Dr. Olisa Mak, ND

Gout is an extremely common yet complex condition that leaves people experiencing intense, debilitating joint pain

It affects 3.9% of adults in the United States, that’s 8.3 million individuals; an increase from 2.7% of adults.1The onset for men is usually after 30 years of age, and in women, post-menopausal.1

Gout develops from excess uric acid crystals that deposit and accumulate in joints. Most commonly, it is the first joint of the big toe that is affected.4 Affected joints swell, become warm to touch and stiffen. For some, movement of the joint becomes restricted and they are unable to perform basic movements.2 These acute episodes spontaneously resolve after 3-10 days3 and are followed by periods with no symptoms. Patients relapse again.

After about 10 years, 2% of individuals eventually develop a crippling form of gout called chronic tophaceous gout.3 Joints become deformed and destroyed and crystals can deposit anywhere in the body, including the circulatory system.3

Is it Gout?

Gout is a type of arthritis and can often resemble other arthritic conditions such as osteoarthritis, rheumatoid arthritis and pseudogout.1 In order to properly diagnosis gout, blood work is a must.

This includes uric acid levels, kidney function tests, inflammatory markers, complete blood count, and blood glucose levels. Uric acid crystals must be aspirated from the affected joint(s) to confirm gout.4 Your Naturopathic Doctor should also physically examine the joint and assess your signs and symptoms.

Should You see a Naturopathic Doctor?

As a Naturopathic Physician, I most commonly see individuals who:

  • have been recently diagnosed with gout and want a second opinion
  • have not found relief in conventional treatments
  • want a more natural approach to their gout and associated symptoms

The Conventional Approach to Treating Gout

Conventional gout medications prevent flare-ups by decreasing uric acid levels or dampening inflammatory responses triggered by the crystals.4 Although these medications can be extremely effective, side effects and cost often compromise compliance, resulting in intermittent therapy.5 This can further trigger or exacerbate gout attacks.4 Consequently, gout therapy is often lifelong.3

NSAIDs or non-steroidal anti-inflammatory drugs, such as naproxen and indomethacin are considered first-line options.3 Side effects include headaches and gastrointestinal bleeding and are of greatest concern in the elderly with renal dysfunction.3 This eliminates NSAIDs as a treatment option for a large number of people who suffer from gout.

Although rare, side effects for allopurinol (the most commonly prescribed drug for gout) can be life-threatening and include skin reactions such as Stevens-Johnson Syndrome.6 2-4% of individuals on allopurinol will only experience mild rashes; however, a mild rash can reflect an increased risk of more serious, life-threatening adverse reactions.6 Individuals who cannot take allopurinol are given febuxostat which can also lead to skin rashes in 5.2% of individuals.6

It’s important to work with a Medical Doctor or a Naturopathic Doctor that is licensed to prescribe pharmaceuticals to re-evaluate your pharmaceutical prescriptions. Both hypertensive medications and low-dose aspirin decrease uric acid excretion, leading to gout.4

The Natural Approach to Gout

The natural approach to gout reduces the duration and severity of symptoms so that you can return to the activities you love and miss. It prevents future flare-ups by addressing the underlying cause. It enables you to live a healthy, happy, pain-free life by addressing chronic conditions frequently associated with gout. A natural approach also eliminates side effects of medications and the need for a lifelong pharmaceutical regimen.

 Diet

For many, the first step is to address the well-established relationship between obesity and gout. 3   A step-by-step revision of one’s diet to decrease protein, alcohol, meats (organ meats & poultry), fats, refined carbohydrates, and calories are a must.4 When considering food choices, opt for selections abundant in natural vitamins, minerals and antioxidants by being unprocessed and of different, naturally-occurring colours. Antioxidants protect the body from chronic health issues that result from chronic stress and inflammation, the underlying cause for many of these chronic conditions. The diet should aim to regulate blood sugar levels and insulin control4. Eating a more alkaline diet also increases uric acid solubility and excretion from the body.4 Simply changing your diet can drastically improve the frequency, intensity and duration of your symptoms, eliminating the need for pharmaceuticals. A regular exercise routine should also be implemented to address obesity.4 Weight loss has been shown to reduce uric acid levels in the body.4

Others – Acupuncture, Supplements, Botanicals

Along with addressing diet, other naturopathic treatment modalities can be used. Acupuncture, for example, can help reduce symptoms during an acute flare-up. Supplements and botanicals can be used at different stages of treatment to rebalance the body and establish the necessary, basic conditions for health – proper pH, nutritional status and efficient elimination by the liver, bowels, kidneys, skin and lungs. Vitamin C has also been found to increase uric acid excretion.3 Drainage therapies such as UNDAs; gemmotherapies can help improve kidney health – a must in every gout treatment protocol.

Your Naturopathic Doctor may also evaluate your toxic metal status as elevated levels of lead can often cause gout.4

Depending on your unique presentation of symptoms, and your Naturopathic Doctor’s own clinical expertise, a combined approach of multiple treatment options (including pharmaceuticals) may be used to best address your needs.

Complications of Gout

Individuals with gout are prone to develop:

  • Chronic kidney disease7
  • Cancer8
  • Metabolic syndrome7
  • Type 2 diabetes7
  • Hypertension7, and other cardiovascular disease7

Several of these conditions are also risk factors for developing gout.8 In an effort to ensure your long-term well-being, these chronic conditions MUST be addressed.

To evaluate the conditions you’re most susceptible to, your Naturopathic Doctor will ask you about your family history, past medical history, and current symptoms. This information will be further supported by laboratory findings (blood work, urine analysis) and relevant physical examinations.

The information above is simply a potential starting point and possible guideline. For best results and your own safety, it’s best to work with a licensed Naturopathic Doctor. 

References

  1. Rai, Sharan K. et al. “The Rising Prevalence And Incidence Of Gout In British Columbia, Canada: Population-Based Trends From 2000 To 2012”. Seminars in Arthritis and Rheumatism (2016): n. pag. Web.
  2. Udhaya Lavinya, B., Ishita Bardhan, and Sabina Evan Prince. “Efficacy Of CoenzymeQ10 In Inhibiting Monosodium Urate Crystal-Induced Inflammation In Rats”. European Journal of Pharmacology 791 (2016): 589-594. Web.
  3. Repchinsky, Carol. Therapeutic Choices. 6th ed. Ottawa: Canadian Pharmacists Association, 2011. Print.
  4. Pizzorno, Joseph E and Michael T Murray. Textbook Of Natural Medicine. 1st ed. St. Louis, Mo.: Churchill Livingstone Elsevier, 2006. Print.
  5. Harrold, Leslie R. et al. “The Dynamics Of Chronic Gout Treatment: Medication Gaps And Return To Therapy”. The American Journal of Medicine 123.1 (2010): 54-59. Web.
  6. Bardin, Thomas et al. “Risk Of Cutaneous Adverse Events With Febuxostat Treatment In Patients With Skin Reaction To Allopurinol. A Retrospective, Hospital-Based Study Of 101 Patients With Consecutive Allopurinol And Febuxostat Treatment”. Joint Bone Spine 83.3 (2016): 314-317. Web.
  7. Feng, Xin, Yao Li, and Wei Gao. “Significance Of The Initiation Time Of Urate-Lowering Therapy In Gout Patients: A Retrospective Research”. Joint Bone Spine 82.6 (2015): 428-431. Web.
  8. Udhaya Lavinya, B., Ishita Bardhan, and Sabina Evan Prince. “Efficacy Of CoenzymeQ10 In Inhibiting Monosodium Urate Crystal-Induced Inflammation In Rats”. European Journal of Pharmacology 791 (2016): 589-594. Web.

    Dr. Olisa Mak is a licensed ND with a general family practice in downtown Vancouver.  She has a special interest in bringing awareness to the mind-body connection using homeopathy, botanicals and lifestyle counselling.
    She is driven to educate, inspire and empower those around her.  Everyone has the potential to achieve their dreams and goals but are often unable to because of their fears, perceptions and circumstances.  Dr. Mak strives to work with her patients to remove barriers, empowering patients to seize opportunities and to make the life they want a reality.

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