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Doctor Murray's Newsletter - Natural Facts For May 25, 2005

Wed, 25 May 2005 11:50:29 -0700

 

 

3:06:2005

Natural Approach for the Relief of Gout

 

Introduction

 

With the increased popularity of the “low carb” diet, there has been a rather

dramatic increase in the prevalence of gout – more than twice as many people

suffer from gout now compared to ten years ago. Gout is a common type of

arthritis caused by an increased concentration of uric acid (the final breakdown

product of purine—one of the units of DNA and RNA) in biological fluids. In

gout, uric acid crystals are deposited in joints, tendons, kidneys, and other

tissues, where they cause considerable inflammation and damage. Gout may lead to

debilitation from the uric acid deposits around the joints and tendons, and

kidney involvement may result in kidney failure.

 

Gout is the result of either increased synthesis of uric acid; reduced ability

to excrete uric acid; or both over production and under excretion of uric acid.

Several dietary factors are known to trigger gout, including consumption of

high-purine content foods (such as organ meats, meat, yeast, poultry), fats,

excessive alcohol,and refined carbohydrates. Obesity is also associated with an

increased rate of gout. Weight reduction in obese individuals significantly

reduces serum uric acid levels. Hydration is also important as a liberal fluid

intake keeps the urine diluted and promotes the excretion of uric acid.

 

Food Prescriptions for Gout

 

The dietary treatment of gout involves the following guidelines, each of which

will be briefly summarized:

 

Low-purine diet

Elimination of alcohol intake

Achievement of ideal body weight

Elimination of refined carbohydrates

Low-fat intake

Avoid high-protein, high-fat foods

Liberal fluid intake

Liberal consumption of cherries or flavonoid-rich extracts

 

A low-purine diet has long been the mainstay of dietary therapy for gout. Foods

with high purine levels should be entirely omitted. These include: organ meats,

yeast (brewer’s and baker’s), herring, sardines, mackerel, and anchovies. Intake

of foods with moderate levels of protein should be reduced to 1 serving every

2-3 days as well. These include: dried legumes, spinach, asparagus, fish,

poultry, and mushrooms. Low-purine foods may be eaten in small amounts daily.

 

Table 1. Purine Content Ranking of Selected Foods

 

High-Purine Foods:

 

Anchovies

Consommé

Herring

Mackerel

Meat extracts

Organ meats (including brain, kidney, and liver)

Roe

Sardines

Yeast, including Baker’s and Brewer’s

 

 

Moderate-Purine Foods:

 

Asparagus

Fish

Legumes

Meat

Mushrooms

Peas (dried)

Poultry

Shellfish

Spinach

 

 

Low-Purine Foods:

 

Eggs

Fruit

Grains

Milk

Noodles

Nuts

Olives

 

 

Alcohol increases uric acid production by accelerating purine breakdown. It also

reduces uric acid excretion by increasing lactate production, which impairs

kidney function. Elimination of alcohol is all that is needed to reduce uric

acid levels and prevent gouty arthritis in many individuals.

 

Obesity is associated with an increased rate of gout. Weight reduction in obese

individuals significantly reduces serum uric acid levels. Weight reduction

should involve the use of a high-fiber, low-fat diet, as this type of diet will

help manage the elevated cholesterol and triglyceride levels that are also

common in obesity.

 

Refined carbohydrates and saturated fat intake should be kept to a minimum.

Simple sugars, such as refined sugar, honey, maple syrup, corn syrup, and

fructose, increase uric acid production, while saturated fats decrease uric acid

excretion. The diet should focus on complex carbohydrates, such as legumes,

whole grains, and vegetables rather than on simple sugars.

 

High-protein and high-protein foods are usually foods that are high in purines.

High- fat animal foods also promote inflammation and should be avoided,

regardless of purine content. High protein foods that are not high in purines

should be eaten only in small amounts to avoid taxing the kidneys, which are

burdened with excreting excess uric acid.

 

Liberal fluid intake keeps the urine diluted and promotes the excretion of uric

acid. Furthermore, dilution of the urine reduces the risk of kidney stones.

Drink at least 48 ounces of water each day.

 

The most popular natural approach to gout has been consuming the equivalent of

one-half pound of fresh cherries per day. This approach has proved useful in

lowering uric acid levels and preventing attacks of gout. The flavonoid

compounds in cherries have been shown to inhibit the production of uric acid as

well as prevent destruction of joint structures. Flavonoid rich extracts like

grape seed extract or pine bark extract may be effective substitutes for

cherries. The typical dosage for these extracts is 300 mg per day.

 

Celery Extract for Gout

 

Though not as popular as the cherry cure for gout, celery seed extract appears

to offer even greater benefit. Specifically, a special celery extract has been

shown to produce significant benefits in the treatment of “rheumatism” – the

general term used for arthritic and muscular aches and pain. The extract is

standardized to contain 85% 3nB (3-n-butylpthalide) - a compound unique to

celery that is responsible for the characteristic flavor and odor of celery as

well as its medicinal effects. In these clinical studies the efficacy of celery

seed extract was evaluated by well-established clinical protocols used to

measure the effectiveness of conventional drugs used in arthritis and muscular

pain. Study participants included patients suffering from osteoarthritis,

osteoporosis or gout.

 

In the first study, the subjects had joint pain present for approximately 10

years in a remittent or continual form and it led to a lack of joint mobility

and pain that prevented the carrying out of household duties, hobbies and

activities involved in employment of these subjects. The subjects were given

only 34 mg of the celery extract twice daily. Nonetheless, the results of the

study were extremely positive and quite statistically significant. The chance

that such a positive effect in reducing pain in these subjects was a placebo

effect was less than 1 in 1000. Subjects experienced significant pain relief

after 3 weeks of use with the average reduction in pain scores of 68% and some

subjects experiencing complete 100% relief from pain. Most subjects achieved

maximum benefit after six weeks of use although some did notice improvements the

longer the extract was used.

 

In a second study, a similar group of patients received 75 mg of the celery

extract twice daily for three weeks. At this higher dosage, the subjects

reported even better results than in the first study. Statistically and

clinically significant reductions were noted in pain scores, mobility, and

quality of life. Like the first study, no side effects were noted other than a

diuretic effect (celery seed extract also exerts significant blood pressure

lowering action).

 

When the data on the subset of patients with gout was analyzed it was clear that

they responded extremely well. Subsequent evaluation to explain the benefits

noted in these patients indicates that 3nB lowers the production of uric acid by

inhibiting the enzyme xanthine oxidase. Eventually celery seed extract lowers

blood uric acid levels, however, quite interestingly the initial blood uric acid

measurements may increase in people with gout as uric acid crystals begin to

dissolve – a very good sign.

 

The proper dosage of a celery seed extract standardized to contain 85% 3nB and

other phthalides for joint and muscle complaints based on the information now

available from trials as well as clinical experience are the following:

 

For the relief of join and muscle pain (including pain due to

osteoarthritis, rheumatoid arthritis, and fibromyalgia): 75 to 150 mg daily.

 

For gout: 75 to 150 mg twice daily.

 

 

Key References

 

Blau LW. Cherry diet control for gout and arthritis. Texas Rep Biol Med 1950;

8: 309–311

Jacob RA, Spinozzi GM, Simon VA, et al. Consumption of cherries lowers plasma

urate in healthy women. J Nutr 2003;133(6):1826-9.

Soundararajan S and Daunter B: Ajvine: Pilot biomedical study for pain relief

in rheumatic pain. School of Medicine, The University of Queensland, Brisbane,

Queensland, Australia, 1991-92.

Venkat S, Soundararajan S, Daunter B and Madhusudhan S. Use of Ayurvedic

medicine in the treatment of rheumatic illness. Department of Orthopaedics,

Kovai Medical Center and Hospitals, Coimbatore, India, 1995.

Hu D, Huang XX and Feng YP: Effect of dl-3-n-butylphthalide (NBP) on purine

metabolites in striatum extracellular fluid in four-vessel occlusion rats. Yao

Hsueh Hsueh Pao 1996;31:13-7

 

 

 

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