Gout is the result of a build up of uric acid crystals, usually around a joint. The immune system attacks these crystals with phagocytes (scavenger cells). The toxic by product of this clash causes the inflammation. Gout could indicate that you either get too much uric acid from your diet, your body is synthesising too much, or your kidneys are excreting too little. It is a long term threat to the kidneys and, if left untreated, can also have a knock on effect on the arteries.

Opinions on how best to treat gout differ (Rev Rheum Eng Ed, 1996; 63: 255-61; N Z Med J, 1991; 104: 115-7). Hospitals use indomethacin and colchicine, while GPs prefer nutritional advice. Long term use of colchicine is associated with renal failure though the exact relationship is not clear (J Rheumatol, 1991; 18: 264-9) and other side effects such as nausea, gastrointestinal haemorrhage, rashes and even hair loss.

Medications such as cyclosporin and the H2 receptors, cimetidine and ranitidine, can cause gout (N Eng J Med, 1989; 321: 287-92; Drug Intel Clin Pharm, 1985; 19: 201-2), and individuals taking thiazide diuretics are at a greater risk. This risk increases significantly if diuretics are used in conjunction with other hypertensive agents (J Clin Epidemiol, 1997; 50: 953-9). Those with SLE (lupus) can be more vulnerable to gout (Br J Rheumatol, 1987; 26: 303-6), and it can also be brought on by surgery (Am J Surg, 1995; 61: 56-9).

An often overlooked, though long established, cause of gout is lead poisoning (Ballieres Clin Rheumatol, 1989; 3: 51-61; Toxicol, 1992; 73: 127-46). The kidneys may be failing to effectively excrete excess lead.

Diet is paramount in treating and preventing gout recurring (Ther Umsch, 1995; 77: 524-7). Follow a low acid diet, avoiding foods rich in the purines that are metabolised to uric acid. Such foods include sardines, anchovies, shell fish and crab, liver, sweetbreads, peas and beans, asparagus and mushrooms. Reducing refined sugar and salt won't directly help, but might ease the load on your kidneys, helping them to work efficiently. Avoid coffee, tea and alcohol. Try to drink at least two pints of water daily.

Herbs such as celery seed (Apium graveolens), guaiacum (Guaiacum officinale), and burdock (Arctium lappa) are all indicated in gout. Other herbs with an anti rheumatic and/or diuretic action include boneset (Eupatorium perfoliatum), wild carrot (Daucus carrota) and yarrow (Achillea millefolium). Bromelian is also an effective anti inflammatory.

Try supplements of vitamin C, vitamin E and the full range of B vitamins, particularly folic acid. Daily doses of calcium (1500 mg) and magnesium (700 mg) can help draw the lead out of your system. Eating cherries, ginger or blueberries may also be of benefit, and likewise, a daily tablespoon of flaxseed oil.