Ask Dr. Mike: Absorption & Distribution of Supplements, Help for Acute Gout

Additional Info

• Segment Number: 4
• Audio File: healthy_talk/1508ht4d.mp3
• Organization: Life Extension
• Guest Website: Healthy Talk MD
• Transcription: RadioMD Presents: Healthy Talk | Original Air Date: February 19, 2015
  Host: Dr. Michael Smith
  
  You’re listening to RadioMD. It’s time to “Ask Dr. Mike” on Healthy Talk. Call or email to ask your questions now. Email: AskDrMikeSmith@RadioMD.com, or call: 877-711-5211. The lines are open.
  
  Alright. So, we’re going to get right to your questions. This first one, let me just read this to you. It’s pretty funny, but it brings up an important issue about taking supplements. So let me just go ahead and read this to you:
  
  “I take supplements, but my wife doesn’t. We got into an argument again over supplements. We were watching Big Bang Theory and Sheldon said to Penny, who was buying supplements, ‘Your body can only absorb so much and you’ll end up with expensive urine.’ I tried explaining to my wife that if the supplement ends up in my urine, it did absorb. She didn’t get it. Can you explain this?”
  
  So, I do like Big Bang Theory, too. I watch it. So, you’re right. If anything you ingest—whether it’s a capsule or powder or food that you chew—I mean, anything that you ingest into your stomach and small intestine, if it ends up in your urine, that means it did absorb well. So, this whole idea that supplements only produce an expensive urine, as if everything—all the supplements I take—they go from my gut, to my blood, into my kidneys and right into the urine--they don’t do any good, is kind of silly. But, you’re right. Lots of people make the mistake with this word “absorption”. What they really mean to talk about is a different word that we use to describe how the body manages a drug or a supplement once it gets into your bloodstream. So, absorption is the word that we use to describe how much of a substance goes from your digestive system into your bloodstream. That’s absorption. And, if you’re taking a supplement and it ends up in your urine--all of it, let’s say--that actually is 100% absorption. That’s awesome, okay? So, “absorption” really is not the right word. What Sheldon on Big Bang Theory meant to say was a different word and that word is “distribution”. Distribution is a word that describes how the body--once it’s in your bloodstream--how it delivers it to the tissues, how the tissues metabolize it, how it then gets out into the urine.
  
  Now, let me just give you some examples. If you take a supplement. Let’s call it “Supplement A” and you take 100 mg of “Supplement A” and 20 minutes later, we measure 100 mg of “Supplement A” in the bloodstream, that’s 100% absorption. That’s really good. But, let’s say 20 minutes later, we measure 100 mg of “Supplement A” in your urine. In that case, the distribution was quite low and Sheldon would be right. That’s just pretty much expensive urine. You’re not really getting much out of “Supplement A”. What you want to see is maybe a little bit of “Supplement A” in your urine, but you don’t want to see a lot of it because you want it to get to your cells and your tissues and you want your cells and tissues to utilize it and metabolize it. What you might end up seeing in your urine are metabolites of “Supplement A”, which would tell me not only did you get good absorption, but you got good distribution to your tissues. So, yeah. If you’re just going to use the word “absorption” and I end up with a bunch of supplements in my urine, hey, that’s good. That means it actually got in my bloodstream. That’s awesome. Absorption’s good. But that’s not really what we’re questioning. It’s really once the supplement is in your blood, how is it getting to the tissues, the cells, how is it being metabolized and that’s really a different word called “distribution.”
  
  You know, another example is, if you ever take a really good, high quality multivitamin and let’s say maybe an hour, two hours, after taking the multivitamin, all of a sudden your urine is neon yellow--like a bright, bright yellow. Has that ever happened to you? That actually is a good sign. That means that multivitamin actually got from your gut into your blood and what you’re actually seeing in your urine is the leftover pigment from the B vitamins. So, a very bright yellow urine after taking a multivitamin is actually a good sign and it’s not the B vitamins. It’s just the pigments. So, that means absorption was good and distribution was good. So, you actually kind of want to see that in your urine.
  
  So, yeah. I think actually Sheldon—what he meant to say is the word “distribution”, not “absorption”. So, anyway, that was from the Big Bang Theory. So, there’s absorption, there’s distribution and there’s elimination. These are three separate terms that we actually use to study drugs and supplements and what you want to see is the highest absorption, the highest distribution, and what ends up being eliminated are just these metabolites of it. If you have high absorption, high distribution and your urine is just full of these metabolites of the original supplement, that’s actually a good sign. You eventually do want to see these things in your urine. Okay. Good. Now, that was from the Big Bang Theory.
  
  Okay. So, let’s go on. Another question we have is, and I think I’m doing okay. I think I’ve got a couple of minutes here. “What helps for acute gout?”
  
  What helps for acute gout? So, gout is when you get these uric acid type crystals stuck in your joints. It causes inflammation and swelling of the joint. It can be very acute. What we call “gouty flare-ups”, a “gouty attack”. Very painful. I mean, traditionally, when I was going through medical school, they said it starts, or it usually happens, in the big toe. Usually in a man. Usually a man in his 40’s or 50’s and it’s his big toe. That’s what the Board exams say. I’ve seen it in kids. I’ve seen it in men. I’ve seen it in women. Old and young. And, I’ve seen it in just about every joint. It is usually the smaller joints because the crystals are small. The inflammation that they cause is not too much. So, usually it takes a small joint space to really feel the inflammation and pain and it can be very, very painful and uncomfortable for people. So, obviously, we’ve got to watch your diet. Certain foods that contain what are called “purines”, like meat and dairy, for instance. Beer, for instance. They have these purines in them that can initiate a lot of uric acid production and that can precipitate a gouty attack. But I think most people know, once you’ve had one attack of gout, you kind of know the foods you have to avoid. Now, whether you do that or not, that’s a different story. Doctors are usually pretty good about educating about the foods we shouldn’t eat. So, I think this question is more about supplements. You know, what helps for acute gout since, you know, we talk mostly about supplements, I’m assuming that’s what this question is focused on.
  
  Well, probably in the middle of a gouty attack, you know, when the inflammation and the pain in a small joint kind of first begins, obviously, you want to really check your diet. That’s for sure. You want to start drinking lots of water. That does help. But, Vitamin C. Vitamin C has been shown to increase uric acid in your urine. So, it helps to get rid of the uric acid so you’re not going to get any more build up. You know, once the crystals have formed and they’ve implanted in the small joint, unfortunately, there’s a waiting game there. You know, unless you actually went in there and drained fluid out of a joint, there’s really no way of getting rid of those crystals. Your body just has to reabsorb them. But, what you don’t want is that gouty attack to continue. So, Vitamin C can decrease the severity and the length of time of a gouty attack simply by helping you to eliminate, in your urine, uric acid. Now, it’s going to have to be probably 1-2 grams of Vitamin C. Maybe even more. Maybe 3-4 grams of Vitamin C for a week or two. It might cause some loose stools. So, try some Vitamin C. Also, with the pain, Tart Cherry Extract, about 1200 mg a day helps as well. So, Vitamin C and Tart Cherry for acute gouty attacks.
  
  This is Healthy Talk on RadioMD. I’m Dr. Mike. Stay well.
• Length (mins): 10
• Waiver Received: No
• Internal Notes: NO GUEST
• Host: Mike Smith, MD