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Gut dysbiosis is one major cause of Gout


Our body is host to various organisms-bacteria, fungus, viruses etc. They are collectively known as the microbiota. Most of these contribute to our body’s natural processes. Dysbiosis typically occurs when the microbes in our gastrointestinal tract (stomach and intestines) - become unbalanced. This can be caused by an imbalance in the microflora, changes in their functional composition and metabolic activities, or a shift in their local distribution. Dysbiosis can play a significant role in many health issues. Many latest researches have proved that there is a close association between dysbiosis and gout.


This article explains this connection between the duo and discusses how gut microbiome in gout patients is different from healthy beings.


What is gout?

Gout is a very uncomfortable, essentially an inflammatory condition, which can cause an attack of sudden burning pain, stiffness and swelling in the joints. It can affect joints and tendons if left untreated. It is a kind of inflammatory arthritis.


A gout attack may come after an illness or injury. The first sign of gout is often pain in the big toe. It usually affects one joint at a time, but it can spread to other joints making them appear red and swollen.


Is gout due to excess intake of proteins?

Conventionally it has been told that gout is due to high intake of proteins but fundamentally, gout is caused by an impairment in purine metabolism. Purines are present in many foods we eat, and when they break down, they are converted into uric acid. This uric acid is usually efficiently excreted so it doesn't cause a problem. However, when uric acid is not expelled properly the levels of it become high in the bloodstream resulting in it being deposited as uric acid salt crystals in joints and surrounding areas. This in turn can lead to excruciating joint pain.


High purine foods are shellfish, organ meats, commercially produced red meat and poultry, beer, yeast, etc


How is Uric acid excreted from our body?

  1. 70% is excreted through the kidney

  2. 30% is excreted by the intestine. Intestinal bacteria play a large role in the metabolism of purine and uric acid. This is because targeted enzymes are secreted by specific intestinal bacteria, which in turn break down the uric acid.

Can Gut bacteria predict gout?

A new study reports that the intestinal microbiome of gout patients is highly distinct from the intestinal microbiome of healthy individuals. Usually, gout is diagnosed using a blood test. This means that intestinal bacteria could become a major diagnostic criteria for gout, rather than the blood test alone. It may even be more accurate and can become the basis of further treatment for gout. The gut microbiota profile of gout patients was also distinct from healthy individuals.


Some recent findings are:

  • Bacteroides caccae were enriched in gout patients. These bacteroides have previously been recognized as a biomarker of Inflammatory Bowel Disease. Hence, the increased level of this bacteria in gout patients could also potentially lead to an inflammatory response.

  • Significantly less presence of the bacteria Faecalibacterium prausnitzii was seen in gout patients. This particular bacterium plays an important role in butyrate production. Butyrate is a short chain fatty acid that is important for the gut. It provides nutrition for the intestinal mucosa, enhances intestinal immunity, promotes growth and repair of the villi on the gut wall, and also helps to keep the gut bacteria in balance.

  • Xanthine dehydrogenase enzyme is an enzyme that degrades the purine to uric acid. This enzyme was enriched in the gout patients, whereas the allantoinase-the enzyme that degrades the uric acid to urea was depleted. This leads to increasing levels of uric acid, which cannot be further degraded to urea, resulting in accumulation of uric acid and consequent aggravation of gout symptoms.

It's time to change the approach to the treatment of gout. Check out our blog on Functional Medicine approach to treating Gout to know how to treat gout.


At Functional Medicine Clinic, we help people reverse their chronic diseases, by addressing the root cause and be healthy & vibrant again!





References

1. Hosomi, A., Nakanishi, T., Fujita, T., & Tamai, I. (2012). Extra-renal elimination of uric acid via intestinal efflux transporter BCRP/ABCG2. PloS one, 7(2), e30456. https://doi.org/10.1371/journal.pone.0030456

2. Guo, Z., Zhang, J., Wang, Z. et al. Intestinal Microbiota Distinguish Gout Patients from Healthy Humans. Sci Rep 6, 20602 (2016). https://doi.org/10.1038/srep20602

3. Thevaranjan, N., Puchta, A., Schulz, C., Naidoo, A., Szamosi, J., Verschoor, C. P., Loukov, D., Schenck, L. P., Jury, J., Foley, K. P., Schertzer, J. D., Larché, M. J., Davidson, D. J., Verdú, E. F., Surette, M. G., & Bowdish, D. M. (2017). Age-Associated Microbial Dysbiosis Promotes Intestinal Permeability, Systemic Inflammation, and Macrophage Dysfunction. Cell Host & Microbe, 21(4), 455–466.e4. https://doi.org/10.1016/j.chom.2017.03.002

4. Carding, S., Verbeke, K., Vipond, D. T., Corfe, B. M., & Owen, L. J. (2015). Dysbiosis of the gut microbiota in disease. Microbial Ecology in Health & Disease, 26(0). https://doi.org/10.3402/mehd.v26.26191

5. Chan, Y. K., Estaki, M., & Gibson, D. L. (2013). Clinical Consequences of Diet-Induced Dysbiosis. Annals of Nutrition and Metabolism, 63(s2), 28–40. https://doi.org/10.1159/000354902

6. Levy, M., Kolodziejczyk, A. A., Thaiss, C. A., & Elinav, E. (2017). Dysbiosis and the immune system. Nature Reviews Immunology, 17(4), 219–232. https://doi.org/10.1038/nri.2017.7

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