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What Is Gout and What Could Cause It?Answered by Dr. Sarah Myhill, MD*
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Q: My one ankle has begun getting swollen, painful and hot at times. My MD said it sounds like gout so I should come in for a look-see. What’s gout and what could cause it?
A: Gout is one of those conditions that never really made sense to me until I learned that uric acid is an important antioxidant in the bloodstream. What this means is that if levels of other antioxidants fall low, then the body compensates for this by pushing out more uric acid.
That is absolutely fine, but the trouble is that if the level of uric acid gets too high, then, being rather insoluble, it precipitates out as crystals in the joint to cause an acute attack of gout.
This is very tiresome because acute gout is extremely painful! The immune system does not like these gritty crystals in the joints and produces lots of inflammation to get rid of it and it is this that causes the heat, pain, swelling, redness and loss of function.
The diagnosis is made by the characteristic clinical picture of acute severe joint pain. But one can also get a low grade generalized arthritis from gout.
Blood tests [www.umm.edu/ency/article/003476.htm] will show high serum uric acid and it is this that gives the game away.
In the acute phase the priority is to stop the inflammation. Non-steroidal anti-inflammatories (NSAIDS) such as indomethacin... are highly effective.
A drug which switches off inflammation in the immune system such as [the prescription drug] colchicine is also highly effective. Colchicine comes from the Autumn crocus.
Prevention of Attacks
This needs to be done by improving the antioxidant status in the bloodstream (See “Antioxidants and Free Radicals – What They are and What They Do.”)
Improving antioxidant levels will bring the level of uric acid down.
This also explains why gout and running a high uric acid is said to be a risk factor for arterial disease. Actually I believe it is the other way round. Having poor antioxidant status is a risk factor for arterial disease and serum uric acid is symptomatic of this.
Acute attacks of gout are often triggered by dehydration for obvious reasons (uric acid more concentrated) and so drinking plenty of fluids helps resolve an acute attack.
* Dr. Sarah Myhill, MD, is an internationally known, UK-based private nutritionist with a special interest in fatigue. This information is reproduced with kind permission from her informative website at www.drmyhill.co.uk. C Sarah Myhill Limited :: Registered in England and Wales :: Registration No. 4545198.
Note: This information is general and should not be taken as medical advice. It is not meant to prevent, diagnose, treat or cure any illness, condition or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.
What Can I Do to Help Morning Muscle Stiffness?Answered by Dr. Sarah Myhill, MD*
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Q: For years, I’ve felt very stiff in the morning, especially in my neck & lower back. The stiffness loosens up as I move around, but sometimes lasts an hour or more. What causes this, and is there anything natural I could try to prevent or help it?
A: Muscle stiffness is a symptom seen when muscles cannot move quickly without getting pain and/or spasm. Sufferers have to move slowly.
They quickly work out that after the muscle has not been used for some time - e.g., on rising from sleep, or from having sat in one position for some time - then their first movement has to be particularly slow, gentle and tentative. Moving too quickly brings about acute pain and possibly spasm. Usually it's the back, neck and proximal muscles of the shoulder and hips which are affected.
I think that the reason for this arises from the fact that evolution never meant human beings to walk on two legs.
However, we have inherited the muscle structure of creatures walking around on four legs. This means that these muscles are working at a huge mechanical disadvantage and therefore great strains are placed on them which evolution never really intended.
Happily they have developed sufficiently well to get us past child bearing, which is all that evolution cares about. So it is no surprise that stiff muscles tend to be associated with old age.
John McLaren Howard also comments that:
• Quite a few muscle stiffness sufferers seem to escape the tendency to spasm and rarely report cramp. This group seem to have high intracellular calcium in the presence of adequate magnesium.
• Those who suffer spasm and cramp when trying to free up muscle stiffness often have low magnesium and/or poor thiamine (B1) status.
[Dr. McLaren-Howard, a pioneer in nutritional and environmental medicine, co-founded the Biolab Medical Unit - a London-based lab specialized in development & provision of tests to assess bodily levels and imbalances of vitamins, minerals, and other nutrients.]
Muscle stiffness is surprisingly common - most people just adapt if the symptoms are not too severe. However, even gentle massage will make enough difference for them to realize that there is a problem. Heavy massage generally makes it worse!
Muscle spasm can occur in people who have no signs at all of general or even specific muscle stiffness.
POSSIBLE CAUSES OF STIFFNESS & SPASM
So the first question to ask is: What are the possible mechanisms that bring about muscle stiffness and spasm?
The answer is I don't really know, but thanks to John McLaren Howard… I now have some ideas which seem to accord very nicely with the clinical practice and bio-chemical findings.
• The first point is that for muscles to relax they require magnesium, and for muscles to contract they require calcium. Any imbalance of this, i.e., too much calcium or too little magnesium very much increases the tendency to spasm and contraction. Modern diets are low in magnesium and high in calcium and this will increase the tendency therefore to spasm.
• Secondly, other dietary indiscretions will also raise intercellular calcium levels. Calcium is held inside cells via a binding protein, and this is stimulated by cyclic AMP and insulin. The two dietary problems which induce these enzymes are caffeine and carbohydrates, respectively. Therefore a Western diet will tend to predispose toward muscle stiffness.
• Thirdly we have the issue of allergic muscles. [See Dr. Myhill’s article "Allergic Muscles," proposing that torn or bruised muscles may come in contact with food antigens in the blood, and become sensitized.]
• Fourthly, having established a tendency to muscle spasm and pain, we get a learned response. The brain anticipates that the muscle will go into spasm if moved too quickly, and therefore all movements are generally slowed down to prevent this from happening.
It may well be that therapies known to be effective for stiff muscles such as Pilates, Bowen technique, massage and other such manipulations are re-educating the brain into realizing that it is now "safe" to move freely. However, they will be much more effective if the underlying physical causes are also addressed.
• Finally there is clearly a neuro-psychological element. The brain is also responsible for muscle tone, and neurological problems such as Parkinson's disease will result in muscle stiffness or even spasticity. Psychological stress will also tend to increase muscle tension and worsen an underlying tendency. Diazepam (Valium) is one of the most useful muscle relaxants. Also see “Fibromyalgia – Possible Causes and Implications for Treatment.”
WHAT TO DO ABOUT STIFF MUSCLES?
• Eat a low allergen, low glycemic index, low caffeine diet. See “Stone Age Diet – A Diet We All Should follow.”
• Take the right balance of calcium and magnesium in the diet, firstly by eating a Stone Age Diet and secondly by taking nutritional supplements.
• Correct mitochondrial function. 40% of resting energy does nothing but kick calcium out of cells and drag magnesium into cells. Therefore should mitochondria start to fail, then one of the first things to go is muscle tone, perhaps because the calcium is building up in cells and magnesium is leaking out. We know that the ageing process results from mitochondrial failure.
(See “CFS is Low Output Heart Failure Secondary to Mitochondrial Failure.” This is a large subject, with links to “Detoxification” and “Magnesium.”)
• Antioxidant function. If a stiff muscle is suddenly stretched, then this will physically tear muscle fibers. Healing and repair is carried out by the immune system, which does this via a process of inflammation. Whilst this is a necessary part of healing and repair, too much inflammation causes too many free radicals which then cause damage in their own right.
Therefore it is very important to have good antioxidant status in order to limit damage created by inflammation – [see “Antioxidants - What They Are and What They Do.”]
• With age there is a tendency towards inflammation. Vitamin D (yippee - lots of sunshine) and essential fatty acids are natural anti-inflammatories. Some herbs such as Devil's Claw and curcumin have anti-inflammatory properties. Poor adrenal function with low levels of DHEA can increase a tendency to inflammation - see “Adrenal Hormones.”
• Be careful with aspirin and other such non-steroidal anti-inflammatories (NSAIs) which cause gut problems and are pain killers - pain is Nature's way of telling you to go gently with a muscle, and one does not want to damage muscle if it should be rested.
PHYSICAL TREATMENTS FOR STIFF MUSCLES
John McLaren Howard again comes to the rescue here with a fascinating idea which makes interesting links between the physical and the biochemical body! The idea here is that if a muscle is gently squashed (massaged) it responds with an "equal and opposite" pressure. Because massage does not involve active contraction of the muscle, calcium is not involved. But when the muscle relaxes, magnesium is involved, so magnesium floods into the cell and pushes calcium out.
Effectively, gentle massage pumps magnesium into cells and calcium out.
Perhaps this is why one feels gorgeously relaxed after gentle massage?
• However, the massage cannot be done by self, because the initiation of that would involve calcium fluxing into cells. It has to be done by another person (or perhaps machine?).
• Furthermore it has to be done very gently - harsher massage would involve calcium fluxing in again and be counter-productive.
People with muscle stiffness can benefit greatly from moving all joints through their full range of movement before weight bearing (i.e., before even getting out of bed). This should be done slowly and gently and there must not be any undue stretching at the end of each movement as this will initiate a calcium-into-cells action.
What one is doing is showing the muscle groups what is expected of them without invoking additional contraction – i.e., without encouraging calcium input into muscle cells.
For more information, see also Dr. Myhill’s articles on:
• “Muscle Pain in Chronic Fatigue Syndrome (ME/CFS) – Causes and Treatment.”
• “Arthritis Basics – Some Self-Care Ground Rules.”
* Dr. Sarah Myhill, MD, is a UK-based fatigue specialist focused on nutrition and preventive medicine. This information is reproduced with kind permission (article 433) from her educational website (DrMyhill.co.uk) ® Sarah Myhill Limited, Registered in England and Wales: Reg. No. 4545198. For ME/CFS patients, a special feature of Dr. Myhill's site is her free 179-page online book - "Diagnosing and Treating Chronic Fatigue Syndrome."
Note: This information has not been evaluated by the FDA. It is generic and is not meant to prevent, diagnose, treat or cure any condition, illness, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with your professional healthcare team.
The Beginning of Arthritis?Answered by Dr. Scott Olson, ND
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Q: With the onset of arthritis in your knees or hands, does it usually start in both knees or both hands about the same time? Can you have arthritis in one hand and never in the other? Thanks - Sam
A: Yes, you can have arthritis in one hand, and the likelihood of this happening depends on what type of arthritis you have. There are many types of arthritis - which means joint inflammation, from the words “arthro” meaning joint, and “itis,” meaning inflammation, the body’s natural response to injury. No matter which kind of arthritis you have, the symptoms are typically the same: redness, swelling, heat, and pain. But the course of the disease and treatment opportunities can be very different, so a diagnosis is important.
Osteoarthritis tends to attack only one side of the body. For example, a left knee may have OA, but the right knee may not.
OA, called "degenerative joint disease," is mostly thought to result from wear and tear, but genetic susceptibility appears to play a significant role. OA involves degeneration of the joint’s protective cartilage covering, and especially affects weight-bearing joints like the knees and hips; or the shoulders, elbows and fingers in someone who has performed repetitive tasks such as farming or assembly line work.
Inflammation can follow the degeneration of cartilage, when bone rubbing on bone leads to a breakdown of the joint. The most common treatment for OA is the use of anti-inflammatory herbs and supplements (such as essential fatty acids, ginger, curcumin, MSM, SAMe, and more) and medications.
By contrast, rheumatoid arthritis, which is a chronic inflammatory condition that is classified as an "autoimmune disease," often attacks the same joints on both sides of the body.
In RA, the body mistakes the joints for something foreign and attacks them. RA is unique in that it tends to cause whole-body symptoms. They are different from person to person, but range from fatigue and overall muscle weakness to infection-like symptoms such as fever and swollen lymph nodes. RA is also the disease that most commonly results in joint deformities, although they can happen with any severe form of arthritis.
The medical treatment for RA is unique because it is an autoimmune disease. It is quite varied, as practitioners attempt many different approaches to find one that works.
Note: This information has not been evaluated by the FDA. It is generic and is not meant to prevent, diagnose, treat or cure any illness, condition, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it with your professional healthcare team.
Other Common Types of Arthritis
Other types of arthritis – for example, gout, pseudogout, or infectious arthritis are also likely to affect only one joint.
• Gout typically strikes the toes, especially the big toe, and ankles, although any joint may be affected. In gout deposits of uric acid crystals in the joint release chemicals that cause inflammation. Prescription drugs are available that block production of uric acid or help the kidneys remove uric acid from the body.
• Pseudogout is more common in the knees, but can also occur in any joint. Pseudogout is inflammation of a joint caused by deposits of calcium pyrophosphate crystals. There are no drugs to treat pseudogout, other than anti-inflammatory and pain medications.
• Infectious arthritis typically strikes a large joint such as a knee or hip joint, but can be found in any joint. The infection may be introduced in many different ways, but is generally the result of an infection - bacteria, virus, or fungus - moving through the blood and ending up in a joint. Infectious arthritis tends to come on quickly.
To read much more about the different common types of arthritis, plus their local and whole-body symptoms, risk factors, diagnosis, causes, treatments, choice of a doctor, related conditions, and other types of diseases that may present with painful joints, such as osteoporosis, check out Arthritis 101 in the ProHealth.com Arthritis Health Site.
- Dr. Scott Olson, ND
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