General Wellness

Routed by Gout

By NATURA Magazine.

Imagine being afflicted by a pain so sharp that it jolts you awake in the middle of the night. The affected area is so sensitive that the pain can be aggravated by even the lightest tickling of a feather! The feeling is so unbearable that the sufferer is unable to put pressure on the limb, so walking or even standing takes a lot of effort. This is the lot of a typical person suffering from gout.

What is Gout?

According to naturopath Ketki Vinayachandra of Natural Medicine at Raffles Place, gout is a kind of arthritis that occurs whenuric acid builds up in blood and causes joint inflammation. “Acute gout is a painful condition that typically affects one joint, while chronic gout refers to repeated episodes of pain and inflammation, which may involve more than one joint,” she explains. “If too much uric acid builds up, uric acid crystals can form and deposit on a joint, causing it swell up and become inflamed, thus causing pain.” The most common joint for this is in the big toe, but gout can occur in any joint in the body, particularly the smaller ones such as those in fingers and toes. These affected joints display obvious swelling and redness, and usually feel warm to the touch.

Traditional Chinese Medicine (TCM) has a different interpretation of this ailment. According to Chew Siew Tiang, a physician at Eu Yan Sang TCM Clinic, gout is a form of rheumatism, and is considered a bi-syndrome(痹症), caused by both internal and external factors, mainly wind(风), dampness(湿), heat(热) and cold(寒). “These four are pathogens(邪气); when they mix, they will affect the flow of qi and blood in the meridians of the body. When the flow is disrupted, it causes pain, and in this case, we call it ‘gout.’”

Both views agree, however, that gout is generally more common in men, post-menopausal women, and those who consume alcohol.

Physician Chew estimates that the ratio of male to female (excluding post-menopausal ones) gout patients is around 20:1. “Gout is common in men in their 40s or 50s, when their ability to metabolise purine starts to deteriorate. For women before menopause, the oestrogen produced in the body helps prevent this ailment.” Ketki adds that people who take certain medicines may have higher levels of uric acid in the blood. People who are obese or have diabetes, kidney diseases and certain other conditions may have a higher risk of contracting gout as well.

Treatment via Naturopathy

The naturopathic approach to gout is a holistic one. It looks at the patient’s lifestyle, diet and any existing medical conditions before developing a customised programme to address the disease.

Ketki, who is also a nutritionist, herbalist and iridologist, recommends dietary and lifestyle changes, as well as specific herbs (such as devil’s claw) and supplements to manage the symptoms and treat the condition. “Herbs and supplements are given in certain doses, so they should be taken under supervision only,” she advises. “This approach is natural and there is no side effect as opposed to taking drugs or painkillers, which are short-term, temporary solutions.” As she stresses, “The patient must be willing to change his diet and lifestyle.”

Treatment via TCM

Physician Chew points out that gout may be caused by different combinations of the four pathogens, and it is important to diagnose which ones are present before recommending a treatment. “The most common combination is wind-dampnessheat, which causes acute gout,” she reveals. “We will prescribe herbs such as plantago seed(车前子), fish poison yam(萆薢), achyranthes root(牛膝) or lycopodii(伸筋草). We also recommend that they consume winter melons, cucumbers, barley and green beans, foods that disperse heat and dampness in our bodies.” She adds that acupuncture may be applied—but only when there is no flare-up, of course—to condition the body. Left untreated, gout can develop into a more serious problem known as ‘chronic gout,’ which may affect the kidneys and cause kidney failure.

While TCM may take longer to effect an obvious change, the results are usually better and last longer. Physician Chew also reminds those with gout to always remember to keep themselves warm, and dry their hands and feet after washing to prevent wind and dampness from seeping into the body. “Singapore is a country high in humidity, which is why gout is a common problem here.”

Prevention Through Diet 

Avoiding the following foods seems to reduce the risk of gout attacks:

  • Alcohol
  • Food high in saturated fats, such as ice cream and fried foods
  • Purine-rich foods such as organs (liver, kidney, sweetbreads), certain seafood (anchovies)
  • Legumes such as beans, especially soya bean
  • Mushrooms, spinach, asparagus, cauliflower

Patients should also exercise frequently,” advises Physician Chew, explaining that obesity, high blood pressure and high cholesterol make one more susceptible to gout. Ketki’s dietary tip is to “maintain sufficient fluid intake,” as this keeps urine dilute, promotes urate excretion, and reduces risk of kidney stones.

Case Study

Physician Chew recalls a stubborn middle-aged patient who at first refused to give up purine-rich foods.

In his 50s, this man first experienced gout when he was woken by a sharp pain in his toe. “Gout often acts up at night because the flow of our qi and blood are slower when we are sleeping,” Physician Chew explains. Displaying classic gout symptoms, the affected toe was red, swollen, and hurt even more when only lightly touched. The man applied ice packs throughout the night to relieve the pain before seeing Physician Chew the next day.

The gout was caused by wind, dampness and heat,” Physician Chew recalls, “and he had to take relevant herbs and foods to relieve the pain and control his condition.” However, shortly after, the patient had to consult Physician Chew again after he indulged in purine-rich foods that he was supposed to cut down on. “After the second time, he obediently followed my advice and has not returned.

It is difficult to cure gout, but it can be very manageable using TCM to relieve the symptoms and reduce the rate of occurrence. However, the patient will need to control what he eats in order to control the condition,” clarifies Physician Chew.>

Photo courtesy of Thinkstock. This article first appeared in NATURA magazine issue No.3. Find NATURA at Eu Yan Sang retail outlets, newsstands and major bookstores in Singapore.