This page about a possible gout cause that's little known, was last reviewed or updated on 7 September 2010.
Aside from the major causes of gout - insulin resistance, purines, obesity and kidney disease, plus the specialised (specialized) ones such as some transplant drugs and genetic purine abnormalities, and over ten others – there is another proposed one. It receives little attention. It was discussed by Dr. Robert Atkins (the Atkins diet) in his book Dr.Atkins Vita-Nutrient Solution and I have seen it proposed on at least one doctor's website.
Uric acid is always something we must get down. And eventually, if treatment doesn't work, it does immense damage to the body. If you've got gout, all you want to do it to get rid of as much uric acid as possible and ensure it doesn't return to trouble causing levels.
URIC ACID AS A BAD BOY
For years, most scientists' understanding of uric acid was that it was a harmless, inert, substance that did nothing except when it crystallised (crystallized) and then of course its salt caused one of the most painful maladies. Many medical scientists thought that, apart from its ability to be a gout cause, it was "just there." So once was DNA. And it was called a waste product.
In the past few years the belief that uric acid causes diseases other than gout has gained greater currency, although precise mechanisms remain unidentified. Modern studies have shown that high uric acid predicts high blood pressure and increases the risk of heart attack.
The debate and research about uric acid causing other diseases rumbles on.
BUT URIC ACID IS ALSO GOOD FOR YOU
Just as there's "good" and "bad" cholesterol, there's another property of uric acid, and this one is very useful. It is not "just there" in the blood to be both gout causing and maybe cause other diseases. The paradox is that uric acid is also an antioxidant, a hero of the body, that neutralises (neutralizes) oxidisation (oxidization) of free radicals. If this is not done, free radicals damage cells, increase risks of diseases such as heart disease and cancers, and age us faster.
There is much more uric acid in the blood than well known antioxidants such as vitamin C, vitamin E, and the carotenoids. (1) And selenium. Isn't that a surprise? And it was shown in the same study that it absorbs many types of free radicals.(1)
But never let this blind you to the fact that if you develop gout, your uric acid level must come down.
SO WHAT'S THIS POSSIBLE GOUT CAUSE?
The proposition about this gout cause is that uric acid (UA) levels rise (irrespective of diet and cell degradation) because the body's antioxidant levels are low, and perhaps too many free radicals are floating around causing damage. So UA rises to neutralise (neutralize) the damaging free radicals. If this is so, it might be expected that the uric acid level falls when the body antioxidant levels are higher. And if it's true, it means the body's supply of antioxidants must be kept up.
I don't think this gout cause theory has been proved. It's just an idea, maybe a useful one. Perhaps this is a minor cause of slow rising uric acid over the years. There aren't a huge number of studies that show, for example, what your blood antioxidants level needs to be, and which ones, to halt uric acid rising or make it fall. Nor, how many ORAC units (see below) a day you would need to consume to lower uric acid. But it is known that generally antioxidants are good for health and good for gout diets, since gout attacks cause more free radicals.
Moreover, during gout attacks, when uric acid levels fall whilst free radicals rise, you might expect uric acid to rise and free radicals to fall - if the theory is true. But uric acid doesn’t rise. It only rises again after gout flares are over. Unless of course, the theory does not apply during gout attacks but only applies in the inter-critical (peaceful) period between gout flares.
Vitamin C, which is also an antioxidant, has been shown in many studies to lower uric acid – Dr. Atkins said 5 grams to 8 grams of vitamin C daily is needed, but another study said just 500 mg daily could do it. But vitamin C does this not because of some natural effect of an antioxidant like vitamin C reducing uric acid levels down from trouble causing amounts, but because vitamin C improves uric acid excretion by the kidneys. That's how it lowers the uric acid level. So uric acid is an antioxidant, but whether it rises or falls in response to rises and falls of other body antioxidants is another matter altogether.
And there’s no question that there are many other major gout causes. This isn't, even if it's true, the only one.
Nevertheless this gout cause theory does have three good lessons for us.
The first is because uric acid is an antioxidant, and if it falls to a very low level – say 2.0 mg/dL or below – you need to be eating plenty of antioxidant rich foods. On any good gout diet you would be doing this anyway, but this is an extra reason. More about this in a few seconds. I doubt any doctor would recommend you attempt to raise your uric acid level, but you can ask.
The second is that, if there's some truth in the theory that a shortage of antioxidants is a part cause of slowly rising uric acid, once again you must be eating lots of antioxidants and taking major antioxidant dietary supplements such as vitamin C, vitamin E, selenium and the ones that make glutathione.
And the third is, once you have uric acid (UA) down to a flare-free level, it would only be a good idea to lower it further if attacks resume at what had been the flare-free level. All this means a regular uric acid blood test for the rest of your life.
And you could consider another test. An antioxidant blood test is not a regular event, but you can get it done in many countries if you are so minded. i.e. you find out your blood level of antioxidants, ex uric acid. Ask your doctor, or a nutritionist, for more details or use the search box on our home page. Use the link to our home page at the bottom of this page. Then enter antioxidant blood tests plus the name of your country
STAY ALIVE WITH FIVE
You eat antioxidants naturally in fruit, veg and spices needless to say. The ORAC score is an amount of antioxidants in foods, which come from vitamins, flavonoids and other nutrients. A higher number means more antioxidant activity against oxygen radicals than a lower number. The amounts in spices, are high but really they are low, because we don't spice our food that much. Ginger and garlic might be exceptions – maybe you could eat 100 grams (about 3½ ounces) of both ginger and garlic a day.
You can download, free, a pdf file with the ORAC numbers of many foods - the Oxygen Radical Absorbance Capacity (ORAC) of Selected Foods, Release 2
This is the latest version, courtesy of the U.S. Department of Agriculture. It has 49 more food scores than the former 2007 version.
Generally, fruits score higher than veggies and among the fruits berries have good ORAC scores. The best berries are chokeberries (aka aronia berries), elderberries and black raspberries. These top three are not widely eaten, but following up behind, and still high scoring, are popular berries like strawberries, red raspberries, blueberries, bilberries, blackberries and blackcurrants.
Other good scorers are pears, plums and pomegranates. And among the veggies - artichokes and red cabbage.
Some nuts score very well. The best are almonds, hazelnuts (aka filberts or cobnuts), pecans and English walnuts. You can see all the scores for yourself when you download the ORAC file.
If you read the berries pages I suggest you read the copy on elderberries. It’s hard to eat them because they don’t have much of a taste but they are made into a healthy high antioxidant drink and there are elderberry dietary supplements.
(1) Uric acid provides an antioxidant defense in humans against oxidant-and radical-caused aging and cancer: A hypothesis. Bruce N. Ames, Richard Cathcart, Elizabeth Schwiers and Paul Hochstein. Proceedings of the National Academy of Sciences USA Vol. 78, No. 11, pp. 6858-6862, November 1981.