Gout; early symptoms

Keywords; gout, early symptoms of arthritis, chiropractic help, what are phytosterols.


What is it and what are gouty tophi?

This is an extremely painful condition, most usually in the great toe, but it can occur in any joint in the body.

The onset is sudden. You wake up in the morning with a slight pain in the lower limb, and by midday you can barely walk. The pain may be in the big toe only, but usually spreads to the whole foot, and even up the leg.

What causes this nasty condition? Uric acid is a quite normal breakdown product of protein metabolism, particularly red meats and sea foods.

In this painful condition there is a missing enzyme that is vital to the break down and normal excretion of uric acid. The result is that urate crystals form in the joints causing them to become red, swollen, shiny and extremely painful; the whole foot becomes hot.

They can also build up in the kidneys causing stones.

Mushrooms have been implicated as a causative factor, as have diuretics.

The vast majority of people with high uric acid remain asymptomatic and never develop pain. Why? We're not sure, but it is mostly to do with the overall wellbeing of the individual. Eat healthily with plenty of fibre from fresh fruit and salad, drinking plenty of water, exercise regularly and you probably won't get gout, even if you are missing the vital enzymme and have high uric acid.

But prolonged and repeated attacks cause gouty tophi.


Essential oils 

Read more about an essential oil from Juniper which can help disperse the uric acid crystals. Essential oil ... especially Juniper.  In general, arthritis is about oils, fatty acids in the body. The juniper contains many organic oils with the unlikely names like pinene, camphor and myrcene. Whilst hard research has not (yet) been done on the effects of these unusual oils on the body, juniper oil has been used for centuries for gout and arthritis, swelling in the lower legs, problems with the prostate gland causing urine retention, and many other ailments.

There is strong scientific evidence however of other essential oils, a deficiency of which definitely causes the early symptoms of arthritis and ultimately the disfigurement and disabality of the arthritic conditions. For example, anti inflammatory omega 3 ...



Odd, only the left foot is affected. With peripheral joints like the toe and elbow the sudden onset of gout is usually easily diagnosed.

However, gout can affect any joint. Over the past two years I have been treating a patient, first with very acute right shoulder pain. Then three months later severe sacroiliac joint pain, then severe pain in the lower back pain radiating to the left hip and thigh. In all instances, the presentation was baffling, both to his medical doctor and myself. It wasn't a frozen shoulder, or rotator cuff syndrome, it wasn't the typical sacroiliac joint syndrome that chiropractors treat on a daily basis.

The severe back and hip pain was more typically a chiropractic problem, but there too on reflection, neither was it straight forward.

Now suddenly, the typical presentation: severe pain in the great toe. Underlying all these episodes that lasted only a few days, but in each cause very severe, atypical joint pain, was gout. A build up of uric acid crystals in the joints.

Why this joint, then that, what sometimes right, sometimes left? No one knows.


What provoked these attacks?

Now this is interesting. Being a doctor is fun, like being a detective, looking for unusual patterns, and the unexpected.

This patient was a fairly heavy beer drinker. Two quarts a night, which probably makes him an alcoholic. But to prove to himself, and his family, that he was the master, not the servant, of alcohol, he would periodically give up all booze for a week or two.

Bingo, giving up beer, coincided with cutting back on two quarts of fluid in his diet. Giving up what was probably the very cause of his gout, alcohol, simultaneously caused severe attacks of pain.


A United States explosion

No one is quite sure why but, whilst hospitalisations in the USA in the last 20 years have increased by 11%, hospitalisations due to the Big G have mushroomed by nearly 400%. That's nuclear! Avoid mushrooms if you suffer from the Big G! Otherwise eat masses of them!

Common sense can be totally misleading, but it's not unrealistic to assume that it's related to the 'crap' fast food diet that Americans 'enjoy'. Getting back to eating a genuine salad (not a leaf of lettuce and a quarter of tomato) several days a week, plenty of fruit and raw food in general, back to nature is surely what it's about.

When did you last eat a bowl of legumes? A beetroot? Cold water fish? A bowl of olives? Bean sprouts? Take a look at our Healthy Living Page ...

Chiropractic Help

It's a very treatable disease but it is doubtful that straight chiropractic has any role to play. In the acute phase it is best treated with NSAIDs and medication to reduce uric acid. As with all inflammatory conditions, icing with an ice cube is the topical treatment of choice. Once the acute phase is over it is best to reduce protein rich foods, especially red meat, which is beneficial anyway. Mushrooms should be avoided. According to Wiki the red wine story is a myth, but beer has a profoundly detrimental effect. Shame!

More salad and, as with all the inflammatory arthritides, fasting may be of value.

Like all diseases, if neglected, it can produce gross changes in the body particularly, in this instance, in the joints.

Of concern is that treatment with a bisphosphonate drug may cause osteonecrosis (bone death) in some joints.

There is much that can be done in the way of natural arthritis relief for the Big G. But you will have to do your homework for good solid dietary suggestions that MAY enable you phase out, or at least minimise your drug intake.

Early signs ...

Most people get early warning signs, and you will have to learn to recognise yours. You are likely to get warnings like this:

  1. You wake in the morning thinking you must have stubbed your toe or sprained your ankle in the night.Within a few hours the foot starts to throb.
  2. A dry mouth.
  3. You'll have your own... write them down.

DO NOT DELAY


First attack

Your first attack will probably pass within a few days. Drink plenty of water, cut out all beer, mushrooms and red meat, and take a few over the counter anti inflammatory drugs, recognising the dangers if you take them for any length time. Max three days.

Exercising the foot to help remove the oedema will be extremely painful. But... if you stand in a cold swimming pool, within a few minutes, you'll be able to move the toes and exercise the foot and ankle too. It's probably not visible on this photograph, but the redness and swelling is progressing up the lower leg. (That's an artifact over the second toe, a bug floating on the water.)



And, if you start to get repeated attacks...


Gout attack kit

A G-attack seems to have a very sharp curve whereby the longer you wait to intervene, the more the related pain/discomfort and therefore the longer it will take to heal. Hit it early!

  1. Drink lots of water
  2. Take one Colchicine 0.5mg tablet
  3. Drink lots of water
  4. Step 2: Take 2 Goutex tablets (from NaturesOwnBrands ...)
  5. Drink lots of water
  6. Mix and then drink a heaped teaspoon of Base Alkalising Salts (from NaturesOwnBrands ...) in a glass of water (repeat the Goutex and Alkalising salts in the evening)
  7. Drink lots of water
  8. Cut out all red meat and alcohol for at least two weeks. Eat plenty of salads and get your protein from vegetable sources like our Authentic Hummus recipe and
  9. Put your feet up above your head
  10. Drink lots of water
  11. Add anti inflammatory foods to your diet. Every day have at least a small amount of fatty fish, freshly ground flaxseed, olive oil and anti inflammatory chili.
  12. Make up a vegetable broth soup with whatever vegetables are available; onion, potato, sweet potato, butternut, broccoli and cauliflower, for example.

Take the colchicine for at least 3 to 4 days, and continue the goutex and alkalising salts once a day for at least a week.


If you delay then there's only trouble coming.

In severe cases, or when you have waited too long, an anti inflammatory works wonders to decrease the severity of the pain. If desperate you might also like to use allopurinol or its generic puricos for a few days to help to inhibit uric acid production, but only in patients who have repeated attacks.


Phytosterols and omega 3 are a part of the solution.

Gout is one of the many forms of arthritis so increasing plant foods that contain phytogens and omega 3 makes sense. A tablespoon of freshly ground flax seed sprinkled daily on your cereal contains both large amounts of both lignans and alpha linolenic acid, one of the omega 3 fatty acids.

And what are phytosterols you may well ask.


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Interesting challenges of the day

1. Mrs D, a 78 year old woman has very severe sacroiliac joint pain, and even more severe cramps in her right leg. There are two problems; she is on two diuretics but no slow K. Taking her temporarily off one diuretic and adjusting the SIJ brought 50 percent relief within four days. 

2. Mr S, a 48 year old man, has right low back pain, groin pain and a numb feeling in his lower leg when he sports. For six months he's been off football. He too has two problems; a very treatable lumbar facet syndrome and a very serious blocked artery in the groin; it's called intermittent claudication. Smokers beware.  

3. Mr S looks like the leaning tower of Pisa; he has a slipped disc at L5 making him lean towards the opposite side. It's called the postero lateral disc hernia; we'll fix it, but he has to stop for a week or two. Antalgias are serious so take them seriously. 

4. Mrs V too has  two conditions; a chronic low grade sciatica giving her an ache in the right leg, and a threatening Morton's neuroma. She's glad I'm back in Holland; chiropractic fixed it before, and we'll fix it again. 

5. Mrs W is one of the lucky ones, says her doctor. I agree. He says only 40% of patients with lumbar stenosis have a successful operation. We fixed a nasty slipped disc three years ago, but it came back two years later; the surgeon did a fine job but she has a weak ankle now giving her subtalar joint pain; it's routine stuff. 

6. I myself had an acute exacerbation of a femoral nerve lesion last year. One immediate treatment of the new strain by my colleague has fixed the pain in the lower back, but there's some residual numbness in the lower leg; no soaring tomorrow alas.

7. This lady is a 86 year old woman with a 63 scoliosis. Chronic lower back has been her lot in life but she's well pleased with chiropractic and comes for chiropractic help once a month; some conditions you can never cure.

8. She is an 78 year old woman, is doing remarkably well with a bad sciatica. But over 200 pounds she is not losing weight; in fact, gaining despite my suggestions. She's high risk for a stroke. I have referred her to a dietician to crack the whip.

9. A 61 year old man with upper cervical pain yesterday; it's not severe but also not getting better of its own accord. He's afraid it may turn very acute as when I treated him three years ago. Since then it's been fine. 

10. A 64 year old woman has had scheuermanns disease; it's left her with a spinal kyphosis and chronic middorsal pain. She responds well to chiropractic treatment provides she come every six weeks or so for maintenance treatment.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mrs D, a middle aged woman with hip pain of one year duration, despite other treatment. Xrays reveal an impingement syndrome and early hip arthritis. There's much to be done.

13. Mrs B has had one of the nastiest of conditions; vertigo caused by a disturbance in the inner ear. Falling repeatedly and vomiting she consulted her doctor but medication didn't help. After two sessions of the Epley manoeuvres she was 50 percent better. After two weeks 75 percent improved. No longer vomiting all falling. She's not enjoying the Brandt Daroff home exercises.

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



Have a problem that's not getting better? Looking for a different slant on your pain? Want to pose a question?


Interesting questions from visitors

CLS writes:

Greetings, Dr B.
You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.

Your own unresolved problem. Pose a question

Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.


You visited this chiropractic help site no doubt because you have a problem that is not resolving and want to know more about what chiropractors do.

The quickest and most interesting way is to read one of my ebooks of anecdotes. Described by a reader as gems, both funny and healthful, from the life and work of a chiropractor, you'll love them. Priced right at $2.99, though Kindle fiddles the price without telling me.