Saturday, December 3, 2022

Preventive strategies for high uric acid & gout

High uric acid levels can be lowered with lifestyle and dietary modifications as well as use of nutrients and supplementation.

Uric acid is a byproduct of the digestion of compounds called purines. These purines are found in many food sources or produced in the body. They are metabolised in the intestines and liver.

Uric acid is oxidised by a digestive enzyme called uricase. However, in some people, uricase production is less than required. The uric acid starts rising in their blood and tissues. Eventually, it crystallises as monosodium urate crystals in the tissues. These needle-like crystals are sharp and painful, leading to a gout attack.

Initially, gout attacks are less frequent and localised to only a few joints. However, if they persist, more and more joints get involved. They can also damage your internal organs. So it makes sense to prevent future gout attacks by lowering serum uric acid.

Preventive Strategies

Gout preventive strategies involve a three-pronged approach:

  1. Lowering serum uric acid levels, by reducing production of uric acid or by increasing excretion of uric acid through urine; and
  2. Reducing joint inflammation.

Towards these goals, one should deploy three types of controls:

  1. Lifestyle changes;
  2. Dietary modifications; and
  3. Nutrients, herbs, & supplementation

The points in bold letters are important and vital. The points in plain text are of optional or adjuvant value.

Lifestyle Changes

  1. Water: Drink at least 2 litres of water a day. That will be roughly 8 glasses. Water helps flush out uric acid from the blood.
  2. If you are likely to get dehydrated in any activity, ensure adequate drinking water is available.
  3. Exercise: Perform 150 min of exercise per week, preferably divided over at least 5 days.

Dietary Control

  1. Alcohol: Avoid! When you drink alcohol, your liver and kidneys have to work overtime to metabolise and eliminate alcohol from the body. That competes with uric acid removal, causing excess buildup of uric acid.
  2. Foods containing Purines: Restrict high-purine foods, such as organ meats, mussels, anchovies, mackerel, and yeast. Reduce moderate-purine foods, such as mushrooms, spinach, dried peas, beans, poultry, other fish and shellfish.
  3. Skimmed Milk: Skimmed milk is found to help prevent the development of gout by lowering uric acid levels in the blood.
  4. Sweetened Drinks: Avoid sweet drinks containing sugar or high-fructose corn syrup. While neither of them are high in purines, they raise serum uric acid levels by increasing cellular processes.
  5. Diet Drinks: Drinks with artificial sweeteners do not affect serum uric acid.
  6. Cherries: Cherries help in reducing gout risk. They contain antioxidants such as anthocyanins and quercetin that help reduce inflammation. While cherries also contain vitamin C, that quantity is too low to matter for gout attack prevention. The amount of cherries to consume per day for this benefit is not known accurately. But various experts advise drinking 250 ml or 8 oz. of unsweetened tart cherry juice.
  7. Tobacco: Avoid tobacco consumption.
  8. Coffee: One to three cups of coffee did not help lower uric acid. However, 4-5 cups of coffee a day helped lower serum uric acid. This benefit was not because of caffeine in the coffee. Even the decaffeinated coffee helped in gout. On the other hand, another drink having caffeine in it—tea—did not lower serum uric acid.
    The benefits of coffee are thought to be due to two features:
    a) Coffee contains a polyphenol called chlorogenic acid that reduces insulin resistance. This, in turn, helps in excretion of uric acid;
    b) Caffeine has the chemical structure similar to allupurinol, which is a medication used for removing uric acid from body tissues as a treatment for gout.
  9. Trans Fats: Avoid foods containing trans fats. They are found in many biscuits, cakes, margarine, and other processed foods.
  10. Refined Foods: Avoid white bread and other flour based foods.
  11. Oxalates: Reduce foods containing oxalates such as spinach, beets, strawberries, and chocolate.
  12. Fiber: Increase intake of foods containing fiber such as green leafy vegetables and oats.
  13. Cooking oils: Use healthy oils such as clarified butter (ghee), coconut oil, or olive oil.

Nutrients, Herbs & Supplementation

The supplementation strategies for gout aim to intervene in the mechanism by which high blood uric acid develops. I have a detailed article on this website: Supplements for high uric acid & gout. In brief:

  1. Vitamin C: It helps reduce serum uric acid by increasing uric acid excretion in urine. Many clinical trials have found that 500 to 1500 mg of vitamin C a day reduces the risk of developing gout in a dose-dependent manner (higher the intake of vitamin C, lesser was the risk).
  2. Omega-3 fatty acids: They reduce inflammation in the body, which is significantly high in gout. One can get some omega-3 fats by eating fatty fish. However, many fish varieties contain purines, which are better avoided by high uric acid patients. A fish oil supplement is the best option because a good quality supplement will have distilled oils that do not contain purines.
  3. Vitamin D: Low levels of vitamin D are found in people with high uric acid.
  4. Bromelain: It is an extract from pineapple plant. Bromelain is an antioxidant and is known to help in inflammation related to arthritic conditions.
  5. Turmeric: It is a natural anti-inflammatory and useful for pain reduction.
  6. Dandelion: Reduces swelling and increases uric acid excretion.
  7. B-Vitamins: Folates (natural vitamin B9), folic acid (synthetic vitamin B9) and vitamin B12 help lower serum uric acid. Folates break down homocysteine which is positively correlated with serum uric acid.
  8. Boswellia: Helps reduce joint inflammation and pain in arthritis and gout. Used extensively in Ayurveda for pain relief. It is a gum resin extracted from a type of guggul plant.
  9. Ermiao Wan: Used for reducing inflammation in Chinese Traditional Medicine.
  10. Methylsulphonylmethane (MSM): Helps in reducing joint pain, stiffness and swelling. Works as an antioxidant.
  11. Vitamin B3 (Niacin): Avoid taking extra. Competes with uric acid for excretion.
  12. Vitamin A: Avoid taking extra.

For More Reading

First published on: 16th December 2021
Image credit: R Khalil on Pexels
Last Updated on: 8th August 2022

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