Dr David L. J. Freed, MB, MD, MIBiol
In the last episode I told you about my ‘gout’, which was only partly caused by urate – the serum and urinary levels were never high enough to explain it entirely whereas attacks could be provoked by a precise combination of three factors – nuts, wine, and URTI – all against that constant background of high-normal serum urate. Once I spotted that pattern of triggers it was fairly simple to stay out of trouble – for a while.
But after about two years the attacks gradually started coming back. As I have said before, it takes a lot of time and much serendipity to track down multi-factorial illnesses, and had I not been living in this body of mine and deeply averse to taking conventional medication I’d never have spotted the patterns. By my early 60’s I was back on allopurinol again after 25 drug-free years. It ameliorated the gout fairly well but it also made me impotent (funny, I don’t remember that happening before, when I was 30!) and in spite of it I was still getting occasional gout. By that stage of my life I was also taking a handful of nutritional supplements supplied by my friend and colleague Margaret Moss and I was indeed protected thereby from the unpleasant feverish colds that I had hitherto caught a couple of times a year. I was particularly pleased by the “magnesium ascorbate”, which as well as tasting quite nice also relieved the chronic constipation I have suffered since childhood. I took up to 20 grams a week of this concoction, which handled and tasted (and probably is) just a simple mixture of ascorbic acid crystals with magnesium hydroxide (Milk of Magnesia) powder.
But then I forgot to take my supplements on holiday with me one year, and the gout attacks stopped. Well well. After a week I also caught one of my old feverish colds, although the grandchildren I been playing with were infection-free at the time. Intrigued, I waited until the URTI passed and I did not re-start the nutritional supplements – the gout stayed away. I took an experimental dose of the ascorbate – and the gout returned. I stopped the ascorbate and the gout stopped. To my fascination, that pattern repeated itself several times though not – frustratingly - every time.
So high-dose vitamin C apparently did two things, over and above its nutritional value: (a) it stopped my feverish colds and (b) aggravated my tendency to gout, and I can’t help wondering whether those two effects are linked. High-dose vitamin C is anti-inflammatory, just like aspirin [1] but not necessarily virucidal, so it could suppress symptoms while at the same time allowing viruses to multiply freely in the body without the healing effects of inflammation. Yes, inflammation is the body’s route to healing, serving to expel antigens from the tissues and clear away the debris of tissue damage so that healing can begin. My hypothesis is that the high-dose magnesium ascorbate was prolonging infections by suppressing inflammation – and those viruses were making my tissues susceptible to allergic inflammation. When I stopped the vitamin C my immune system was suddenly released from its handcuffs and started doing its job properly, giving me the inflammation (and its symptoms) that got rid of the viruses and so stopped the gout. Well, that’s all hypothesis of course; had the gout stayed away I would have been satisfied.
I bought my own ascorbic acid crystals and some magnesium hydroxide powder and mixed them in a 1:4 ratio instead of the 1:1 of my original concoction, and with that I seem to be OK. I stopped the allopurinol and remained gout-free for nearly two years.
Then of course the attacks gradually re-commenced, and once again only stopped when I forgot my supplements for a while. I was suspicious of my remaining handful of nutrient supplements, but which one(s)? I tried stopping them all then reintroducing one at a time, but got no clear answer (as is typical of a multi-cause condition) – I was at impasse.
Enter serendipity (I have seen “serendipity” defined as going to search for a needle in a haystack, and finding the farmer’s daughter!) Concerned about my continuing erectile dysfunction and my mild residual angina, I began to wonder if chelation therapy might help. A hair analysis at Biolab showed a high mercury load so I took myself to my friend Dr Shideh Pouria who gave me a diagnostic chelation drip and found evidence of several toxic elements in the post-drip urine – arsenic, nickel and lead, as well as mercury (all probably from overdosing on fish – I had been eating a lot of fish under the impression that the omega-3’s would be good for me). She started me on a course of chelation, and Margaret adjusted my nutrient intake in accordance with further test results from Biolab and Acumen.
I also sought the advice of a local CAM practitioner, Dr Kalman. An interesting guy this – he has a PhD in psychoanalysis and hypnotism and practises all sorts of wacky way-out CAM methods. He prescribed Damiana ticture and ginseng for the impotence but they gave me gout, so he decided to treat my gout first.
Now Dr Kalman’s treatment for gout consists of blistering the painful joint, to “suck out the poisons”. This is achieved by applying a suitably sized piece of linen impregnated with Cantharides (“Spanish Fly” – the extract from a type of mediterranean beetle) for 24 hr, after which there is a big blister over the site, containing about 1-2 ml of clear straw-coloured fluid, and the joint feels better! I sent
the blister fluid to Nick Miller at Biolab, together with a simultaneous blood sample for comparison, and he confirmed Dr Kalman’s prediction that the fluid would be rich in urate (considerably more than the urate in the blood at the time). I sent another blister fluid a few weeks later and both results are here:
|
|
Blood |
Blister fluid |
| uric acid |
356 N (210-420) |
541, 436 high |
| albumin |
46.7 N (35-60) |
32, 33 low |
| total antioxidant |
1.21 low (1.32-1.58) |
|
| nutritional antioxidant |
354 low (450-800) |
|
| mercury |
11.7 acceptable (<15) |
none |
| cadmium |
<1 acceptable (<3) |
0, later 19 (‘acceptable’ but higher) |
| arsenic |
65 high (<60) |
63 high |
| cobalt |
|
49.6 high (10) |
| nickel |
|
27.0 high (5-13) |
| selenium |
|
1.57 low (1.75-3.5) |
The albumin in the blister fluid was a lot lower than in the plasma, so this fluid is not a simple transudate of serum – either some dilution or some ultrafiltration has gone on in the transition from blood to interstitial fluid – so a higher level of anything in the blister fluid (urate and on one occasion cadmium) is strong evidence of sequestration in the tissues. I’ve applied blister plasters to about a dozen areas around my ankles (favourite site for gout these days) and the gout is about 90% better though I still have some lingering pain. I find it hard to believe that lowering the urate level in the joint tissues by a total of half a micromole would make much difference, but I suppose a dozen such treatments might – maybe it really does suck out the poisons as Dr Kalman asserts.
So the gout is under pretty reasonable control now, and the angina very mild and very rare (only after a heavy meal).
And the sexual function? Mind your own business!
REFERENCES
1) McEwen LM. EPD and Allergy (2003). McEwen Laboratories, Pangbourne, pA13.12
Appendix: Nutritional notes from Margaret Moss
I assessed David’s various problems, to guide my nutritional advice.
He keeps fairly much to a stone age diet, which limits the extent to which he can reduce purines. He tried having more of the lower purine meats and fishes, with no apparent benefit. I suggested he avoid alcohol. Wine and beer are both reported to increase the incidence of gout attacks. Beer contains guanosine, a nucleoside, containing the pentose ribose and the purine guanine. However, intake of wine appears to be as much related to gout as intake of beer. I advised David to minimise his fructose intake, whether from fruit or sucrose. Sucrose is a disaccharide, made of fructose and glucose. Fructose intake is strongly associated with gout. In addition, fructose glycates LDL more than glucose, leading to atherosclerosis.
Too much or too little molybdenum is associated with gout. Xanthine oxidase and dehydrogenase are molybdenum containing enzymes, involved in making uric acid. Molybdenum supplements are to be avoided in gout, unless there is laboratory evidence of deficiency. Folic acid inhibits xanthine oxidase, as well as recycling homocysteine, a substance thought to cause artery damage. High dose vitamin B3 as nicotinic acid (niacin) is to be avoided, as it competes with uric acid for renal excretion. Vitamin A supplements are to be avoided, as aldehyde oxidase and aldehyde dehydrogenase convert retinol to the more toxic retinoic acid. Aldehyde oxidase is another molybdenum enzyme, and may be particularly active in those with highly active xanthine oxidase. Moreover, retinoic acid increases the synthesis of S-adenosylhomocysteine from S-adenosylmethionine, leading to increased homocysteine production. Plasma zinc may be deceased during gout attacks, and zinc is needed for making all cells, including those of the immune system. So those like David who are prone to infections should make sure their zinc intake is adequate. Vitamin B12 and B6 also lower homocysteine. Vitamin B6 depends on vitamin B2, zinc, and magnesium, and magnesium depends on vitamin B1. Magnesium inhibits blood clotting and vascular muscle contraction. Vitamins E and C and beta carotene have been found to be negatively associated with endothelial tissue damage.
Vitamin E reduces clotting. Vitamin C in men is inversely associated with serum uric acid. Low vitamin D is associated with all-cause and cardiovascular mortality. L-lysine may act against established atherosclerotic plaque, and is needed to make L-carnitine, the amino acid that transports long chain fatty acids into mitochondria for beta oxidation, to make energy for cells, including heart cells.
I therefore asked David to take
Health Plus Multivitamins Without Vitamin A (and without molybdenum), 1 with breakfast
Solgar magnesium 100 mg as amino acid chelate,1 twice a day
Solgar folic acid 400 mcg, 1 a day
Lamberts L-lysine 500mg, 1 a day
Lamberts zinc 15 mg as citrate, 1 at bedtime
Solgar vitamin E 200 IU, 1 with evening meal
Higher Nature vitamin D 500 IU, 1 with evening meal.
