Pain is a great motivator providing the impetus for patients to seek help and change their habits. 

It is also one of the hallmark signs of inflammation and a powerful signal that something is amiss in the body. Like many other physiological processes, inflammation is very useful in the short term; allowing the body to protect itself, heal, and rid itself of pathogens, but when allowed to continue ad infinitum, it becomes detrimental to the whole system as we will see in this case.

Initial Consultation

A 34-year-old male presented with a 12-year history of gout occurring in his knees, fingers, ankles, elbow and wrist. The patient had a visibly swollen right elbow and wrist at his initial consultation. He reported sharp pains every day which he treated with the NSAID Diclofenac 12.5 mg 5-6 tablets daily along with diazepam 5 mg 1-2 times daily. His case history revealed poor energy (4/10), high stress (7.5/10), loose bowel movements, abdominal pain (associated with NSAID use) with occasional blood on the toilet paper, low libido, tired muscles with cramping in hands and legs, salt and carbohydrate cravings and overweight. He had a strong family history of diabetes on both sides of his family.

His diet was of poor quality consisting of highly processed, high glycaemic index snack foods, with the exception of a green smoothie containing lemon, cucumber, bok choi, carrot, ginger, garlic and kale for breakfast and a low water intake. Initial treatment was aimed at reducing pain and downregulating inflammatory pathways, improving uric acid removal, assisting with kidney and liver detoxification, and correcting nutrient insufficiencies.

Initial Treatment

Treatment consisted of a liquid herbal containing clivers (Galium aparine) 25 mL, juniper (Juniperus communis) 15 mL, dandelion root (Taraxicum officinale) 20 mL, devil’s claw (Harpagophytum procumbens) 40 mL, ginger (Zingiber officinale) 5 mL given at a dose of 7.5 mL twice daily, along with a herbal tablet for reducing inflammation containing boswelia (Boswellia serrata), turmeric (Curcuma longa), celery (Apium graveolens) and ginger (Zingiber officinale) given at a dose of 1 tablet 3 times daily.  He was also prescribed another herbal/nutritional tablet for reducing inflammation and healing soft tissue containing grape seed extract (Vitis Vinifera), ginger (Zingiber officinale), bromelains, ascorbic acid and quercetin dihydrate – given at a dose of 2 tablets twice daily.

To improve nutritional status, reduce cramping and support healthy insulin signalling (as healthy insulin signalling is a key factor in improving uric acid clearance in gout), I prescribed a nutritional powder containing magnesium (as citrate, phosphate and orotate) along with B vitamins and micronutrients at a dose of 1 teaspoon twice daily in water. The patient was instructed to continue his own vitamin C tablet at 1000 mg twice daily. Dietary advice included reducing red meat and avoiding oily fish to assist in reducing uric acid build up, increasing water intake to 2-3 L daily, replacing black tea with green tea to reduce caffeine intake reduce uric acid buildup, and replacing starchy, processed carbohydrates with vegetables and whole grains.

2-Week Follow-Up 

On the second visit (2 weeks later) the patient reported that his joint pain had been better except for an ‘attack’ after eating a bolognaise the night before, he had not been taking any diazepam and had reduced his use of diclofenac to one tablet once per week. He noted that the swelling had gone down in his right hand, but his elbow swelling remained the same. His energy had improved from a 4/10 at the initial visit to 6/10, and his bowel movements had normalised with no loose stools, pain or blood. He reported muscle fatigue in the mornings. His diet was somewhat improved with the removal of many of the high carbohydrate snack foods and an increase in water consumption, however his vegetable intake was still very low.

Blood work showed elevated uric acid, high ferritin (indicating acute inflammation), high LDL and low HDL cholesterol, elevated TSH, low testosterone, and low vitamin D3. His previous prescription was continued, with the addition of Vitamin D3 1000 mg twice daily, additional blood glucose support provided by a tablet containing chromium, gymnema (Gymnema sylvestre) and cofactors to support insulin signalling taken 1 tablet 3 times daily with food. He was also prescribed a herbal tablet to support thyroid function containing bladderwrack (Fucus vesiculosus), bacopa (Bacopa monnieri) and withania (Withania somnifera) 1 tablet 3 times daily. Dietary advice was reinforced and I offered the patient further suggestions about how to achieve these goals.

4-Week Follow-Up

At the third consultation 2 weeks later, again the patient reported that his reduction in joint pain was amazing, he would still get pain from time to time, but was taking no pharmaceutical medication at present. The swelling was yet to improve. He also reported feeling more energy within one week of taking the new supplements, said he was bouncing out of bed and his energy was now 8/10. His muscle fatigue was no longer present and his gut health continued to be stable.

The patient made significant improvements to his diet with the inclusion of more green vegetables, however further changes were encouraged. His treatment remained the same as previous, with the inclusion of additional herbal and nutritional tablets to support adrenal output and energy production containing withania (Withania somnifera), Siberian ginseng (Eleutherococcus senticosus), licorice (Glycyrrhiza glabra), rhodiola (Rhodiola rosea), Korean ginseng (Panax ginseng) and Tyrosine given at a dose of 1 tablet twice daily with breakfast and lunch. Unfortunately, the patient ceased consultations at this point so I was unable to follow up on his biochemistry and monitor his progress. I have no doubt that with extended treatment this patient’s remaining health issues would continue to improve with further reduction of inflammation and insulin resistance in his body.