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Why Don’t Doctors Prescribe Vitamin C for a Gout Attack?

A diet that has little seafood, red meat, soft drinks or beer and lots of cherries and celery seed may reduce the risk of a gout attack.

Pain gets everyone’s attention. Whether it’s a stubbed toe or a headache, heartburn or arthritis, pain signals that something has gone wrong. With appropriate treatment, most of these conditions are manageable. Then there is pain that is impossible to ignore and hard to control, such as a gout attack. It can be excruciating!

What Causes Gout?

In this extremely painful condition, uric acid builds up in the bloodstream. Ultimately it precipitates in the form of needle-like urate crystals that lodge in joints.

The resulting inflammation causes redness, swelling, warmth and extreme tenderness. The joint that is most commonly affected is the big toe. That said, nearly any joint can be afflicted. Sudden severe pain in a joint deserves prompt medical attention for diagnosis.

Triggers for a Gout Attack:

Foods:

Health professionals often blame diet as a precipitating factor. Historically, people thought “rich” foods were responsible for gout. That’s because our bodies break purine-containing meats and seafood down to urate–the primary risk factor for gout. A diet that limits purine is frequently recommended. That means reducing consumption of red meat and seafood like shrimp.

Beverages:

High-fructose corn syrup is a particular culprit and should be avoided (American Journal of Medicine, Nov., 2016). To do that, stay away from soft drinks and read labels on other prepared foods. Limiting alcohol consumption, especially beer, is also important. Coffee, on the other hand, might be protective.

Medicines:

Medications can also contribute to gout. Tens of millions of Americans take drugs that raise uric acid levels. Diuretics are among the worst culprits.

One reader shared this story:

“When I developed high blood pressure, my doctor prescribed hydrochlorothiazide (HCTZ). Before long, I started having pain and tingling in my hands and then it became hard to walk or stand for any length of time. The pain would wake me up at night.

“My ankles, knees and hands hurt on a daily basis. The doctor told me to lose weight, which wasn’t helpful. I stopped taking the HCTZ and the gout pain went away.”

One doctor took us to task for mentioning that thiazide diuretics like HCTZ can cause side effects. You can read his criticism at this link.

Other medications that can trigger gout flare-ups include the immune suppressant cyclosporine, the Parkinson’s drug levodopa, other diuretics like furosemide, the pain reliever celecoxib and beta blockers such as carvedilol.

Alternatives to Avoid a Gout Attack:

If a medicine is contributing to high uric acid levels, it may be possible to substitute a different drug that will not produce such a side effect. Doctors can prescribe pain relievers like ibuprofen or naproxen or medication such as colchicine to reduce the inflammation and pain associated with a gout attack. If that doesn’t work, the physician may prescribe a corticosteroid like prednisone. To prevent another attack, they could prescribe drugs like allopurinol or febuxostat.

A Reader Shares His Vitamin C Story:

Q. I have been taking 1000 mg of vitamin C daily. As a result, I believe, I have not had a gout flare-up in over 15 years.

When I used to get a flare-up, I would boost the dose and add ibuprofen. That resulted in milder pain that only lasted a few days instead of weeks.

A. I first wrote about vitamin C against gout over 50 years ago. Why doctors seem so negative about vitamin C is beyond my understanding.

Back in 2005, researchers at Johns Hopkins University conducted a placebo-controlled study to find out how taking vitamin C (500 mg daily for two months) affected blood uric acid levels (Arthritis and Rheumatism, June 2005). That trial demonstrated that the vitamin supplement significantly lowered this primary risk factor for gout.

The Physicians’ Health Study II collected data from middle-aged male doctors for a decade. A recent analysis of the information on these 14,641 men shows that those taking vitamin C (500 mg/day) were diagnosed with gout at a rate of 8 per 1,000 person-years (American Journal of Clinical Nutrition, Sep. 2, 2022).

In comparison, the men on placebo developed gout at rate just over 9 per 1,000 person-years. That may not sound impressive, but it is a 12 percent relative reduction in the risk of gout.

More Research Supporting Vitamin C to Prevent a Gout Attack:

A study involving computer simulation supports vitamin C and some other vitamins against high levels of uric acid (hyperuricemia). The research was published in Chemico-Biological Interactions, May 25, 2022).

They report:

“Over-consumption of foods high in purines like seafood, red meat, and alcoholic beverages leads to hyperuricemia causing gout attacks. Xanthine oxidase was reported responsible for the overproduction of uric acid.”

In this study, four vitamins demonstrated an ability to inhibit the enzyme xanthine oxidase. The vitamins were E, C, D3 and B9.

The conclusion:

“The obtained results promise an excellent strategy using vitamins to enhance immunity, treat hyperuricemia, and minimize the usual drug side effects.”

A Word of Caution:

In 2020 the American College of Rheumatology issued a conditional recommendation against the use of vitamin C against gout (Arthritis Care & Research, June, 2020). Therefore, we cannot encourage anyone to take vitamin C to prevent a gout attack!

Please check with your physician and point out that there are studies suggesting that vitamin C may be beneficial, but there is no consensus among rheumatologists that this nutrient would be beneficial (Best Practice & Research Clinical Rheumatology, Dec. 2021).

The authors do point out that:

“A 2011 meta-analysis of RCTs [randomized controlled trials] which included 556 patients without gout in which a median dose of 500 mg/day was associated with a statistically significant but minor reduction in serum urate (0.35 mg/dL). A prospective study looking at 46,994 male participants, with no history of gout at baseline, reported that higher vitamin C intake was independently associated with a lower risk of gout.”

Home Remedies for Gout:

Many readers report success with home remedies such as tart cherries or cherry juice. There is even scientific support for this approach (BMC Complementary and Alternative Medicine, March 1, 2016).  Celery seeds may also reduce uric acid formation (Food Chemistry, Dec. 15, 2013).

One reader reports:

“I’ve suffered from gout on and off for many years. Celery seed extract and nettle root extract are my remedies of choice–all natural with no side effects, and they work.”

To prevent another attack, susceptible people should drink lots of water and cut back on beer, soft drinks and starchy carbohydrates. Cherry juice and celery seed could make a good addition to a prudent gout prevention diet.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.”.
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