Back to Back Issues Page
Gout Dugout.Issue #078 |
September 30, 2017

Hello and Welcome to the Summer 2017 edition of the Gout Dugout newsletter. The Gout Dugout is the 15 minutes' read from that gives you useful ideas that may help you with your gout.

Does knowledge of urate crystals help diagnose gout ? I explain how in this issue's first story.

GOUT DUGOUT JUNE 2017 keywords gout crystals (full bar) gout crystals photos full bar, can crystals from gout cause kidney stones (full bar) gout crystals negative birefringence (1/3 bar) pseudogout crystals (full bar) test for gout (look up) urate crystalsand goit (full), gout urate crystals(full) CHECK FOR GOUT MICROSCOPE

word count 1,143

GETTING THE BEST TEST FOR GOUT Although the joint aspiration (aka arthrocentisis) test is the best test for gout, the only real test for gout, it isn’t perfect, and may not work well. There are some snags with this test and you might run into them.

In theory, what happens is that a sample of synovial fluid (the fluid in the joints) is taken from the gout attack site. An examination under an illuminated, polarised, (polarized) microscope ( a microscope using polarising filters somewhat similar to the polarising filter you may have for your camera) reveals whether there are MSU gout crystals or not.

The gout crystals are birefringent, and it is that property that the polarizing filter is able to tie in with that makes them visible. Gout crystals are yellow or blue, depending on the position in relation to the polarizing filter or polarizer. The crystals are not rounded but needle shaped with sharp ends. You won't see them with your naked eye. If correctly identified, they confirm gout.

So what are the snags ?

In the first place your regular PCP/GP won’t have the necessary polarising (polarizing) microscope, nor will every rheumatologist. But your nearest hospital should have one. So to get this test done, you may have to search around, hopefully with your Doctor’s help.

Secondly, the sample of synovial fluid taken out of your joint to be examined under the microscope may not be good enough. That is there may not be enough uric acid crystals which are large enough to be certain of what they are. The operator needs experience to identify crystals correctly.

Thirdly, the person doing the test on you may not be able to get enough synovial fluid – some joints don’t have much – e.g big toe joints, (fingers others ?). A "good thing" about knee gout, is that there's plenty of synovial fluid.

Gout or pseudo gout The operator may have to tell gout crystals from pseudo gout crystals Gout crystals are also birefringent, but CPPD (Calcium Pyrophosphate Deposition Disease)crystals (pseudo gout crystals) are weakly birefringent. That makes the gout ones easier to identify.

And there are other crystals in synovial fluid but they are inconsequential.

Antoni van Leeuwenhoek said 1,000 uric acid crystals would not equal the width of a human hair. By contrast the CPPD crystals of pseuo gout are rhomboid shaped (LINK). Early tanks, the British ones in World War One, were rhomboid shaped. CPPD crystals cannot be seen under a polarising (polarizing) microscope. CHECK. There are other crystals in synovial fluid but they can be ignored. Try CPPD in full on

So is it gout ? If the microscope operator correctly identifies the needle shaped gout crystals, - long (around 1/8 inch ), thin, pointed ends - it's gout, no question. That might save you two years or more trying to decide what you have got.

I don’t know how many readers have actually undergone the joint aspiration/arthrocentesis test for gout.But if anyone has an experience to relate, I would be very pleased to hear from them.


It was only as recent as 1961 that it was finally established for most doctors that the urate crystals deposited in joints were actually the cause of gout pain and inflammation. As far back as 16?? Antoni van Leeuwenhoek in Holland was the first to look at tophi under his revolutionary-at-the-time microscope, and see that it consisted of crystals. The truth that the crystals came from uric acid was learnt in 1851 ? by Sir Alfred Garrod in England using his original threads test.LINK to page.

Antoni van Leeuwenhoek is here on a Rwandan stamp. Perhaps gout has been a huge problem in Rwanda, Africa.

Two hundred years from the 1600's top the 1800's and then another 100 to 1961, progress in gout has taken time.

So what happened in 1961 ? Two gout researchers, Daniel McCarty and ?? Hollander published a study that ??? USE THE PIX I HAVE OF LEEUWENHOEK Yes the Rwanda stamp. And 123rf has a polarizing microscope pix.


Whereas over the years, institutions and others have paid for thousands of gout studies somehow an obvious one that gouty individuals would find very useful has eluded sponsorship and publication – a really detailed purines table which even shows the purines’ breakdown NAMES of all foods and major alcoholic drinks. Purines remain relatively unknown among general publics everywhere. And among chefs, celebrity and otherwise, too.

If you knew the 4 main purines in a food NAMES and know that two of them (NAMES) are thought to create more uric acid than the other two (NAMES), you would be able to refine a low purine diet somewhat further to reduce consumption of those purines that matter.

To some extent you can do this here by studying this purines table, LINK which gives the breakdown for many foods.


Regular readers know that I am encouraged about a new biologic gout drug under development - pegsiticase(SEL 212).This one, if it makes it, goes a step further than an existing biologic for gout for treating patients with advanced gout.

It attempts to deal with many of the adverse effects of a biologic.

Pegsiticase/SEL's developer recently reported on ts Phase 2 trial. (Phase 2 trials are the last ones before the last Phase 3 trials, the ones before possible approval

Use's search box, located towards the bottom of the Home Page, to find site references to any word you enter into it. It is a good way to find out where and what the site has to say about any gout topic. For example, want to know more about Rasburicase for gout? Type Rasburicase in the search box.

There are currently around 260 pages, including all the back issues of this newsletter. It works. Use it!

Next issue - Autumn/Fall 2017, around the end of September.

Thanks for reading and all the best of gout free health.

John Mepham BA (Econ)
Makati City

Why were strawberry study results so inconsistent? All the participants ate the same batch of strawberries, and the same amount, but most failed with uric acid reduction. Those that succeeded must have more responsive biochemistry to the substances in strawberries. What this biochemistry is, is not yet known. It's probably the Vitamin C in strawberries that does it, (or most of it). How? It's thought that Vitamin C boosts the kidney’s performance and therefore uric acid excretion.

To improve your chances of success eating the best is de rigueur. That means ripe and fresh, and a better variety. Consider PYO (pick your own) farms (Britain) or U-Pick (USA). If you can buy your strawberries off a farmer ask what cultivar they are. You could look for Elsanta, Honeyoe, and Alba. Your chances of getting a result if you do this, are greater as they are with for example the best fish oil and the best (black) tea.

More about the other gout beneficial substances in strawberries on our strawberries-for-gout page

We are foods that help gout.Try us and see !


When thinking over eating strawberries for your gout it’s a good idea to remember their folate (folic acid) content. Strawberries are among the richest food sources of folate. They contain 25.5 - 99 mcg. Per 100 grams. (2) And you'd even get a decent amount in strawberry jams, desserts and strawberry flavoured (flavored) yoghurt (yogurt).

There's a belief that folate (folic acid) can lower uric acid too.

Folate or folic acid You will sometimes read the word folate for folic acid. What’s the difference ? There are scores of varieties of folate (too complicated to need to understand for our requirements) but the main difference we need to know is that folate is the form found in foods such as strawberries and juices such as orange, lemon and lime; folic acid is the form in dietary supplements and foods fortified with it.

In many countries folic acid is added to popularly eaten basic foods such as flour, (and products made from it such as bread), cereals, and rice to ensure we get enough. Hence they call themselves fortified. Around 35 mcg goes into 100 grams white bread and up to 26 mcg in 100 grams of whole wheat bread.

But the food form is said to be better. So it would be better to get your folate from strawberries than from a dietary supplement or a fortified food. But the supplements offer the most : 400 mcg - 1000 mcg per tablet/capsule.

It has been shown that 2 weeks' consumption of strawberries raises the blood folate (folic acid) level by an average of 3.4%, but inconsistently.(5) It also found in other amounts in other berries. But strawberries are the best berries for folate, and among strawberry cultivars (types) the highest in folate in one study were Elsanta 1, and Honeyoe. (2)

And it just may be that eating a portion of strawberries a day would give us enough folic acid (folate) – see the folic acid for gout page under the sub heading "folate is protective against gout." Link below. A study in Taiwan found that 134 mcg, and 62 mcg, was protective against gout. That is about 125 -200 grams worth of strawberries daily. But not enough to lower uric acid.

Is this disheartening? Not really If folic acid is to have a lowering effect on uric acid it needs much more than the amount in strawberries. See the website's Folic acid for gout page

About one in five gout sufferers has kidney stones. Get rid of them naturally if you can. Click on the banner ad

Kidney Stone Natural Treatment


Use's search box, located towards the bottom of the Home Page, to find site references to any word you enter into it. It is a good way to find out where and what the site has to say about any gout topic. For example, want to know more about Rasburicase for gout? Type Rasburicase in the search box.

There are currently around 260 pages, including all the back issues of this newsletter. It works. Use it!

Next issue - Summer 2017, end of June.

Thanks for reading and all the best of gout free health.

John Mepham BA (Econ)
Makati City

(1) Impact of strawberries on human health: insight into marginally discussed bioactive compounds for the Mediterranean diet. Tulipani S, Mezzetti B, Battino M. Public Health Nutrition. 2009 Sep;12(9A):1656-62. doi: 10.1017/S1368980009990516.

(2) Possibility of increasing natural folate content in fermented milk products by fermentation and fruit component addition Holasova, M, Fiedlevova V, Roubal P, Pechacova M. Czech Journal of Food Science

(3) Effects of strawberry consumption on plasma antioxidant patterns and parameters of resistance to oxidative stress: preliminary evidence from human subjects S. Tulipani, S. Romandini, M. Battino, S. Bompadre, F. Capocasa, B. Mezzetti. ISHS ACTA Horticulturae 842: VI International Strawberry Symposium

(4) Serum Antioxidant Capacity Is Increased by Consumption of Strawberries, Spinach, Red Wine or Vitamin C in Elderly Women Guohua Cao, Robert M. Russell, Neal Lischner, and Ronald L. Prior Journal of Nutrition 2383–2390, 1998

(5)Abstract Folate content in different strawberry genotypes and folate status in healthy subjects after strawberry consumption. Tulipani S, Romandini S, Alvarez Suarez JM, Capocasa F, Mezzetti B, Busco F, Bamonti F, Novembrino C, Battino M. Biofactors 2008.

If you are not a subscriber to the Gout Dugout, this free gout newsletter, you can sign up at this page - click on the link below.

Back Issues for The Gout Dugout Newsletter

Go to the home page by clicking on this link.

Back to Back Issues Page