Prevention of gout

Identifying things that cause you to have gout symptoms can help you to eliminate these triggers and reduce your chances of having it again. Gout can be prevented from reoccurring so often and so severely by making changes to your diet and taking medicines if needed.

Diet

What you choose to eat and drink can have an impact on gout. There are some foods that are very high in purines, which can increase the amount of uric acid in your blood. It’s best not to eat much of these foods very often. These include:

• liver and kidneys
• oily fish, such as mackerel, sardines and anchovies
• shellfish, including mussels, crab and shrimp
• certain vegetables, such as asparagus, cauliflower, lentils, mushrooms and spinach
• oats and oatmeal

If you’re planning to make changes to your diet, ask your doctor or a dietitian for advice to ensure you still get all the nutrients you need. Eating a well-balanced diet will help you to manage your symptoms. See our frequently asked questions for more information.

Aim to drink less alcohol – especially cutting out beer, stout, port and fortified wines because these can have the greatest effect on causing gout symptoms. Drinking enough water every day will help to dilute your blood and urine, lowering the uric acid levels in your body.

If you need to lose excess weight, doing regular exercise will help you towards your goal. The recommended healthy level of physical activity is 150 minutes (two and a half hours) of moderate exercise over a week in bouts of 10 minutes or more. You can do this by carrying out 30 minutes on at least five days each week.

Medicines

In addition to changing your diet, you may need medicines to prevent gout. These help control the levels of uric acid in your blood. The aim is to prevent you getting gout again and if you do, make it last for a shorter time and be less severe. These medicines aren't used to treat symptoms of gout and are usually prescribed several weeks after your last gout symptoms have gone.

Your doctor may prescribe you a medicine called allopurinol to take daily. An alternative is febuxostat if there is a reason why you can’t take allopurinol. Both of these medicines prevent gout by stopping the formation of uric acid. Both allopurinol and febuxostat may actually cause more symptoms of gout when you first start taking them. To help prevent this happening, your doctor may prescribe NSAIDs, colchicine or steroid tablets for you to take alongside allopurinol or febuxostat for up to three months. Make sure you drink enough fluids when taking these medicines.

Your doctor may prescribe you other medicines, such as probenecid, to increase the amount of uric acid that is removed from your body in your urine.

Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Treatment of gout

You will usually have symptoms of gout for up to two weeks and then they will go away, even without treatment. You may only have one episode of gout in your lifetime, but it might return. If you have no treatment to prevent gout, there is an eight in 10 chance of it returning within three years. Your symptoms of gout may also be more frequent and last for longer.

Self-help

There are a number of steps you can take to reduce the pain and swelling from having gout.

• Raise and rest your joint. Don’t do any vigorous physical activity. Rarely, your doctor may give you a splint to wear to stop you moving your joint.
• Keep your joint cool and don't cover it. Ice the affected joint using an ice pack or ice wrapped in a towel for about 20 minutes at a time to reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage it. If you need to repeat this, let your joint return to its normal temperature first.
• Drink enough water.

Medicines

There are medicines your doctor can prescribe to help to ease your pain and swelling from gout.

Your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, which may relieve pain and inflammation. If you have a heart condition, high blood pressure, kidney or lung disease, or if you're over 65, these medicines may be harmful, so you need to talk to your doctor before taking them. Don’t take aspirin because this medicine can affect your uric acid levels and make your gout last longer.

If NSAIDs aren't suitable for you, your doctor may prescribe a medicine called colchicine instead. Colchicine also reduces inflammation, but in a different way to NSAIDs. You may have side-effects from this medicine including diarrhoea, but this can be reduced by taking lower doses.

Occasionally, your doctor may prescribe steroid tablets if you can't take NSAIDs or colchicine. Alternatively, he or she may recommend a steroid joint injection if you have gout in a large joint (such as your knee).

Diagnosis of gout

Your GP will ask about your symptoms and examine you. He or she will also ask you about your medical history and that of your family. Your GP will usually take a sample of your blood, which will be sent to a laboratory to measure the levels of uric acid. Your blood sample may also be tested to find out whether there may be another reason for your symptoms. 

Your GP may refer you to a rheumatologist (a doctor specialising in conditions that affect the joints) for further tests.

Your doctor may remove some fluid from your swollen joint with a needle. This usually causes no more discomfort than a blood test. If uric acid crystals can be seen in the fluid under a microscope, you have gout. If calcium crystals are seen, you have a similar condition called pseudogout. The crystals formed when you have pseudogout are made of a calcium salt called calcium pyrophosphate. See our frequently asked questions for more information. 

You may need to have an X-ray of your joint in order to rule out other conditions and to find out if any damage has occurred, but this isn’t used to diagnose gout.

Causes of gout

You can develop gout if you have too much uric acid in your body. Uric acid is a chemical that everyone has in their blood. It's a waste product formed from substances called purines, which are found in every cell in your body and certain foods. Uric acid is formed in your body when the purines in foods you eat are broken down. It’s also formed when old cells in your body are broken down and replaced by new cells. Excess uric acid is passed through your kidneys and out of your body in your urine. However, the level of uric acid in your blood can rise if:

• your kidneys don't pass uric acid quickly enough
• your body produces too much uric acid

If the level of uric acid in your body is too high, it can form tiny crystals that collect in your tissues, particularly in and around your joints. This is what may cause your swelling and pain. These crystals tend to form at a cooler body temperature, which is why gout is more common in your fingers and toes.

You may have high levels of uric acid, but not get gout, or you may get gout, but not have high levels of uric acid. It's not known why some people develop gout and others don't. However, there are certain factors that can increase your likelihood of getting gout. You're more likely to get gout if you:

• are a man aged 30 to 60
• are a woman who has been through the menopause
• eat a diet that contains high levels of purines, which are found in red meat, seafood and some other foods
• drink too much alcohol, especially beer
• don’t drink enough fluids daily and become dehydrated
• take certain medicines, such as diuretics (water tablets), which increase the flow of urine from your body
• have a family history of gout
• have kidney disease meaning that your kidneys don't pass enough uric acid out in your urine
• are overweight, have diabetes or high blood pressure
• have psoriasis (itchy, dry and flaky skin), which can sometimes cause your body to produce too much uric acid
• are taking certain types of cancer medicines

Complications of gout

Having gout won’t always lead to further problems, but you can reduce your risk of having complications by having treatment and making changes to your lifestyle and diet.

The most common complication of gout is progressive joint damage, which leads to long-term pain, deformed joints and eventually, disability. This may be prevented by changes to your diet and by taking medicines that lower your uric acid levels. There is also some evidence that prolonged high levels of uric acid in your body can increase your risk of vascular diseases, which may lead to a heart attack or stroke.

Other complications that you may have are as follows.

• Gout affecting several of your joints (called polyarticular gout). This happens more often in older people with gout.
• Getting kidney stones (if uric acid crystals collect in your urinary tract). This happens to between one and three in 10 people who have gout.
• Damage to your kidneys (if uric acid crystals collect in your kidney tissue).

Symptoms of gout

You may only ever have gout once in your life and it may go away without any treatment.

The first symptoms of gout in your affected joint include:

• severe pain
• swelling and warmth around the area
• red and shiny skin around the area, which may peel later on

You may also have a mild fever.

If you have gout that reoccurs over many years, you may have further symptoms. This can include firm, white lumps developing beneath your skin – these are made of uric acid crystals and are called tophi. Tophi usually take up to 10 years to develop from your first episode of gout. Having tophi can lead to a range of problems, including:

• the tophi becoming inflamed, which can cause discomfort
• tophi breaking down and leaking out a white, paste-like substance

You may want to discuss with your GP treatments to ease discomfort from having tophi. However, taking antibiotics for inflamed or leaking tophi won’t help because tophi aren’t caused by bacteria.

These symptoms may be caused by problems other than gout. If you have any of these symptoms, see your GP for advice.

Natural cure and remedies for treating Gout

There is no natural 'cure' for Gout but you can naturally prevent Gout ever happening again for the rest of your life.  All you need to do is change your diet and you will 'cure' yourself of Gout. So its a natural way to prevent Gout attacks, which is much better.

The change in diet will help you cure Gout from mild to the severe type where your ankles are purple, your joints hurt and you can not walk because of the Gout. This natural remedy or cure for Gout will also benefit your skin if you have Gout related escma, especially on the face and head.

Trust me, this change in your diet works to cure Gout, no matter how painful or bad your Gout attacks normally are.

The natural cure or remedy for Gout by changing your diet is not instanteous and it takes effort to start with but the rewards of curing Gout are worth it. You can take a pill everyday for the rest of your life or by changing your diet you can cure yourself naturally of Gout.

This diet as a natural cure for Gout will take a few weeks or months to really show the benefit but its so subtle that you dont realise its working, until someone reminds you that your skin has cleared up and 'when did you last have a Gout attack?' and you can not remember the answer :)

The diet is basically what you are adviced to avoid on other lists but if you roughly stick to it long term it will naturally help you to not have any more Gout attacks. The Gout diet allows you to still eat all the foods you like but you need to cut down on them to once a week or month if they are in the 'not good for Gout' list.

The natural cure or remedy for Gout diet

* Eat lost of fishy stuff
* Brown pastas and rice
* If you must have bread then eat brown or special low yeast bread
* Alcohol try to reduce but if you have to drink then have wines and especially white wines)
* Chicken only once a week

Avoid or reduce

* Red meat
* Alcohol (especially yeasty alcohol like Beers and Lagers, Real Ales)
* Pastry (yeast)
* Chocolate
* Dairy milk (its full of antibiotics anyway but also avoid Soya milk as it mostly GM)
* Vinegar (acid)
* Tomatoes! Very difficult but this is a real high priority as tomatoes are very bad for Gout
* Acid fruits like lemons etc

Alcohol 

* Alcohol - needs to be reduced, especially at the start of the diet. Once you are a few months into the diet you will find that a session of drinking alcohol does not trigger a Gout attack anymore

Does this diet to cure Gout work?

* Absolutely. Its not an instant natural cure for Gout but if you stick to it then it is a natural cure for Gout for the rest of your life.
You can also still eat and drink the stuff you really like but you just got to keep it in moderation. You will know when you have been indulging to much when your skin or ankles start to flare up with the old signs of Gout.

No matter how severe your Gout and related skin conditions are this will remove the Gout and reduce greatly your skin conditions. Depending on how much you stick to the diet will related to how well it cures your Gout related skin conditions.

Trust me, i am not a Doctor, so I dont want you to take a pill every day for the rest of your life, especially as you do not need to.


Anything else natural to help cure or be a remedy for Gout

When you start this natural cure or remedy diet for Gout your body will need to be supported with extra replacement minerals. The best person to go and see is a local homeopathy person. They will also give you support and refine your diety need, in fact you should create your Gout natural cure or remedy diet with them. Homeopathy does work. You just have to understand what is happening to see why it works. Yes it is watered or diluted down. How homeopathy works is that everything in the universe is electric because everything is made up of atoms and sub atomic particles and whatever else we will discover smaller than these particles. They all have a frequency and energy. Water is life and energy and when shaken the atoms get energy excited and their information or energy is either passed on or influences the atoms around them.

What you put in you get out

Its simple. Western medicine never cures you its cures a sympton. You are ill for a reason. Eastern medicine tries to balance and cure your body so that you are ill less often. What sounds better? Western medicines cure for Gout? Take a pill for each day of the rest of your life. Not change what is put in to your body that causes Gout. If you are still eating the same diet then your body is till out of balance. The pill only reduces the symptons, it does not cure your out of balance body.

About Gout: Diet and Gout

Gout is one of the most painful yet treatable forms of arthritis, but it’s often not treated properly. Today, it’s estimated that two to five million Americans have gout, with most male victims suffering a first gout attack between 40 and 50 years of age. Women develop gout later, in the years following menopause. With Americans living longer and growing stouter, both of which are linked to gout’s prevalence, it’s important that the disease be diagnosed promptly and accurately, and treated effectively, to prevent disability, joint damage, lost workdays, and diminished quality of life.

Gout Qs and As

Q. Is gout an “old man’s disease?”

A. Gout is that rare example where the myth is true, though for reasons that people throughout history could not have surmised. It is true that gout remains predominately a disease of men (it is eight times more prevalent in men than women), and disease prevalence increases with age. Men over 30, for instance, represent one percent of all attacks, while men over age 65 account for approximately 10 percent of all attacks. The male predominance has to do with elevated uric acid levels in the bloodstream. In men, uric acid levels begin to rise after puberty, while in women, uric acid levels do not begin to rise until after menopause. This suggests that the hormone estrogen may have a protective effect in women.

Q. What causes gout?

A. Gout is caused by excess levels of uric acid in the blood. When this excess urate is present, it will often crystallize in a joint, typically the big toe, leading to inflammatory arthritis. Uric acid is a substance that forms when the body breaks down purines, components of DNA that occur naturally in the tissues of the body. It is part of the normal process in which tissues are replaced.

Purines are also present in many foods. In the process of digestion, purines are metabolized to form uric acid. For most people, uric acid does not pose a significant problem, since the kidneys simply filter it through the normal renal processes. Approximately 90 percent of people who have gout develop excess levels of uric acid because they can’t excrete it in their urine due to either to the genetic make-up of the kidney or to the kidneys not working effectively. The other 10 percent of gout patients simply overproduce uric acid.

Thiazide diuretics, which are often used to treat high blood pressure, can also cause gout by increasing uric acid levels. Low doses of aspirin can do the same, as can anti-rejection medication used by people who have had organ transplants. In addition, untreated high blood pressure, diabetes, and elevated cholesterol levels may predispose a person to gout attacks.

After a few years of gout without proper diagnosis and treatment, uric acid crystals begin to form large tophi—unsightly deposits that appear to be lumps just under the skin, typically on the ear, fingers, and toes. If left untreated, tophi can severely damage a joint.

Q. Are dietary overindulgences and increased alcohol consumption the main causes of gout?

A. For most people, dietary indulgence is not the main cause of gout. As with many diseases, the problem is the underlying genetic condition that predisposes certain people to experience the accumulation of too much uric acid (a condition known as hyperuricemia). Diet, however, does exert an influence for those predisposed to the disease. If you have a genetic predisposition for gout and have higher than normal levels of uric acid to begin with, a poorly-balanced diet (low consumption of fruits, vegetables, and dairy products, and high consumption of fatty meats) will add to the problem, increasing your risk for a gout attack by about three percent.

Q. Which foods most likely contribute to gout attacks?

A. Historically, gout patients have been advised to avoid all foods that are rich in purines because they are more likely to cause or aggravate gout. These include organ meats, such as liver, kidneys, brains, and sweetbreads, as well as sardines, anchovies, clams, and purine-rich vegetables (peas, beans, cauliflower).

In order to get a better picture of the effects of purine-rich foods on gout, Dr. Hyon K. Choi, a rheumatologist at Harvard Medical School, undertook a study that was published in a recent issue of The New England Journal of Medicine. Dr. Choi’s research highlighted several dietary considerations for those concerned with staving off gout. By taking a comprehensive look at a broad range of dietary factors, he was able to confirm the long-held—yet never proven—suspicion that consumption of certain purine-rich meats and seafood increases the risk of gout.

Over the course of twelve years, Dr. Choi and his fellow researchers at Massachusetts General Hospital and Harvard University tracked the dietary habits of 47,150 men aged 40 through 75 with no history of gout, comparing those who developed gout (730) during the course of the study with those who remained gout-free. After adjusting for weight and for any medications the men were taking, Dr. Choi and his colleagues reached the following conclusions:

• Meats. Those who consumed meats with the highest purine concentration (specifically organ meats, beef, pork, and lamb) were 40 percent more likely to develop gout than those who ate the least.
• Seafood. All types of seafood are high in purines. Those who ate the most seafood (including canned tuna, shrimp, lobster, and scallops) were 50 percent more likely to develop gout than those who ate the least.
• Vegetables. Vegetables high in purines, including peas, beans, mushrooms, cauliflower, and spinach, were not associated with gout attacks.
• Dairy. The incidence of gout decreases with increasing intake of dairy products. Low-fat dairy products may have protective benefits, most likely due to the proteins in milk that help reduce uric acid levels. Those who drank one or two glasses of skim milk per day were 48 percent less likely to develop gout.
• Alcohol. Those who consumed the least alcohol also tended to follow a low-purine diet with a low-fat dairy component, thereby recording fewer gout flare-ups. (Note: Beer is the only alcoholic beverage acknowledged to have a high-purine content. A more recent study of 50,000 men in the Lancet reported that beer increases uric acid concentrations in blood plasma, which may precipitate gout attacks. Moderate wine consumption was not linked to a risk of the disease in this Lancet study.)