Gout – Signs, symptoms and nutritional support

Gout is an inflammatory form of arthritis and is a condition that is believed to affect around 1 in 50 people around the United Kingdom. As quoted on the NHS website: “Gout is a type of arthritis in which small crystals form inside and around the joints. It causes sudden attacks of severe pain and swelling.”

In this week’s blog we look at some of the most common signs and symptoms of gout, its link with high levels of uric acid, and nutritional considerations.

Signs and symptoms of gout

Symptoms of gout almost always occur suddenly, especially at night. Gout causes the joints to become swollen, red and often stiff. The big toe is most commonly affected because gout symptoms typically develop in areas of the body that experience the most trauma. When the toe is affected, the symptom is often called podagra.

Other commonly affected joints include the ankles, heels, knees, wrists, hands, fingers, and elbows. The pain can often be severe.

Symptoms generally diminish after a week or two. Once symptoms are gone, the affected joints are not painful. However, if the patient does not receive treatment, attacks will come back (with increased frequency), and they will usually last longer and affect more joints.

How does gout come about?

Gout occurs when there is a large volume of uric acid circulating in the bloodstream, which is known as hyperuricemia. Sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling. This is known as gout and the pain can often remain for between 3 and 10 days.

Pain and discomfort are not the only considerations for gout-sufferers, however, as hyperuricemia has also been implicated in the development of other more serious conditions such as arteriosclerosis, cerebrovascular and cardiovascular diseases, along with nephropathy in diabetic patients.

Uric acid

Uric acid is a waste product that forms when the body breaks down purines, which are compounds found at high levels in red meat, poultry, and fish. In healthy people, uric acid is continuously broken down in order to maintain normal levels in the blood. A person’s gender, genetic makeup, hormonal changes, diet, and some medications may cause the body to produce too much uric acid or prevent it from being properly broken down.

Here are some of the most common risk factors associated with an ability to effectively break down uric acid:

Diet: Eating a diet that’s high in meat and seafood and high in beverages sweetened with fruit sugar (fructose) promotes higher levels of uric acid, which increases your risk of gout. Alcohol consumption, especially of beer, also increases the risk of gout. Here is a list of foods on the Gout Society website that are high in purines (avoid) and low in purines.

High purine foods include: (avoid)

  • Offal – liver and kidneys, heart and sweetbreads
  • Game – pheasant, rabbit, venison
  • Oily fish – anchovies, herring, mackerel, sardines, sprats, whitebait, trout
  • Seafood – especially mussels, crab, shrimps and other shellfish, fish roe, caviar
  • Meat and Yeast Extracts – Marmite, Bovril, commercial gravy as well as beer

Moderate purine foods (eat in moderation)

  • Meat – beef, lamb chicken, pork
  • Poultry – chicken and duck
  • Dried peas, beans and legumes – baked beans, kidney beans, soya beans and peas etc.*
  • Mushrooms
  • Some vegetables – asparagus, cauliflower, spinach*
  • Wholegrains – bran, oatbran, wholemeal bread

*However, more recently it has been shown that purine-rich plant foods like legumes and vegetables do not increase the risk of gout.

Low purine foods

  • Dairy – milk, cheese, yoghurt, butter
  • Eggs
  • Bread and cereals – (except wholegrain)**
  • Pasta and noodles**
  • Fruit and vegetables (see moderate purine list

**Although low in purines it would not be advisable to eat refined breads, cereals, pasta and noodles**

Obesity: If you are overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid, which greatly increases your risk of gout.

Medical conditions: Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.

Certain medications: The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.

Family history of gout: If other members of your family have had gout, you’re more likely to develop the disease.

Age and sex: Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.

Recent surgery or trauma: Undergoing surgery or trauma has been associated with an increased risk of developing gout.

Nutrition for Gout

Studies show that excessive intake of alcohol, meat, soft drinks and fruit juices increase the risk of developing gout. On the other hand coffee and dairy products increase the excretion of uric acid and so have been shown to decrease the risk of hyperuricemia.

A diet based on the Mediterranean diet is appropriate – with plenty of anti-inflammatory vegetables and healthy fats (eg olive oil). The diet should also be low in purines (<400 mg purines per day) so limiting animal meats (especially red meat, organ meat and seafood), as well as fructose and other sugars. Research on specific nutrients in relation to gout includes:

Vitamin C

As noted on the Arthritis Foundation website, a study from 2009 published in the Archives of Internal Medicine showed the following:

“During the 20 years that researchers studied nearly 47,000 men, 1,317 of them developed gout. But the risk was not shared equally. For every 500-milligram increase in vitamin C intake, the risk for gout fell by 17 percent. The risk dropped by 45 percent when study participants took more than 1,500 mg of vitamin C a day.”

It was noted in the research that although vitamin C was shown to reduce the risk of developing gout, in cases of people who already have gout, the benefits are unclear.

Pantothenic acid

Pantothenic acid, a type of B vitamin (B5), is needed to help with the excretion process of uric acid. Stress often depletes the body of this vitamin which may in part explain why gout flares during times of stress.

Flavonoids

Studies have shown the benefits of flavonoids in reducing uric acid and inflammation – for example quercetin, green tea polyphenols and anthocyanins. Quercetin is found in onions and apples, and anthocyanins in cherries and other purple and blue coloured berries. Drinking organic cherry juice daily may lower levels of uric acid.

A study carried out at the University of California showed that there was a decrease in plasma urate after cherry consumption.

Bromelain

Bromelain is an enzyme present in pineapples, with highest concentrations being found in the tough centre that we tend to discard. It has anti-inflammatory effects and is reported as being useful for the swelling associated with gout, although studies are lacking. It may also contribute to the improved absorption of the flavonoid quercetin, a flavonoid nutrient shown to reduce uric acid levels.

Other considerations

Other important considerations  are staying well hydrated at all times to support the kidneys to flush out uric acid. This will also prevent the uric acid from becoming too concentrated and inhibit uric acid crystalization.

Also, 70% of the uric acid that your body produces is excreted through the kidneys, but the other 30% is excreted through the intestine, and the efficiency of this excretion process relies heavily on the presence of a healthy bacterial balance within the gut. In addition animal studies show the gut microflora moderate the inflammation associated with gout.

As with many conditions that are so common in the modern era, diet and lifestyle are particularly important when it comes to the prevention of gout. Removing high purine foods, including low purine foods and maintaining a healthy overall diet lifestyle is the key to preventing and supporting gout.


If you have any questions regarding the topics that have been raised, or any other health matters please do contact me (Clare) by phone or email at any time.

clare@cytoplan.co.uk, 01684 310099

The Cytoplan editorial team: Clare Daley and Joseph Forsyth


Cytoplan Products

Bromelain

Bromelain is an enzyme complex derived from pineapple.

Cherry C

Cherry-C capsules are rich in vitamin C and carotenoids, with the cherry-like fruits being one of the richest-known natural sources of vitamin C.

Phyte Inflam

Phyte-Inflam is a natural phytonutrient herbal complex containing curcumin from turmeric, gingerols from ginger root and piperine from pepper.

Phytoshield

Phytoshield is a phyto-antioxidant nutrient formula containing high levels of flavonoids and carotenoids. Each capsule supplies 650mg of mixed flavonoids and 15mg of mixed carotenoids.

Pantothenic Acid

Food State Pantothenic Acid (vitamin B5) is combined in a food base of inactive Lactobacillus bulgaricus in which it naturally occurs.

Acidophilus Plus

Acidophilus Plus contains Lactobacillus acidophilus and 8 further live native bacterial strains, plus a small amount of prebiotic. This blend of native bacterial strains is designed to have activity throughout the whole GI tract.

Krill Oil

Krill is a source of Omega 3 fatty acids EPA/ DHA; astaxanthin, and phospholipids


Bibliography

Cheng L C et al (2015) – Flavonoids and phenylethanoid glycosides from Lippia nodiflora as promising antihyperuricemic agents and elucidation of their mechanism of action. J Ethnopharmacol., 24;176:485-93.

Chen G et al (2015) – Green tea polyphenols decreases uric acid level through xanthine oxidase and renal urate transporters in hyperuricemic mice. J Ethnopharmacol, 175:14-20.

Kaneko K et al (2014) – Total purine and purine base content of common foodstuffs for facilitating nutritional therapy for gout and hyperuricemia. Biol Pharm Bull. 37(5):709-21.

Nickolai B and Kiss C (2016) – Nutritional therapy of gout. Ther Umsch, 73(3):153-8

Steves C J et al (2016) – The Microbiome and Musculoskeletal Conditions of Aging: A Review of Evidence for Impact and Potential Therapeutics. Journal of Bone and Mineral Research, Volume 31, Issue 2, Pages 261–269


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51 thoughts on “Gout – Signs, symptoms and nutritional support

  1. Very interesting article. I believe that drinking half a teaspoon of bicarbonate of soda up to 3 times a day can relieve symptoms.

    1. I got severe pain on the back of my right knee.Also swollen.Arthritis problem is common with many of our family members.Requesting proper treatment.

      1. Hi – I am afraid it is impossible to know exactly what is going on from your brief description and to really help I need full information. In the first instance it would be advisable to visit your Dr and understand what he feels is going on and the nature of the problem. In situations like this it is really important to see the limb and it would be wrong for me to suggest remedies without this. But if your Dr gives you a diagnosis and you are able to give me more information after this I will be better able to help you.

  2. I have lots of pain in my ankles and three fingers of both my hands and wrists.
    It feels like pins and needles.
    What medicines do you suggest?
    Thanks for your advice
    Regards, Tina Wildblood

    1. Thanks for your question on our blog. Firstly I would suggest that you visit your GP for investigation of your symptoms. We cannot recommend medicines. In terms of supplements I would suggest taking an all round multivitamin and mineral with good levels of B vitamins eg our CoQ10 Multi. Perhaps you could send me an email with further details on when these symptoms started and any other health conditions you have and I will see if there are any further recommendations I can make. My email address is clare@cytoplan.co.uk

    2. I have gout broblem in my ankle I’m suffering painful now im 55 yrs old and no budget for a doctor check up and deficult to go hospital because of the pandimic. what medicine you recommend for me for my gout in my ankle, thanks…

      1. Hi Jimmy,

        Black cherries ad organic cherry juice can help lots with this problem acutely but ultimately it comes down to diet and understanding individual susceptibility. If you are ale to complete a health questionnaire, downloadable from our website and return it to us we will be able to help safely and effectively.

        Thanks,
        Amanda

        1. Hi – please can you complete a health questionnaire which is available on our website under the tab Nutrition Advice as we really need more information to help you sustainably. What you describe sounds unusual and hence important for us to understand the full picture and more exact details of your diet and medical history.

      2. I think this was an informative article . My Doctor is doing urinalysis now because my blood work showed slight increase creatinine .
        I don’t drink alcohol . I am not over weight . I do have many situations in my life causing stress over the last 6yrs. I have had ex rays , CT scans , ultra sound which show some deteriorating of my second toe next to big toe. I have no bog toe pain . The two toes closest to my little toe are the painful ones . They have also recently separated from each other with a big gap. The pain on the ball of my foot by these toes is extreme . I can’t walk any distance .
        This problem started 3 years ago and only went away during the first lock down . It then came back with a vengeance.
        I think I would be better able to cope if it gave me breaks in between but it doesn’t . Only had that one break in 3 yrs .
        Does this sound like gout to you ? My doctor is perplexed but he is still trying to help me figure this out .

        1. Hi Victoria – It is possible that gout is playing a role, there is certainly inflammation present in the joints of the toes and feet, however, I am unable to diagnose therefore it is great that you GP is working well with you. If you would like to have more tailored advice feel free to complete a health questionnaire.

    3. I began suffer of this uric acid since around 2017 and I got to doctor & the doctor was directing me to take zyloric acid and zyloric acid don’t treat my problems which is uric acid

    4. I like seeing thought this, what medicine will completely Finnish my gout? It’s now 3days sleeping in the house.

      1. Hi Nathan – food and supplements that lower Uric acid usually give quick relief from gout. But to help you we first need to understand the reasons you have gout. Please can you complete our FREE health questionnaire. Once we have this information we will be able to advise safely and effectively In the meantime, I can advise you to eat cherries or drink organic cherry juice which contains a substance that binds and removes uric acid from your body ad combine that with a diet that is low in purines – examples of this can be found online. Thanks, Amanda

    5. I have pain in my middle finger of my hand I suspect it’s a gut can you suggest a good medicine to me

      1. Hi Crisanto – I would start with 2 x Boswellia to help reduce inflammation and Phytoshield which is an antioxidant complex and contains nutrients useful for reducing uric acid, which builds up and causes pain in joint with gout.

  3. I’ve really not suffered from gout until now so this is great information. Being a self employed carpenter l need my feet and not being able to walk without so much pain in my big toe I’m going to start and be more careful on what I’m going eat and drink
    Thanks again for all of the great information on what’s causing the gout

  4. Really educational for me because I am a gout patient. I will take serious consideration on the diet. Its a good article

  5. Hi…i have a question about my uric acid what drugs to be use to relieve when uric acid attack especially my joint in my foot?thanks

    1. Hi Amel – You need to look at a diet that is low in uric acid and avoid foods known to be high in it – such as sardines, game, anchovies and alcohol. Eating black cherries can help as can drinking organic cherry juice as cherries contain actives that can remove uric acid from the body. A change in diet is the most sustainable solution but supplements like curcumin and Boswellia can help acutely to reduce the pain associated with the condition.

      Thanks,
      Amanda

  6. I am struggling with my gout pain and I’ve got a high cholesterol is that I am voice and you’re making me very to take

    1. Hi Ben – please can you clarify what you’re asking and I will pass your query to our nutritional therapist.

      Thanks

  7. I began suffering from gout about three years ago. It just appear on my left foot. Earlier than this, I was diagnosed and prescribed some medications for my prostatitis. I am a 58 years old male. I have noticed – that when I will be feeling pain in my left foot and see some swelling – I will also notice sharp pain in my lower abdomen area – the prostatitis ( I guess). My question, since those two are related to a high protein diet – can they be related or they just happen to have the same triggers?

    1. Hi Jerry,

      It is likely that inflammation or inflammatory triggers are involved in both of these processes. If you are able to complete a health questionnaire downloadable from our website under the tab nutrition advice we can help safely and effectively address both of these issues where possible.

      Thanks,
      Jo

  8. I have joint pains around my shoulder,elbow, ankles, thumb this happens normally once in a while but I feel a lot of pain I experience swelling as well it’s so painful but am 28yrs only

  9. Just recently I got this strong pain in my hands and feet. It’s become stiff and bit swollen. I have DM since 2007 but uric acid & cholesterol are okay. Kidney also ok
    Still active in a company as CEO, so I do really still need full ability of my hands and feet. Pls notify me what to do.

  10. My Uric acid is normal but still in have joint pain thumb and heel pain swelling please guide thank you

    1. Hello – It would be a good idea to complete a health questionnaire as there can be multiple drivers of joint pain. However Boswellia can be useful for helping to reduce inflammation particularly in joints and muscles particuallrly along with a good quality omga 3 and multivitamin and mineral to ensure optimum intake of all nutrients.

  11. I had blood test 4 days ago and my GP phoned me today to say that I have tested positive for gout. I am overjoyed, I know that sounds weird but I have a diagnosis, to go along with my rheumatoid, sjorgrens, bronchiectasis, fibromyalgia and others.
    My 2 sons have it , as does their father and his father before him. I have had Alloprinol added to my repeat scripts.
    My question is where can I find a diet which is good for gout. I am T total and eat very little meat, but I do eat fish. Also overweight which I gather is not good.

    1. Hi Chris – The best diet for gout is one that is low in purines. There are many such diets available online and to help prevent recurrence you will need to follow it most of the time. Organic cherry juice is helpful in acute cases of gout as it contains actives that help to bind uric acid, abundance of which causes the pain and inflammation of gout. If you have difficulty in finding a diet please do email us again and we will find one for you.

  12. my right ankle painful and now left feet very pain.

    so the food i take normal but i don’t know the cause. Is apple and oranges are good rite.

    1. Hi Mani – it would be best for you to contact our office directly (01684 310099) or complete one of our free health questionnaires (click here), so we can understand more details about your symptoms and diet in order to advise safely. I hope this helps.

  13. My father is having gout problem. It often comes back and today he felt pain at the big toe area . After going through your article, i gain alot . Midway, i wanna raise a question ‘Are diary products really recommended for gout ,tho they are rich in protein?’
    Thank you

    1. Hi – dairy products are low in uric acid and can help the elimination of uric acid so long as they are well tolerated by the person. If not they will further exacerbate the inflammation of the disease process. So I think it is a case on assessing what is appropriate for each person with this condition, individually.

  14. My name is Dorbor and I live in Liberia, West Africa. I’m having pain in my left ankle. It started in my big toe. What do I need to treat the gout. Thanks.

    1. Hello – please can you complete our free health questionnaire here, to allow us to support your safely and efficiently. Meanwhile try and eat a diet that is low in uric acid. If you need more help with this please email me separately (amanda@cytoplan.co.uk)

    1. Hi Judith – I am not quite sure what you are describing. Usually heat is a sign of inflammation but to help you we really need to know more. Please can you email me directly with further information and I can also ask you some specific questions amanda@cytoplan.co.uk

    1. Hi – it is both preventable and curable. To prevent gout, if you are susceptible, you need to follow a diet that is low in purines and uric acid, probably ongoing as once you have had it you are more susceptible to future attacks. Acutely gout can be helped by the above diet and also either by eating organic cherries or drinking organic cherry juice as cherries contain an active that binds and removes uric acid. As gout is so painful anti inflammatory nutrients like Vitamin C and Boswellia can also help reduce the pain in acute episodes.

  15. I am also suffering this gout especially in my ankles and knee. This article gives me a lot helpful. Thank you so much…from Myanmar!

  16. thanks sir for this great article
    sir i experienced most of the symptoms you stated above, am 26 years now and i noticed most of the symptons since 2015 or less but only on both of my legs from my knees to my ankle sometimes only one and sometime both and its only happens in the night when am sleeping and most of the time its happen if i over work or i walk for long distance in the day, but unfortunetly today’s night i suffer it for both of my hands at midnight i wakeup around 2am i didn’t have able to back to sleep untill after 5am and is thesame pain as the one on my legs.

    1. Hi Abdul – I am sorry as it sounds as if you are suffering badly. If you want more personalised help please complete the health questionnaire on our website, under the tab Nutrition Advice and we can give you dietary and supplement advice that will help overcome this problem if it is gout. With more information we can also identify for you if that is what it is or if there anything else that needs to be done to help you safely and sustainably.

  17. Very interesting and informative.
    I have a question on gout if you can possibly spare the time . It started in my big toe on my right foot, later changing to the big toe on my left foot. I was prescribed Allopurinol by my GP. At that time I was living in Wales (UK) but have since moved to Thailand. Unfortunately I have, as yet been unable to find the same. Is there another pharmaceutical remedy, besides the recommended dietary that I can look for. I am 77 years old. and otherwise quite fit through exercise using the local Gym.
    Thanking you in anticipation. Have a nice day. L.J.

  18. Hi
    My gout in my ankles is severe and just returned suddenly.
    I am 79 years old male . I am diabetic and have other under lying health issues. Please advise me as Colchacinne is not helping my condition i am in severe pain.

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