Gout and Uric Acid
Get Your Uric Acid Levels Measured, Now!
If you were a diabetic or had high cholesterol you would get regular blood tests to see if your cholesterol or blood sugar is below the target level.
Well, hyperuricemia, the medical term for high uric acid (UA) levels, is no different.
If you have gout or uric acid kidney stones, there are medical guidelines that recommend you keep your UA level below a specific target. This is because you are much less likely to suffer from gout attacks if your uric acid can be kept below these targets.
To help prevent gout attacks, physicians recommend that sUA (serum uric acid) be lowered and maintained to a target of less than 6 mg/dL. This is a simple blood test and can be done in conjunction with other route blood work in your annual physical or other occasions when your blood needs to be tested or monitored.
During a gout flare, UA levels can be normal because the uric acid is deposited and somewhat sationary as urate crystals in the joints, and the level in the bloodstream is reduced. This means that you will need to wait a few weeks after an attack has completely gone before having your sUA measured.
A raised UA levels in your blood does not completely prove that an attack of joint pain was gout. Most people with slightly raised blood UA levels do not develop gout. However, the higher the level, the more likely it is that gout will develop at some point in your life.
Remember, keeping your UA level below target levels will help to stop gout attacks in the long term.
It is not only gout that is brought on by high uric acid levels. High UA is not a medical condition in itself but it is associated with several diseases such as gout, Lesch Nyhan syndrome, cardiovascular diseases, diabetes, metabolic syndrome, and kidney stone formation.
In managing UA levels, it is important to avoid purine-rich food and large amounts of foods with even moderate concentration of purine. Beer, red meat and seafood rank high on the list of no-no's. A diet low in purine content (low-fat dairy products, fresh fruit, fresh vegetables, nuts and grains) can play an important role in managing these levels because purine can increase the amount of uric acid in the body and may trigger a gout attack.
It is also advisable to reduce the amount of fructose in your diet, an ingredient found in sugar-sweetened soft drinks and other processed foods. Foods heavy in fructose are also commonly cited for their role in contributing to the obesity epidemic.
However, if your diet and lifestyle changes alone are still not achieving proper UA levels, perhaps a dietary supplement like PURIXA can help.
Water Can Be a Gout Sufferer's Best Friend
Our blood contains a certain percentage of uric acid at any one time. This uric acid is usually filtered from the bloodstream by the kidneys then it is eliminated from our bodies through urine. That’s when very thing works normally.
The problem begins when there is a buildup of excessive amounts of uric acid in your system (either in blood or kidneys) or the rate at which it is being eliminated through urine is too little. The condition is known as hyperuricemia (the medical term for high uric acid levels in the blood).
The increase of UA in your system will encourage the formation of tiny uric acid crystals. These crystals usually start to accumulate mainly around joints and eventually cause a reaction with our immune system when the crystals precipitate and release from the joint. This reaction with the immune system triggers sudden attacks of pain and inflammation at the affected area, usually in the toes or fingers.
With patients at risk of developing gout, certain conditions /events can cause acute attacks of gout due to the buildup of uric acid. These conditions include dehydration, excessive eating of food high in purines and fructose as well as heavy alcohol intake, particularly beer and grain alcohol.
There are several natural or homeopathic ways to deal with gout but we’ll just focus on the role of hydration in this article.
When you don't drink enough water, your body gets dehydrated. Dehydration may lead to improper kidney functioning. When kidneys do not function properly it might lead to formation of kidney stones, kidney infection and cause uric acid build-up.
Dehydration does not result just from lack of drinking enough water. Your body can get dehydrated if you consume drinks like coffee, alcohol or carbonated drinks. So for gout prevention and treatment, the first step you need to take is to reduce the intake of these drinks and increase the consumption of water. Sometimes it can be hard to motivate yourself to drink a lot of water during the day. In such cases you can drink fruit or vegetable juices. But it is best to stay with water as much as possible.
Often gout sufferers can tell when an attack may occur. In such instances it’s recommended that you drink 8 oz of water, six to eight times a day.
This helps the kidneys promote excretion of uric acid build up. Ultimately, this may help in reducing the frequency of gout attacks or at least making them less severe.
Body Building, Gout and Casein…What’s the Connection?
For as long as body builders have been…well building bodies, they knew the value of the dairy-based protein, Casein. Casein makes up about 80% of the protein in cow’s milk. It contains many of the necessary amino acids for muscle formation. Today, Casein is taken in significant quantity by body builders and fitness gurus as part of a daily regimen. Their results cannot be disputed and the safety risks are extremely low. So, good for body builders…what does that have to do with gout and high uric acid levels?
Well as it turns out, Casein, a no-purine, protein has a dual action of both blocking the production of uric acid as well as the attribute to promote its excretion. This sounds like a gout sufferer’s dream…a supplement that attacks uric acid from two sides. OK, curb your enthusiasm! It’s not the end-all, be-all to UA reduction, but it is a great start to achieving healthy uric acid levels. In fact there were two large studies done to prove Casein’s wonderful uric acid busting abilities.
In 1991, "The American Journal of Clinical Nutrition" published one of the most comprehensive studies on the subject. It found that uric acid levels in the blood significantly decreased three hours after the ingestion of lactalbumin, a component of casein protein. This is due to the fact that dairy has a "uricosuric effect." In other words, it causes the excretion of uric acid from the body.
A more recent study in a 2005 issue of "Rheumatology and Arthritis” (Choi, et al), found that dairy products, specifically milk on a daily basis, reduce the risk of gout in men, who are at the greatest risk. The study included 14,800 subjects.
See the figure below to understand the effects of Casein and other uricosuric and xanthine oxidase inhibitors (XOI’s decrease uric acid production by interfering with xanthine oxidase).
PURIXA's Dual Action
New findings of gout and kidney disease among US Veterans
A new study was released in May 2013 in abstract by Stanford University, Stanford, California that showed male veterans with gout and uric acid levels greater than 7 mg/dl had an increased risk of kidney disease. Normal levels are considered to be “6.8”. The study attempted to look at the relationship between uric acid levels and the risk of kidney disease among veterans with gout and tophi.
The study followed service personnel for an average of six and half years and found a direct correlation between higher risks of kidney disease and gout. The men in the study had a high prevalence of other co-morbidities like hypertension, hyperlipidemia and diabetes.
The full study is expected to be released in the July, 2013 issue of Journal of Rheumatology, but the bottom line is that with high uric acid levels and the signs and symptoms of gout there is a good chance of kidney disease occurring.
Also earlier this year in the Oxford Journals (February, 2013) another study of US veterans with gout and high uric acid levels showed a direct association between hyperuricemia and the excess risk for developing diabetes. The study revealed that approximately 1 in 11 new cases of diabetes were statistically attributed to hyperuricemia. That study followed 1923 patients for over 6 years. The risk of diabetes was dramatically increased when uric acid levels were greater than 9 mg/dl.
Just a little background to these studies before we ridiculously assume that serving in the armed forces will causes gout. The prevalence of gout in the general US population is about 1.4% to 2%. The Department of Veterans Affairs is the largest health care delivery system in the US providing care to 5.2 million veterans. Although no solid statistics or studies are known at this time regarding gout prevalence among US veterans, gout is estimated to be at least twice as common in veterans as in the general population. Why? Veterans are older, more likely to be male, and have greater prevalence of other co-morbidities like hypertension and diabetes. So there is a high concentration of hyperuricemic patients in the VA just by the group’s natural selection. Researches who study the effects of high uric acid are more likely to find the VA a good testing ground with application to the general population.
The main take away from these recent US veteran studies is hyperuricemia can be linked to diseases other than gout. Gout and its signs and symptoms like gout attacks, tender and swollen joints and tophi on the feet, hands, elbows and ears are just the result of observable effects of high uric acid. But as the acid builds and “pools” in the body, accumulating over long periods of time, perhaps decades in the form of urate crystals or kidney stones, other organs like the heart and liver can also become reservoirs for the urate material.
On a personal note, my uncle Howard is a war veteran, 85 years old and has always led a “clean” and good lifestyle; never a drinker or a smoker, likes a steak on occasion but certainly not a “meat and potatoes guy”, does not like seafood or shellfish and exercises regularly. You know what? He has gout. So sometimes the stereotype “gout guy” does not fit the profile.
Please, get your uric acid measure on a regular basis and know your UA number!
What’s the Connection between Temperatures and Gout Attacks?
Cold feet from a day spent out in the snow, followed by an attack of gout the next morning is an example of a commonly reported trigger of acute gout. In cooler temperatures urate crystals form more easily. For that same reason, tophi (deposit of monosodium urate crystals in people with longstanding high levels of uric acid in the blood) form in the feet, hands, knees, elbows and even helix of the ear (upper rim of outer ear). In these extremities, body temperature tends to be a bit lower. This aids in the development of tophus.
But to fully understand this we first need to understand a little science. Gout is a true crystal deposition disease in which all clinical signs are considered to be directly attributable to the presence of monosodium urate (MSU) crystals. At normal body temperatures (98.6oF / 37oC) urate crystals form when uric acid approaches and exceeds urate acid levels of 6.8mg/dL. At times then body extremities go down to 95oF /35oC it actually takes less urate acid to form crystals. Because uric acid has limited solubility in bodily fluids, monosodium urate crystal formation occurs. These crystals and the while blood cells that attack the MSU crystals form the tophi.
Reduced solubility of urate at lower temperatures has therefore been suggested to account for the occurrence of gout at cooler distal joints such as the foot-ankle complex.
Thus, one aim of gout attack prevention is to keep the hands and feet warm. But remember, it all starts with keeping your blood uric acid levels in check through diet, lifestyle changes and medications. If you are looking for a natural way to support healthy uric acid levels, PURIXA can help.