Gout Folklore & Fallacies
“Folklore” remedies for gout, be they time-worn advice from your neighbor or any of the countless suggestions on the Web, appear to be something that should be viewed with a grain of salty doubt.
One suggestion on the Web, for example, was that of mixing green papaya cubes with green tea, and the suggester cited friend-and-family testimonials to its effectiveness.
Some folklore remedies for gout have been studied, and others, such as the green-papaya- cubes-and-green-tea idea, or collagen from seaweed, etc., do not have much in the way of published studies to allow them to be evaluated by the medical community, says Dr. Theodore Fields, Professor of Clinical Medicine at Weil-Cornell Medical College, and Director of the Rheumatology Faculty Practice Plan at the Hospital for Special Surgery.
“A key thing for people with gout to remember,” he says, “is that the conventional treatments for gout are actually extremely good and very effective in the long term, and are generally very well tolerated. I’d strongly advise people with gout to try conventional treatment. Now, especially with several conventional treatment options available, the vast majority of people with gout can be well-controlled.”
Until about four years ago, the only medications available for gout were allopurinol and probenecid, Dr. Fields says, but since that time febuxostat (Uloric®) became available as an alternative. Subsequent to that, the intravenous agent pegloticase (Krystexxa®) came on the market. “These give more ways to get patients to the goal of uric acid less than 6,” says Dr. Fields. “There are additional medications under study which work either to decrease production or increase excretion of uric acid.”
One finds Web advertisements for “Natural Xanthine Oxidase Inhibitors” to be used in reducing uric acid. “Fortunately,” says Dr. Fields, “the commercially available xanthine oxidase inhibitors, allopurinol and febuxostat (Uloric®) are effective and safe enough that it just doesn’t seem logical to use over-the-counter supplements, which are not reviewed by the FDA.”
And how about the fellow who reports using a specialty prescription cream containing “Diclofenac, Indomethacin, Triamcinclone and Lidocane,” with which he applies topically when he feels an attack coming, and in conjunction with colchicines for a full-blown attack? “Topical anti-inflammatory agents, topical anesthetics and topical steroids may have some soothing effect in gout, but the inflammation is usually deep enough in the joint that topical medications just aren’t enough to handle the problem,” says Dr. Fields. “If a topical medication helps a person with gout, there is no specific reason not to use it, but if the attack isn’t getting better, it’s very likely a systemic medication is needed, i.e., by mouth.”
There is a “grain of truth” in some folklore, Dr. Fields says, as in the advice not to eat a big meal in the evening before going to bed. “We know that gout does tend to occur a bit more often during the night,” he says. “If the meal at night is high in purines, as with red meat or shellfish, this might add to the risk of a night-time attack.”
However, Dr. Fields stress that it is a fallacy to consider gout a dietary disease. Gout is a genetic disease, he reminds us, which predisposes patients to get elevated uric acid in the blood and gouty inflammation in the joints. And patients without a genetic tendency to gout don’t get gout even if they eat all the “wrong foods.”
“Having said that, it is still possible for patients with gout to decrease their frequency of gout attacks by watching their diet, since diet can absolutely set off gout attacks,” he says. “We advise being as moderate as possible with red meat, shellfish, high-fructose corn syrup (as in regularly sweetened sodas) and alcohol, especially beer.”
It’s especially important to watch your diet if you are not taking a medication to lower your uric acid, he says, and in the first six months after starting a medication to lower your uric acid. Flares are more common in the first six months of treatment.
“Also, studies have shown that even the absolutely lowest purine diet, which is lower than most any patient can eat outside of an experimental setting, will only lower the uric acid by 1 mg/dL, and we need to get gout patients’ uric acid less than 6 mg/dL,” he says. “If patients are starting out at a uric acid of 7 mg/dL or more, it is extraordinarily unlikely that they can get their uric acid to ‘goal’ just with diet – they will need medication as well.”
On questions of gout folklore and fallacies, MDs, being a scientific bunch, tend to stress the issue of whether something has been supported by rigorous study. The question of vitamin C’s role in gout, for example, is especially relevant for gout-afflicted people who may be considering “alternative” remedies, says Dr. Fields.
“There was a fair amount written online after a study showed that when normal people (people without gout, that is) were given 500 mg of vitamin C daily, they lowered their uric acid (but only by a little),” he says. “As a result, people were suggesting that perhaps gout patients should take vitamin C. However, a study was recently published where they gave gout patients vitamin C, and in them, the uric acid didn’t drop at all. There were some theories about why this should be true, but whatever the reason, it shows how important it is for something to be studied in a controlled way before people can know which things may actually help their gout.”