Supplements for high uric acid & gout

Executive Summary
Here are the supplements that are advisable for high uric acid and gout.

Necessary:
Vitamin C (1,500 mg a day);
Bromelain (1,000 mg a day);
Boswellia (250 mg a day); and
MSM (1,500 mg a day).

Optional:
Omega-3 fish oils (1,000 mg a day omega-3 oils or 3,000 mg a day fish oils); and
B-vitamins.

There are other supplements that are helpful, too. Read the article for more details.

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Gout is a type of arthritis that is caused by high levels of blood uric acid. Arthro– means joint; –itis is an appendage that implies inflammation or swelling of that organ. So arthritis means a swollen joint.

There are many causes, and therefore types, of arthritis. When high blood uric acid leads to a swollen joint, that arthritis is called gout.

In this article, I will discuss the use of supplements that help with gout. Let’s start by knowing a bit of the underlying science.

Introduction

There are certain chemicals called purines that are found in all animal and plant cells. Even our body makes them. In fact, nearly two-thirds of the purines in our body are made internally and the rest are obtained from the food we eat.

When these purines are processed in the body, they create a byproduct called uric acid. In general, uric acid is not harmful. In fact, it is considered an antioxidant that helps with immunity.

Uric acid is poorly soluble in blood and so it has a tendency to form crystals if its levels are high. Normally, an enzyme in the body called uricase converts it into a highly soluble compound called allantoin. This helps the kidneys to excrete allantoin, reducing the blood levels of uric acid. A little bit of uric acid is also excreted through stools.

In some situations, the blood levels of uric acid rise above normal. This condition is called high blood uric acid or hyperuricemia.

How High Blood Uric Acid Develops

If you understood the science described above, you can guess the different ways in which one can get hyperuricemia. The blood levels of uric acid can go higher than normal in four possible situations:

1. The body produces more uric acid (this can happen due to genetic causes);
2. The person consumes an excessive amount of foods and drinks that are high in purines;
3. The body does not make enough uricase enzyme; and
4. The kidneys are not able to flush out uric acid from the blood.

Nearly twenty per cent of the population has such hyperuricemia.

These high levels of uric acid are not healthy. Such people are likely to have other medical conditions such as kidney stones, chronic kidney disease, type 2 diabetes, high blood pressure, and heart disease. It is unclear why these conditions are associated with high blood uric acid levels.

Another main problem resulting from high blood uric acid is gout. Four per cent of the population (which is one-fifth of the people suffering from high blood uric acid) develop gout.

How Gout Develops

As mentioned, uric acid is poorly soluble in the blood. So its high levels cause it to crystallise as monosodium urate crystals in the body tissues. They are often formed in the synovial fluid that surrounds the joints of feet and big toes. These needle-like crystals are sharp, which causes severe and painful swelling. That is known as 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.

Supplementation for High Uric Acid and Gout

Gout is a medical condition needing proper treatment. Untreated gout can cause various complications. The supplements mentioned in this article are meant to complement your medical treatment. Discuss with your doctor if you wish to try supplementation along with your medication.

Supplementation strategies for high uric acid rely on three pillars:

1. Reducing the production of uric acid in the body;
2. Increasing excretion of uric acid through urine; and
3. Reducing joint inflammation.

Supplements to Reduce Uric Acid Production

1. B-Vitamins: Folates (natural vitamin B₉), folic acid (synthetic vitamin B₉), and vitamin B₁₂ help lower blood uric acid. Folates break down a compound called homocysteine, the levels of which are positively correlated with blood uric acid levels.
2. Vitamin D: Low levels of vitamin D are found in people with high uric acid. Take 2,000 to 4,000 IU a day, preferably with vitamin K₂.

Supplements to Increase Uric Acid Excretion

1. Vitamin C: Increases uric acid excretion in urine. Many clinical trials have found that 500 to 1,500 mg of vitamin C a day reduces the risk of developing gout in a dose-dependent manner (that is, the higher the intake of vitamin C, the lesser the risk).
2. Dandelion: Reduces swelling and increases uric acid excretion.

Supplements to Reduce Joint Inflammation

1. Bromelain: It is an extract from the pineapple plant. Bromelain is an antioxidant and is known to help in inflammation related to arthritic conditions.
2. 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.
3. Methylsulphonylmethane (MSM): Helps in reducing joint pain, stiffness and swelling. Works as an antioxidant. 1,500 mg a day.
4. Omega-3 fatty acids: They reduce inflammation in the body and joints. One can get omega-3 oils by eating fatty fish. However, many such fish varieties contain purines, which are better avoided by people with high uric acid. A high-quality fish oil supplement will have distilled oils that do not contain purines. Aim for 3,000 mg a day of fish oil (1,000 mg of omega-3 oils). Read a detailed article on this nutrient on this website: Omega–3 oils: A complete guide.
5. Turmeric: It is a natural anti-inflammatory and useful for pain reduction.
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 prevent gout attacks. Drink 250 ml or 8 oz of unsweetened tart cherry juice or consume dried cherry powder equivalent to 10 to 30 cherries a day.
7. Ermiao Wan: Used for reducing inflammation, as per Traditional Chinese Medicine (TCM).

Supplements to Avoid

1. Vitamin B₃ (Niacin): Avoid taking extra. Competes with uric acid for excretion.
2. Vitamin A: Avoid taking extra.

Long Term Complications

• If untreated, uric acid crystals can get deposited in small nodules called Tophi. Such tophi can develop in the joints of fingers, hands, elbows, and feet. During a gout attack, they can become swollen and painful.
• Some people get gout attacks very frequently. They can cause permanent damage, deformity, and stiffness to the joints in the hands and feet.
• Most kidney stones are of calcium oxalate and calcium phosphate. However, if one has gout for many years, one may develop kidney stones of made of urates.
• Untreated gout and kidney stones can lead to kidney scarring and damage.
• Since gout attacks are extremely painful and debilitating, recurrent attacks can lead to stress, anxiety, and depression.

My Views

1. Many simple lifestyle changes go a long way towards helping you lower blood uric acid. Read on this website: Preventive strategies for high uric acid & gout.
   
   
2. Most plant-based foods have 10 to 15 mg of purines per 100 g. Most animal-based foods have 120 to 400 mg of purines per 100 g. So a plant-based diet is generally safe for preventing gout attacks.
   
   
3. Many websites erroneously advise avoiding all high-purine foods for gout patients. However, new research shows that not all high-purine foods raise uric acid equally. Here is a bit of science:
   • There are four purines: adenine, guanine, hypoxanthine, and xanthine. Adenine and hypoxanthine are far worse for uric acid production and gout compared to the other two purines.
   • More than fifty per cent of the total purines in animal– and fish meats are hypoxanthine.
   • More than sixty per cent of the total purines in cereals, beans, soy, legumes, and mushrooms are adenine and guanine.
   • As a result, animal-based foods generate far more uric acid compared to plant-based foods with a similar amount of purines.
   • So, don’t avoid plant-based proteins even if they are high in purines.
     
4. If you need help with any of the points discussed, write to me at madhur.kotharay@gmail.com (Disclaimer: No medical advice from my side, please. But I will be happy to help with the supplement selection part). Kindly mention “Supplements for Gout” in the subject of the email.

For More Reading

• Cleveland Clinic: Gout;
• UpToDate: Treatment of Gout Flares;
• Arthritis-Health: Hyperuricemia – High Uric Acid Levels and Gout;
• HealthLine: 10 Supplements That May Help Treat and Prevent Gout;
• Arthritis Foundation: Gout and Supplements: What You Need to Know;
• On this website: Can dehydration cause a gout flare-up?;
• Nutrients Journal: Uric Acid and Plant-Based Nutrition.

First published on: 15th April 2022
Image credit: Photo created by doucefleur – www.freepik.com
Last Updated on: 7th July 2022