Magnesium For Gout

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Gout, or hyperuricemia, is a fairly common condition in the United Kingdom, affecting between 1-2 people in every 100. Classified as a type of inflammatory arthritis, gout is caused by a build-up of uric acid in the blood which, over time, crystallises causing pain, discomfort, and swelling.1 Uric acid itself is a by-product produced when the body breaks down chemicals called purines. The build-up happens because we are consuming too much purine-rich food and drinks such as alcohol, some types of meat and fishes and our kidneys are failing to remove uric acid from the blood; therefore, high blood pressure, imbalance gut microbiome, and obesity or diabetes can be a contributing factor.

Magnesium is a mineral found in leafy greens, nuts, seeds, beans, milk, yoghurt, and water.2 Magnesium is very important for the body; it maintains muscles, and energy production, and supports nerve function.2 Although there aren’t often symptoms for low magnesium levels, chronically low levels have been associated with an increased risk of high blood pressure, type 2 diabetes, and heart disease.2

There’s evidence to suggest that a magnesium-rich diet can be beneficial for gout sufferers. Read on to discover why.

What role does magnesium play in a gout diet?

Gout, once known as “the rich man’s disease” or “the disease of kings”15 is associated with an indulgent diet. Consumables that induce gout are high in purine such as alcohol, seafood and the likes of venison and turkey. During the breakdown of purine, our bodies generate uric acid as a by-product. Excess uric acid can create a buildup, which in time crystallises. The sharp crystals create the pain, inflammation and swelling commonly associated with gout.

The body reduces the uric acid level in the blood in two ways: through the kidneys, around 70%, and through the intestines which excrete the remaining 30%.5

There are strong ties between the gut microbiome and gout. There’s evidence to suggest that the gut of gout sufferers generates less anti-inflammatory proteins than normal; these proteins play a key role in metabolising uric acid, thus combating excess uric acid.3,4  This condition is known as dysbiosis, or an imbalance of the gut microbiome.

Magnesium promotes healthy intestinal function, mitigating things like constipation and diarrhoea, and it is also very important for creating a healthy, balanced, gut microbiome.6,7

Magnesium is a great addition to the diet because it promotes healthy blood flow. This flushes the blood of uric acid and minimises its build-up and eventual crystallisation.8

How much magnesium should you have?

The amount of magnesium you consume is dependent on several factors including kidney function and sex. For healthy people, the NHS recommends 300mg a day for people assigned male at birth, and 270mg a day for people assigned female at birth. This amount of magnesium in the diet will promote healthy blood flow and vitality.9

Although not much research has been done in the area, taking too much magnesium has been shown to be detrimental to the gut microbiome. A study conducted in 2020 on laboratory rats shows that taking too much magnesium may cause dysbiosis (imbalance of the gut microbiome).10 Equally the NHS informs us that “taking high doses of magnesium (more than 400mg) for a short time can cause diarrhoea”.9 This is contrary to the health advice given in the US where the recommended daily allowance (RDA) for people assigned male at birth is 400-420mg and for those assigned female at birth is 310-320mg.11 This discrepancy could be accounted for by the difference in the average national diet and the NHS’ observation about diarrhoea could be attributed to an adjustment period necessary for the body to adapt to a higher daily intake of magnesium.

Benefits of magnesium for gout

As stated above the benefits of magnesium for gout pain sufferers are two fold: Firstly, magnesium is good because it promotes blood flow, getting blood to the kidneys faster where uric acid is filtered out; secondly, consuming a normal amount of magnesium builds a healthy gut biome and leads to the healthy functioning of the intestines - recall that the intestines are another place where uric acid is broken down.

This controlled study from 2018 investigates the hypothesis that magnesium is a powerful combatant of uric acid excess. A high uric acid level has a suspected association with the reduction of inflammation and inflammation-related conditions.12 The study was the first to look specifically at the relationship between dietary magnesium intake and hyperuricemia and found a correlation between the two. It warns that most Americans (who were the nationality the trial was conducted with) fail to meet their daily RDA for magnesium and so are at greater risk of developing hyperuricemia. In fact, the prevalence of gout in the US adult population was found to be around 4% in the US in 2016.13 This is a larger figure than the UK value of around 2.6% of the population and could be due to dietary variations.14, 12 

Magnesium supplements side effects

Although it is very uncommon to consume too much magnesium in food, there is an increased likelihood if you’re taking concentrated magnesium supplements. An expert with the Mayo Clinic warns against the overuse of magnesium supplements: “High doses of magnesium from supplements or medications can cause nausea, abdominal cramping and diarrhoea”.16

It has also been reported that magnesium supplements can interfere with other medications, especially antibiotics.17 The reason for this is that common medicines and magnesium use the same transport and metabolic pathways, resulting in the failed absorption of one or the other.17 The focus of this absorption is in the intestines, which is also where antibiotics are absorbed into the blood. The result is that the efficacy of antibiotics could be strongly inhibited whilst on magnesium supplements, and conversely that the body may absorb less magnesium whilst taking other medicine.

Other treatments

There are a variety of alternative means of combating gout pain which vary from other mineral supplements to prescribed medication or even surgery as a last resort. 

Acute gout attacks can be treated with prescribed non-steroidal anti-inflammatory drugs (NSAIDs) which act to ameliorate the swelling of the joints which is one of the main symptoms of gout. Magnesium salicylate is a popular example of NSAID. Another means of reducing the swelling is to apply an ice pack to the affected area. Although these are some of the most common treatments, they fail to address the root cause. 

Similar to the effects of magnesium, there are medicines which directly target uric acid production within the body. Allopurinol and febuxostat are two drugs which help to limit the amount of uric acid the body makes.18 Although these may be effective, they are often accompanied by side effects such as rashes, nausea, and reduced liver function. Febuxostat has been associated with an increased risk of heart-related death.18 Other drugs seek to improve uric acid removal from the blood such as probenecid which acts to increase kidney function; again there can be side effects including stomach pain and kidney stones.18 Some vitamins such as vitamin C may also reduce the uric acid level.  

An Epsom salt bath is reportedly a very quick and effective way to relieve gout attacks.20 Bathing in dissolved Epsom salt reportedly alleviates the symptoms of gout by promoting blood flow and having a significant anti-inflammatory effect.20 Although you must not ingest Epsom salt, there have been cases where this has led to severe magnesium poisoning.21

Other means of countering gout pain include lifestyle changes. Reducing the amount of purine-rich food and drink we consume reduces the amount of uric acid the body produces in the first place - a significant candidate to be cut out is alcohol. Exercise has also been shown to be beneficial for gout.18 Elevating the heart rate encourages healthy blood flow and promotes good kidney function. 

The NHS advises you seek professional medical advice if the symptoms get worse, i.e, increases in joint pain, or you are suffering from gout symptoms and fever as this can indicate an infection.19 Infections can occur when large crystals develop and lacerate the tissue within the joints, sometimes these crystals cant be broken down by noninvasive means and may necessitate surgery.19

Summary

To conclude, even though magnesium isn’t a catch-all solution for gout and other circulatory conditions, it is simple and cost-effective with proven evidence to show that it can help ameliorate the symptoms of gout. Magnesium also supports a number of healthy bodily functions via the gut biome and magnesium deficiency has been associated with depression, migraine headaches, inflammation, and chronic conditions such as type 2 diabetes and cardiovascular disease.12

Ultimately a balanced diet and exercise are paramount for longevity and good quality of life. Although magnesium supplements may sometimes be necessary, it is often the case that simply eating your greens will be preventative enough!

References

  1. Gout symptoms and treatments [Internet]. [cited 2023 Jan 25]. Available from: https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/gout.
  2. Gout symptoms and treatments [Internet]. [cited 2023 Jan 25]. Available from: https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/gout.
  3. Wang Z, Li Y, Liao W, Huang J, Liu Y, Li Z, et al. Gut microbiota remodeling: A promising therapeutic strategy to confront hyperuricemia and gout. Frontiers in Cellular and Infection Microbiology [Internet]. 2022; 12. Available from: https://www.frontiersin.org/articles/10.3389/fcimb.2022.935723.
  4. Bardin T, Richette P. Definition of hyperuricemia and gouty conditions. Current Opinion in Rheumatology [Internet]. 2014; 26(2):186. Available from: https://journals.lww.com/co-rheumatology/Abstract/2014/03000/Definition_of_hyperuricemia_and_gouty_conditions.14.aspx.
  5. Chu Y, Sun S, Huang Y, Gao Q, Xie X, Wang P, et al. Metagenomic analysis revealed the potential role of gut microbiome in gout. npj Biofilms Microbiomes [Internet]. 2021; 7(1):1–13. Available from: https://www.nature.com/articles/s41522-021-00235-2.
  6. jamesburgin. Mindd [Internet]. 2016. The Importance of Magnesium; Available from: https://mindd.org/the-importance-of-magnesium/.
  7. Jørgensen BP, Winther G, Kihl P, Nielsen DS, Wegener G, Hansen AK, et al. Dietary magnesium deficiency affects gut microbiota and anxiety-like behaviour in C57BL/6N mice. Acta Neuropsychiatrica [Internet]. 2015; 27(5):307–11. Available from: https://www.cambridge.org/core/journals/acta-neuropsychiatrica/article/abs/dietary-magnesium-deficiency-affects-gut-microbiota-and-anxietylike-behaviour-in-c57bl6n-mice/5C88146E8479E64F485E9C79D9CDDDB8.
  8. Zhang Y, Qiu H. Dietary Magnesium Intake and Hyperuricemia among US Adults. Nutrients [Internet]. 2018; 10(3):296. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872714/.
  9. Vitamins and minerals - Others. nhs.uk [Internet]. 2017. Available from: https://www.nhs.uk/conditions/vitamins-and-minerals/others/.
  10. García-Legorreta A, Soriano-Pérez LA, Flores-Buendía AM, Medina-Campos ON, Noriega LG, Granados-Portillo O, et al. Effect of Dietary Magnesium Content on Intestinal Microbiota of Rats. Nutrients [Internet]. 2020; 12(9):2889. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551274/.
  11. [Internet]. Available from: https://www.hsph.harvard.edu/nutritionsource/magnesium/#:~:text=RDA%3A%20The%20 Recommended%20Dietary%20Allowance,cause%20harmful%20effects%20on%20health.
  12. Zhang Y, Qiu H. Dietary Magnesium Intake and Hyperuricemia among US Adults. Nutrients [Internet]. 2018; 10(3):296. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872714/.
  13. Chen-Xu M, Yokose C, Rai SK, Pillinger MH, Choi HK. Contemporary Prevalence of Gout and Hyperuricemia in the United States and Decadal Trends: The National Health and Nutrition Examination Survey, 2007-2016. Arthritis Rheumatol. 2019; 71(6):991–9.
  14. Cea Soriano L, Rothenbacher D, Choi HK, García Rodríguez LA. Contemporary epidemiology of gout in the UK general population. Arthritis Res Ther [Internet]. 2011; 13(2):R39. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132018/.
  15. Blogs & News [Internet]. Available from: https://mydoctor.kaiserpermanente.org/mas/news/understanding-treating-and-managing-gout-1759065.
  16. Pros and cons of taking a magnesium supplement. Mayo Clinic [Internet]. Available from: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/magnesium-supplements/faq-20466270.
  17. Gröber U. Magnesium and Drugs. Int J Mol Sci [Internet]. 2019; 20(9):2094. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6539869/.
  18. FitzGerald JD, Dalbeth N, Mikuls T, Brignardello‐Petersen R, Guyatt G, Abeles AM, et al. 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis Care Res [Internet]. 2020; 72(6):744–60. Available from: https://onlinelibrary.wiley.com/doi/10.1002/acr.24180.
  19. Gout symptoms and treatments [Internet]. Available from: https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/gout.
  20. Pharmaspa. PharmaSpa [Internet]. 2021. How Can Epsom Salts Help Relieve Gout?; Available from: https://pharmaspa.ca/how-can-epsom-salts-help-relieve-gout/.
  21. Shoaib Khan M, Zahid S, Ishaq M. Fatal Hypermagnesemia: an acute ingestion of Epsom Salt in a patient with normal renal function. Caspian J Intern Med [Internet]. 2018; 9(4):413–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6230454/.

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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George Chowdhury

Msc Robotics and Computation, WiFi, UCL
George Chowdhury is a science and technology writer who draws upon a wealth of academic and industry experience to democratise the state-of-the-art.

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