Gout |
What Causes Gout?
Gout is the result of excess uric acid. This excess uric acid then leads to the formation of crystals in a joint, and it causes pain and inflammation. Gouty arthritis comes on quickly, is extreamly painful, and generally occurs at the small joint at the base of the big toe. Other joints that may be affected include the ankles, knees, wrists, and elbows. Gout generally only affects one joint at a time. After one attack, it is much more likely to experience another attack of gouty arthritis. However, the next attack may not occur for years. Hard deposits of uric acid crystals manifest in various soft tissues in the body and when they occur, they are most commonly found around the big toe, fingers, and tips of elbows. However, they may occur in any body location. WHO IS AT RISK? People who are obese, have recently gained weight, have high blood pressure, consume large amounts of alcohol, take certain medications such as thiazide diuretics, niacin, or low-dose aspirin, are dehydrated, or have a disease called hypothyroidism (low thyroid hormone) are at increased risk for developing gout.
Gout affects approximately 1 million people every year in the United States alone. Men are affected much more commonly than women. It is rare for women to have gout until after menopause. Treatment
Gout Uric Acid Treatment Research shows that Gout Uric Acid comes in the following conditions.
1. Kidney yang weakness.
2. Liver yang distorted.
3. Spleen yang weakness.
4. Or Channel of Qi energy distorted.
Rheumatoid Arthritis RA affects millions of individuals worldwide, with an estimated prevalence from 0.3-1.5% of the population in North America. RA can occur at any age, with a peak incidence between the fourth and sixth decades of life. Although their causes and disease courses differ, both OA and RA can result in significant and disabling joint pain and damage with impaired activities of daily living, and substantial healthcare costs.
Nutrition and Rheumatoid Arthritis
Rheumatoid Arthritis (RA) is a systemic inflammatory disease that typically occurs in the synovial membrane of joints, including the cervical spine, fingers, wrists, elbows, feet, and others. The chronic inflammatory process of RA can eventually lead to severe joint dysfunction and deformity. Although the exact mechanisms are unknown, the role of the immune system is considered paramount in this autoimmune disease. Specific components of the body’s natural immune system, such as T-cells and cytokines, have been implicated as the major players in RA and its progression. Within this paradigm, studies have generally tried to explain both the benefits and ill effects of nutritional components on their ability to modulate inflammation and inflammatory substances in the body. There is a genetic component to the development and progression of RA. However, many believe that environmental triggers, such as nutrition, can also play a role in RA, especially in those who are already genetically susceptible. Despite variation among study outcomes, several nutritional components have come to the forefront as candidates in the prevention and treatment of RA. A study involving 238 RA patients in England found that 44% of these individuals had used some sort of herbal or over-the-counter remedy in a 6 month period. Following are some of the more widely studied nutritive components and evidence supporting or disputing their use in the treatment of arthritis.
Omega-3 Fatty Acids and Fish Oil
Omega-3 fatty acids, also called n-3 PUFAs (polyunsaturated fatty acids), are a naturally occurring component of certain foods and oils. Omega-6 fatty acids are another type of PUFA. Omega-3 and Omega-6 fatty acids are distinct and have opposing physiologic functions. Metabolism of omega-6 PUFA produces arachidonic acid (AA), which leads to certain pro-inflammatory cellular products. In contrast, metabolism of omega-3 PUFA, produces docosahexaenoic (DHA) and eicosapentaenoic acid (EPA), which have anti-inflammatory effects that balance that of omega-6 fatty acids. Major omega-6 and omega-3 PUFAs are linoleic and alpha-linolenic acid, respectively. The body cannot produce these substances making them essential to the diet. It is thought that the increased consumption of omega-6 PUFA-rich vegetable oils, such as sunflower oils and spreads in today’s Western diets, has dramatically increased the ratio of omega-6 to omega-3, shifting the balance of cellular products to a more pro-inflammatory state.
Sources of omega-3 fatty acids include: Flax seeds, seafood and fish such as chinook salmon, halibut, shrimp, and scallops, walnuts, cooked soybeans, raw tofu, winter squash, green leafy vegetables, as well as flaxseed oil and soya bean oil. Dietary sources rich in omega-3 PUFA can increase omega-3 fatty acid tissue concentrations, but these concentrations are hard to obtain in a regular diet. For this reason, and due to concern over mercury and other toxins in fresh fish, fish oil has recently become a popular supplement. Fish oil contains a high content of omega-3 fatty acids and are most often available in coated gel capsules. Dosages vary, and most recommended dosages can be quite high, in excess of 3-4 grams. People with diabetes, bleeding disorders and patients on blood-thinners should take caution when taking large doses of fish oil. Always discuss the potential risks and side effects before starting any new supplement with your doctor. In addition to health benefits in heart disease and several other conditions, beneficial effects of dietary supplementation of fish oil on RA has been observed in at least 13 double-blind, placebo controlled studies since 1985. A common feature of the studies has been a reduction in symptoms and in number of tender joints. Decreased morning stiffness and decreased dose of analgesic medications were also noted. One study reported a significant reduction in NSAID (non-steroidal anti-inflammatory drug) usage in patients receiving a fish oil supplement compared with those taking a placebo.
Olive Oil
Olive oil contains large amounts of an omega-9 MUFA (monounsaturated fatty acid) called oleic acid. Metabolism of oleic acid produces eicosatrienoic acid (ETA). Similar to omega-3 products, ETA competes with omega-6 PUFAs, tipping the scales to a less inflammatory state. Some have hypothesized that the prevalence of olive oil in Mediterranean diets is one reason for the reduced incidence of arthritis in Mediterranean populations. In a Greek population, consumers of high amounts of olive oil (almost daily throughout life) were four times less likely to develop RA than those subjects who consumed the oil less than six times per month. Although olive oil studies are not as common as fish oil studies, there is some evidence for the potential benefit of olive oil in arthritis. One study found that RA patients who consumed olive oil capsules (6g/day) had significant reduction in pain and joint symptoms at 6 months and some patients were able to reduce their dose of NSAIDs by 400 mg of ibuprofen/day. Another study found a significant trend between increased olive oil consumption and decreased risk of RA development. Although the strength of these studies is not ideal, they do present a small amount of evidence that olive oil can be beneficial in countering the inflammation of RA. With a virtually absent side-effect panel and a delicious food influence, it is certainly not unreasonable for arthritis patients to explore the option of incorporating olive oil into their diet.
Red Meat
Some studies have looked at possible correlations between the consumption of red meat and the incidence of RA. Four controlled studies have looked at vegetarian diets and pooled results have implied that eliminating meat from the diet may be useful in the treatment of RA. These studies are difficult to interpret since the effect may be a result of excluding meat, or things such as increased fruit and vegetable intake (and subsequent vitamin C intake). One ecologic study including 16 countries demonstrated a positive correlation between the national prevalence of RA and the per capita consumption of red meat. Interestingly, another recent study from 2004 showed a higher level of total protein intake increased the risk of inflammatory arthritis by almost three-fold. The study concluded that high levels of red meat consumption is an independent risk factor for development of inflammatory arthritis, although they were unsure if this association was causative.
One concept that may explain this apparent association is that red meat provides a dietary source of arachidonic acid (AA), the aforementioned cellular product that is involved with production of pro-inflammatory molecules. In addition to AA, red meat is also a large source of iron. In animal studies, iron has been shown to accumulate in rheumatoid synovial membranes, causing tissue damage. There is also evidence of iron-catalyzed oxidative reactions, shown to be causative in worsening synovial inflammation following iron infusions. Ironically, iron-deficiency anemia is not uncommon among RA patients. Although not proven, it has been hypothesized that some of these anemia cases could be caused by uptake of iron by inflamed synovial tissue.
Coffee and Green Tea
Coffee and green tea, two of the most popular beverages in the world, have been tested in only a few arthritis studies, and they have produced conflicting inconclusive results. One study reported that greater than 3 cups of coffee per day, especially decaffeinated coffee, is a risk factor for RA development. Another recent study found no significant association between decaffeinated coffee consumption greater than 4 cups per day and risk of incident RA. This same study found no relationship between caffeinated coffee consumption over 4 cups per day, or regular tea consumption, and risk for RA. The Nurses’ Health Study is a very large, ongoing study of thousands of women. As of 2002, this study had found no significant association between drinking coffee or tea and the risk of RA. There are no human studies or evidence that green tea is effective for RA or other forms of arthritis. The anti-oxidant polyphenol compounds found in green tea are thought to reduce inflammation. As with many things, it appears that consumption in moderation may be the guideline for coffee and tea. However, one may wish to remove coffee from their diet for a period of time to see if its removal may prove beneficial for arthritis symptoms.
Vitamin C
Vitamin C is well-known for its purported benefits with such things as the common cold and for its role as an anti-oxidant. Studies of vitamin C for the treatment of arthritis have produced mixed results. One animal study showed a decrease of inflammatory cell infiltration into synovial fluid (the fluid that is present between certain joints in the body) with the supplementation of vitamin C. One human study from 1999 failed to show any beneficial effect of vitamin C on the synovial inflammatory process. A population-based study of UK residents looked at dietary intake and found that over time, patients who developed inflammatory arthritis consumed less vitamin C than matched controls. A Framingham study found that a high intake of vitamin C was associated with a three-fold decrease in risk of OA pain and progression. There are many who advocate taking very large doses of vitamin C for many different things. Although vitamin C toxicity is rare, it is possible with extremely large doses. No acute dose causing toxicity has been identified, but a chronic dose of 2 grams/day has been quoted. Signs may include renal colic (ie, nephrolithiasis), diarrhea, nausea, and occult blood in the stool. Dietary sources of vitamin C include citrus fruits, green peppers, strawberries, tomatoes, broccoli, sweet and white potatoes.
Vitamin D
The role of vitamin D in prevention of bone loss and building bone mass is well known. There are some studies that have looked at vitamin D intake and its correlation with RA. The Iowa Women’s Health Study looked at over 29,000 women and found that a greater intake of vitamin D may be associated with a lower risk of RA in older women. These results were not definitive by any means, but an interesting finding for further studies to build on. There are also animal studies supporting potential vitamin D benefit in RA. Arthritis patients taking steroids may be at risk for steroid-induced osteoporosis. Steroids can impair intestinal absorption of calcium. It is recommended that patients should at least meet recommended vitamin D as well as calcium dietary intake guidelines. Sources of vitamin D include cheeses, fortified milk and fortified cereals.
As with other vitamins and supplements, overdose is possible with very large supplementation.
Acute toxicity effects may include muscle weakness, apathy, headache, anorexia, nausea, vomiting, and bone pain. Chronic toxicity effects include the above symptoms and constipation, anorexia, polydipsia, polyuria, backache, hyperlipidemia, and hypercalcemia. Findings may also include calcinosis, followed by hypertension and cardiac arrhythmias. Acute toxic dose is not established, and chronic toxic dose is more than 50,000 IU/d in adults. In children, 400 IU/d is potentially toxic. A wide variance in potential toxicity exists. The recommended daily allowance is 400 IU for persons older than 1 year. Individual supplements are generally around 400 IU per tablet.
Vitamin E
Vitamin E (alpha-tocopherol) is most frequently recognized for its anti-oxidant properties. Vitamin E deficiency and low tissue vitamin E has been reported to enhance inflammatory components of immune response. The ability of vitamin E to alleviate both OA and RA symptoms has been evaluated in studies, most of them of short duration. One study found that vitamin E worked better than NSAIDs for OA symptoms. Another molecular study demonstrated enhanced anti-inflammatory effects of aspirin with vitamin E supplementation, suggesting a reduction in the dosage of aspirin needed for RA symptoms. Other studies have produced conflicting results. Arthritis patients may find benefit with vitamin E supplementation. Recommended daily allowance is from 15-30 mg. Although it is very rare, toxicity can occur at very high doses. The potentially toxic dose is more than 3000 IU/d for 7-9 weeks. Supplements usually are 100-1000 IU per capsule. People with heart problems, or at risk for heart problems, should use Vitamin E with caution and only after a careful conversation with their doctor. While some studies have suggested improved cardiovascular health with Vitamin E supplementation, at least one study has shown that in people with a history of coronary artery disease, Vitamin E may negatively influence outcomes. Different medications may affect the relationship between Vitamin E and outcome. Again, as with starting any supplement, discuss the potential pros and cons with your doctor. Signs of toxicity from Vitamin E may include bleeding, especially in people taking blood-thinners. Dietary sources for vitamin E include whole grains, nuts, wheat germ, green leafy vegetables, and some oils.
Selenium
It is hypothesized that selenium levels drop in response to inflammation and that selenium supplementation may have anti-inflammatory effects. Studies of selenium supplementation in RA patients have produced conflicting results. One of the largest studies reported a significant decrease in RA symptoms, reduced reliance on cortisone and NSAIDs, and a significant decrease in biochemical inflammation markers in a group receiving selenium. However, both placebo and study groups were receiving fish oil as well. Although levels of selenium are low in RA patients, it should be noted that the human body requires only very small amounts of selenium. Side-effects of selenium supplementation may include nausea, vomiting, nail changes, and fatigue. Good dietary sources of selenium include crab, liver, fish, poultry, and wheat. More studies on selenium supplementation in arthritis patients are needed to accurately evaluate any benefits it may have.
GLA (gamma-linolenic acid)
GLA is also known as evening primrose oil or black currant oil. Several studies have shown that GLA can ease RA pain and inflammation in humans. GLA is an omega-6 fatty acid that, unlike the other aforementioned omega-6 fatty acids, can possibly have an anti-inflammatory effect. GLA is available in capsules as well as oil, with a usual dosage of approximately 1800 mg per day. It is possible that GLA can enhance the effects of blood-thinners, leading to bleeding, as well as cause nausea, diarrhea, and abdominal pain. There are also potential drug interactions that can occur with GLA supplementation and one should always speak with a physician prior to beginning GLA supplementation.
Folate and B12
Folate and B12 may be of particular importance to those RA patients taking methotrexate, a very common DMARD used in the treatment of RA. A Cochrane review of seven trials described a positive effect of folic and folinic acid supplementation in reducing gastrointestinal side-effects of low-dose methotrexate in RA patients. A 79% reduction in mucosal and gastrointestinal side-effects were observed with folic acid supplementation alone, with no apparent differences between low and high dose folic acid. Patients taking methotrexate for their RA may want to discuss folic acid supplementation with their physicians.
Cigarettes
Although it is not considered a nutrient, cigarette smoke is, unfortunately, a daily intake for many individuals. Cigarette smoking has consistently been found to be a risk factor for the development of RA and other inflammatory arthritis conditions. This risk factor is within every person’s control, and smoking cessation should be considered a top priority for arthritis patients. Following are a few links that provide assistance with smoking cessation:
Treatment:
Our clinic uses a gout herbal patch, applied on the painful joint and wrapped with a bandage. The herbal patch needs to be changed every 24 hours, usually 2 to 3 days. The swelling and pain will reduce dramatically. The patient also needs an internal herbal tea to drink in order to flush the acid out from their body, usually we will give the patient one herbal tea to drink per week. A treatment called cupping is helpful with a small puncture to extract a few drops of blood from the local area. This helps to increse blood flow and decrease the symptom of pain.
Prevention:
Dieting correctly is very important to prevent gout. Avoiding foods high in purines and moderating alcohol consumption can prevent gout from developing.
Food like asparagus, organ meat, sardines, shrimp, crab, lobster, and mushrooms are high in purines, which can lead to uric acid build-up in the blood and cause gout.
In the years of my practice I find that the above food cause and built-up in uric acid, but also beef, chicken and other meats can cause gout too.
The best way to prevent gout from happening again is to consume more vegetables less meat in the patients diet and do some exercise; exercise can help the kidney function better and sweat also helps to reduce the high levels of uric acid.
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