Gout: Symptoms, Causes and Natural Support Strategies
If you have sudden painful, swollen joints in your toes or feet or perhaps your ankles, knees, fingers, hands, or elbows, you may be experiencing gout. Gout is a condition caused by a buildup of uric acid causing inflammation and irritation in your joints resulting in pain, swelling, and other symptoms. If you are dealing with gout, know that this is not a life sentence. There are some simple natural support strategies that you can try to improve your health.
In this article, you will learn what gout is. You will understand its common symptoms and main causes. I will share the best lab testing options for gout. I will also offer my top natural support strategies to improve your health.
What Is Gout
Gout is a type of arthritis. It is a condition caused by accumulation and buildup of uric acid from poor dietary habits and metabolic issues. Gout causes damage and swelling in various joints of the body. When uric acid builds up in your body, it forms crystals called urates. Urates are rather sharp and can penetrate into your joints causing irritation and inflammation (1, 2, 3).
Gout usually affects your feet, particularly, your big toe. It can also affect your ankles, wrists, knees, elbows, and fingers. It is characterized by pain and swelling. You may experience gout attacks that are sudden and intense as if your foot is on fire (1, 2, 3). Gout can be a frustrating and painful condition, however, it is possible to reduce and manage your symptoms of gout and restore healthy metabolic function through natural lifestyle strategies that I will cover later in this article.
Major Symptoms of Gout
- Intense joint pain
- Lingering discomfort
- Limited range of motion
You may notice these symptoms in your toes (especially your big toe), feet, knees, wrist, elbows, and fingers. Acute gout symptoms may last for 3 to 10 days. You won’t be experiencing symptoms of gout until your next gout attack (1, 2, 3).
Untreated gout may turn chronic, however, cause hard lumps called tophi to develop in your joints, skin, and surrounding tissue. Since tophi can cause permanent joint damage, addressing acute gout, and reducing your risks of gout attacks is critical (4).
Major Causes For Gout
Gout affects over 3 million people in the United States. Men, women after menopause, those with kidney disease, those with hypertension, hyperlipidemia, and diabetes are more likely to be affected (2). Gout may develop for a variety of reasons, including one or more of these major causes of gout:
Your genetics may increase your chances of developing gout. Gout tends to run in families. If you have one or more people in your family with gout, your risk of developing gout yourself is higher (3).
While you cannot change your family history, gout may develop for more than one reason. If you have a family history of gout, it is particularly important that you pay attention to other major causes of gout that you can control easier through a healthy diet and lifestyle.
Poor Blood Sugar and Insulin Resistance
Insulin resistance happens when your cells in your fat, liver, and muscles are unable to respond to insulin properly and cannot handle all the glucose from your blood. This forces your pancreas to make more and more insulin to help glucose to enter your cells. Insulin resistance and poor blood sugar can increase your risk of diabetes which can increase your risk of gout (2).
According to a 1998 study published in the Annals of Epidemiology and a 2013 study published in PLoS, those with gout also have an increased risk of insulin resistance and diabetes (5, 6). Insulin resistance may also increase inflammation in your body which further aggravates your gout symptoms.
Poor Purine Metabolism
Uric acid forms from two major biochemical patterns. The most commonly associated pathway that doctors discuss when it comes to gout is through purine metabolism. Purines are molecules that are formed by a grouping of nucleic acids.
Pure purine metabolism and foods high in purine, such as shellfish, fish, red meat, turkey, organ meats, gravies, and soups may increase your risk of gout (2). Purine converts into uric acid in your body. The problem is that if your kidneys are unable to flush the excess uric acid, it can create a buildup in your bloodstream and end up depositing in your joints leading to gout.
Gout is the most common condition seen in those with poor purine metabolism. According to a 1998 study in Biochemistry Journal, purine metabolism abnormalities can increase the risk of both gout and neurological dysfunction (7).
In general, some people don’t tolerate these foods as well as others. As a clinician, I typically recommend my clients consume grass-fed red meats and organ meats, however, if they do have a history of gout, I will have them abstain from these foods for a while until we get their metabolism and microbiome back in order.
Poor Fructose Metabolism
Poor fructose metabolism and eating or drinking foods or drinks high in fructose, especially high-fructose corn syrup may also cause gout. This second biochemical pathway indicated that fructose triggers the body’s production of uric acid from and important energy molecule adenosine triphosphate (8, 9, 10).
According to a 2010 study published in the Journal of American Medical Association, participants who drank one fructose-rich beverage a day were 74 percent more likely to develop gout than those who only had one high-fructose drink a month. Those who had two or more high-fructose beverages had a 97 percent higher risk (11).
In New Zealand, the Maori people rarely encountered gout. Now, ten to fifteen percent of their population has gout symptoms in their lifetime. Seafood seems to be the major trigger for these Pacific islanders; however, they have always eaten a lot of seafood. These people eat fifty times more sugar and fructose (much like typical Americans) than they did 100 years ago (12).
While high-fructose corn syrup is an obvious problem for your health, you have to be aware of other and natural forms of fructose. Fructose is a sugar molecule found in corn, fruits, agave, and honey, and food or drinks created from them, including fruit juices or food sweetened with agave, honey, or high-fructose corn syrup.
Poor Oxalate Metabolism
Poor oxalate metabolism is another potential cause of gout. Oxalate is a naturally occurring molecule found in fruits, vegetables, nuts, seeds, grains, and legumes. High-oxalate foods include berries, kiwis, purple grapes, figs, potatoes, beets, spinach, okras spinach, rhubarb, Swiss chard, peanuts, soy, cashews, almonds, bran flakes, wheat germs, tea, cacao, and chocolate.
Too much oxalate may cause kidney stones and kidney issues may increase the risk of gout (2). According to a 2009 study published in Urology Research comparing 100 patients with uric acid stones and gout, 43 patients with gout, 100 patients without gout, and 30 control subjects, there is a relationship between oxalate stone formation and gout (13).
Certain medications may also cause gout. According to the American College of Rheumatology, certain diuretics or water pills, including hydrochlorothiazide (Hydro-D and Esidrix) and Lasix, low-dose aspirin intake, and certain immunosuppressants used in organ transplants, including tacrolimus (Prograf) and cyclosporine (Sandimmune and Neoral) may raise uric acid levels and cause gout (2).
If you are taking any of these medications and experiencing gout, talk to your healthcare professional to check for alternative options and solutions.
Best Lab Tests
Lab tests can help to identify the underlying causes of your gout and also understand your risk factors of developing gout. Lab testing can also help your healthcare provider to create the best, personalized treatment plan to reduce your symptoms of gout, lower your risk of developing gout, and improve your overall health.
I recommend working with a functional health doctor, such as myself. They are not only able to recommend an array of testing that may not be used at your regular doctor’s office but can also help to create a personalized treatment plan focusing on natural support strategies that support your health. There are a variety of lab tests that I recommend.
Uric Acid Levels
Uric acid is created in your body by breaking down purine. Gout is caused by the buildup of uric acid in your body, hence testing your uric acid levels is the first important step and measure to look at your risks of gout (1, 2, 3).
Uric acid tests are simple urine or blood tests that can help to diagnose gout, determine your risk of gout, and help to monitor gout. Normal uric acid levels are between 2.4 and 6.0 mg/dL for females and 3.4 and 7.0 mg/dL for males.
A serum ferritin test is a simple test that checks the level of ferritin, a blood cell protein that stores iron, in our body. According to a 2018 study published in Arthritis Research and Therapy, high ferritin levels may increase your risk of gout (14).
Low ferritin may also indicate anemia, while high ferritin levels may lead to inflammation, liver disease, autoimmune conditions, and cancer (15). The optimal range is 30 to 400 and the optimal range is 50 to 150 for females and 75 to 150 for males.
Since insulin resistance and poor blood sugar levels are one of the main causes of gout, it is important to test your fasting insulin levels (2, 5, 6). Both high or low insulin levels can cause an issue.
High insulin levels are a sign of insulin resistance, prediabetes, diabetes, and metabolic syndrome, which can all lead to inflammation, gout, and other health issues such as hypertension. The clinical range for fasting insulin is between 2.6 and 24.9 uIU/ml and the optimal range is between 1.0 and 5.0 uIU/ml.
Hemoglobin A1C or HbA1c gives the average amount of glucose in the blood, or blood sugar, over the past 3 months. This test is another good indication of poor blood sugar levels, one of the top causes of gout (2, 5, 6). A high HbA1c is an indication of high levels of advanced glycation end-products (AGE’s) that damage proteins and tissues in the body including the red blood cells.
Red blood cells are constantly forming and dying and generally live for about three months, hence this test is a good indication of your blood sugar levels for that period. This is a great test for prediabetes and diabetes, both of which increase your risks of gout. Poor levels of HbA1c also indicate inflammation in the body. The clinical range is between 4.8 and 5.6, but the optimal range is 4.5 to 5.2.
Red Blood Cell Width
The Red Blood Cell Distribution Width (RDW) is a great test to see if there is inflammation in your blood. According to a 2014 study published in Science Reports, there is a correlation between your RDW and uric acid levels (16).
As you know, elevated uric acid levels can result in gout. Your RDW levels may also indicate a risk for other health issues. The clinical range is between 12.3 and 15.4 percent and the optimal range is 11.7 and 15 percent.
C-Reactive Protein (CRP), is a blood test that assesses your inflammation levels. Since gout is characterized by joint inflammation and inflammation is a common underlying cause of most health conditions, it’s important to measure your inflammation levels (2). CRP is a protein produced by your liver. Increased and decreased levels mean inflammation or trauma that may increase your risk of inflammatory, chronic, and other health issues, including gout and causes of gout. The clinical range is between 0 to 3 mg/L and the optimal range for CRP is between 0 and 2 mg/L.
To learn more about these tests, I recommend reading this article. To tests for the markers that we’ve just discussed, I recommend a Comprehensive Blood Analysis, a sophisticated test that looks at all kinds of markers for health, including a Complete Blood Count, Complete Metabolic Panel, Urinalysis, Lipid Panel, Zinc/Copper ratios, Vitamin A & D levels and Thyroid Panel.
Checking your oxalate levels is important, since elevated oxalate levels may increase your risk of gout (2, 13). High levels of oxalate may also indicate an increased risk of developing kidney stones. Normal levels are less than 45 milligrams per day.
To test your oxalate levels, I recommend a Comprehensive Organic Acid Test. This is a simple urine test that looks at complex biomarkers from various metabolic pathways. These biomarkers give an overview of several major systems in the body and an analysis of nutritional deficiencies in the body.
Top Natural Support Strategies
If you have gout or have an increased risk of gout, you can support your body naturally through some simple nutritional and lifestyle natural support strategies, as well as, the right supplementation. Here is what I recommend.
Anti-Inflammatory Nutrition Plan
Gout means that there is inflammation in your joints and following an anti-inflammatory nutrition plan may be helpful to keep your symptoms at bay and reduce your risk of gout attacks (2). Remove inflammatory foods, such as refined sugar, refined oil, grains, gluten, artificial ingredients, deep-fried food, processed foods, junk food, and sugary or artificial drinks.
Focus on a diet rich in anti-inflammatory foods, including greens, vegetables, herbs, spices, fermented foods, low glycemic index fruits, healthy fats, such as avocadoes, coconut oil, or organic butter and ghee, and clean animal protein, such as grass-fed beef, pasture-raised poultry and eggs, and wild game. To learn more about the diet the anti-inflammatory ketogenic nutrition plan I recommend, read this article.
Keep Fructose Levels Down
Too much fructose in your diet can increase your risk of gout. Keeping your fructose levels down may improve your health. Foods that may have added fructose in them include salad dressings, sauces, sugar drinks and sodas, processed foods with high-fructose corn syrup, baked goods, fast food, and yogurt. Foods that are naturally high in fructose include honey, agave, molasses, fruits, dried fruits, and fruit juices.
Opt for low-fructose, low-sugar whole foods, and read labels. Keep your fructose levels under 20 grams per day. Following the anti-inflammatory nutrition plan, I recommended earlier should help you to achieve a low-fructose diet.
Consider a Low-Oxalate Nutrition Trial
High-oxalate foods can trigger gout. If you have gout, consider a low-oxalate nutrition trial. High-oxalate foods include berries, kiwis, purple grapes, figs, potatoes, beets, spinach, okras spinach, rhubarb, Swiss chard, peanuts, soy, cashews, almonds, bran flakes, wheat germs, tea, cacao, and chocolate.
Try a low-oxalate diet for 2 weeks and see if you feel better. If you feel better, consider following this plan. Working with a functional health doctor or functional health coach can help you to create a low-oxalate plan for you. Here is a helpful article on oxalates.
Consider a Low-Purine Nutrition Trial
High purine foods can cause gout. If you have gout, consider a low-purine nutrition trial. Foods are high in purine, such as shellfish, fish, red meat, turkey, organ meats, gravies, and soups. Try a low-purine diet for 2 weeks and see if you feel better.
If you feel better, consider following this plan. Working with a functional health doctor or functional health coach can help you to create a low-purine plan for you.
Reduce Stress and Improve Sleep
Gout is characterized by inflammation, so keeping your inflammation levels down is critical (2). Lowering your stress levels and improving your sleep can lower inflammation and support your overall help. Reduce stressful activities in your life. Learn to cope with stress better by practicing meditation, mindfulness, deep breathing exercises, journaling, gratitude, prayer, positive affirmations, grounding, and mindset shifts.
Improve your sleep by avoiding electronics, stress, and food several hours before bedtime. Engage in relaxing activities. Take a relaxing bath, read a book, journal, meditate, color, pray, practice breathwork, have calm family time and sip on some calming herbal tea. Make sure that your bedroom is a safe, peaceful sanctuary with supportive pillows, bedding, and a comfortable bed. Make sure to sleep 7 to 9 hours a night.
Daily Movement and Regular Exercise
Regular movement and exercise are essential for optimal health and well-being. Regular movement may also help to reduce inflammation and support joint health, which is important since gout is characterized by joint inflammation (2).
Start your day with light stretching, morning yoga, a short walk, or rebounding. Stay active throughout the day by getting up to stretch, taking walks at lunch, walking your dog, playing with your kids, opting for the stairs, walking or biking instead of driving short distances, using a standing desk, gardening, or dancing to your favorite song.
Stretch out or do some light yoga in the evening. Exercise at least 20 to 30 minutes, 3-5 days a week. Mix up cardiovascular exercises, such as dancing, biking, swimming, or jogging, strength and resistance training, such as weight lifting, bodyweight workouts, kettlebell training, TRX, or CrossFit, and low-impact workouts, such as yoga, pilates, or Barre workouts.
If you are currently experiencing or recovering from a gout attack, choose exercises that don’t further activate your joint pain. Low-impact activities and strength training supporting other areas may be beneficial during this time. Working with a physical therapist well-versed in gout and joint pain may help you get started with a personalized plan.
Optimize Hydration Levels
Optimal hydration is essential for your overall health and well-being. Drinking plenty of water is also important for healthy kidney function, and as you know, poor kidney health may increase your risk of gout (2). Start your day by drinking 16 to 32 oz of clean water.
Drink throughout the day. I recommend drinking a glass every hour or so to stay hydrated. Remember, if you are feeling thirsty, you are probably already dehydrated. Cravings and hunger may also be a sign of hunger, especially close after mealtimes. Make sure that you drink clean water by using a water purifier and avoiding regular tap water or bottled water in plastic.
Certain supplements may also support your body if you have gout. Here is what I recommend daily:
Vitamin C, Citrus Bioflavonoids & Quercetin
Vitamin C is a water-soluble vitamin that is fantastic for your immune system and overall health. Citrus bioflavonoids are great antioxidants that may reduce inflammation and oxidative damage. Quercetin is a flavonol found in many fruits, vegetables, leaves, seeds, and grains; red onions, and kale. According to a 2019 study published in the International Journal of Molecular Science, quercetin has positive effects on microbial metabolites and supports your body (17).
According to a 2016 randomized, double-blinded, placebo-controlled, cross-over trial published in the British Journal of Nutrition, quercetin may improve uric acid levels (18). According to a 2009 prospective study published in Archive Internal Medicine, vitamin C may improve gout in men (19).
Fish oil is high in anti-inflammatory omega-3 fatty acids and may help to lower inflammation levels and decrease the risk of health issues. Fish and most seafood is also high in omega-3s, however, some fish and most shellfish are high in purines and may aggravate gout.
However, according to the Arthritis Foundation, fish oil is not high in purine and is safe for those with gout. The Arthritis Foundation recommends 2,000 milligrams of EPA and DHA from fish oil daily for those with gout (20).
According to a 2017 study published in the Journal of Advanced Research, deficiency of certain enzymes that are involved in purine metabolism may lead to increased uric acid and gout (21).
According to a 2011 report published in the Journal of the American Medical Association, intravenous enzyme pegloticase may be an effective strategy for those with difficult-to-treat gout that don’t respond to conventional treatments (22). Systemic enzymes, which are specific proteolytic enzymes taken on an empty stomach, may support purine metabolism and may be beneficial for gout.
Turmeric & Ginger
Turmeric and ginger are both powerful anti-inflammatory herbs that can reduce pain and improve your health. Researchers found that they may also be effective for gout. Turmeric is often used for inflammation and joint pain associated with arthritis.
According to a 2019 mice study published in Medicina (Kaunas), turmeric nanoparticles may serve as an effective anti-gout agent (23). According to a 2017 study published in the International Journal of Scientific and Technology Research, red ginger could relieve some of the pain associated with gout (24).
Tart cherries are a delicious fruit with great health benefits, including the potential to reduce gout attacks. According to a 2012 study published in Arthritis and Rheumatology, cherry consumption may reduce the risk of recurrent gout attacks (25).
According to a 2019 systematic review published in Evidence Based Complimentary and Alternative Medicine, cherries may help to decrease uric acid levels and gout associated with increased uric acid (26).
Gout is a condition caused by a buildup of uric acid causing inflammation and irritation in your joints resulting in pain, swelling, stiffness, redness, and heat. With the help of some lab testing, your functional health doctor or other healthcare provider can help to determine your risk factors and underlying causes of gout and offer a personalized treatment plan to support your body naturally.
If you want to work with a functional health coach, I recommend this article with tips on how to find a great coach. At my clinic, we offer long-distance functional health coaching programs. For further support with your health goals, just reach out and our fantastic coaches are here to support your journey.