स्वप्नदोष, व धातुदोष, को दूर करने के लिए होम्योपैथी, इलाज, औषधियों से उपचार :-

GOUT

Gout is an arthritic condition (inflammation of the joints) that mostly affects men age 40 and older. It is nearly always associated with chronic hyperuricemia, a long-lasting abnormally high concentration of uric acid in the blood.

Metabolism of Purines. The process leading to hyperuricemia and gout begins with the metabolism of purines, which are nitrogen-containing compounds that are important for energy. Purines can be divided into two types:

• Endogenous. Endogenous purines are manufactured within human cells.
• Exogenous. Exogenous purines are obtained from foods.

All mammals except humans possess an enzyme called uricase that breaks purines down into a very soluble product called allantoin. Without uricase, purine ultimately breaks down into uric acid , which can build up in body tissues if it is not adequately eliminated in urine.

Uric Acid and Hyperuricemia. Uric acid is produced in the liver and enters the bloodstream. The path leading to high concentrations of uric acid and gout is the following:

• Most uric acid eventually passes through the kidneys and is excreted in the urine. The rest is disposed of in the intestines, where it is processed and broken down by bacteria.
• Normally these processes keep the concentration of uric acid in the blood plasma at a healthy level, which is below 6.8 milligrams per deciliter (6.8 mg/dL).
• Under certain circumstances, however, the body produces too much uric acid or excretes too little. In either case, concentrations of uric acid increase in the blood. This condition is known as hyperuricemia.
• If concentrations of uric acid reach 7 mg/dL and above, the blood becomes supersaturated and needlelike crystals of a salt called monosodium urate (MSU) form.
• In time, as MSU crystals accumulate, they cause inflammation and pain, characteristic symptoms of gout.

Gout and Other Conditions Associated with Hyperuricemia

High levels of uric acid are associated not only with gout but also with a number of other conditions.

They can occur independently but may also develop one after the other if gout is untreated.

Acute Gouty Arthritis. Acute gouty arthritis is the stage at which the first symptoms of gout appear. It most often occurs in men.

Chronic Tophaceous Gout and Tophi. After several years, persistent gout develops called chronic tophaceous gout. This long-term condition often produces tophi, which are solid deposits of MSU crystals that form in the joints, cartilage, bones, and elsewhere in the body. In some cases, tophi break through the skin and appear as white or yellowish-white, chalky nodules that have been described as looking like crab eyes.

Without treatment, tophi develop on average about 10 years after the onset of the disease, although their first appearance can range from three to 42 years. They are more apt to appear early in the course of the disease in older people. In the elderly population, women appear to be at higher risk for tophi than men.

Today, drug therapy has reduced the prevalence of chronic tophaceous gout to as little as 3% of patients. Certain groups, such as transplant patients receiving cyclosporine, however, still face a high risk of developing tophi.

Uric Acid Nephrolithiasis (Kidney Stones). Uric acid nephrolithiasis occurs when kidney stones form from uric acid. In one study, however, patients with these stones were more likely to have elevated levels of uric acid in their blood than in their urine, suggesting that gout is responsible for these stones. Uric acid and other kidney stones are present in 10% to 25% of patients with primary gout, a prevalence more than 1,000 times that of the general population. In gout caused by other conditions (called secondary gout), the reported incidence reaches 42%.

It should be noted that uric acid stones can also form in the absence of gout or hyperuricemia. Also, not all of the kidney stones in patients with gout are composed of uric acid; some are composed of calcium oxalate, calcium phosphate, or those substances combined with uric acid.

Chronic Uric Acid Interstitial Nephropathy. Chronic uric acid interstitial nephropathy occurs when crystals slowly form in the structures and tubes that carry fluid from the kidney. It is reversible and not likely to injure the kidneys.

Kidney Failure. Sudden overproduction of uric acid can occasionally block the kidneys and cause them to fail. This occurrence is very uncommon but can occur with the following conditions:

• After chemotherapy for leukemia or lymphoma.
• After severe heat stress from vigorous exercise.
• Following epileptic seizures.

After corticosteroid therapy for severe allergic reactions.

Prevalence

Gout is one of the most common types of arthritis. Based on self-reports, gout is estimated to affect about 2.1 million Americans (1.56 million men and 550,000 women).

Some experts believe, however, that this may be an overestimate. The prevalence of gout has been rising in recent decades, not only in America but in other developed countries, possibly because of dietary and lifestyle changes, greater use of medications that cause hyperuricemia, and aging populations.

Gout is very uncommon in less-developed countries, however, and in 1952 it was said to be unknown in China, Japan, and the tropics.

Age

Middle-Aged Adults. Gout usually first occurs in middle-aged men, and peaks in mid-40s. It is most often associated in this age group with obesity, high blood pressure, unhealthy cholesterol levels, and heavy alcohol use.

Elderly. Gout can also first develop in older people, when it occurs equally in men and women. In this group, gout is most often associated with kidney problems and the use of diuretics. It is less often associated with alcohol use.

Children. Among children, the levels of uric acid in both girls and boys are low, on average 3 to 4 mg/dL. Except for rare inherited genetic disorders that cause hyperuricemia, gout in children is almost unheard of.

Gender

Men. Men are significantly at higher risk for gout. In males, uric acid levels rise substantially at puberty, with the result that the level exceeds 7 mg/dL (considered to indicate hyperuricemia) in about 5% to 8% of American men. Gout typically strikes only after 20 to 40 years of persistent hyperuricemia, however, so men who develop it usually experience their first attack between the ages of 30 and 50 years. In one study that followed male medical students for 28 years, the prevalence of gout was 5.8% in Caucasian men and 10.9% in African American men.

Women. Before menopause, women have a significantly lower risk for gout than men, possibly because of the actions of estrogen. This female hormone appears to facilitate uric acid excretion by the kidneys. (Only about 15% of female gout cases occur before menopause.) After menopause the risk increases in women so that after age 60 the incidence is equal in men and women, and after 80, gout occurs actually more often in women.

Family History

A fairly substantial proportion of patients with gout (10% to 20%) has a family history of gout. According to a 2001 Taiwan study, patients with possible inherited conditions were more likely to have an earlier onset (about 41 years) compared to those whose gout is due to other factors (48 years). They were also more likely to have family histories of obesity, type 2 diabetes, and kidney insufficiencies.

Other Risk Factors

Obesity. Researchers report a clear link between body weight and uric acid levels. In one Japanese study, overweight people had between two and over three times the incidence of hyperuricemia as those of normal or low weights. Obesity may be an especially important risk factor for gout in men. Children who are obese may have a higher risk for gout in adulthood.

Hypertension and Diuretics. The use of diuretics, which are agents used to treat high blood pressure, are highly associated with gout. Hypertension  itself, is found in 25% to 50% of patients with gout, but whether it causes hyperuricemia is uncertain.

Alcohol Use. Alcohol use is highly associated with gout in younger adults. Binge drinking particularly increases uric acid levels. It appears to play less of role among elderly patients, especially among women with gout.

Thyroid Dysfunction. Some studies have reported a higher prevalence of gout in people with hypothyroidism . There is also some evidence to suggest that hyperthyroidism can increase uric acid levels, although not to the degree that low thyroid hormones levels do.

CAUSES GOUT:-

Gout is classified as either primary (the most common type) or secondary, depending on the cause of the associated hyperuricemia .

In both types of gout, between 70% and 95% of hyperuricemia cases are the result of under-excretion of uric acid, rather than uric acid over-production.

Many people develop hyperuricemia, however, but not all people with the condition develop gout.

Researchers are unable to determine the reason for this, or why gout develops in certain joints but not in others.

Primary Gout

More than 99% of primary gout cases are referred to as idiopathic, meaning that the cause of the hyperuricemia cannot be determined.

They are most likely due to a combination of hormonal and genetic factors that cause metabolic abnormalities resulting in overproduction of uric acid or reduced excretion of uric acid.

The remaining 1% of primary gout cases are traceable to either of two rare inherited enzyme defects that affect purine synthesis in the cells.

Secondary Gout

In secondary gout, hyperuricemia is caused by drug therapy or by medical conditions other than an inborn metabolic disorder that increase uric acid concentration.

Alcohol Use. Alcohol use is a major contributor to gout and increases uric acid levels in three ways:

• By providing an additional dietary source of purines (the compounds from which uric acid is formed).
• By intensifying the body's production of uric acid.
• By interfering with the kidneys' ability to excrete uric acid.

Renal (Kidney) Insufficiency and Its Causes. Hyperuricemia occurs in between 30% and 85% of people who have renal insufficiency. Renal insufficiency is a major cause of gout in older people. This results in an impaired ability of the kidneys to eliminate waste products, including uric acid, which then build up in the blood. This condition, in turn, can be the result of the following:

• Thiazide diuretics (the "water pills" used to control hypertension). These agents are very highly associated with gout. In fact, 75% of elderly-onset gout patients report the use of diuretics.
• Organ transplantation . Kidney transplantation poses a high risk for renal insufficiency and gout. In addition, other transplantation procedures, such as heart and liver, increase the risk. The procedure itself poses a risk. In addition, cyclosporine an immunosuppressive agents used after these procedures to help prevent rejection of the implant, poses a particular risk for gout. (Alternative agents may be effective and pose less of a risk.)

 RISK FACTORS FOR GOUT:-

Risk factors are attributes or activities associated with a greater-than-normal likelihood of developing a particular disorder. Sometimes a causal connection between the attribute or activity and the disorder can be established, but at other times there is simply a statistical correlation. The risk factors for gout, of which there are several, are identical to those for hyperuricemia.

SYMPTOMS OF GOUT:-

Gout is often divided into four symptomatic stages:

• Asymptomatic hyperuricemia.
• Acute gouty arthritis.
• Intercritical gout.
• Chronic tophaceous gout.

These stages may differ depending on the age of onset:

• In middle-aged adults, symptoms are more likely to occur in one joint, most often in the lower limbs. About 60% of cases in this age group first occur in the big toe.
• In elderly people, symptoms are more likely to occur in a number of joints in the upper extremities, particularly the fingers.

Asymptomatic Hyperuricemia

Asymptomatic hyperuricemia, in which MSU slowly builds up, always precedes gout and is considered the first stage of the disorder. It lasts for an average of 30 years.

Note: Hyperuricemia does not inevitably lead to gout. In fact, less than 20% of the hyperuricemic population develops the full-blown arthritic disease.

Acute Gouty Arthritis

Acute gouty arthritis occurs when the first symptoms of gout appear. Sometimes gout is heralded by brief twinges of pain (petit attacks) in an affected joint, which can precede the actual full-blown condition by several years. MSU crystals form at normal body temperature when concentrations in the blood reach 7 mg/dL. At lower temperatures, crystals form at lower concentrations. Since blood temperature falls with distance from the heart, gout strikes the toes and fingers first.

The symptoms of acute gout arthritis are described as follows:

• The primary symptom is severe pain at and around the joint. Some patients describe it "crushing" or resembling a dislocated bone. The area can be so tender that walking and even the weight of bed sheets can be unbearable. One writer described gout in the toe as "walking on my eyeballs." The pain usually takes eight to 12 hours to develop. In many cases the attack occurs late at night or early in the morning and announces itself by waking the sufferer.
• Swelling may extend beyond the joint, indicating fluid build-up within.
• The skin over the affected area is often red, shiny, and tense. After a few days it may start to peel.
• Chills and mild fever, loss of appetite, and feelings of ill health may occur with an attack.

Most often symptoms first start in one joint, a condition is called monoarticular gout . If more than one joint is affected, it is known as polyarticular gout . (Multiple joints are affected in only 10% to 20% of first attacks.)

• Monoarticular Gout. The joint of the big toe is the site of about 60% of all first monoarticular gout attacks in middle-aged adults. This occurrence is known as podagra. Symptoms can also occur in other locations, although most often they develop somewhere on one lower limb in middle-aged men.
• Polyarticular Gout. Older people are more likely to have polyarticular gout. In this condition, the joints of the foot, ankle, knee, wrist, elbow, and hand are the most frequently affected. The pain usually occurs in joints on one side of the body and it is usually, although not always, in the lower extremities. People with polyarticular gout are more likely to have a more gradual onset of pain and a longer delay between attacks. Older people are at higher risk for polyarticular gout than younger adults and it tends to occur in the upper extremities, often in the fingers. People with polyarticular gout are also more likely to experience the low-grade fever, loss of appetite, and a general feeling of poor health.

An untreated attack will typically peak 24 to 48 hours after the initial appearance of symptoms, and subside after five to seven days, although it can last only hours to as long as several weeks.

Intercritical Gout

Intercritical gout is the term used to describe the periods between attacks. The first attack is usually followed by a complete remission of symptoms, but left untreated, gout nearly always recurs at some point in the future. One study reported that 62% of subjects experienced at least one further attack within a year. At the end of two years, 78% of patients experienced a recurrence. After 10 years, 93% of the patients had had repeat attacks.

Symptoms of Chronic Tophaceous Gout

Development of Chronic Pain. When gout remains untreated, the intercritical periods typically become shorter and shorter, and the attacks, although sometimes less intense, can last longer. Over the long term (about 10 to 20 years) gout becomes a chronic disorder characterized by constant low-grade pain and mild or acute inflammation. Gout may eventually affect several joints, including those that may have been free of symptoms at the first appearance of the disorder. In rare cases, the shoulders, hips, or spine are affected.

Symptoms of Tophi. Tophi, the knobby MSU crystal deposits that form during chronic gout, generally form in the following location:

• Helix of the outer ear (the curved ridge along the edge of the ear).
• Forearms.
• Elbow or knee.
• Hands or feet. (Older patients, particularly women, are more likely to have gout in the small joints of the fingers.)
• In rare cases, they can settle in regions around the heart and spine.

Tophi, generally, are painless. However, they can often cause pain and stiffness in the affected joint. Eventually, they can also erode cartilage and bone, ultimately destroying the joint. Large tophi under the skin of the hands and feet can give rise to extreme deformities.

Triggers for Gout Symptoms

Gout symptoms may be precipitated by various conditions including the following:

• Severe illness (an important trigger). Between 20% to 86% of patients with gout experience a recurrence when they are hospitalized. Gout accompanies and can be exacerbated by serious conditions that are associated with kidney and heart disease including diabetes, obesity, unhealthy cholesterol levels, insulin resistance, and high blood pressure.
• Stress.
• Infection.
• Joint injury.
• Weight loss.
• Surgery.
• Certain drug treatment (an important trigger).
• Overindulgence in alcohol or purine-rich foods.
• Over-strenuous exercise. Even a long walk can trigger symptoms in a patient who is not sufficiently physically fit.

Symptoms occur more frequently in the spring, with the peak in April, according to some studies.

HOW SERIOUS IS GOUT?

Gout rarely poses a long-term health threat if properly treated. It does, however, remain a source of short-term pain and incapacity for thousands of Americans.

Pain and Disability

Left untreated, gout can develop into a painful and disabling chronic disorder. Persistent gout can destroy cartilage and bone, causing irreversible joint deformities and loss of motion. Tophi can grow to the size of handballs and can destroy bone and cartilage in the joints, similar to the process in rheumatoid arthritis. If they lodge in the spine, tophi can cause serious damage including compression, although this is very rare. In extreme cases, joint destruction results in complete disability.

Kidney Conditions

Kidney Stones. Kidney stones occur in between 10% and 40% of gout patients, and can occur at any time after the development of hyperuricemia. Although the stones are usually composed of uric acid, they may also be mixed with other materials.
Kidney Disease. About 25% of patients with chronic hyperuricemia develop progressive kidney disease, which sometimes ends in kidney failure. It should be noted, however, that many experts believe that chronic hyperuricemia is unlikely to be a common cause of kidney disease. In most cases, the kidney disease comes first and causes high concentrations of uric acid.

Gout and Heart Disease

Gout often accompanies heart problems, including high blood pressure, coronary artery disease, and congestive heart failure. Hyperuricemia, in fact, has been associated with a higher risk of death from these conditions. One 2001 study reported that disease activity in gout may contribute to unhealthy cholesterol and lipid levels. Some interesting evidence, however, suggests that hyperuricemia may occur as a response to inflammatory damage that occur with heart disease and may even be protective.

Other Medical Conditions Associated with Gout

The following are some conditions that are associated with long-term gout:

• Cataracts.
• Dry eye syndrome.

Complications in the lungs (in rare cases, uric acid crystals occur in the lungs).

HOW IS GOUT DIAGNOSED?

Medical History and Physical Examination

Determining which joints are affected is an obvious first step in any diagnosis. A physical examination and medical history can reveal a number of significant indictors that help confirm or rule out gout. The following are some examples:

• Gout is more likely if arthritis first appears in the big toe than if it first appears elsewhere.
• The speed of the onset of pain and swelling is relevant; symptoms that take days or weeks rather than hours to develop probably indicate a disorder other than gout.
• Abnormal enlargements in joints that had been affected by previous injury or osteoarthritis are possible signs of gout. This is particularly significant in older women on diuretics.

Examination of Synovial Fluid

Examination of synovial fluid is the most accurate method for diagnosing gout. It may even be helpful in detecting gout during intercritical periods. The synovial fluid is the lubricating liquid that fills the synovium (the membrane that surrounds a joint and creates a protective sac). The fluid cushions joints and supplies nutrients and oxygen to cartilage, the slippery tissue that coats the ends of bones.

Procedure. The procedure for taking a sample of synovial fluid from an affected joint is called aspiration:

• A needle attached to a syringe is inserted into the joint and suction is used to draw the fluid into the syringe.
• Local anesthesia is avoided because it can reduce the effectiveness of aspiration, but normally the procedure is only mildly uncomfortable.
• Following the procedure there can be some minor discomfort in the area where the needle was inserted, but it usually dissipates quickly.

Aspiration can cause infection, though this occurs in less than 0.1% of patients. Aspiration sometimes eases a patient's symptoms by reducing swelling and pressure on the tissue surrounding the joint.
Analyzing the Fluid. After the sample is taken, it is sent to a laboratory, where a specialist examines the sample through a microscope under polarized light. This special light will reveal the presence of monosodium urate (MSU) crystals, which will nearly always confirm a diagnosis of gout. The laboratory can also test the sample for infection.

Blood Test for Uric Acid Levels

A blood test is usually given for measuring uric acid and detecting hyperuricemia. A low level of uric acid in the blood makes a diagnosis of gout much less probable, and a very high level increases the likelihood of gout. Some experts argue, however, that such measurements are not very useful, given what is known about the variability of uric acid levels in people with gout:

• Uric acid levels in the blood during an attack of gout can lie within or below the normal range.
• Even if hyperuricemia is present, it is very common in the population and does not necessarily indicate the presence of gout.

Determining Uric Acid Excretion in Urine

It is sometimes helpful to gauge the amount of uric acid excreted by the patient, particularly if the patient is young and has pronounced hyperuricemia that might be related to a metabolic disorder. If uric acid exceeds a particular value in the urine, further tests for an enzyme defect or other identifiable cause of gout arising from uric acid overproduction are justified. Greater-than-normal amounts of uric acid in the urine also indicate that the patient faces a greater risk of developing uric acid kidney stones.

24-Hour Urine Sample. Typically, urine samples are taken over the course of 24 hours. To provide a urine sample, the following steps are taken:

• The urine is collected during an intercritical period, after the patient has been placed on a purine-reduced diet. The patient is also asked to temporarily stop using alcohol and any medications that can interfere with the test.
• The patient should not change any of his or her usual eating or drinking patterns when performing this test.
• The patient discards the first urination on the day of the test.
• Afterward all urine passed over the next 24 hours is collected, including the first urination on the morning of day two.
• The container is then delivered to the patient's physician or sent directly to the laboratory.

Imaging Techniques

X-Rays. For the most part, x-rays do not reveal any abnormalities during the early stages of gout, and their usefulness where gout is concerned lies in assessing the progress of the disorder in its chronic phase and in identifying other health problems whose symptoms may resemble those of gout. Tophi can be seen on x-rays before they become apparent on physical examination.

Advanced Imaging Techniques. Advanced imaging techniques being investigated for identifying tophi include computed tomography (CT), magnetic resonance imaging (MRI), and Doppler ultrasonography (US). A 2002 study comparing these approaches found that CT scans offered the best images.

Diagnosing gout

The American College of Rheumatology has 11 criteria, and the presence of six more or less suggests that gout is present. The 11 criteria are:

1. More than one attack of active arthritis
2. Maximum inflammation develops within one day
3. Oligoarthritis attack
4. Redness observed over joint
5. First metatarsalophalangeal joint painful or swollen
6. Unilateral first metatarsalophalangeal joint attack
7. Unilateral tarsal joint attack
8. Tophus (proven or suspect)
9. Hyperuricaemia
10. Asymetrical swelling within a joint on radiography
11. Complete termination of an attack

Ruling Out Other Disorders

As part of the diagnosis, other disorders that produce gout-like symptoms or cause hyperuricemia should be ruled out. In general, it is easy to distinguish acute gout that occurs in one joint from other arthritic conditions. The two disorders that may confuse this diagnosis are pseudogout and septic arthritis. Chronic gout can often resemble rheumatoid arthritis.

A number of other conditions may at some point in their course resemble gout.

1.Pseudogout:

Pseudogout, is very similar to gout, but is caused by deposits of calcium pyrophosphate dihydrate crystals in and around the joints. (It is, in fact, medically referred to as calcium pyrophosphate dihydrate deposition disease, or CPPD.) Though pseudogout resembles gout in some ways, there are differences:

• The first attack typically strikes the knee rather than the joint of the big toe but it may involved any joint. At least two-thirds of cases affects more than one joint during a first attack.
• The symptoms of pseudogout also appear more slowly than those of gout, taking days rather than hours to develop.
• Pseudogout is more likely to first develop in elderly people, particularly those with osteoarthritis. (It affects between 10% and 15% of people over 65.)

• Pseudogout is more likely to occur in the autumn while gout attacks are most common in the spring.

LIFESTYLE MEASURES CAN HELP PREVENT GOUT:-

Generally, gout is unheard of in vegetarians. It is a condition that responds favorably to improvements in diet and nutrition.

Avoiding Excessive Energy Demands:

Any activities that increase energy demands also increase metabolism or purines that produce uric acid. Avoiding stress and staying healthy are important for preventing attacks.

Dietary Recommendations:

The American Medical Association recommends the following dietary balances for patients with gout:

• High in complex carbohydrates (fiber-rich whole grains, fruits, and vegetables).
• Low in protein (15% of calories and sources should be soy, lean meats, or poultry).
• No more than 30% of calories in fat (with only 10% animal fats).
• interest, however, was a 2001 study reporting a 67% reduction in gout attacks when patients limited their diet to 1,600 calories a day but only 40% were from complex carbohydrates while 30% were from protein and 30% from vegetable-based fats. Cholesterol levels also improved. More research is warranted on the optimal diet for gout patients.

Reduce Foods Containing Purines:

Because uric acid levels are only minimally affected by diet, dietary therapy does not play a large role in the prevention of gout in the first place. Still, people who have suffered an attack of gout may benefit from reducing their intake of purine-rich foods if they habitually eat unusually large quantities of such foods.

(Because purines are found in all protein foods, no one should eliminate all purines.)

Purine-containing foods include the following:

• Beer and other alcoholic beverages.
• Anchovies, sardines (in oil), fish roes, herring.
• Yeast.
• Organ meats (eg, liver, kidneys, sweetbreads).
• Legumes (eg, dried beans, peas).
• Meat extracts, consommé, gravies. ( Note: Any meat, fish, or poultry has moderate amounts of purines. And diets high in protein, particularly animal protein increase uric acid. No studies have determined the value of reducing protein in gout patients, however.)
• Mushrooms, spinach, asparagus, and cauliflower.

Possibly Helpful Foods:

Some specific foods may have benefits:

Cherry:

The cherry, sweet or sour, is considered in effective treating gout, as they lower uric acid and reduce inflammation. To start with, the patient should consume about fifteen to twenty five cherries a day. Thereafter, about ten cherries a day will keep the ailment under control. While fresh cherries are best, canned cherries can also be used occasionally.

Dark berries, such as blueberries, blackberries are also effective.

Vegetable Juices:

Raw vegetable juices are used for gout treatment. Carrot juice, in combination with the juices of beet and cucumber, is especially valuable. Beet juice - 100 ml and cucumber juice - 100 ml should be mixed with 300 ml of carrot juice to make 500 ml of combined juice and taken daily

French Beans:

The juice of French or string beans has also proved effective in treating gout. About 150 ml of this juice should be taken daily by the patient suffering from this disease.

Soybeans are also legumes, but one study of gout patients suggested that eating tofu, which is made from soybeans and is a source of complete protein, may be a better choice than meats.

Apple:

Apples are regarded as an excellent source for curing gout. The malic acid contained in them is believed to neutralise the uric acid and afford relief to gout sufferers. The patient is advised to take one apple after each meal.

 

Banana:

Bananas have been found beneficial in the treatment of gout. A diet of bananas only for three or four days is advised for providing some relief from gout. A patient can take eight or nine bananas daily during this period and nothing else.

Lime:

Lime is also used as a source in treating gout. Vitamin C is known to prevent and cure sore joints by strengthening the connective tissues of the body. The citric acid found in lime is a solvent of the uric acid which is the primary cause of this disease. The juice of half a lime, squeezed into a glass of water, should be taken twice daily.

Certain fatty acids found in certain fish (eg, salmon), flax or olive oil, or nuts may have some anti-inflammatory benefits.

Vitamin A, however, may increase the risk for gout attacks.

Gout Diet:

Fast of Orange juice and water:

For an acute attack, there is no better remedy than a fast of orange juice and water. In severe cases, it is advisable to undertake a series of short fasts for three days or so rather than one long fast.

All fruit diet:

After the acute symptoms subside, the patient may adopt an all fruit diet for another three or four days.

Natural food diet:

Thereafter, he may gradually embark upon a well-balanced diet of natural foods, with emphasis on fresh fruits, raw vegetables, and sprouts.

Avoid purine and acid producing foods:

The patient should avoid all purine and uric acid-producing foods such as all meats, eggs, and fish; tea, coffee, sugar, white flour and its products; and all canned, processed, and fried foods.

Other Gout Treatment:

Warm water enema:

A warm-water enema should be used daily during the period of fasting to cleanse the bowels.

Epsom salt bath:

Epsom salts foot baths are advised twice daily. About 250 gm - 500gm of these salts may be added to tolerably hot water for this purpose. Full Epsom salt baths should also be taken three times a week. The baths may be reduced to two per week later.

Cold packs, fresh air, exercise, reduced stress:

Cold packs, applied to the affected joints at night, will be beneficial. Fresh air and outdoor exercise are also essential. The patient should eliminate as much stress from his life as possible

3-4 raw garlic may be eaten daily for relief from gout and uric acid

Diet

Nutritional supplements

Vitamin E and selenium are recommended to decrease the inflammation and tissue damage caused by the accumulation of urates.

Folic acid has been shown to inhibit xanthine oxidase, the main enzyme in uric acid production.

The recommended dosage range is 400–800 micrograms per day.

The amino acids alanine, aspartic acid, glutamic acid, and glycine taken daily improve the kidneys' ability to excrete uric acid.

Bromelain, an enzyme found in pineapples, is an effective anti-inflammatory. It can be used as an alternative to NSAIDs and other prescription anti-inflammatory drugs. It should be taken between meals at a dosage of 200–300 mg, three times per day.

Herbs

Dark reddish-blue berries such as cherries, blackberries, hawthorn berries, and elderberries are very good sources of flavonoid compounds that have been found to help lower uric acid levels in the body.

Flavonoids are effective in decreasing inflammation and preventing and repairing the destruction of joint tissue. An amount of the fresh, frozen, dried, juiced, or otherwise extracted berries equal to half a pound (about 1 cup) fresh should be consumed daily.

Devil's claw, Harpagophytum procumbens, has been shown to be of benefit. It can be used to reduce uric acid levels and to relieve joint pain.

Gout represents a serious strain on the kidneys. The dried leaves of nettles, Urtica dioica, can be made into a pleasant tea and consumed throughout the day to increase fluid intake and to support kidney functions. However, some people are allergic to nettles.

Applications of ice or cold water can reduce pain and inflammation during acute attacks.

Maintain Healthy Weight

A supervised weight-loss program may be a very effective way to reduce uric acid levels if the patient is overweight. Crash dieting, on the other hand, is counterproductive because it can increase uric acid levels and can cause an acute attack.

Maintain Fluids

Drinking plenty of water and other nonalcoholic beverages helps remove MSU crystals from the body. Some researchers are studying the anti-inflammatory properties of green tea, which might have some benefit for gout. It should be noted, a Japanese study reported a higher association between gout and tea drinking (although the study did not describe the type of tea).

Avoid Alcohol

Alcohol should be avoided, since it promotes purine metabolism and uric acid production; it also may reduce excretion of uric acid. Heavy drinking, especially binge drinking of beer or distilled spirits, should especially be avoided.

Avoid Joint Injury

People with gout should also attempt to identify and avoid activities that cause repetitive joint trauma, such as wearing tight shoes.

Preventing an Attack During Travel

Travel is an example of an activity that increases the risk for gout. It not only increases stress, but eating and drinking patterns may change. Before traveling, patients should discuss preventive measures with their physicians. The doctor may prescribe a prednisone tablet to be taken immediately at the first sign of a gout attack; in most cases this stops the episode.

Homeopathic treatment:-

Having understood that Gout is caused by the constitutional factors, it calls for constitutional approach towards its treatment. The constitutional approach involves evaluation of the individual factors inclusive of one's personal and family history (ascertaining the genetic tendency), while planning a long-term treatment. Homeopathic approach to Gout treatment is more of a totalistic approach. Homeopathy helps in controlling the pain during the acute attack of gout as well as helps in preventing the recurrence of such episodes. It helps in reducing stiffness and improves the mobility of the joints. Homeopathy is very strongly suggested for the treatment of Gout

We believe in strong Patient-Doctor relationship and our motto is: 'Healthy People Wealthy Nation'

Dr.GurpreetSingh MAKKAR

Homeopathic Physician 

Sukhmani homeopathic Multispeciality Clinic
9872-735707

www.askdrmakkar.com