September 13, 2008 at 3:00 pm #2725
This discussion about gout and iron is now closed. Please see Gout and Iron Revisited and Alternative Treatment For Gout – Blood Letting. If you still have questions, please start a new topic in this gout forum.
There is some very interesting research work that has been done by Drs. Hugh McGrath and PG Rigby at the Louisiana State Health Services Center in New Orleans. There is an article that appears in the November 2004 issue of Rheumatology that speaks to the role of iron intake to the process of inflammation. There is also an article in Medscape Medical News written by Janis Kelly. I found that writeup at webmd. Undoubtedly, these are copyrighted but they are worth getting a copy of even if you have to pay for them.
The thing for gout-sufferers to know is that iron plays a pivotal role in the inflammation process. If you want to increase inflammation, feed yourself with iron. Particularly, iron from meat and seafood are to be avoided because the body can absorb the iron in these foods better than they can the iron in vegetable sources. Obviously, you need some iron to avoid anemia but not the amounts that most Americans are consuming. Also, middle-aged men and postmenopausal women probably don't need to be taking a multivitamin that supplements their iron intake. There are multivitamins designed for older Americans that don't supplement iron. If you are middle-aged or postmenopausal, switching to one of these is a good idea anyway.
If your physician has prescribed iron supplements then get the article and show it to him/her. Folllow your doctor's advice.
There are also many processed foods that are supplemented with iron. They are identified on the side of the boxes or cans. Avoid them.
There are other research studies that point to the role of iron in inflammation and in gout attacks. Some work was done at the Duke Univeristy Medial Center in Durham, North Carolina by a research team of Ghio, Rao, Cooke, Milller and Holdal on the role of iron in gouty inflammation. A writeup appeared in the September 1994 issue of Arch. Biochem. BioPhys.
The best approach is not to get fanatical about eating meat or seafood but limit the amounts. Also, avoid taking supplemental iron either in pill form or in enriched foods. Also, studies have shown that low-fat dairy and coffee are helpful in avoiding gout attacks. Both of these foods contain substances that limit iron absorption in the intestines. If iron is the key player in inflammation, then there may be hope in finally bringing the attacks down in number and severity.
The other major player is sleep apnea. If you are already hyperuricemic, then this condition can easily result in gout.September 13, 2008 at 9:33 pm #3901
I have just read through the message that I posted earliier. The article that Janis Kelly wrote was on the subject of the work done by McGrath and Rigby. This might not have been clear. I have been reading some of the work done on Rheumatic Arthritis. These works take it for granted that iron is heavily involved in the inflammation process of arthritic diseases. Sure there are differences, but the inflammation processes work about the same. With a few exceptions, the feeling I get is that gout is the poor cousin of the other types of arthritis. I read several articles that speak of gout as “curable”. Somebody should spend some time going to the different gout websites and see how curable it is.
I believe hyperuricemia should be treated as a serious medical condition in its own right. I do believe that it contributes to renal disease, high blood pressure, cardiovascular disease, and adult onset diabetes. They reinforce each other. The medical profession calls it “metabolic syndrome”. The rest of us know it as “falling apart”. Most of the family physicians that I have seen are so focused on medicines and surgery that they are not as knowledgeable on two important areas that are critical to dealing with gout. One is in the area of sleep research and especially sleep apnea. The other is in nutrition. Nutrition is not considered as a legitimate field of medicine. It is as if the medical profession is waiting for the disease to happen so they can treat it with their medicines. The best defence is to keep the ailments from happening in the first place. This is why nutrition is the single most important field of medicine there is!
I'm new to blogging. Exactly, what are the copyright laws as to what is posted on internet sites? Does quoting a copyrighted work count as publication?September 14, 2008 at 3:46 am #3902
Copyright is the same on websites as it is anywhere else – you must get the permission of the copyright owner before reproducing the work.
There is a “fair use” exception, whereby you may quote excerpts for review purposes. This area is very complicated, but generally, the limit is around 10%.
As far as I know, you are at liberty to describe the ideas in your own words. Similarly, I believe you may, for instance, present a chart of data in your own format.
Most scientific works produce an abstract which may be reproduced in full. Almost all of these are available on PubMed.September 14, 2008 at 4:18 am #3903
I've had a look at the research you mention.
The McGrath Rigby study is interesting, and available in full online. These reports often get moved or taken down, so I won't link to it directly. However it is easy to find by searching for “Hepcidin: inflammation's iron curtain”.
There is no abstract available. The most interesting part of it, for me, is:
A broader phlogistic potential of iron towards the joint comes from a recent report that iron depletion by serial phlebotomies diminishes recurrences of gouty arthritis
The report to which it refers is “Near-iron deficiency-induced remission of gouty arthritis”, a fascinating tale of blood-letting and gout remission.
The abstract is available:
Objectives. Previous evidence supports a role for iron in the pathogenesis of gout. For example, iron, when added to media containing urate crystals, stimulated oxidative stress with subsequent complement and neutrophil activation. Conversely, iron removal inhibited these responses as well as urate-crystal-induced foot pad inflammation in rats in-vivo. The objective of the present study was to investigate whether or not iron removal may improve the outcome of gouty arthritis in humans as well.
Methods. Quantitative phlebotomy was used to remove iron in 12 hyperuricaemic patients with gouty arthritis and maintain their body iron at near-iron deficiency (NID) level (i.e. the lowest body iron store compatible with normal erythropoiesis and therefore absence of anaemia).
Results. During maintenance of NID for 28 months, gouty attacks markedly diminished in every patient, from a cumulative amount of 48 and 53 attacks per year before (year –2, –1), to 32, 11 and 7 during induction (year 0) and maintenance (year +1, +2) of NID, respectively. During NID, attacks were also more often of milder severity.
Conclusions. During a 28-month follow-up, maintenance of NID was found to be safe and beneficial in all patients, with effects ranging from a complete remission to a marked reduction of incidence and severity of gouty attacks.
KEY WORDS: Gout, Arthritis, Hyperuricaemia, Oxidative stress, Near-iron deficiency.
Anybody know where I can get leeches?September 14, 2008 at 11:23 am #3904
The body has no effective way of excreting iron. It guards its iron stores very jealously. Each day, we need only a trace amount of iron to replace the trace amount that we lose. Meat is the major source of iron for us because our bodies can readily absorb it. While vegetables and grain contain iron, we can only absorb two to three percent of that iron when these foods are eaten by themselves.
Excess iron does cause problems in the body. To protect itself, the body has a protection mechanism. The higher the body's iron stores, the less iron is absorbed from the food eaten. The problem is that that is only partially effective. If you are like me, you have been eatiing meat with every meal for decades. The result iis that iron has been building up for decades.
After you are fully grown, your need for iron drops dramatically for men. After menopause, women's need for iron drops dramatically. There are groups of people, like premenopausal women, who need more iron. For most of us, we don't need a multivitamin containing iron. Also, we do not need iron-enriched food. (Obviously, if your physician says that you need it, then follow his/her advice.)
I eat meat and seafood sparingly. I have switched to a multivitamin without iron. In addition, I check the foods I buy to see if they are iron-enriched. If so, I don't buy them. Also, I intend to start making regular blood donations. After I have made several donations, I will post a message about the impact. It may take a while since there is a period between donations. Is anyone out there who is already donating blood? If so, has it made a difference?September 17, 2008 at 11:07 pm #3911
There is some interesting research work that has been done by Andrew Ghio and others. One is a study titled “Iron regulates xanthine oxidase activity in the lung”. Xanthine oxidase is also the enzyme that converts purines into uric acid. The more iron, the more uric acid. The less iron, the less uric acid. Ghio has done other studies on the subject. The writeup was at address http://ajplung.physiology.org/cgi/content/full/283/3/L563. The significance is that there are foods that help the absorption of iron in the intestines and those that inhibit the absorption of iron. By including the foods that inhibit the absorption and avoiding the ones that promote the absortion, we can affect the amount of iron we take in. Unfortunately, the big food that promotes absorption is ethanol as in alcoholic beverages. The foods that inhibit absorption are dairy foods (particularly low-fat dairy), coffee, and foods high in phytic acid. Anyway, take a look at the research and see what you think.March 11, 2009 at 5:27 am #4221
A most interesting final paragraph in that report:
Rather than preventing generation of a remarkably beneficial iron chelator and antioxidant [uric acid - my italics] with allopurinol or increasing its urinary excretion with probenecid, perhaps a more rational treatment for hyperuricemia might be not only the avoidance of highly absorbable iron in red meat, but also regular voluntary donation of blood to decrease the relatively elevated body iron stores of men and postmenopausal women, thereby balancing decreased uric acid production with antioxidant needs.
I've spent some time looking at this, related research, and natural chelators in diet, e.g. green tea and coffee.
I have not yet drawn this altogether in publishable form, but the evidence seems overwhelming.
Excess iron encourages more uric acid (from the aforementioned report).
Given that meat is iron rich, and dairy products, through the calcium content, I believe, are natural iron chelators, I begin to question the conclusions of some famous gout and diet statistical studies.
Also, coffee is a good iron chelator. Can this explain the link between coffee consumption and reduced gout?March 20, 2009 at 1:29 pm #4290
I'd be curious to know how often one should be donating blood if they want to decrease their iron content level. Also, reducing iron content sounds good, but we need to have more information through tests if it actually lowers the blood uric acid level and elminates or reduces hyperuricemia.
If it does lower the uric acid level, then we need to see what effect reducing the dosage of Allopurinol would have. It would be nice to get to the point where gout could be managed solely through diet, however we should be careful before we jump to that conclusion.
Keep up the good work on the articles and research!May 10, 2010 at 6:26 pm #8604
Will blood banks take my Gouty + Allop polluted blood? I thought I would ask before getting the process rolling.
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