by Dr. John Neustadt

Gout is one of the oldest diseases ever recorded. Gout affects 8.3 million people in the United States and occurs in approximately 4% of the population. However, the risk of getting gout increases with age. About 10% of people 80 years or older have this form of excruciatingly painful arthritis.

Gout becomes so common as we age that it was memorialized in Lord Byron’s (1788-1824) poetic reflection on old age: ‘‘They kindly leave us, though not quite alone; but in good company—the gout or the stone.”

While gout can affect different joints, typically it’s the big toe that experiences the flare up. The classical presentation of gout is that it occurs after trauma or overindulging in food or alcohol. Surgery, fatigue, emotional stress, infections or poor circulation can also precede gout.

However, gout can seemingly come out of nowhere, without any warning or apparent reason. Often the pain starts at night and becomes progressively more severe and debilitating.

The affected joints usually become red, swollen, hot and exquisitely tender to touch. The overlying skin becomes shiny red or purplish with signs of infection.

The first attack usually affects a single joint, but later attacks can affect multiple joints. People with gout can experience, fever, rapid heart rate, chills, and feeling just generally wiped out.

The first few attacks usually last only a few days but later attacks can persist for weeks with joint deformity occurring if gout continues to flare up.

Gout is an inherited disorder in which a breakdown of purine results in a dangerous accumulation of uric acid in the blood. The high levels of uric acid results in uric acid crystals forming and depositing in joints, particularly in the big toe, feet and knees. The crystals can also create uric acid kidney stones.

Gout is usually diagnosed based on the signs and symptoms. Blood tests alone are not sufficient for the diagnosis. High amounts of uric acid may be found on a blood test; however, during a gout attack, frequently blood uric acid will be normal.

The good news about gout is that if you’re willing to change your diet, gout is relatively simple to deal with naturally. Here’s what you can do.

Eliminate alcohol

Alcohol hits the gout-prone person with a double whammy. Alcohol accelerates purine breakdown to uric acid. At the same time, alcohol increases lactate production, which impairs kidney function. When that happens, your kidneys are less efficient at filtering uric acid out of the blood. Frequently acute gout attacks occur after a night of drinking. For many individuals, simply eliminating alcohol will prevent gout.

Eliminate foods high in purines

Purine is found in high amounts in animal products. Organ meats, beef, shellfish, herring, sardines, mackerel and anchovies should be avoided or almost entirely eliminated. Brewer’s and baker’s yeast also have purines.

Restrict consumption of foods with moderate purine levels

Moderate amounts of purines are found in beans, fish, poultry, spinach, asparagus, and mushrooms.

Consume a high-fiber diet

After eliminating high purine foods from your diet, follow a high-fiber, low-fat diet rich in whole, unprocessed, preferably organic foods, especially plant foods. A diet in which you’re consuming lots of fresh fruits, vegetables, whole grains, nuts (especially walnuts) and seeds can be helpful. Shoot for consuming a minimum of 30 grams of total fiber per day. For help on increasing the amount of whole foods and fiber in your diet, read my Fiber Handout.

Minimize sugars and saturated fats

Simple sugars (refined sugar, honey, maple syrup, corn syrup, fructose, etc.) increase uric acid production while saturated fats decrease uric acid excretion. This sets up a situation similar to drinking alcohol where more uric acid is being created but less is being removed from the body. If you’re unsure what qualifies as a saturated fat, they’re fats that are solid at room temperature. This includes fats in meats, butter and cheeses.

Eat moderate amounts of protein

The amount of protein you’re eating should be adequate (0.8 g/kg of body weight) but not excessive. Proteins are made up of amino acids, which the body then recombines in many different ways to make hormones and connective tissue (eg, bone collagen, skin, muscle).

Another important role for amino acids is that increase the amount of uric acid that’s excreted from the body by the kidneys. This in turn lowers the amount of uric acid in the blood and can help reduce the risk of another gout flareup.

You might think that if some protein is good, then eating more must be even better. But that’s not the case. High protein intake increases uric acid production, which is definitely what you don’t want to do if you have gout.

To calculate the number of grams of protein that you should be eating, use the following calculation.

1. Take your body weight (in pounds) and convert it to kilograms by dividing is by 2.2.
2. Then multiply that number by 0.8. That will give you the amount of protein, in grams to consume each day.

For example, If you weigh 150 pounds, it would be 150 divided by 2.2 which equals 68. Sixty-eight x 0.8 equals 54 grams.

To get a better understanding of how much protein is in different foods, see my Protein Handout.

During an acute attack, rely on fruits and vegetables for two weeks. Juices are excellent, especially cherry juice. Also, drink celery juice. Blueberries, cherries and strawberries help to neutralize the uric acid and are full of antioxidant nutrients. Foods high in Vitamin C will also help to neutralize and eliminate uric acid (peppers, citrus).

Drink tart cherry juice

For decades drinking tart cherry juice (TCJ) has been recommended to reduce symptoms of gout. Until recently, this was based largely on anecdotal evidence and theoretical understanding of TCJ’s potent antioxidant and anti-inflammatory properties.

A 2019 clinical trial published in the journal Current Developments in Nutrition demonstrated that drinking 8 ounces of tart cherry juice per day for four weeks reduced serum uric acid nearly 20%. Inflammatory markers such as C-reactive protein (CRP) were also reduced in people drinking TCJ.

Drink plenty of water

Staying hydrated can help dilute the uric acid in the blood and reduce the likelihood that it will precipitate out into uric acid crystals. A good rule of thumb is to drink half your body weight in ounces of water per day.

For example, if you weight 150 pounds, you’d drink 75 ounces of water, or about nine 8-ounce cups. Since coffee increasing how much you pee, add one cup of water to your daily amount for every cup of coffee you drink.

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