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Natural Doctor's Casebook: Gout

MagazineFebruary 2014 (Vol. 24 Issue 11)Natural Doctor's Casebook: Gout

After monthsand months of tests, I've just been diagnosed with gout-something I'm quitesurprised about as I'm not overweight and don't drink alcohol

Gout

Q

After months and months of tests, I've just been diagnosed with gout-something I'm quite surprised about as I'm not overweight and don't drink alcohol. I'm keen to find out more about the causes of gout and whether there are any natural treatments that have been proven to work. Can you help?-J.T., Newcastle

A

Gout is a form of arthritis caused by the buildup of uric acid crystals usually around a joint, but also in other tissues. The immune system attacks these crystals with phagocytes (scavenger cells), and the toxic byproduct of this clash causes joint inflammation.

The big toe is the most common site, but gout can also affect the ankles, knees, wrists and hands. Classic signs are redness, swelling and attacks of severe pain.

As you mention, alcohol and obesity are key risk factors for gout, but there are several other triggers that you may not be aware of. Certain foods are known to play a role because they are high in purines-chemicals that the body converts to uric acid. These foods include organ meats, shellfish, peas, beans, anchovies, sardines, asparagus and mushrooms. A diet heavy in these foods can lead to uric acid buildup in the blood which, in turn, leads to the formation of crystals in a joint, thereby causing the pain and inflammation characteristic of gout.

Other risk factors include certain illnesses and medications. People who suffer from hypertension, diabetes, kidney disease and lupus are more vulnerable to gout, as are those who regularly take diuretics, low-dose aspirin (1-2 g/day) and drugs commonly prescribed to organ transplant recipients such as cyclosporine.1,2

An often overlooked cause of gout is lead poisoning;3 the kidneys may be failing to effectively excrete excess lead. If you suspect this could be the case, take a look at last month's issue (WDDTY January 2014) for some pointers on how to detox the body of heavy metals naturally and safely.

Here are some other natural methods that may also help.

Watch what you drink

Drinking alcohol, especially beer, appears to raise the risk of gout,4 so it's good that you avoid it. But also watch out for sugary soft drinks and even fruit juices (the ones rich in fructose), as they have also been associated with gout.5

Pass up purines

Follow a low-acid diet, avoiding foods that are rich in purines. In one study, men who switched to a purine-free diet significantly reduced their blood uric acid levels after just a few days.1 This may help prevent attacks of gout from recurring. Drinking six to eight glasses of water a day may also help, as water will dilute uric acid levels in the blood.

Eat cherries

Munching on cherries-around half a pound to a pound a day-is a traditional remedy for gout and even has some evidence to back it up. US researchers found that patients with gout who ate cherries over a two-day period had a 35 per cent lower risk of attacks compared with those who did not.6

If you're not a fan of cherries, taking a cherry extract supplement could also help.

Celery juice (or celery seed) is another folk remedy for gout that is said to be widely used in Australia.

Consider quercetin

A flavonoid found in onions, capers, watercress, buckwheat, kale and dill, quercetin is sometimes recommended for gout. In test-tube studies, it inhibited an enzyme involved in the development of gout,7 although these results may not apply to human beings.

Bromelain, an enzyme found in pineapples, is often taken alongside quercetin to enhance absorption of the flavonoid.

Dosage: 150-250 mg of quercetin three times a day (between meals)

Supplement with C

A daily dose of vitamin C may be useful for gout prevention and treatment, one study suggests. After two months, participants taking vitamin C saw their blood levels of uric acid drop significantly compared with those taking
a placebo.8

Other supplements that may help include fish oils, B vitamins (particularly folic acid) and vitamin E.

Dosage: 500 mg/day of vitamin C

Try acupuncture

Combined with a nutritional approach, this traditional Chinese technique is worth a try, according to some evidence. People undergoing acupuncture treatment for a month had a greater reduction of uric acid and other markers of gout than did a control group. The researchers said that acupuncture may even help prevent kidney damage from gout.9

Use herbs

For natural pain relief, you could try the herb devil's claw (Harpagophytum procumbens). Based on evidence for its effectiveness in various forms of arthritis and back pain, it's often recommended for gout.10

Try homeopathy

The following homeopathic remedies may be helpful for the various symptoms of gout. The usual dose is three to five pellets of a 12X to 30C remedy, taken every one to four hours until symptoms improve.11

Aconite:for sudden burning pain and attacks after shock
or injury

Belladonna:for intense, throbbing pain

Bryonia:for pain made worse by motion, but gets better with pressure and heat

Clochicum:especially good if there's nausea associated with the attacks

Ledum:for joints that are mottled, purple and swollen.

Giardiasis

Q

A friend of mine has giardiasis and is suffering with diarrhoea, weight loss and constant tiredness. I'm trying to find out about effective alternative treatments for her, as the antibiotics she's taking don't seem to be helping. Can you point me in the right direction?-K.T., via email

A

Giardiasis is an intestinal infection caused by the parasite Giardia lamblia, which affects an estimated 200 million people globally each year. Although it's traditionally been considered a tropical disease, giardiasis is becoming more common in the developed countries, especially among children. Nearly 2 per cent of adults and 6 to 8 per cent of children are reportedly infected with the microorganism in developed countries worldwide, but the true figures are likely to be much higher, as many cases have been mis- or undiagnosed.

Symptoms include diarrhoea, abdominal pain, bloating, loss of appetite, weight loss and fatigue, but half the time there may be no symptoms at all.

Antibiotics like metronidazole are the usual treatment of choice, but drug resistance is an increasing problem, with laboratory studies showing that Giardia parasites are now resistant to the currently available antigiardial drugs.1 There's also the issue of safety, as metronidazole can cause serious neurological side-effects like seizures, peripheral neuropathy (nerve damage with numbness and pain in the extremities) and encephalopathy (disordered brain function and/or structure).2

More common side-effects include vomiting, diarrhoea, upset stomach and loss of appetite, which ironically are also the symptoms of giardiasis itself.

Happily, there are safer, more effective ways to manage the infection.

Your friend would be better off seeking the help of an experienced naturopath who can make recommendations and prescribe supplements and dosages based on her individual symptoms, although here are some herbs and simple dietary changes that may help, according to the evidence so far.

Garlic

Allium sativahas a long history of use as an antiparasitic and antimicrobial agent, and research suggests that both whole raw garlic and some of its constituents possess antigiardial activity.3 In a small trial of Giardia-infected children, both fresh garlic and a commercial garlic supplement seemed to clear up symptoms within a day and a half. After three days, stool samples revealed that the garlic-treated children were free of the parasite.4

Indian long pepper

Used in Ayurvedic medicine to treat intestinal disorders, Indian long pepper (Piper longum) shows Giardia-killing activity in test-tube and animal studies. In mice, the herb was found to reduce the number of intestinal trophozoites-the active form of the parasite-by 75 per cent after five days.5 These results, though, may not apply to humans.

Pippali rasayana

Prepared from P. longum and Butea monosperma ('Flame of the Forest' or 'palash' tree), Pippali rasayana is a traditional Ayurvedic remedy for chronic dysentery and worm infestations.

In a trial of 50 giardiasis sufferers, the herb was better than a placebo at clearing the infection and improving symptoms.6

It appears to work by enhancing the immune system and other mechanisms responsible for clearing infection from the body.7

Dosage: 1 g three times daily

Oregano

In the lab, this common culinary herb has demonstrated antigiardial activity superior to that of tinidazole, an antiparasitic often used to treat giardiasis. More recently, among 18 tested essential oils, oregano oil (Origanum virens) was one of the most active against Giardia trophozoites.8

Berberine herbs

Berberine is a compound found in several plants, including barberry, Oregon grape and goldenseal. According to test-tube studies, berberine salts and extracts can inhibit the growth of Giardia trophozoites.9 Plus one clinical trial suggests berberine may help ease gastrointestinal symptoms.7

Propolis

This sticky substance made by bees from plant resins is often used to treat infections. A 20 per cent propolis solution was just as effective as the drug tinidazole at resolving giardiasis in one study, and worked with no side-effects.10

A high-fibre diet

Eating a whole-food, high-fibre, low-simple-carbohydrate and low-fat diet may help reduce the symptoms of giardiasis, boost the body's defence mechanisms and even prevent the growth of trophozoites.7 In particular, your friend should make sure she's getting enough insoluble fibre, which had a beneficial effect in animal studies.11 Good sources include beans, brown rice, oats and lentils.

Wheat germ

Including wheat germ in the diet may be helpful, as it contains an agent called agglutinin, shown to inhibit the growth of Giardia trophozoites in the lab.12 In one placebo-controlled trial, a few spoonfuls of wheat germ a day seemed to improve symptoms and significantly reduce trophozoite numbers in giardiasis sufferers.13

Dosage: 1-2 Tbsp three times a day

Probiotics

These friendly gut bacteria should be on your friend's shopping list, as they can directly inhibit Giardia growth and trigger innate immunological antigiardial mechanisms.

Lactobacillus johnsoniistrain La1, for example, inhibited the growth of Giardia in test-tube studies and enhanced levels of immunoglobulin A (IgA; an antibody that plays a crucial role in protecting mucosal surfaces) immune responses.7,14

The L. acidophilus strain La5 and L. rhamnosus strain GG also appear to enhance immune responses, which may help to encourage intestinal clearance of Giardia.

Your friend could try eating half a cup of low-fat yoghurt a day containing one or more of these strains (with minimum 10/mL guaranteed levels of viable bacteria) or taking a probiotic supplement.

And see page 60 for information about cultured foods like kefir, which are rich in good-guy bacteria.

GOUT references

1

Arthritis Res Ther, 2006; 8 Suppl 1: S2

2

Br J Rheumatol, 1987; 26: 303-6

3

Toxicology, 1992; 73: 127-46

4

Lancet, 2004; 363: 1277-81

5

BMJ 2008; 336: 309-12

6

Arthritis Rheum, 2012; 64: 4004-11

7

Pharmacol Res Commun, 1985; 17: 831-9

8

Arthritis Rheum, 2005; 52: 1843-7

9

J Tradit Chin Med, 2004; 24: 185-7

10

BMC Complement Altern Med, 2004; 4: 13

11

Duke Center for Integrative Medicine. The Duke Encyclopedia of New Medicine. London: Rodale Books International, 2006

giardiasis references

1

Expert Opin Drug Saf, 2003; 2: 529-41

2

J Med Case Rep, 2011; 5: 63

3

Microbiology, 2000; 146: 3119-27

4

J Egypt Soc Parasitol, 1991; 21: 497-502

5

Phytother Res, 1999; 13: 561-5

6

J Ethnopharmacol, 1997; 56: 233-6

7

Altern Med Rev, 2003; 8: 129-42

8

Rev Invest Clin, 1994; 46: 343-7; Nat Prod Commun, 2010; 5: 137-41

9

Tokai J Exp Clin Med, 1990; 15: 417-23

10

Acta Gastroenterol Latinoam, 1988; 18: 195-201

11

Am J Trop Med Hyg, 1989; 41: 512-20

12

J Clin Invest, 1994; 94: 2283-8

13

Am J Trop Med Hyg, 2001; 65: 705-10

14

Appl Environ Microbiol, 2001; 67: 5037-42

Send us your most pressing medical questions and we'll put them to our natural doctor: letters@wddty.co.uk


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