By Van Merkle, DC, CCN, DCBCN, DABCI

"Beep, Beep, Beep," It's Monday morning and your bedside alarm forces your eyelids open. You roll over to smack the snooze button for five more minutes of bliss and yowza! Just the slight brushing of the sheet across your feet sets your gout ablaze. My patients have described it as one of the most excruciating pains they have ever known.

Gout is an arthritic condition typically found in the joints of the feet, especially the bottom of the joint in your big toe.¹ Affecting more than 2 million Americans, gout is caused when uric acid builds up in a joint or surrounding tissue, creating sharp, needle-like urate crystals.² These crystals cause fire-like pain, inflammation and swelling.

Traditional medical doctors will typically prescribe a naproxen class/NSAID pain reliever (except aspirin) for the symptoms and a xanthine oxidase inhibitor to reduce uric acid production in the body.³ But does that "fix" the problem? What caused the person's uric acid levels to climb in the first place? Unfortunately, most medical doctors don't take the time to figure that part out, and the drugs they prescribe have a load of side effects including liver dysfunction, joint pain, nausea, chest pain, numbness, weakness, blistered peeling skin, blurred vision and even an increase in gout symptoms!⁴

A century ago, gout was know as a "rich man's disease" when it was discovered that eating and drinking certain foods could increase your uric acid levels. As the body digests an organic compound called purines, uric acid is produced as a waste product and sent to the kidneys and liver for disposal.⁵ Purines are found in organ meats (brain, liver, pancreas, etc.), sardines, meat extracts, mincemeat, mussels, gravies, bacon, fructose, alcohol, peanuts, soda, etc.⁶ It's interesting to note that plant foods rich in purines (asparagus, cauliflower, spinach, mushrooms, green peas, lentils) do not increase your chances of developing uric acid build-up or gout.⁷

Several other factors have been linked to increased uric acid levels, such as diabetes, high cholesterol, high blood pressure, obesity, sedentary lifestyle, dehydration, medications such as diuretics or low-dose aspirin, and elevated lead levels.^8-9

Case Study

A 72-year old man quite literally hobbled into my office a few years back with a severe case of gout in both feet that had started about three weeks prior. He had barely been able to walk or stand for the past three days. Aside from the gout, he also suffered from poor concentration/memory and some numbness in his limbs. At 6'0," he was overweight at 211 lbs. and his blood pressure was elevated at 142/80. He took no medications.

The first thing I wanted to know was what other factors could have been affecting or contributing to his gout and overall health. A complete blood work-up and hair analysis was a good foundation, checking diabetic markers, hepatic, renal, cholesterol, inflammatory markers, CBC, vitamin D 25-hydroxy, metabolic profile and thyroid function, as well as toxic and essential elements in the hair.

The high uric acid was expected, along with the increased inflammatory markers ESR and CRP from the arthritic gout. The remainder of his test results showed a textbook case for almost everything linked to increased uric acid levels. Add on inadequate exercise, uncontrolled high blood pressure and poor diet and we have several areas to begin working on:

• High cholesterol (total cholesterol, LDL cholesterol, total/HDL cholesterol)
• Diabetes (glucose, hemoglobin A1C, vitamin D – low levels reduce insulin resistance)
• Dehydration (potassium, protein, creatinine, calcium)
• Liver dysfunction (AST, ALT, GGT) – the liver is responsible for expelling uric acid waste; liver dysfunction is a sign of being overworked

One additional area of major concern was the hair test, which showed virtually no toxic elements! This patient worked almost his entire adult life in an atomic energy facility that handled plutonium detonators for nuclear weapons, generators for space probes, and radioactive and hazardous waste. It was a very toxic environment, yet according to the test, his body expelled no toxins. More than likely, this meant those toxins were stuck inside his body. Many times toxic elements can displace essential elements in the body (16 of this patient's were low including calcium, magnesium and selenium) and cause a slew of problems.

I recommended the patient complete a urinary chelation challenge to see what levels of toxins his body has stored. I found some of the highest levels of lead I have ever seen, jumping from 9 on the pre-challenge to 120 with a chelator!

Now that I'd identified the problems, I could recommend nutrients and dietary changes to help:

• High uric acid: Build to 30 minutes of aerobic and resistance training 3-4 days per week, eat plenty of clean protein and lots of vegetables while avoiding purine-rich foods, soda and alcohol (this also helps lower cholesterol and improve diabetes)
• High cholesterol: diet/exercise and fish oil
• Diabetes: diet/exercise, chromium picolinate, fish oil, and vitamin D3
• Inflammation: ginger/tumeric, high doses of vitamin C and vitamin E
• Dehydration: 4 quarts of reverse-osmosis water daily
• Liver dysfunction: diet changes, B-complex
• Toxins: DMSA (a strong chelator)
• Low essential elements: supplement base vitamin and mineral stores

About a month later, the patient reported that he was feeling much better, had more energy, had lost 13 lbs, and his gout symptoms were gone. He said, "I thank the Lord for your abilities to help without medication; this is the only way to treat sickness and disease." A few months after that, we rechecked his bloodwork and saw some great improvements in the testing. He had no further gout flare-ups and was playing golf, riding a bike and doing odd jobs around the house, and had lost 21 more lbs.

As we continued with chelation therapy, the patient's toxic element levels also drastically improved. Toxic elements are released by atomic weight, with the heaviest toxins expelled first. Therefore, as the lead dropped from 120 to just 65, other metals such as mercury began showing increased elimination. This patient worked in a toxic environment for decades, so it will likely take years to flush out these dangerous toxins.

Getting patients on the road to better health requires a comprehensive thought process. One nutrient or dietary change will not fix a problem. But by thoroughly evaluating diet, blood tests, heavy metals and mineral levels, we can better assess the steps needed to not only relieve their symptoms, but also improve their overall health and hopeful detour and prevent future medical problems.

Dr. Van D. Merkle, president of Science Based Nutrition, is a diplomate of the American Clinical Board of Nutrition and the American Board of Chiropractic Internists. He is also a diplomate of the recently formed Chiropractic Board of Clinical Nutrition and currently serves as vice president. Dr. Merkle has practiced in the Dayton, Ohio area for more than 25 years, and hosted the call-in radio talk show "Back To Health, Your Guide to Better Living" since 1995.