Monday, May 11, 2009


It was Linus Pauling who first came out with the idea of using mega doses of ascorbic acid (Vitamin C) to overcome the common cold and the pharmaceutical industry made a fortune capitalizing on this unproven concept during sixties and seventies. Even to day many believe that high intake of Vitamin C can give protection against cold and related ailments. With more knowledge emerging regarding the role citrus Bioflavonoids play in giving resistance against cold, combination of Vitamin C and Citrus Bioflavonoids is prescribed by many physicians.

The new role for Vitamin C in alleviating Gout symptoms and even to prevent development of Gout disease seems to be reviving the same therapy that was popular against Cold. Over 5 million people are affected by Gout disease across the world for which no effective treatment is readily available in Allopathic medicinal system though many claims are made regarding its successful management in Ayurvedic and Homeopathic systems. Probeniced and Sulfinpyrazone are routinely prescribed to treat persistent cases of this disease. Gout is one of the most painful forms of Arthritis manifesting in intense pain at the joint of the big toe to begin with and subsequently spreading to ankles, heels, insteps, knees, elbows, hips, thumbs or fingers. The causative factor for the precipitation of Gout syndrome is Uric acid, a by-product of nucleotide metabolism that is prevalent at the cellular level. Too much accumulation of Uric acid in blood can lead to formation of sharp and tiny Urate crystals and their deposition in connective tissues and around the joints causing inflammation and pain. Normally Uric acid levels in blood can be in the range of 2 mg to 20 mg per deciliter and beyond 7 mg/dL hyperuricemia condition develops as it is not soluble at this concentration and beyond. However, 95% of the population having hyperuricemia condition do not develop Gout and may not experience Gout attack any time in their life time for which clear reasons are not yet known.

According to some experts Uric acid accumulation is associated with heart disease (CVD) and hyperuricemic subjects are 2.5 times more likely to die due to CVD. The rationale behind such a link is yet to be explored. The fact that Gout affects people over 30 years of age, overweight persons, frequent consumers of alcoholic and sweetened beverages, regular eaters of red meat, internal organs, yeast, poultry or sea food may explain the association of Uric acid with CVD. The connection between diet and hyperuricemia is rather tenuous because more than two thirds of purines, the precursor of Uric acid in the body come from metabolic reactions and only one third is contributed by the food that is consumed. This is similar to cholesterol which again is made in the body with contribution from the diet often being not very substantial.

Regular consumption of Vitamin C, at levels higher than 500 mg a day has proved to be beneficial in containing Gout symptoms. Between 250 mg and 499 mg of Vitamin C intake per day the relative risk (RR) of developing Gout is reduced to 0.97, 500 mg to 999 mg/ day lowers the RR to 0.83, 1000 t0 1499 mg/day brings down the RR to 0.66 and above 1500 mg the RR is just 0.55. With every 500 mg increase of Vitamin C intake the risk of getting Gout is reduced by 17% but consumption beyond 2000 mg a day is not advisable due to many reasons. This vitamin has been shown to reduce Uric acid levels in the blood significantly by several studies. As a strategy those suffering from hyperuricemia will be better off to avoid foods rich in purines such as Anchovies, Beer, Caviar, Goose meat, Partridge meat and Mushrooms. Medium purine containing foods like Asparagus, Beet, Pork, Meats, Cauliflower etc should also be avoided when Gout symptoms appear. Vitamin C rich foods like citrus fruits can help. As Vitamin C is acidic in nature, the high daily doses that can bring relief must be taken in 2-3 portions to avoid hyper acidity problems.

How does Vitamin C manage to obviate the Gout conditions is not yet clear though there are some surmises to explain its beneficial role. Kidney stones formed due to Calcium Oxalate build up is known to be dissolved by mega doses of Vitamin C up to 4 gm a day and this has been attributed to acidification of urine which favors dissolution of Oxalate crystals. Probably same may hold good for Gout also but this needs confirmation by further clinical studies. The role of Vitamin C in the synthesis of Collagen protein that gives shape to connective tissues is well recognized and since Gout affects connective tissues, high doses of Vitamin C may be providing quick healing to the damaged tissues.

While mega dose therapy using Vitamin C against Gout is a subject matter of focus amongst many health experts, Coffee consumption has been linked to significant reduction of Uric acid levels and many believe that regular consumers of this beverage rarely develop symptoms of Gout in their life. There appears to be connection between lower C-peptide levels in coffee drinkers which is a marker for insulin levels in the body. Strong association between insulin resistance and elevated Uric acid levels further points to the role of coffee in lowering the Uric acid levels. Coffee also contains chlorogenic acid, an antioxidant par excellence which is known to inhibit glucose absorption in the GI tract. Further studies are required to confirm the mechanism by which coffee protects against Gout.

Food scientists need to come up with plant based foods and edible materials, consumption of which can help reducing build up of Uric acid in the blood through the food route, enabling Gout affected patients lead a normal stress-free life through modified diets of proven efficacy.


1 comment:

John said...

"Kidney stones formed due to Calcium Oxalate build up is known to be dissolved by mega doses of Vitamin C up to 4 gm a day and this has been attributed to acidification of urine which favors dissolution of Oxalate crystals. Probably same may hold good for Gout"

So the theory here is the Vitamin C acidifies the urine and therefore favors the dissolution of uric acid crystals? Or are you saying that it dissolves uric acid crystals in the joints and the urine acidity is a non-issue?