out is one of the oldest known joint diseases. Incidences of gout are recorded in the ancient medical records. Hippocrates, the Father of Western Medicine, had enlisted the key clinical features of the disease, popularly known as the “Aphorism of Gout” in the 5th century BC. The ancient physicians blamed the affluent lifestyle for the joint disorder that primarily affected older men. However, recent epidemiological data suggests that though the prevalence of the disease is still higher in the economically advanced nations, the number of gout patients is steadily increasing in developing countries. Prevalence of gout among women has also increased dramatically in the modern era.  Hence, managing the symptoms of gout is crucial for improving the quality of health of people afflicted by this disease.
Accumulation of monosodium urate crystals (MSU) in the tissues in and around the joints causes gout. This is a systemic disease associated with elevated serum uric acid level, also known as hyperuricemia. When the uric acid level rises above the point of saturation, it starts crystallizing into MSU. Though hyperuricemia is the main cause of gout, only 5% of people with serum uric acid level above 9mg/dl actually develop the disease. Therefore, it is believed that genetics plays an important role in the development of gout. Lowering the serum uric acid level below the threshold with the help of drugs and dietary modifications helps in controlling gout. 
Causes of Gout
Uric acid is a byproduct of the metabolism of purine, a compound that occurs naturally in a large number of foods. Foods that are especially known for their high purine content are organ meat, game meat and sea foods including mussels, sardines, herring and anchovies, and beer. Red meat, chicken, fish, beans, lentils, peas, spinach, cauliflower, asparagus, and mushroom are moderate sources of purine.  In normal conditions most of the uric acid produced in the body is flushed out through urine. Overproduction of uric acid or under-excretion of uric acid elevates the serum uric acid level, which in people genetically predisposed to gout, leads to deposition of MSU crystals in the tissues.
Deficiency of an enzyme essential for the metabolism of uric acid elevates the serum uric acid level. This is a rare condition that results in early onset of gout in children and young adults. Hyperactivity of a specific enzyme associated with purine metabolism is another possible cause of uric acid overproduction. However, only 10% of cases of enzymatic disorders lead to overproduction of MSU crystals. Though purines are present in a large number of foods, studies have shown that overproduction of uric acid occurs primarily by eating cooked and processed seafood and animal food and consuming alcoholic drinks especially beer.
Inflammatory diseases, hematological disorders, and malignancies are known to speed up endogenous uric acid production. Leptin, a hormone which is elevated in overweight and obese individuals, could increase urate production. Hence, the risk of high uric acid level and gout are higher in people who are overweight. Excess urate production could also be stimulated by tissue damage and chemotherapy.
However, only 10% of all cases of gout are associated with overproduction of uric acid, whereas, decreased excretion of uric acid accounts for 90% of the cases. 
Symptoms of Gout
The major symptom of gout is intense pain in the affected joints. The joint of the big toe is the most common site of a gout attack. Gout can also affect the ankles, elbows, fingers, wrists, and knees. During the acute stage, the severity of the pain increases within the first 4 to 12 hours. Though the pain starts subsiding over time, you will continue experiencing discomfort in the affected joint that could last for a few days or even for weeks. The duration of the pain and discomfort tends to increase as the disease spreads to the other body joints. In addition to pain, the joints become red, warm, tender and swollen. It also limits the mobility of the affected joint. 
How to Control Gout Symptoms
There are a number of natural ways to alleviate the pain and discomfort and reduce the risk of recurrent gout attacks.
1. Increase Intake of Vitamin C
Several studies have revealed an association between high vitamin C intake and lower risk of gout. Vitamin C helps in lowering the serum uric acid level probably by inhibiting renal re-absorption of uric acid, thereby increasing uric acid excretion through urine. Research suggests that regular intake of 1500 mg or more of vitamin C could reduce risk of gout by up to 45%.  For managing the symptoms of gout and controlling the uric acid level, add fruits and vegetables rich in vitamin C to your daily diet. Among fruits, citrus fruits, pineapple, berries, watermelon, mango, papaya, kiwi fruit, and cantaloupe are best known for their high vitamin C content. Vitamin C is found in large quantities in a number of vegetables especially bell peppers, cauliflower, broccoli, cabbage, spinach, leafy greens, tomato, winter squash, and potatoes. 
2. Eat Cherries Daily
Consumption of cherries could help in lowering the risk of gout attack. A study has shown that consuming up to three servings of cherry for two days helped reduce gout attack risk by 35%. However, the further increase in cherry intake did not provide additional benefit. Researchers found that the risk of gout attack decreased by 45% by consuming cherry extract during the same period. The high concentration of anthocyanins that are known for their powerful anti-inflammatory activities is believed to be a possible cause of the beneficial effect of cherries. Tart cherries are also known to decrease the serum uric acid level by inhibiting uric acid production and by stimulating uric acid excretion by reducing renal reabsorption.  If you are susceptible to a gout attack, eat half a dozen cherries daily to reduce the risk of recurrent attacks. For fast relief from the symptoms of an existing attack, eat 20 to 30 cherries when you experience the initial symptoms. 
3. Add Magnesium Rich Foods to Diet
Studies have found an inverse association between intake of magnesium-rich foods and elevated serum uric acid level or hyperuricemia. Marginal to moderate deficiency of magnesium is known to worsen chronic inflammation. People deficient in magnesium usually have a high level of serum C-reactive protein, which is the most important biomarker for inflammation. The uric acid-lowering effect of magnesium combined with its anti-inflammatory activity seems to help in alleviating the gout symptoms.  The magnesium-rich foods that are easily available are pumpkin seeds, almonds, spinach, cashews, soy, peanut, avocado, oatmeal, brown rice, and kidney beans. 
4. Eat Turmeric
Curcumin, the main bioactive constituent of turmeric, is known for its anti-inflammatory activity. It inhibits synthesis of inflammatory substances known as prostaglandins, thereby relieving pain and swelling. Although the anti-inflammatory activity of curcumin is similar to that of the pain-relieving drugs, it is weaker than the conventional medications. Nevertheless, unlike the pain relief drugs, turmeric is safe for long-term use and can help in fighting chronic pain. When taken in high doses, curcumin stimulates the production of cortisone, the body’s own pain-relief chemical.  Furthermore, curcumin is also known to inhibit an enzyme essential for the production of uric acid, which further enhances the benefits of turmeric in gout management. 
5. Drink Ginger Tea
Because of its anti-inflammatory effect, ginger is believed to be an effective remedy for inflammation and pain associated with gout. In a study, investigators have attributed the beneficial effect of ginger in fighting acute gout attacks to its bioactive component 6-shogaol.  Ingesting a piece of raw ginger or ginger tea several times a day could help in alleviating the gout symptoms. You can also apply ginger root paste to the affected area. 
6. Use Juniper Berries
Juniper berries are being used by herbalists in Europe since the 16th century for management of gout. Traditionally, the berries are cooked in wine and then ingested. Topical application of juniper berry oil is also believed to be an effective remedy for gout pain and discomfort.  Juniper berry is a natural diuretic. By stimulating the kidneys, it helps in increasing uric acid excretion that helps provide relief from gout attacks. To reduce the risk of recurrent gout attacks, you can take 0.5 to 1 ml juniper berry tincture thrice a day. However, people with a kidney disorder should avoid juniper berries. 
7. Have Stinging Nettle Tea
Stinging nettle is another natural diuretic that is known to speed up the excretion of uric acid, thereby alleviating the symptoms of gout. If you are susceptible to gout, you can take nettle tea prepared by steeping one tablespoon of nettle leaves in two pints of boiling water for 10 to 15 minutes. Tea prepared with nettle roots is a more powerful diuretic than nettle leaf tea. To prepare nettle root tea, boil one teaspoon of root in two pints of water for one to two minutes. 
8. Try Devil’s Claw
The root of Harpagophytum procumbens is commonly known as devil’s claw. It works as a natural analgesic and could reduce gout pain. You can take 750 mg of the herb thrice day. However, devil’s claw is not recommended for people on blood-thinning drugs.  In a clinical study, researchers found that people with gout or rheumatic pain who took 1230 mg of the root extract daily for up to a month experienced improvement in the symptoms with fewer side effects. Furthermore, devil’s claw was found to be more effective than the non-steroidal anti-inflammatory drug phenylbutazone. 
9. Manage Pain with Boswellia
The gum resin of the Boswellia serrata tree is widely used in traditional Indian medicine for combating arthritis pain. Studies with animal models have revealed that administration of boswellic acid, the important active constituent of the gum resin, helps in reducing pain induced by deposition of monosodium urate crystals. Hence, it can be used as a remedy for gout pain.  For managing the gout symptoms, you can take 300 to 400 mg of Boswellia extract with 70% Boswellic acids thrice a day between meals. 
10. Fish Oil Supplement
The anti-inflammatory activity of the omega-3 fatty acids found in fish oil could help in providing relief from pain and swelling related to gout. Though fatty fish such as salmon and mackerel are rich sources of omega-3 fats, but because of their high purine content, fish oil supplement is believed to be a better source of these important fats for gout patients. Try to get 3 to 6 grams of omega-3 fatty acids with meals. 
11. Bromelain Supplement
Bromelain is a proteolytic enzyme derived from the pineapple stem. It is known to help in attenuating swelling of the soft tissues associated with trauma or injury. This beneficial effect of bromelain, in addition to its analgesic property, could help in relieving symptoms of gout.  To combat gout attack, you can take 40 mg bromelain thrice a day. However, avoid bromelain supplement if you are taking an anticoagulant. 
12. Drink Celery Seed Tea
Celery seed is recommended in folk medicines as a remedy for gout. It seems to work by lowering the uric acid level. Furthermore, it is a source of anti-inflammatory compounds. Gout patients can drink celery seed tea daily. To prepare the tea, steep one to two teaspoons of freshly crushed celery seeds in a cup of boiling water for 20 minutes. Strain and drink the tea. You can drink up to three cups of celery seed tea daily. Celery seed extract can also help. 
13. Try Baking Soda Solution
Regular intake of baking soda solution is believed to be an effective remedy for gout. Baking soda is known to restore the normal pH of the blood that indicates that it is capable of breaking down excess uric acid. It is also believed to support excretion of uric acid. Frequency of gout attack could be reduced by taking one teaspoon of baking soda with an ounce of water daily. 
In addition to the aforementioned natural remedies, certain dietary and lifestyle changes can help in alleviating the gout symptoms and reducing recurrent attacks. Follow a healthy diet and drink plenty of water. Limit intake of purine rich foods especially organ meat, red meat and seafood and alcoholic drinks and beverages sweetened with fructose. Exercise daily to maintain healthy body weight.