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Gout Dugout.Issue #084 |joint aspiration explained | Epsom salts for gout | vitamin C got gout
December 30, 2018

Hello and Welcome to the Winter (December) 2018 edition of the Gout Dugout newsletter.

I begin this issue with an article about Epsom Salts for gout. Further on are videos of gout's joint aspiration diagnosis, also called arthrocentesis, and some interesting information about Vitamin C and uric acid.


Epsom is a former spa town in southern England, south of the greater London conurbation. It is known internationally for two reasons.

One is the famous Epsom Derby horse race which began in 1780. The other is Epsom Salts which were discovered on Epsom Common (open public ground) in 1618, by a cows' herdsman. His cows refused to drink the water in a pool fed by an underground spring, and it was found the reason was the water contained a salt. i.e magnesium sulphate. A few years later it was discovered the magnesium sulphate was a laxative (relaxing agent).

Samuel Pepys wrote in his diary (1667), “We got to Epsom by 8 a-clock to the Well, where (there was) much company; and there we light (alighted) and I drank the water.”

The horse race has survived and is held every June, on Epsom Downs above the town, but the salts did not. Seems they were too popular. They ran out about 1740 and Epsom was no longer a spa town, but the name stuck.

Epsom salts

So how do you use Epsom Salts ?

Although Epsom Salts look somewhat like table salt (sodium chloride) they are actually magnesium sulphate.

When added to warm water they relax the body and muscles, soften skin and can relieve some pain, swelling and stiff muscles. To relax with them the favourite (favorite) way is to soak in an Epsom Salts warm water bath, made with a couple of full cups of Epsom Salts. The magnesium sulphate enters your body though the pores in your skin.

Or gout sufferers with foot, big toe, other toes or ankle gout can do a foot soak. Soak your feet for as long as you feel you're getting some benefit. About half an hour – add more warm water if you want with more Epsom Salts. For a foot soak use half a cup of Epsom Salts. Heat the water to be warm enough to be comfortable but last as long as possible. It does not have to be unbearably hot.

Don't expect too much. They are a moderate pain reliever. They will not stave off a gout attack, neither will they eliminate pain, nor will they cure gout because they do not lower uric acid.

But they should ameliorate some pain and swelling as they often do for people with arthritis pain. For gout sufferers they are worth a try during a gout attack.

Epsom Salts are not expensive. Find them in pharmacies, health food shops and some supermarkets. Or check the packaging information of any bath salts you already have – they may be mainly Epsom Salts.


Having a joint aspiration done is very, very important in gout treatment. Everyone with gout should know about it, but it is surprising that many do not.

If you go for a joint aspiration (also called arthrocentesis), and people who suspect they have gout definitely should, what you see in the videos below is more or less what to expect.

The significance of these videos is that here we are shown the way to the correct diagnosis of one of the world's most strongly growing human body disorders - Madam Gout. Joint aspiration is the best way to diagnose it. Its importance is that gout is often not correctly diagnosed for a long time, sometimes never. But do this and it's very likely you will get a correct diagnosis.
So what happens ?

A syringe's needle is inserted into the affected joint to remove its synovial fluid. Next, the fluid is examined under a microscope which has a special polarising (polarizing) filter to be able to view the MSU gout crystals.

If they are seen, gout is confirmed.

Of course it is not quite as simple as that. The microscope operator must be able to spot MSU gout crystals by observation. This includes understanding of the difference between gout crystals and pseudo gout crystals. That takes some experience.

More about the difference between gout and pseudo gout crystals on this page.

Gout and pseudo gout

Some joints contain more synovial fluid than others - there simply may not be enough there for examination. And the Doctor's syringe needle must find the correct joint which, given the inflammation, may not be easy

If you feel queasy watching needles enter the body you may not want to watch these.

Big toe joint aspiration video

Elbow joint aspiration video

Click on this advert, underneath, if you want more information about the Kidney Stones Removal report - kidney stones are related to gout

Kidney Stone Natural Treatment

VITAMIN C SCORES AGAIN After baking soda, (bicarbonate of soda) Vitamin C is probably the best natural remedy for gout. There are more studies about it, and with better results, than for cherries, celery, apple cider vinegar or the other foods, drinks and nutrients thought to be good for gout.

Although there have been gout related studies where Vitamin C has not lowered uric acid or behaved in a positive for gout way, a meta-analysis study (that's a study of studies) has shown that on the whole Vitamin C does lower uric acid or the risk of gout.

Another study-analysis of various foods and nutrients found that Vitamin C did lower uric acid. (1) The information we are interested in here was taken from a large seven years study about various foods and uric acid levels conducted in the U.K.

The amount of daily Vitamin C was calculated from the dietary and supplement intake of 2,076 healthy men and women. i.e. from the amount of Vitamin C in their daily consumption of foods, drinks and supplements.

Results for Vitamin C The higher participants’ daily intake of Vitamin C, the lower was their uric acid level. And vice versa. Their Vitamin C intake was not especially high. The most was 177.9 mg from food and supplements (if supplements were taken).

(a) (b) and (c) represent different amounts of Vitamin C taken (1st line) and blood uric acid levels (2nd line)

For daily intake, three numbers were published –

(a) 177.9 mg (b) 151.4 mg (c) 143.8 mg.

The corresponding blood uric acid level was -

(a) 212.3 mmol/dL (b) 279.3 mmol/dL (c) 359.5 mmol/dL

One amount of Vitamin C recommended for uric acid reduction is 500 mg daily of Vitamin C, which is probably best taken three or four times a day i.e. about 125 mg each time.

1,000 mg (1 gram) is likely to be more effective, but that hasn't been proved. So if the most they had taken was at least 500 mg daily over 7 years, their uric acid levels may well have been lower.

The problem with the amounts was that a small 5% decrease - (b) to (c) - of Vitamin C intake led to a much greater increase in uric acid (almost 29%). Sounds too much.

Factors which could have affected participants uric acid levels, irrespective of diet and supplements, and not factored in, were their lifestyles, especially exercise; participants own internal production of uric acid, and their use of diuretic medications which can affect uric acid.

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Next issue - Spring 2019, end March.

Thanks for reading and wishing you a happy New Year. and gout free 2019.

John Mepham BA (Econ)
Makati City


(1) Zgaga L et al The association of dietary intake of purine-rich vegetables , sugar-sweetened beverages and dairy with plasma urate, in a cross-sectional study. PLoS One. 2012;7(6):e38123. doi: 10.1371/journal.pone.0038123. Epub 2012 Jun 6.

I am pictured here with my Filipina wife who helps me with my gout researches for this website. In 2006 it was her belief that she had gout that began my enquiries into "the disease of kings." However, as it turned out, she happily did not !

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