Is This The Most Mismanaged Condition In Medicine?

Over the last two decades the number of people living with this painful medical condition has more than doubled from 20 to 42 million worldwide. The pace of increase is described by experts as “astonishing,” with rates rising quickest here in North America.

Conventional doctors are at odds on how to treat it with one rheumatologist describing the situation as one of the “most mismanaged chronic conditions” in medicine. Adding insult to injury, this condition is not taken seriously by some doctors. But if you’ve ever suffered with it, you’ll know this is no laughing matter…

I’m talking about gout.

The 18th century British writer, Lady Mary Wortley Montagu, explained this painful, debilitating condition, saying, “People wish their enemies dead – but I do not; I say give them the gout.” Her comment reflects the excruciating pain that can accompany an acute attack.

The pain is caused by a buildup of uric acid (urate), a waste product created when the body breaks down a type of protein called purine. Purines are produced by the body but are also found in foods. It builds up if the kidneys are unable to expel it properly. Rising levels lead to deposits of needle-like crystals in and around the joints and under the skin causing pain, swelling and discomfort.

Gout Effects Joints and Organs

Gout is considered a form of inflammatory arthritis but the problems it causes go well beyond the joints. Gout also affects the arteries around the heart. After a flare up there’s a higher risk of suffering a heart attack or stroke over the next four months. Gout can also lead to kidney stones and a severe reduction in kidney function.

Even though the condition should be taken seriously, it’s been the target of comedians and cartoonists for centuries. Why is this?

Well, for centuries it was a disease of the wealthy.

Why Only the Rich Suffered Gout

Long ago doctors believed that gout was a self-inflicted condition only available to financially affluent, middle-aged, gluttonous men who had the means to overindulge in red meat, port, and beer. Famous gout sufferers include King George III, Henry VIII and one of America’s founding fathers, Benjamin Franklin.

But today you don’t have to be rich to suffer with gout; even people of modest means can fall victim because food and alcohol are readily available.

Tam Fry, from the UK National Obesity Forum, said in August 2022: “Forget Falstaff, Henry VIII and the rich Victorians who made gout infamous. Today’s Elizabethans are eating and drinking them all under the table.”

Anthony James, professor of neuro-rheumatology at Manchester University, agrees. “Gout is increasing because of bad habits. We drink too much, eat the wrong food, do little exercise and are overweight.”

However, bad dietary and lifestyle habits are only part of the story, as genetic factors are thought to have a large influence on who develops the condition in the first place.

Although the reality is that gout is not difficult to treat, patients are too often let down by conventional medicine.

Rheumatologists vs. General Practitioners

For example, in the United Kingdom Mr. Fry is livid about the way it’s treated, saying, “Gout sufferers are miles from getting the treatment they need, and their appalling care is little better than that delivered in the days of the Dark Ages.”

His concern centers around the rise in obesity and its poor management. Tempers are also frayed on this side of the Atlantic but for different reasons.

James O’Dell, M.D., chief of rheumatology at the University of Nebraska Medical Center, in Omaha, agrees that “gout is horribly mismanaged.” He said it only takes a simple test done in the doctor’s office for a definitive diagnosis to be made and, in the acute phase, a drug prescription to lower uric acid levels.

“If they take that medicine [forever]” he said, “they’re going to be pain-free from their gout for the rest of their life. What can be better than that?” This approach is taken by the American College of Rheumatology (ACR) and EULAR, the experts in rheumatology in Europe, but not by the American College of Physicians (ACP). But neither are entirely right…

The Problem With Drugs For Gout

As usual American doctors prefer to target pain symptoms with pain killers and anti-inflammatory drugs. In fact, doctors in primary care treat gout patients most of the time and are likely to follow the ACP guidelines. But, according to Dr. O’Dell, even if they do use a uric acid-lowering drug, “they never check the uric acid level again. And that is what happens with the majority of patients with gout.” With such an approach repeated flare ups will occur with potentially harmful consequences.

If you’re prone to gout, not on permanent urate lowering therapy, and looking for natural solutions, there are a few things you can try.

Weight Loss is Key

The big increase in gout over the last few decades has paralleled the rise in obesity. That’s why losing weight is essential to stopping future attacks of gout.

In a recent review, researchers at Yale and Harvard wrote: “Weight was consistently identified as a key determinant of serum urate levels [and] weight loss appears to have beneficial effects on preventing incident gout, reducing serum urate, and decreasing flare frequency.”

Then, there are simple natural remedies that you can try…

Natural Remedies For Gout

Remedies for gout attacks date back to the Middle Ages. Some of them were very far out. For instance, one was to salt an owl, bake it until it can be ground into a powder, mix with boar’s fat, and apply it to the affected area.

Fortunately for you and me, natural medicine has come a long, long way.

Vitamin C at 500 mg daily modestly lowers blood uric acid levels and reduces the risk of new gout diagnoses. Other remedies include cherries, tart cherry juice (or extract in supplement form) and the plant flavonoid, quercetin—which is also available in a supplement.

To prevent a flare up people susceptible to gout should restrict purines. These are compounds found at high levels in meats, seafood, meat and yeast extracts, beer, and alcohol.

A combination of smart dietary choices, supplements and common sense can greatly reduce your risk of ever getting gout and ensure that it never comes back again if you do.