What Causes Gout? High Uric Acid


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What Causes Gout? High Uric Acid

What Causes Gout? High Uric Acid
Painful attacks may be the symptom most associated with gout, but you shouldn't let them prevent you from addressing its underlying cause. Gout is caused by a buildup of uric acid in your blood (hyperuricemia). As your uric acid level rises, so does the potential for gout and gout flares.
There are pain medications available to help during gout flares. But taking steps to decrease your uric acid and keeping it at a healthy level (less than 6 mg/dL) can help you manage gout over the long term.
There are options that may help get you there. So, if you're still suffering from gout flares, it's time to take action. Talk with your healthcare professional about your flares and your high uric acid level.
What Triggers a Gout Attack?
Gout flares occur when excess uric acid forms crystals, causing inflammation in your joints that leads to swelling and pain. It is hard to say exactly what triggers an attack. They sometimes occur for no apparent reason. . .other times, something may seem to trigger the attack. Gout attacks may be triggered by alcohol, certain medicines, another illness, stressful events, or other factors.
Other Known Gout Triggers Include:
  • Joint injury
  • Surgery
  • Eating too much of certain foods
  • Crash diets
  • Infection
  • Rapid lowering of uric acid levels
    with uric acid-lowering medicines
Reducing uric acid levels to below 6 mg/dL is the goal for managing gout over the long term.
Diet & Uric Acid
You may hear suggestions that eating or avoiding certain foods is the "key" to managing gout. But changing your diet alone is not typically enough to get rid of the uric acid buildup in the body. In fact, even the strictest low-purine diet has been shown to reduce uric acid levels by only about 1 mg/dL.
Gout: the Diet Myth
The mistaken belief that diet "causes" gout has been around for centuries. You may have heard gout being described as the "Disease of Kings." This is because kings were thought of as having rich diets, and centuries ago it was believed that gout was caused by what you ate. However, today we know that this just is not true.
Now we know it has a lot more to do with how your body handles uric acid, the underlying cause of gout, than the kinds of foods you eat. In some people (10%), uric acid builds up in the blood because their body produces too much of it. In the rest (90%), the kidneys don't eliminate uric acid efficiently, causing it to build up.
In reality, although certain foods may trigger a gout attack, they aren't the cause of gout. Gout's true cause is high uric acid in the blood. In order to reduce your risk of gout flares over the long term, you'll need to take steps to decrease your uric acid level and keep it low. Reducing uric acid levels to less than 6 mg/dL is the goal for managing gout over the long term.
The Role of High-Purine Foods
The uric acid in your blood comes from purines, substances that are produced by your body and also found in many foods. Most of your uric acid (2/3) is produced naturally by your body, while the rest (1/3) comes from your diet.
There's no denying that important steps like drinking plenty of nonalcoholic beverages (lots of water, less alcohol), exercising, maintaining a healthy weight, and limiting high-purine foods are smart choices for people with gout.
Eliminating high-purine foods from your diet may help lower your uric acid level. However, in most cases just changing your diet alone may not be enough to control your high uric acid.
Managing Your Gout
Effectively managing gout isn't just a matter of taking pain medicine during a gout attack. You should also talk with your healthcare professional about positive lifestyle changes, like good nutrition, exercise, and weight loss, which may make a difference in your gout and your overall health. In addition, your healthcare professional may consider including medicines to help address the high uric acid that is causing your gout.
By knowing how to reduce your pain during flares and ways to keep your uric acid at a lower, healthy level, you can help manage your gout more effectively, both short- and long-term.
Managing the Pain
There's no doubt that pain management is an important part of an overall gout treatment plan…especially when you're in the middle of a gout attack! Luckily, there are a lot of options when it comes to managing gout pain.
 To treat the pain from attacks, your healthcare professional's recommendations are likely to include common pain relievers and anti-inflammatories, such as:
  • NSAIDs (Examples: indomethacin, naproxen, Aleve and Advil)*
  • Colchicine
  • Steroids (Example: prednisone)
It may be easy to forget that you have gout between painful attacks, but you do! So you'll still need to think about a comprehensive gout treatment plan. Pain medication can help relieve your immediate pain, reduce swelling, and may shorten the duration of the attack…but it doesn't address the high uric acid that actually causes gout to begin with.
Be sure to stay in contact with your healthcare professional on an ongoing basis…especially if you're still experiencing gout flares. If you don't mention your continuing flares, he or she may assume you're not having any!
Managing Gout Long Term
Decreasing your uric acid to the recommended target level (less than 6 mg/dL) is the goal for managing gout over the long term. You'll need to talk with your healthcare professional about important steps you can take to get there. Remember, over time high uric acid can lead to attacks that are more severe, last longer, and occur more often.
Once you've worked with your healthcare professional to manage the immediate pain of a gout attack, it's time to talk about how to reduce your risk of future gout attacks and manage your gout over the long term. Gout's underlying cause is a high level of uric acid in the blood. If uric acid levels remain high, crystals can form and build up silently in your joints, even between flares. Over time, this may lead to attacks in other joints, constant pain, and joint destruction.
The Goal: Less Than 6 mg/dL
Reducing uric acid levels to less than 6 mg/dL is the goal for managing gout over the long term. If you don't know your uric acid levels, you may want to ask your healthcare professional about including a simple blood test to measure your uric acid level during your next office visit.
Higher risk of future attacks
Lower risk of future attacks
Decreasing uric acid level to less than 6mg/dL is the goal for managing gout over the long term
Gout Management Plan
Talk to your healthcare professional about a comprehensive treatment plan. The best plan for you may include making heath healthy lifestyle changes, taking pain medicines when you're flaring and having your uric acid levels monitored by your healthcare professional. Your plan may also include taking medication to help lower your uric acid level.
Currently there are two types of medication available by prescription to lower the amount of uric acid in your blood.
They are:
  • Medication to help reduce the production of excess uric acid
  • Medication to help your kidneys get rid of excess uric acid
Talk to your healthcare professional about your options to help lower your high uric acid.
Ongoing Discussion With Your Doctor
Remember, in helping you manage gout over the long term, your healthcare professional needs as much information as possible. It's a good idea to discuss your gout with your healthcare professional on an ongoing basis.
Healthy Lifestyle Changes
The foods you eat aren't the cause of gout . . . but a high-purine diet is one of many things that can trigger gout attacks if you already have a high uric acid level. And maintaining a healthy weight and getting regular exercise is an important part of your overall health.
. If you notice that you have gout attacks after different foods and drinks, it's a good idea to avoid those choices. You should be aware that changing your diet alone isn't usually enough to reduce uric acid levels. In fact, even when people follow the strictest low-purine diet possible, they generally don't reduce their uric acid levels by much more than 1 mg/dL. Any reduction in uric acid level is positive, but you'll most likely need to do more to lower your level enough to the recommended target level of 6 mg/dL.
Healthy Choices
A lot of people misunderstand the role of diet in gout, but here are some good tips that you can discuss with your healthcare professional:
  • Drink plenty of liquids, like water. Fluids like water help remove uric acid from the body.
  • Add low-fat dairy products to your diet. Eating more of these dairy products is associated with a decreased risk of gout.
High-Purine Foods
A high-purine diet is one of many things that can trigger gout attacks if you already have a high uric acid level. Limiting or avoiding these foods may help from triggering an attack.
  • Beef
  • Organ meats
  • Pork
  • (such as liverwurst, kidney, and brain)
  • Lamb
  • Meat-based gravies
  • Beer
  • Anchovies
  • Herring
  • Scallops
  • Sardines
  • Mussels
  • Trout
  • Roe (fish eggs)
  • Codfish
  • Haddock
  • Spinach
  • Cauliflower
  • Asparagus
  • Mushrooms
  • Oatmeal
  • Peas
  • Dried beans
  • Lentils
Low-Purine FoodsBreads and Grains
  • Breads
  • Pasta
  • Grains
  • Rice
  • Cereals
  • Carbonated drinks
  • Coffee
  • Milk and milk products
  • Tomatoes
  • Some types of green vegetables
  • Fruits
  • Cheese
  • Olives
  • Chocolate
  • Eggs
  • Sugar
It's a good idea to maintain a healthy weight and get regular exercise. But don't forget that the foods you eat aren't the cause of gout. To best address gout, you need a comprehensive treatment plan that addresses healthy lifestyle changes including diet and exercise, pain management for gout flares, and the long-term treatment of high uric acid that causes gout.
Part of coming up with this plan is having an honest discussion with your doctor about what you are doing right now.
  • What is your daily diet like?
  • Are you taking herbal supplements or eating a lot of particular foods (such as cherries or drinking cherry juice) that you heard might help?
  • What kind of exercise are you doing and how frequently?
  • Are you taking your medication as prescribed?
Your doctor can tell you whether or not you are on the right track.
Homeopathic Remedies for Gout
Homeopathic remedies can provide a measure of relief during painful attacks of joint pain and inflammation. A constitutional remedy prescribed by an experienced homeopath may help to reduce the likelihood of further episodes. The following homeopathic remedies are particularly useful for gout.
Aconitum napellus - The person is anxious, with a good imagination that can picture many terrible things. The joints are swollen and painful. The pain is worse at night and with warmth, but better with fresh air and rest.
Arnica: Arnica can also be very helpful for discomfort that comes with gout. Pain is sore and bruise-like, and it hurts to walk. The person may be afraid to be approached or touched, because of pain.
Belladonna: Useful for symptoms such as sudden onset, swelling, throbbing, heat, and. The joints look red, inflamed, and shiny - with sharp or violent pains that are worse from touch and jarring. The person may feel restless, flushed, and hot. Take
Benzinum acidum: 3X every four hours in gouty subjects with high- smelling urine.
Berberis vulgaris: Twinges of pain in gouty joints, or stitching pains that are aggravated by changing position or walking, may indicate a need for Berberis vulgaris. Berberis is often indicated for people who ache all over; some have nagging back pain or a tendency toward kidney stones.
Bryonia: Bryonia is helpful when tearing pain is worse from the slightest movement.
Calcarea fluorica: When the finger joints become enlarged because of gout, and the knees and toes may be involved, it may be time for this remedy. Stabbing pain is experienced, and the joints may make a cracking sound on movement. Discomfort is worse during weather changes, and warmth may bring relief.
Colchicine: 3X, every two to four hours for great weariness, nausea, shoutings and tearings in muscles and joints worse with movement, better at night. Tearings in legs, feet, and toes with swelling.
Colchicum: Colchicum is useful for gout in the big toe or heel-so painful the person finds both motion and touch unbearable. The joints are swollen, red and hot. Pain is often worse in the evening and at night. Flare-ups may occur in the springtime or with weather changes. Individuals who need this remedy often have a feeling of internal coldness and are very tired.
Guaiacum 3X, every four hours in gout.
Ledum palustre: Ledum palustre is indicated when the foot and big toe are swollen. Shooting pains are felt all through the foot and ankle, moving upward to the knee. Cold applications relieve both the swelling and the pain.
Pulsatilla nigricans: 3, every two hours when gout flies about from joint to joint.
Rhododendron: When you experience gouty swelling of the big toe joint that flares up before a storm, this remedy may be indicated. Other joints may ache and swell, especially on the right side of the body. Pain usually is worse toward early morning and after staying still too long. The person may feel better from warmth and after eating.
Rhus toxicodendron: This remedy can be helpful for joints that are hot, stiff, painful, and swollen. Symptoms are worse in cold, damp weather and improved by warmth and gentle motion.
Sabina - The person is depressed. There is gouty pain and nodules may develop at the afflicted joint. Movement and heat make the pain worse; cool fresh air makes it better. Also when connected with uterine disorder
Sulphur: When you have painful gouty joints that itch, along with a burning feeling in the feet, sulphur may be useful. The knees and other joints may be involved. Problems are aggravated by heat in any form, and are often worse in damp weather and in springtime.

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