Alan is Roger's son, age 31, 6'5" and 285 pounds. Around age 18 he found that bumps and bangs on his elbows and knees,  such as from jostling during basketball, resulted in huge painful joint swellings that took weeks to resolve. The degree of swelling was way out of proportion to the minor injury. 

Initial tests for gout were negative,  and he was told he had overreactive joints. However, the problem recurred and worsened–his elbows  and knees appeared swollen all  the time. Fairly severe gout was diagnosed years later. Alan now takes medication and three grams of vitamin C daily, and strongly limits his meat, fish, legume and beer intake. 

Roger and Alan aren't alone: gout affects three adults per thousand in the general population, but over 95 percent of cases occur in males over 30.  Most gout attacks involve the big toes only. Gout is a disease that has been known since ancient times. In the past gout was thought  to have  a nutritional cause, but we now know that gout results from several genetic disorders which cause build up or impair the excretion of uric acid. Gout can be effectively controlled with diet, and nutritional supplements. 

Good Nutrition for Gout 

Uric acid levels in the  bloodstream are higher than normal in  a person with gout. The kidneys can't excrete the excess uric acid in the urine, so sodium urate crystallizes in joints, causing painful inflammation and severe arthritic symptoms. Uric acid is the normal form in which biochemicals called purines are excreted after they are digested and metabolized. Purines are components of nucleic acids (DNA and RNA). Generally, high protein foods are rich in purines,  but there are important exceptions. Diets for gout often recommend avoiding nearly all protein, but this is unnecessary. A large percentage of purines come from  the body recycling its own tissue proteins, so it's impossible to completely eliminate purine metabolism. 

Any recommended diet for gout starts by limiting or avoiding foods especially high in purines, including organ meats, shellfish, red meat, anchovies, sardines, herring,  and mackerel. Legumes, especially peanuts, should also be limited or avoided. Poultry and white fish are better choices but should not be eaten in excess. Dairy proteins (including whey and casein protein isolates) and egg whites are animal byproducts, but they don't contain the levels of DNA and RNA that organs, muscles and seeds do and therefore  can be eaten. Many sports nutrition protein powders, beverages and meal replacements are good choices for those with gout. 

You can choose supplements that can help, too. I recommend three to six grams of vitamin C, three to four grams of fish oil, a multivitamin/mineral, and antioxidant supplements daily to help reduce inflammation and to provide nutrients lost when limiting protein foods. Vitamin C is  also thought to help reduce uric acid levels  in the bloodstream. Be aware that nutritional and brewer's yeast and supplements with organ tissue extracts are high in purines and could pose a risk if taken regularly. 

Alcohol consumption exacerbates  gout by reducing uric acid excretion and slightly increasing uric acid production from purines. Beer and wine are higher in purines than other alcoholic beverages due to yeast residues. Men who drink more than seven beer per day are more likely to have gout than those who drink less beer. 

Plenty of pure water is a must!  Even mild dehydration increases the risk for formation of urate crystals. In fact, Roger's gout is probably triggered by dehydration from prolonged exercise with limited water intake. 

Xanthine oxidase is  the enzyme that does  the final step in converting purines to uric acid. The prescription medication given for gout prevention, works by reducing the action of xanthine oxidase. About 10 common flavonoids have been shown do this job almost  as well as allupurinol. Herbs rich in these flavonoids are chiso (Perilla frutescens), yarrow (Achillea millefolium), carrots (Daucus carota), chamomile (Matricaria recutita) and many mints (Mentha spp). There aren't any clinical studies  of these herbs for gout prevention, but since they're very safe, they're worth trying. Eating cherries daily is a European folk remedy for gout. Cherries, grapes, blueberries and bilberries are not particularly rich in  the flavonoids listed above, but are high in anthocyanidins. Anthocyanidins may increase  the excretion of uric acid. 

Native Americans suffered from gout, too. Twenty-six plants used for gout by indigenous Northeastern North Americans were tested for their ability  to inhibit xanthine oxidase. Eighty-eight per cent of  the plants were inhibitors, but tamarac (American larch;  Larix laricina) was the most effective. Plants that were good inhibitors were high  in tannins  and related compounds. 

James Duke, PhD, economic botanist, has  gout and uses celery seed extract as an alternative  to medication. He's seen no good research on it, but read about it as a folk remedy. Duke takes four capsules of celery seed extract per day and has not had  a gout attack  in two and a half years. According  to Duke, celery (Apium graveolens) has at least 26 antiinflammatory compounds. Celery stalks contain fairly high concentrations of a flavonoid  that inhibits xanthine oxidase, but this flavonoid isn't concentrated in  the seeds, so just how  the seed works is unknown. Duke agrees with another recommendation for gout he's heard: fresh carrot juice daily. 

Colchicine,  an ancient  gout remedy derived  from the autumn crocus (Colchicum autumnale) bulb is prescribed to alleviate acute gout attacks. Colchicine is  a poisonous alkaloid used in doses of less than one milligram. Autumn crocus  and related lily bulbs (like daylily) that may have colchicine are sometimes available in herbal products or  can be collected in the wild, but self-medication is not recommended. During painful acute attacks, herbal alternatives  to arthritis drugs include boswellia (Boswellia serrata), curcumin (Curcuma longa), yucca (Yucca spp)  and devil's claw (Harpagophytum procumbens). These may help reduce inflammation. 

The British Herbal Pharmacopoeia  recommends guaiacum resin extract for gout and commercial preparations are available in the UK.  Boswellia is fairly similar to guiacum and is more readily available in North America. Whichever herb is selected, make sure  the dosage used is high enough for this very painful condition. I recommend at least two 500 mg dried herb capsules three times per day for two  to seven days. 

Longterm Considerations 

If gout is untreated, microscopic crystals of sodium urate can damage organs, especially the heart and kidneys. This leads  to premature aging of organs and possibly urate kidney stones. For chronic gout, I would recommend supplementation to support  the cardiovascular system. Use all the supplements listed above, and consider adding coenzyme Q,o, magnesium, alpha-lipoic acid, chromium and L-car-nitine. High doses of niacin may interfere with uric acid excretion, so don't use niacin to lower cholesterol, for example, without professional supervision. Very high intakes of fructose can elevate uric acid. Those with gout should choose a diet free of excessive amounts of sweets, corn syrup, and fruit.