Keeping Gout At Bay

When an agonising pain in his big toe roused Stephen* from sleep in the middle of the night, he was more baffled than worried. But when the pain – and swelling accompanying it – failed to subside after a month, getting in the way of walking and standing, the 31-year-old knew he needed help.

While he had experienced some pain previously, which he treated with anti-inflammatories and painkillers, this was much worse.

The swelling in his right metatarsophalangeal joint – which connects the foot to the big toe – turned out to be a classic sign of gout, especially since the pain was exacerbated by a meal of seafood or meat. Both contain high levels of purine, which breaks down to form uric acid, explains Eu Yan Sang Physician Yu JieXin. Gout, a severe form of arthritis, sets in when there is a build-up of uric acid in the body.

The disease usually attacks one joint at a time, although more than one joint can be affected when it becomes chronic. Besides the big toe, it can also affect the instep, ankle, heel, knees, wrists, fingers and elbows, which become red, swollen and feel warm to the touch. Tophi, or uric acid deposits, look like lumps on the skin.

Incidence of gout is rising in both the US and the UK, even if many patients go untreated, but it has only been in the last decade that there has been significant interest in the disease.

Disease of not only Kings
Historically, gout has been referred to as the “Disease of Kings” – it afflicted a number of monarchs, including Henry VIII, and was linked to a lifestyle of excess, due to its association with rich food and alcohol consumption. While such excesses are contributing factors, Traditional Chinese Medicine (TCM) practitioners view gout as a result of a range of internal and external factors, including pathogens such as wind (风), cold (寒), dampness (湿) and heat (热), says Physician Yu. A combination of these pathogens can affect the flow of qi and blood in the meridians of the body, causing pain and other classic symptoms of the disease.

The first step for a TCM practitioner is to determine which pathogen – or combination of pathogens – is at the root of a patient’s problem, she says.
In the case of Stephen, who also suffered from a cough, sticky stools, lethargy, sluggish joint movements and a feeling of heaviness in the limbs, the diagnosis was dampness and heat, or damp-heat syndrome.

His TCM physician prescribed two weeks of herbal medication aimed at dispersing heat, clearing the obstructed meridiens for better circulation of qi and blood, expelling wind, and eliminating dampness. Within a week, Stephen began to experience some relief from the pain and other symptoms.
While prescriptions are tailored to the specific condition, constitution and lifestyle of individual patients, commonly prescribed herbs include plantago seed (车前子), fish poison yam (萆薢), achyranthes root (牛膝) and lycopodii (伸筋草). A TCM physician may also recommend a diet that includes winter melons, cucumbers, barley and green beans, all foods believed to disperse heat and dampness in the body.

Some physicians may recommend acupuncture as a longer-term approach to gout, provided there isn’t an ongoing flare up, when acupuncture may cause discomfort, says Physician Yu.

Patients may also be advised to keep warm, and dry their hands and feet after washing to prevent wind and dampness from seeping into the body. High humidity is believed to trigger flare ups. A 2014 study of 632 US-based subjects published in the American Journal of Epidemiology found that high ambient temperatures and extremes of humidity were associated with an increased risk of a gout attack.
In the case of Noel*, a 40-year-old whose gout had advanced to the toes of both feet as well as his knees before he sought help, keeping warm and avoiding strenuous exercise was part of his treatment, which also included herbal medication and dietary changes.

Living with gout
Both Western medicine and TCM agree that gout is generally more common in men, post-menopausal women, and those who consume alcohol.
Some TCM physicians put the male to female ratio as high as 20:1, citing the reduced ability of middle-aged men to metabolise purine. Pre-menopausal women have high levels of oestrogen, which helps the kidneys process and excrete uric acid more effectively, reducing the risk of gout, explains Physician Yu.

Certain types of medication, such as diuretics (pills that promote the expelling of water and salt as urine), immuno-suppressants, and aspirin can also increase the risk of uric acid accumulating in the body. Those who are obese or have conditions like diabetes or kidney disease are also more prone.

But it is possible to prevent flare ups – and important to do so. Left unabated, gout can become chronic, affecting the function of the kidneys.
While painkillers help, they are short-term solutions, says Physician Yu. She advises a combination of herbal treatments and moderating the consumption of food and drinks high in purine, including seafood and meat (see box).

She also recommends a balanced lifestyle that includes frequent exercise since obesity, high blood pressure and high cholesterol levels make a person more susceptible to gout. Drinking enough fluids, meanwhile, helps dilute urine, promote the excretion of urate, and reduce the risk of kidney stones.

“While gout is difficult to cure, it can be managed, including with TCM. But the patient has to play his part to keep the condition under control.”

Gout prevention: Watch what you eat
Both Eastern and Western medicine recognise that certain types of food and drink can increase the risk of gout. Foods to avoid or consume in moderation include:
1.    Alcohol
2.    Food high in saturated fats, such as ice cream and fried foods
3.    Purine-rich foods such as organ meat (liver, kidney, sweetbreads) and some types of seafood, like tuna, mackerel, scallops, mussels, squid, sardines and anchovies
4.    Legumes, especially soya beans
5.    Mushrooms, spinach, asparagus and cauliflower