Triggers for gout attacks

Ask the expert

I have gout. Which foods should I avoid? Which foods are beneficial for people with gout?

Doctor’s response

Foods that you eat, and don’t eat, can impact your gout by increasing or decreasing your blood uric acid levels. You will also want to make adjustments to your diet if you have any of the conditions that are commonly found in people with gout, including, hyperlipidemia, hypertension, diabetes, obesity and impaired glucose tolerance.

The primary dietary goal for gout is to limit your intake of foods with high amounts of purine in them. Ideally, you will have little or no foods that are high in purine and only small amounts of those with moderate amounts of purine.

Foods considered high in purine content include:

  • Some fish, seafood and shellfish, including anchovies, sardines, mackerel, scallops, herring, mussels, codfish, trout, and haddock
  • Some meats such as bacon, turkey, veal, venison, liver, beef kidney, brain, and sweetbreads
  • Alcoholic beverages

Foods considered moderate in purine content include:

  • Meats such as beef, veal, poultry, pork, and lamb
  • Crab, lobster, oysters, and shrimp
  • Vegetables such as asparagus, spinach, green peas, mushrooms, and cauliflower
  • Kidney beans, lentils, and lima beans

Your other goals will be to:

  • Lose weight if you are overweight: Make sure that you do this slowly because fast weight loss will actually increase the uric acid levels in your blood.
  • Drink plenty of fluids: This can help with removing uric acid from your blood. Be sure to limit fluids with caffeine and/or calories; water and seltzer are the best choices.
  • Increase your lowfat dairy intake: There has been some research that has shown that those who drink lowfat milk or consume lowfat yogurt have lower uric acid levels than those who do not.
  • Keep your fruit and vegetable intake up: You may get a reduction in your uric acid levels by having fruit, such as cherries, and vegetables (those that are not sources of purine), as part of your diet.

It’s still important to have a well-balanced diet. If you have any trouble doing so with these recommendations, I would recommend working with a dietitian to design a plan that fits your preferences and lifestyle. You can find one in your area by speaking with your physician.

Symptoms

According to the Mayo Clinic, common symptoms of gout are:

  • Intense joint pain that is most severe in the first 12 to 24 hours
  • Joint pain that lasts a few days to a few weeks and spreads to more joints over time
  • Redness, tenderness and swelling of the joints

Gout vs. rheumatoid arthritis

Gout and rheumatoid arthritis (RA) both cause bumpy, painful joints, but they couldn’t be more different. Rheumatoid arthritis is a disease in which the body’s immune system attacks itself, causing damage to tissue and organs while gout has nothing to do with the immune system. “Unfortunately, when chronic, it can involve many joints making it difficult to distinguish from rheumatoid arthritis,” Dr. Nathan Wei, a rheumatologist and director of the Arthritis Treatment Center in Frederick, Maryland, told Live Science. “Obviously, if the patient has a high level of rheumatoid factor and anti-CCP, that helps. However, a few patients may have concomitant RA and gout.”

Gout vs. Pseudogout

Gout and pseudogout closely resemble each other, but they each have very different characteristics. “The amount of pain suffered by a patient with pseudogout is usually less than is experienced by a gout patient,” Edwards said. “The main difference between gout and pseudogout are the types of crystals that deposit into the joints and cause inflammation.” Edwards went on to point out that monosodium urate (MSU) crystals cause gout, while pseudogout is caused by calcium pyrophosphate crystals.

Test and diagnosis

While gout has painful and distinctive symptoms during flare-ups, its symptoms can be vague during other times. A doctor may extract a sample of joint fluid so it can be examined under a microscope for any presence of urate crystals, according to the NIAMS.

Certain joint infections can produce symptoms similar to gout. If an infection is suspected, the doctor may check joint fluid for bacteria.

Blood tests can reveal the concentration of uric acid in the blood and further confirm the diagnosis. However, according to the Mayo Clinic, blood tests can be misleading, because some gout patients do not have an unusual level of uric acid in their blood, and some people with high levels of uric acid do not go on to develop gout.

Other than a blood test and joint fluid tests, X-rays, ultrasounds and CT scans may be used to confirm a diagnosis.

Treatment and prevention

“A patient’s gout will not get better until they start taking uric-acid-lowering drugs. Patients need to know that their serum uric acid level should be below the target of 6 milligrams per deciliter (mg/dL). While gout cannot be cured, it can be better managed, or even controlled completely, with the right medications and lifestyle choices,” Edwards said.

In most cases, long-term medications for lowering uric acid will be used to treat gout and prevent flares gout. “Generally, patients with gout will need to be on these drugs for life. If they stay on them over time, their gout symptoms and risk of deformity or disability will be greatly decreased,” Edwards added.

The painful symptoms of gout can be alleviated by nonsteroidal anti-inflammatory drugs (NSAIDs), which can reduce both pain and inflammation around the joints, according to the University of Maryland. Depending on the severity of the flare-ups, patients can be treated with over-the-counter NSAIDs such as ibuprofen (Advil or Motrin), or naproxen (Aleve) or with prescription-strength painkillers such as indomethacin (available under the trade name Indocin).

Corticosteroids, such as prednisone, can be injected directly into the affected joints for relief within a few hours, according to Mayo Clinic. However, despite their effectiveness, corticosteroids must be used sparingly, because they can weaken bones or poor wound healing.

Another pain reliever commonly used to reduce gout pain is colchicine. It is most effective when taken within the first 12 hours of symptoms, according to NIAMS. Once the flare-up subsides, the doctor may prescribe low, daily doses of colchicine to ward off future attacks.

Beyond medications, patients can also control the frequency of flare-ups through exercise and diet adjustments. Because uric acid is created during the digestion and breakdown of purines, patients can reduce the concentration of uric acid in the blood by avoiding high-purine foods such as anchovies, asparagus, dried beans and peas, mushrooms and organ meats (such as livers and kidneys). The Mayo Clinic also suggests that patients should drink more water and less alcohol, because alcohol can raise the level of uric acid in the blood.

This article is for informational purposes only, and is not meant to offer medical advice.

Additional resources

  • U.S. National Library of Medicine: Gout
  • Gout and Uric Acid Education Society: Stages and Symptoms of Gout
  • NIH: Gout Research

What Is Gout?

Jump to: Symptoms | Causes | Diagnosis | Treatment | Is it curable? | Diet | Prevention

What is gout?

Nicknamed “the disease of kings” or “rich man’s disease,” gout tends to conjure up images of Henry VIII–bacchanalian-esque rulers who indulged in too much wine and rich meals that most people couldn’t afford. However, gout is a fairly common (and very painful) form of arthritis that has been on the rise for decades and may now affect more than eight million Americans–men and women.

Gout definition

Also known as gouty arthritis, gout is caused by a buildup of uric acid in the bloodstream (hyperuricemia) triggering joint pain and inflammation. When too much uric acid accumulates in the body, it collects into needle-shaped crystal deposits that settle into the joints (often in the feet, particularly in the big toe), causing bursts of pain, redness, and swelling. Attacks tend to occur at night and subside after three to 10 days, even without medication. Flare-ups can also reoccur a few months or years later, and, left untreated, gout can cause permanent damage to the joints and the kidneys, which remove uric acid from the body.

Although gout can almost always be controlled with certain medications and by avoiding alcohol and foods that contain chemicals called purines, it may be hard for doctors to initially diagnose the disease, especially because other forms of arthritis cause similar symptoms.

Signs and symptoms of gout

When uric acid crystals settle into the joint, they trigger swelling and an intense bout of pain. About half of all people with gout will first experience these symptoms in their big toe, although any joint–including the ankles, knees, wrists, fingers, and elbows–can be affected. In some cases, the affected joint will be red and sore and radiate heat.

In the early stages of gout, these attacks tend to flare up at night and are painful enough to rouse you from your sleep. The symptoms usually subside after three to 10 days and can lie dormant after that for months or even years. Over time, however, the attacks can become more frequent and last for longer periods of time. And although gout is almost always treatable, it’s possible for gout to cause long-term damage–including severe attacks, chronic arthritis, and kidney stones–if you don’t seek medical care.

RELATED: 9 Surprising Triggers of Gout Pain

Because the symptoms of gout tend to mimic those of other forms of arthritis, doctors may have trouble finding a diagnosis right away. To test for gout, physicians use a needle to draw out joint fluid from the affected area, then they look for uric acid crystals under the microscope. (Complicating matters, however, is the fact that some people have normal or even lower levels of uric acid during a gout attack.) Doctors can also use CT scans and, for more chronic forms of gout, X-rays to check for signs of joint damage.

Experts also note that gout tends to be linked to high blood pressure, heart disease, kidney disease, and medications that increase the body’s level of uric acid.

Symptoms of gout:

  • Intense pain in the affected joints (usually those of the foot, and specifically the big toe)
  • Swelling
  • Redness
  • Warmth
  • Joint stiffness

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What causes gout?

Gout is caused by the buildup of uric acid, which is formed after the body breaks down substances called purines. Purines are part of human tissue, but they’re also found in foods like anchovies and venison.

After the body breaks down purines, the resulting uric acid travels into the bloodstream. Usually, it passes through the kidneys and is shuttled out of the body through urine. But when too much uric acid builds up–or the kidneys can’t metabolize it quickly enough–it collects into crystals and settles into the joints.

Although gout was once associated with medieval rulers–who were the only people wealthy enough to drink alcohol and eat meat regularly–anyone can develop gout. Eating high-purine foods (see below for a list) can increase your risk of the disease, but other culprits play a role too. For example, people who are overweight have more body tissue; more body tissue means more purines that need to be broken down, producing more uric acid in the process. If you have high blood pressure or an underactive thyroid gland, you may be more likely to have higher levels of uric acid. Or, if someone in your family developed gout in the past, your genetics may be partly to blame.

How is gout diagnosed?

Because the symptoms of gout–namely, inflammation and joint pain–are similar to those of other forms of arthritis, doctors might have trouble diagnosing the condition right away. Still, there are some signs: Unlike, for example, rheumatoid arthritis–in which multiple joints are affected–gout tends to target just one or two joints, and usually the big toe. (There is also a disease called pseudogout, which triggers symptoms that are similar to gout, but is caused by a buildup of calcium phosphate, not uric acid.)

Doctors can test for gout by ordering a uric acid test. The physician will insert a needle into the affected joint to extract joint fluid, then study the sample under a microscope to look for uric acid crystals. If uric acid crystals are present, the doctor can confirm the diagnosis. (That said, these test results can occasionally be misleading. Some people have lower or normal levels of uric acid in their joint fluid during a gout attack; likewise, people with higher levels of uric acid don’t always have gout.) The symptoms of gout are also similar to those of a joint infection, and your doctor may test the joint fluid sample for bacteria.

For people with more advanced stages of gout, doctors may order a CT scan or an X-ray to check for joint damage.

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Gout treatment

Corticosteroids like prednisone, which are hormones that target inflammation, can help ease the pain from a gout flare-up, as can non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and indomethacin. Although these medications can relieve short-term joint pain, they don’t reduce the levels of uric acid in the body.

In the early stages of an attack, doctors may prescribe an anti-gout medication called colchicine, which relieves swelling and other symptoms of gout. This type of medication not only helps ease an immediate attack, but can also prevent an attack before it starts. For severe attacks, doctors can prescribe a medication called anakinra; although it’s approved for people with rheumatoid arthritis, it is sometimes used off-label to ease the symptoms of gout.

If your gout flares up repeatedly, your doctor may want you to start taking a medication that can lower the levels of uric acid in the blood. These drugs include allopurinol (which blocks uric acid production), probenecid and lesinurad (which help the kidneys remove uric acid), and an injection called pegloticase (which breaks down the uric acid itself). You may also want to avoid alcohol and foods like anchovies and mackerel, which are high in purines.

RELATED: 8 Famous People With Gout

Gout medications

  • NSAIDs: non-steroidal anti-inflammatory drugs help to ease pain and swelling
  • Colchicine: an anti-gout attack medication that helps relieves swelling and other gout symptoms
  • Corticosteroids: medications like prednisone, which help reduce inflammation in the body, much like the naturally occurring hormone called cortisol
  • Anakinra: a rheumatoid arthritis medication that blocks a specific protein called interleukin, which causes joint damage
  • Allopurinol: available in tablet-form and taken once or twice a day, this medication decreases the production of uric acid in the bloodstream
  • Probenecid: used to treat chronic gout, this medication prevents painful attacks by helping the kidneys remove uric acid from the body
  • Lesinurad: available in tablet-form and taken once daily, this medication helps the kidneys remove uric acid from the body
  • Pegloticase: an injection that decreases the amount of uric acid in the body, thereby preventing gout attacks

Home remedies for gout

  • Cherry products: A 2012 study found that people with gout were 35% less likely to have an attack if they also ate cherries or consumed cherry extract. The researchers suspect that the fruit can lower the levels of uric acid in the blood.
  • Ice: Holding an ice pack or a cold compress over the painful joint might help ease gout pain.
  • Water: Staying hydrated has been linked to fewer gout attacks, possibly because extra water helps flush out uric acid through urine.

Is gout curable?

Gout is treatable–meaning, that with the right medications or dietary adjustments, it’s possible to prevent future flare-ups from occurring and to decrease the severity of the ones that you do experience. But because there’s a risk for another attack–even years down the road–it’s hard to say whether gout is “cured.” Luckily, there are medications available that can treat both the short-term joint pain during a gout attack and lower the levels of uric acid in the body to help prevent future symptoms of gout. Adjusting your diet to avoid foods that are high in purines can also help reduce your risk of another gout attack.

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Gout diet and foods to avoid

Because alcohol can thwart the kidneys’ ability to remove uric acid from the body, experts say to limit intake to one drink per 24 hours. In a 2014 study, having one to two drinks a day increased a person’s risk of a gout attack by 36%; having two to four drinks a day increased a person’s risk by 51%. Foods that are high in purines–a compound that, when broken down in the body, produces uric acid–can also trigger a gout attack. Some offenders include shellfish, red meats, and sugary drinks. According to a 2012 study, people with gout who ate the most purine-rich foods were almost five times as likely to have an attack than those who ate the lowest amount of purine-rich foods. The Boston University researchers also found that the impact from animal products were much larger than that of plant products. While doctors previously recommended avoiding plant-based foods that are rich in purines, some now believe they are safe to eat for people with gout.

Some doctors suspect that eating dairy might help prevent gout attacks. Older research found a link between eating more low-fat dairy products and having lower uric acid levels, but experts don’t entirely understand why that might be.

Foods to avoid or limit if you have gout:

  • Alcohol
  • Anchovies
  • Asparagus
  • Dried beans
  • Dried peas
  • Fruit juice
  • Game meats (i.e., quail, duck, deer, etc.)
  • Gravy
  • Herring
  • Lobster
  • Mackerel
  • Mushrooms
  • Sardines
  • Scallops
  • Shrimp
  • Sugar-sweetened drinks
  • Sweetbreads

RELATED: 13 Great Recipes If You Have Gout

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Gout prevention

If you’ve been diagnosed with gout, doctors can prescribe medications like allopurinol and lesinurad to help lower the levels of uric acid in the body, thereby warding off a future attack. And by avoiding foods that are high in purines, it’s possible to avoid a flare-up of gout symptoms. Other health problems that can boost your uric acid levels include high blood pressure, hypothyroidism, and psoriasis. Treatment for these conditions may help prevent gout. Losing excess weight may help decrease uric acid levels in the body.

Talk to your doctor before taking any new supplements or medications; some, like diuretics and niacin (a form of vitamin B3), may also raise the uric acid levels in your body.

How to prevent gout attacks

Published: July, 2013

To reduce painful recurrences of gouty arthritis, know your uric acid level and take appropriate doses of medication.

Gout is a painful joint condition that affects 3.4 million American men. Historically, it was called the “disease of kings” because of its association with excess aristocratic consumption of mutton and mead, but the underlying cause is more down to earth: Gout attacks flare when uric acid, a chemical produced in the body, builds up to an excessive level and starts to form crystals in the affected joint. This triggers inflammation and severe pain, sometimes with fever, muscle aches, and other flu-like symptoms.

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Gout pain can be debilitating, so using natural remedies can offer gout suffers much relief. Gout is a condition characterized by a buildup of uric acid. Uric acid is the result of purines breaking down, which are found naturally in the human body as well as in food.

Typically, uric acid becomes released from the body through the kidneys and urine, but too much uric acid can crystallize and surround joints and tissue. This crystallization results in pain and swelling and can make walking or even wearing shoes difficult.

Symptoms of gout include joint pain, discomfort, inflammation, redness and limited range of motion. Eating foods high in uric acid – red meat for example – can increase a person’s risk of developing gout, along with being obese, medical conditions like high blood pressure, family history, surgery and trauma.

If you are living with gout and are seeking relief from gout pain, here are 19 natural remedies for gout pain relief.

19 Natural remedies for gout pain relief

Use ice: Anytime we encounter an injury we are advised to apply ice. Ice constricts blood vessels which in turn reduces swelling. Furthermore, a reduction of blood flow to the area can help ease the pain as well.

Rest the joint: Gout pain should be treated similar to an injured body part. The best way to promote healing is to rest, so when you are encountering a gout pain attack the best thing to do is rest. Overuse of the joint will only result in more pain and inflammation.

Drink plenty of fluids: Because uric acid can be expelled through urination, it’s important to drink plenty of water in order to remove excess uric acid.

Avoid alcohol: Alcohol, in particular beer, is high in purines, which get broken down into uric acid. Avoiding alcohol can reduce the amount of uric acid in the body.

Foods to eat: Although foods high in purines can worsen gout, there are specific foods you should eat as a natural remedy for gout pain. Fruits, vegetables, lean meat and whole grains can help ease pain and inflammation associated with gout.

Avoid high-purine foods: This includes oily fish, offal, organ meats, and vegetables such as asparagus and spinach. Purines are metabolized into uric acid, so eliminating them in your diet will help prevent gout. Eating foods that are low in purines will help to reduce uric acid levels in the body. Berries are known for helping to reduce uric acid in the body. Also, staying hydrated by drinking an adequate amount of water will ensure your kidney’s filter out uric acid effectively.

Keep your weight down: Being overweight not only increases your risk of gout, it can also worsen gout pain. Losing weight can reduce uric acid in the body and alleviate stress put onto the joints.

Take extra care of your joints: Getting rest and icing joints are effective ways of taking care of your joints. Also minimize the time spent on your joints and lose some weight if you are overweight.

Create gout-friendly socks: Having the affected area cooped up in a sock can cause further irritation. You can simple make gout-friendly socks by cutting out an area of the sock to allow the toe – most commonly the big toe – to poke through. You may also choose to wear open toe shoes or sandals when permitted.

Tame your sheets: Because an affected joint is so sensitive, even the light weight of bed sheets can cause pain. Keep your sheets at calf or ankle level so your foot can be exposed. Tucking them into the mattress will ensure they don’t move about as freely.

Get naked: Keep the affected area as exposed as possible by not wearing closed shoes or socks for long periods of time.

Elevate your foot: When blood flows to a specific area it can cause swelling and pain. By elevating the affected foot you can relieve some of the swelling.

Get a cane: Because you don’t want to add unnecessary pressure onto the joints, the use of a cane may be ideal.

Apple cider vinegar: A common natural remedy used by gout patients, taking it as soon as you feel a gout attack coming on may help relieve the associated pain. It works by helping your body become more alkaline with the acidity of apple cider vinegar helping to relieve acute gout pain. You may also consume it by adding one to two tablespoons to a glass of water and drinking it two to three times a day.

Baking soda: A commonly used baking ingredient, this item is also a great natural remedy for gout sufferers. It works by making your body more alkaline, helping to relieve gout symptoms. Most people using baking soda consume half a teaspoon in a glass of water about six times a day to get the best results. However, it is advised that those suffering from high blood pressure limit their baking soda intake as it is very high in sodium.

Cherries: An effective food for lowing uric acid levels due to their high antioxidant properties. A study involving 600 gout patients found that eating half a cup of cherries every day, which is around 10 to 12 cherries, resulted in a 35 percent reduction in the risk of successive gout attacks. Eating two to three servings of cherries further reduced this risk to only 50 percent. If you don’t enjoy the taste of cherries, supplements do exist.

Epsom salt: Commonly added to baths, Epsom salt can also help to relieve gout pain. This is thanks to its high magnesium content that aids in the relaxation of muscles, aches, and pains. To get the best results, add one to two cups of Epsom salts to your bath and soak the affected joint or entire body for at least 30 minutes

Activated charcoal: A common emergency treatment used to prevent drug overdose or poisoning, activated charcoal can also be found in tablet form in your local pharmacy. It helps to absorb uric acid, reducing gout symptoms. You can also choose to soak in a bath mixed with charcoal powder or make a paste and apply it to the affected joint.

Lemon juice: Helps to alkalinize the body, reducing the amount of acid. Lemon juice can be mixed with half a teaspoon of baking soda or simply to water to reap its effects.

These are 19 natural remedies to help gout pain. If pain is unbearable or persistent, you may want to speak to your doctor about specific medications in order to better treat gout. Essentially, easy lifestyle changes should be able to alleviate the majority of pain and swelling caused by gout.

Related:

How to treat gout naturally with essential oils

Pseudogout: Causes, symptoms, prevention, and treatment

Picture: Getty Images

Your bed is much, much more disgusting than you imagine – in fact, it’s a mass of fungi, bacteria, soil, sweat, sputum, vaginal juice, poo, urine and especially skin, with humans shedding, on average, 10g of skin per day for dust mites to feast on.

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That, combined with the 100 litres of sweat you produce every year – and all those snacks you ate in bed – means your bed is a breeding ground for fungi and bacteria.

So skimping on the number of times you wash your sheets isn’t just dirty, it can be dangerous, according to Dr Lisa Ackerley, Hygiene Doctor and Dettol Expert, speaking to the Daily Mail.

The bacteria and fungi living in your bed mean that you can catch athlete’s foot easily off a partner – and if one of you is ill, you may well catch viruses such as colds off the sheets.

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Dr Ackerley says, ‘Think of all the things you do in bed. Apart from being the place where we go to sleep, it can double up as the home office, the tea room, the dining table or even your dog or cat’s bed.

‘Depending upon what your bed is used for, and also how clean you are when you get in it (and indeed whether you wear nightwear), your bed can get pretty filthy and may actually be causing your body harm.’

Ackerley advises vacuuming regularly around the bed, and washing bedding at high temperatures – or, if you’re washing at low temperatures, use a laundry cleanser.

She also says families should wash their nightwear regularly – every three days – and wash bedding once a week (or if you can’t manage that, every two weeks).

What you should do to stay clean

Dr Lisa Ackerley, Hygiene Doctor and Dettol Expert, says, ‘First, get rid of the dust! Vacuum the room and around and under the bed, and the mattress and send your duvet off to be cleaned. Wash pillows if they can be washed and tumble dry to stop clumping – or send them off to the laundry as well.

Use pillow protectors on your nice clean (or new) pillows and a mattress protector – you can wash these easily. Spray the mattress with Dettol all in one Disinfectant Spray when having a spring or autumn clean, and destroy any nasty germs and bugs that may be lurking there.

Wash bedding at above 60°C if you can, or even higher – I have white cotton and go to 90°C. This blitzes everything – but if you have more delicate fabrics, then wash at a lower temperature but always use a laundry cleanser. Remember bacteria grow best at body temperature, so a 30-40 degree wash isn’t going to do the job without a laundry cleanser.

Wash bedding once a week if you can, or at least every two weeks.

Have a shower before bed – then you keep the dirt down! At the very least, wash your hands before bed time.

Wash nightwear every three days.

Have some anti-bacterial wipes handy in case you have any spills.

If you have a cat or dog and allow it on the bed, get a blanket for them to lie on and wash that every week at least.

If someone is ill, step up the cleaning and launder the linen more frequently.

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