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Gout: The silent pandemic

“Many patients with chronic gout would be willing to pay money every month in perpetuity to be cured of their gout. Younger patients, patients whose main health concern is gout, and patients with frequent attacks are willing to pay the most.” (Willingness to Pay for a Cure in Patients with Chronic Gout; Dinesh Khanna, MD, MS: Medical Decision Making, Vol. 28, No. 4, 606-613 (2008)

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If gout were a communicable disease, the World Health Organisation (WHO) would classify it as a pandemic.

 Studies done in the US and UK state in 1999 the prevalence of gout and hyperuricemia was as high as 41 per 1000 in the US, and in the UK the prevalence of gout diagnosis was 14 per 1000. Studies also indicate that the worldwide incidence of gout is on the rise.

According to Dr. Khanna’s study and international statistics, it’s evident that gout treatment is a multibillion-dollar a year income source for both the medical profession and pharmaceutical industries.

It is such a potential profits source for pharmaceutical companies; they’re investing in continued research to find new gout medications.

However, the people who can’t afford doctors and medications rely on traditional home remedies passed down from generation to generation. There are a host of different home remedies for gout, but probably the most universally recommended is vinegar.

Ask your doctor about vinegar, he will probably raise an eyebrow and say, “It’s good for salad dressing and on fish and chips, but it’s not medicine.”

Ask most Internet doctors, and they’ll comment back saying, “There are no studies that say vinegar will help gout or anything else. There’s no science to backup any health claims about vinegar.”

Despite what the doctors may believe, there is actually science behind the use of vinegar to treat and manage gout. Unfortunately, finding the science is not as straightforward as typing ‘Vinegar and Gout’ into an Internet search to discover a horde of credible scientific research papers. There are no peer-reviewed studies in medical journals about the use of vinegar as a gout treatment. As a matter of fact, there are very little research about vinegar and health.

The reason being: To scientific researchers, vinegar is condiment, a mixture of flavonoid chemicals in diluted acetic acid sitting on the kitchen shelf. When doing experimental research, scientists reach for the bottle of glacial acetic acid or use a salt made from acetic acid such as potassium, sodium, or calcium acetates.

In the human body, scientists use the words acetate or acetyl. Consequently, if you’re looking for scientific papers on vinegar or even acetic acid and gout, you won’t find any, and you will only find a few mentions about acetate salts directly relating to gout.

However, when it comes to scientific research done on acetate’s essentiality to the biochemistry of virtually all living things, there are more studies than a person can count. In fact, acetate is so important to every aspect of our being, not only do we find some form of it in our everyday diet, but also, our liver produces it by enzymatic action on fatty acids. Even in our large intestine, a family of bacteria called acetobacter produces acetic acid that enters the blood.

Acetate is essential to all our body’s enzyme functions from the brain function to DNA repair.

Getting back to gout:

High uric acid levels (hyperuricemia) are usually associated with gout, but it’s not necessarily the case because gout can occur in people with normal uric acid levels. The important factor is the acidity of blood and urine. In an acid environment, uric acid becomes what urologists call a ‘free ion’ where it’s less soluble and more likely to form the uric acid crystals (monosodium urate) associated with gout and uric acid kidney stones.

When the blood becomes acidic, the whole body is acidic, and it affects all metabolic functions.

With increasing blood acidity, there is also an increase in serum sodium.

At this point, we have the perfect environment for the formation of the monosodium urate crystals. The crystals form mainly in the extremities of the body where the blood circulation is poor, such as the big toe and fingers.

The reason for this is that as blood flows farther from the heart, the less force there is behind the circulation of blood. The slowing of blood flow in the extremities, where gout usually occurs, provides the opportunity for a reaction between sodium and uric acid to form monosodium urate crystals.

It doesn’t matter whether the blood has high or low levels of uric acid; it’s the high blood acidity and excess sodium that creates the environment for the crystallization to occur.

However, making the blood slightly more alkaline can change the solubility of uric acid almost 10-fold, thus causing the monosodium urate crystals to dissolve back into the blood. A rise in blood alkalinity also raises the alkalinity of the urine and all body fluids. This means that the uric acid crystals dissolve and the uric acid reenters the blood in a more easily excreted form.

A simple way to test your urine acidity is to take a small sample (about a tablespoon full) and add a pinch of baking soda (bicarbonate of soda). If you see bubbles and it begins to dissolve, your urine is acid – the more it bubbles, the higher the acidity of the urine. If it sinks to the bottom without any reaction, you are either neutral or on the alkaline side. More than likely, if the urine is acidic (the baking soda bubbles and dissolves fast), you’re on your way to an attack of gout.

In most healthy people, the blood should be on the alkaline side.

Acidic blood and urine are also indicators of other health problems and health problems that may occur in the future such as diabetes, heart, and hypertension, etc.

Now, what does this all have to do with vinegar and gout?

There is a function that called the "alkaline tide" that happens when we eat. When the stomach produces acid for digestion, the blood becomes alkaline. This function keeps the blood acid/alkalinity level in balance. However, if for some reason, the blood becomes too acid, the alkaline tide can’t make the right adjustment, and the blood remains acid. 

Ingesting diluted vinegar before eating will help raise the blood alkalinity. The acetic in vinegar is absorbed directly through the stomach lining and into the blood stream where the acetate converts into bicarbonate (an antacid). This increases blood alkalinity. Once the blood acid/alkalinity in normalized, the “alkaline tide” function works properly.

The “alkaline tide” in also important to normal kidney functions the elimination of uric acid.

People, for whom vinegar/acetic acid works, report relief from gout symptoms with in hours after ingestion due to the rapid rise in blood alkalinity. 

The alkaline blood takes up the uric acid, and holds it in solution until eliminated in perspiration and urine.

Some studies done using acetate based hemodialysis show that blood acetate has a dilating effect on blood vessels, which would also aid in dissolving sodium urate crystals via increased blood flow to the affected areas.

The fact of the matter is that any old vinegar will do the trick; however, unpasteurized, naturally fermented vinegar may be more beneficial in the long-term. The reason for this being that if someone suffers with lower digestive tract problems, they might be lacking in the population of acetobacter necessary to produce acetic acid. The unpasteurized vinegar will help in the recolonization of acetobacter.

To maintain a bustling colony of symbiotic acetobacter, it is best to introduce some whole grain products/fiber into your diet, as the acetobacter love to devour fiber. The acetobacter need an adequate supply of food to produce the acetic acid that supplements our system with acetate to regulate blood acid/alkali levels and make other essential metabolic functions occur.

Once you have and maintain a thriving acetobacter colony in your intestines, you may never have another problem with gout again.

You don’t have to go to the health food store and buy expensive ‘organic vinegar’ suggested by many advocates. It’s easy enough to make your own unpasteurized vinegar. Simply open the top on a bottle of cheap wine and let it sit a few weeks – acetobacter also love alcohol.

The homemade fruit vinegar is more pleasant tasting. You can make your own by letting the fruit juice ferment in a glass, stainless steel, or food-grade plastic container for three weeks to a month. The secret is to give it a stir every few days as oxygenation makes the process happen faster.

There are plenty of wild acetobacter floating around in the air to make vinegar fermentation happen naturally; all you have to do is sit back and let nature take its course.

Then all you have to do is dilute a tablespoon or two in fluid and drink before each meal to stabilize your blood and urine acid/alkali balance throughout the day.

There are other benefits from the intake of acetate documented in medical journals such as increased energy production, cholesterol reduction, and even beefing-up the immune system. However, other than the essentiality of acetate to the existence of life, there is little research about dietary acetate and its possible benefits.

It also would be beneficial to increase potassium rich foods in your diet and stay away from phosphate and nitrogen rich foods. Too much phosphate and nitrate in the diet produce high blood acid levels.

Also, adequate fluid intake is important to uric acid elimination.

For those of you who enjoy visiting your doctor and chatting about various gout medications, have him grab his pill book and take a look at potassium acetate.

In “A Practitioner's Handbook Of Materia Medica And Therapeutics,” it states that potassium acetate (a salt of acetic acid) is effective in treating gout.

The American Medical Association also recommends it in their book for treating kidney problems related to hyperuricemia, “A Handbook of Useful Drugs," stating: “Potassium acetate is oxidized in the organism to potassium carbonate or bicarbonate. This tends to make the blood alkaline, and the salts excreted by the kidney render the urine less acid… It is a marked diuretic, increasing the amount of urine and the solids of the urine without irritation of the kidney…”

So, in spite of the doctors’ sour medical opinions about vinegar, it can inexpensively help most suffers manage their gout. ###

References: 

 1. (Willingness to Pay for a Cure in Patients with Chronic Gout; Dinesh Khanna, MD, MS: Medical Decision Making, Vol. 28, No. 4, 606-613 (2008). 

 2. Increasing prevalence of gout and hyperuricemia over 10 years among older adults in a managed care population; KL Wallace et al: Journal of Rheumatology 2004 31; 1582-1587.

 3. Gout epidemiology: results for the UK General Practice Research Database, 1990-1999; TR Mikuls, et al: Annals of the Rheumatic Diseases 2005 64: 267-272. 

 4. Percipation of uric acid - Nature Cure: Philosophy and Practice Based on the Unity of Disease and Cure; Henry Lindlahr, M.D.: The Nature Cure Publishing Company, Chicago - 1922 (The most coherent and feasible explanation I found).

 5. The contribution of the large intestine to blood acetate in man; Scheppach W, et al: Am J Physiol Endocrinol Metab 271: E58-E64, 1996. 

 6. Randomised controlled trial of acetate in preterm neonates receiving parenteral nutrition; Olufunmi Peters, et al:  Arch Dis Child Fetal Neonatal Ed 1997;77:F12-F15 ( July ). 

 7. Plasma Acetate Turnover and Oxidation; CL Skutches, et al: Journal of Clinical Investigation, 1979. 

 8. 80%-85% Success Rate With Medical Therapy to Treat, Prevent Uric Acid Stones:  Elizabeth Mechcatie: Family Pratice News ,  April 15, 2000.  

 9. Kinetic aspects of acetate metabolism in healthy humans using [1-13C] acetate; E. Pouteau,et al; Am J Physiol Endocrinol Metab 271: E58-E64, 1996. 

10. Carbohydrate fermentation in the human colon and its relation to acetate concentrations in venous blood: E W Pomare, Et al: Journal of Clinical Investigation, 1985. 

11. Alkaline Tide: http://en.wikipedia.org/wiki/Alkaline_tide. 

12. Sodium acetate-induced relaxation of mesenteric arterial rings: Jauchem JR, et al; Microcirculation 1:37–54, 1981.

About the Author

George Glasser is a UK based writer. He is mainly noted, internationally, for his investigative environmental journalism on water quality issues. In 2001, Glasser won the prestigious "Project Censored Award" for the expose' "Is Your Bathtub a Toxic Dump?" published in Earth Island Journal. He is best known for his expose on drinking water fluoridation and the phosphate fertilizer industry. Presently, Glasser is broadening his scope to write on other health issues.

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