Gout is one of the diseases of the rheumatic type. It usually manifests itself when chronically high uric acid levels have formed in the blood, uric acid crystallizes and the crystals become painfully noticeable in the joints.

Gout = high uric acid levels

Gout is an inflammatory-rheumatic disease that shows up in the blood count with high uric acid levels (hyperuricemia) and is accompanied by joint pain. Uric acid is produced during the metabolism of purines (1). These substances are mainly found in meat, sausage and fish. The uric acid eventually forms crystals that lead to pain in the joints – especially in the big toe, knee and fingers.

Alcohol also causes uric acid levels to skyrocket. A plant-based diet with only non-alcoholic beverages is therefore a good solution here.

Throughout history, the condition has always been associated with overeating and alcohol consumption. It is even known as the “king’s disease” and symbolized a high social status in ancient times, as only the upper class could afford to consume wine and meat.

In the meantime, the disease has developed into a global health problem. It rarely occurs alone but usually occurs together with other metabolic diseases (obesity, diabetes, high blood lipid levels, high blood pressure) and increases the risk of premature death.

How the typical pain occurs

Uric acid can form sharp, needle-like crystals that are deposited especially in the joints. These deposits of uric acid crystals create swelling, redness, warmth, pain, and stiffness in the joints.

Although the joints are most commonly affected, crystal deposits can also form under the skin and in the kidneys (kidney stones) or in other parts of the urinary tract.

Uric acid is normally dissolved in the blood and is filtered through the kidneys before being excreted in the urine. People who suffer from gout either produce excessive amounts of uric acid or their kidneys have a problem with excretion. This condition is called hyperuricemia and is diagnosed as such when the uric acid in the blood exceeds a value of 7 mg/dl.

However, not all people with hyperuricemia necessarily develop gout. And in contrast, there are also people who suffer from the disease even though they have normal uric acid levels. In many cases, the cause of the disease is not known (idiopathic).

Risk of heart disease increases

A long-term study that examined data from the National Health and Nutrition Examination Survey found that elevated uric acid levels increase the risk of fatal heart disease.

A distinction is made between primary and secondary gout. The primary variant has unknown causes. The liver produces too many purines or there is a congenital inability to excrete purine. This variant is considered rare. Secondary forms of the disease with a known cause are more widespread.

Medication stops uric acid excretion

Secondary gout often develops due to diet-related acidification of the body, as a result of another disease or due to side effects of some medications.

For example, diuretics are used to treat high blood pressure because they flush water out of the body. The loss of fluid in the blood vessel system lowers blood pressure. These drugs can retain uric acid in the body, which then leads to an increase in uric acid levels in the blood.

Gout is sometimes confused with a form of arthritis called pseudogout, as it also has comparable symptoms such as inflammation and swelling. In the pseudovariant, however, the deposits consist of calcium phosphate crystals and not of uric acid crystals.

Risk factors and causes

Family history

Some people are born with an enzyme defect that causes purines to not be metabolized properly. Approximately 18% of American gout patients show a corresponding familial burden.

Gender and age

The disease is more common in men, especially between the ages of 30 and 50.

Excessive alcohol consumption

Too much alcohol, especially beer, supplies the body with purines and can also hinder the organism in its uric acid excretion.

Sugar

Some research has also linked heavy consumption of sugary drinks to an increased risk of gout.

Nutrition

Excessive consumption of foods high in purpurin, such as meat, offal and seafood, as well as high consumption of yeast-rich foods such as bread and beer, can lead to an overgrowth of yeast fungi in the intestine, which in turn can increase the formation of uric acid (2).

Low-fat dairy products, on the other hand, are said to reduce the risk of disease, especially in combination with probiotic cultures (yoghurt, kefir).

Fiber deficiency

A healthy intestinal flora could produce short-chain fatty acids from fiber. These can get into the blood and have an anti-inflammatory effect there (in the case of acetate) – e.g. if inflammatory processes occurred due to uric acid crystals in the blood. Another anti-inflammatory short-chain fatty acid is butyrate, which is involved in the regulation of uric acid metabolism and prevents abnormalities here.

A diet of fiber-rich whole grains, vegetables and fruits is therefore very important for diseases such as gout.

Long-term use of certain medications

Many medications interfere with the body’s excretion of uric acid, as these often affect kidney function. These include diuretics, painkillers, immunosuppressants, and Parkinson’s medications. Chemotherapy leads to an increased breakdown of abnormal cells, which causes a large amount of purines to be released in the body. These then cause the uric acid level in the blood to rise.

Anemia

In anemia, the number of red blood cells and the concentration of the red blood pigment hemoglobin is lower than normal. Uric acid levels can rise here if an excessive number of blood cells disintegrate.

Lead exposure

Studies have found a link between the occurrence of gout and exposure to lead. You don’t even have to be excessively heavily contaminated with lead. Values in the upper range within the blood lead level, which is currently still considered acceptable, are sufficient to increase the risk of rheumatic disease by 3.6  times (3).

The three stages of gout

Gout can be divided into different stages:

Incipiency

In the first stage, the patient shows increased uric acid levels in the blood (hyperuricemia), otherwise there are no other symptoms. This stage is called asymptomatic hyperuricemia and is rarely treated with medication.

Even without treatment, the first stage often disappears on its own within 3 to 11 days. With drug treatment, the pain attack can be interrupted within a few hours.

Even if the swelling and pain disappear at first, gouty arthritis recurs in the vast majority of cases in the same joint or in another. Most of the time, the patient is pain-free for a certain period of time.

Second stage

The second stage is called acute gouty arthritis. The patient suddenly develops a hot, red and swollen joint, which is triggered by the deposition of uric acid crystals. In most cases, the big toe joint or knee is affected.

These attacks are often triggered by certain factors, such as chronic diseases (diabetes, high blood pressure), injuries, surgery, alcohol, foods high in purines, or certain medications.

The attacks usually begin at night in a single joint. The pain can become so bad that even just a blanket can intensify it. Chills and slight fever may also occur.

Third stage

During the third stage, the patient has no symptoms and has normal joint functioning. The next gout attack generally occurs within the next 2 years, followed by further attacks.

If left untreated, the intervals between attacks can become shorter, more painful and last longer. Over time, the attacks can spread to other joints, usually affecting the upper extremities, such as the fingers. These attacks may also be accompanied by a joint infection (septic arthritis).

Chronic course

If the disease remains untreated for several years, it can become chronic. During this last phase, chronic pain and inflammatory reactions occur. The affected joints are permanently damaged due to the large amount of uric acid crystals deposited. This causes nodular thickening, usually near the knuckles or finger joints, which is called gout tophi. These are also deposited in bones and cartilage, such as in the ear.

How to prevent gout

In principle, it is important to keep the uric acid level in the blood within a normal range (below 7 mg/dl) in order to prevent gout. This can be achieved through the following measures, among others:

1. Maintaining a normal body weight through a healthy diet and regular exercise.
2. Avoid excessive consumption of purine-rich foods. Foods that are particularly rich in purines are, for example: fish and seafood, offal, bacon, meat, legumes and yeast.
3. Preferably eat plant-based food (alkaline diet as a cure, followed by a permanent alkaline diet. Such a diet causes the urine pH value to rise. In a 2010 study, it was shown that with an alkaline diet, uric acid excretion increased from 302 mg/day at a pH of 5.9 to 413 mg/day at a pH of 6.5 (4), even though the alkaline diet contained a lower purine load than the acidic diet.
4. Limit alcohol consumption or avoid it altogether. Excessive alcohol consumption, especially beer, can hinder the excretion of uric acid. Alcohol should be avoided, especially in the case of an acute gout attack
5. Drink plenty of good water (2.5 to 3 litres per day). Water helps to dilute and excrete uric acid in the blood and urine.
6. Alkaline baths (foot and/or hand baths, as well as full baths) are occasionally recommended in naturopathy to drain uric acid through the skin. However, the actual excretion of uric acid through the skin is most likely too low. If you sweat during a hard workout, uric acid excretion is even retained.
7. The intake of high-quality minerals – if the mineral requirement cannot be covered by the diet – helps with the excretion of uric acid. However, mineral surpluses should be avoided as they increase the risk of uric acid accumulating.
8. Leech therapy – in some countries medical leeches are put on the swollen joints to suck out the blood and reduce the pain of the swelling.