Q: My friend has gout. What causes this, and how can he get relief?

A: Gout is a type of arthritis that causes intense aching, usually in the feet and especially the big toe. It develops when uric acid (a normal waste product of protein metabolism) crystallizes and builds up in the joints. Risk factors include hypertension, high cholesterol and/or high triglycerides (blood fats), obesity, diabetes and a family history of gout. Many people with gout have insulin resistance, a prediabetic condition in which the body’s cells don’t properly use the glucose-transporting hormone insulin. This raises levels of insulin and glucose, impairing the kidneys’ ability to remove uric acid from the body. Alcohol, organ meats and shellfish (especially shrimp) may increase uric acid levels, provoking a gout attack within 24 hours. A gradual buildup of uric acid can occur from long-term use of aspirin or various diuretics.

To minimize uric acid formation and crystallization, your friend should eat lots of fiber and limit less healthful carbohydrates, such as cookies and soda… drink 64 ounces of water daily… eat one to two dozen fresh, frozen or dried Bing cherries daily, or take 1,000 mg three times daily of cherry extract… and take celery seed extract at a dose of 500 mg three times daily.