An important observation
Back from my trip and each day was an aggregation of little terror’s.I was on the end of a bad attack-about 6 weeks worth and had finishedthe last week of the attack with an agressive 1 week of cortizone,which bty the way, for me, does a great job of relieving theinflammation but nothing to make the cause, the crystal deposits,better.
When I am finishing a bout with the pain, my toe seems to be a verysensitive detector for what causes pain. That pain is alwaysassociated with meals. Particularly on a trip, where you are supposedto be having fun, you are under peressure. If not direct pressure,certainly a social kiknd of pressure, to eat some of the great foodthat you encounter on your trip.
Well, I have noticed that there are two kinds of pain stimuliassociated with food. The first will come within one hour of eatingand the second, often not related to the onset or the intensity ofthe second pain happens some 6 to 8 hours after the meal and usuallyhits in the middle of the night. that one, bacause I am now verycareful about what I eat, does not happen very often, but I do slipup and eat a steak or some other offender.
I believe I understand this pain after 1 hour phenomenon now.
Again it goes back to Chemistry but this time it is not really thatsimple. I will try to explain the principle and once you get it, youwill be able to remove some of the stimuli that get you into trouble.i.e. into the pain and swelling.
In the chemistry world there is a phenomenon that has been understoodand taught to chemistry majors for as long as our currentinstitutions have been standing. The Germans of old, I mean back inthe alchemy days had measured the solubility of compounds and thephenomenon dates well back into the 17th centruy. It has to do withsoluability of weakly soluable substances in water and there is, withevery substance, what is called a soluability constant. Ksp is theterm if you are going to ask your doctor but he is unlikely to knowwhat it really means.
Now don’t freak out because you see a formula..
NaU <=====> Na+ and U-This is an equillibrium situation and there is a soluability thatsodium urate will achieve when there is an excess of the solid formand this equillibrium will be establ;ished if the system is a testtube or if it is your foot. The constant K is the product of theamount of Sodium (Na+) times the amount of Urate (U-) that will bedissolved in an aqueous solution. If you increase the amount of, forexample, sodium that is in the solution, then the amount of urate (U-) that it takes to make the constant goes down.
In other words, if you put salt into your system, it will tend tomake the Sodium Urate that is dissolved in your blood want tocrystallize out. Increase your salt intake and you will inducecrystal formation.
I’ll finish this later but you have the overall conclusion.
I am proposing that we need to go onto a low salt diet during anattack. It is the salt in the ood we eat that makes that attack afteran hour of eating. the 6 to 8 hout one comes from breakdown of thefood into the uric acid and tha is different.
Low salt intake during an attack.
Julius Lucca on July 22nd, 2007
Good observation you got here. I just wanted to ask if based onyour experience, you were able to totally isolate the effect of saltfrom the uric acid coming from the food and vice versa. Have youtried eating food loaded with salt but almost nothing with purineand/or food heavily loaded with purine but nothing with salt? If youdid this, what was the effect on the after-one-hour and after-6-to-8-hour gout attack?
Sabina Shamel on July 23rd, 2007
I’ll let you try the food loaded with purenes during an attack-i.e. atouch of insanity doing that-
But I love salt in my diet, I love Chinese food and I love saltedchips and popcorn with salt.My wife often cooks with a lot of soy, salt and other sodiumcontaining seasonings and she is a great cook.
Believe me, it will be hard to keep away from the salt.
But, you can try eating a meal high in salt, usually Chinese cookingis loaded in salt, particularly the sauces and most particularly thecurry sauces. Have a Chinese meal with heavy sauce, add soy sauce tothe rice-soy sauce is very heavily laden with salt and if you are achronic gout sufferer, you will feel the familiar twinges in yourtoes within one hour.
I have tested it three times now on purpose. the last time with justrice that was salted beyond reason. Just rice and salt will make ithurt. It takes about a gallon of water, literally a whole gallon, tobring my system back into a stable non-painful state.
I am certain that salt will bring on the pain and if you are sailingalong in life gout free, say for a year pain free, and you have asystem that is supersaturated with Uric acid,
A DRAMATIC INCREASE IN YOUR SERUM SALINITY, COULD TRIGGER A BADATTACK.
For example, come in from working in the yard, dehydrated, have abeer which will reduce or mess up your kidney function, and then eata very high salt containing meal. I don’t, however, think that’s theusual trigger for the bad attacks. I am certain however, that thesalt will make whatever attack you have, worse.
CALCIUMI’m convinced that Calcium plays an important role in the overallcrystallization process because: 1) It happens in a joint-(high calcium locally). 2) Long term, gout attacks actually remove calcium from our bones.(look in the literature and you will find many x-ray’s of the loss ofcalcuim from bone.)
I do not, however, have even an intuition as to whether we need moreor less calcium. If any one has any information on this I would beinterested in reading about it. The reason it is so critical is thatcalcium is a required mineral and as we age, our ability to deal withcalcium and to use calcium is dimminished. It is a mineral however,that we need to have in our diet, and I want to get an understandingof just how much calcium we need to take in. I am not sure from thechemistry of calcium and uric acid alone if it is, per se, good orbad. My mother’s rhumatologist has her on 4K mg a day along with 300mg of allopurinol and she has been attack free for over 4 years now.
I’ll give you my emotional and subjective belief right now based onlyon my own experience and the experience of my grand father who livedwith gout for about 60 years having had his first attack at the ageof 39. Milk, Skim milk initially, was about the only drink he wasable to tolerate other than water and, for his last 10 years of hislife, from 89 to 99, he survived on Kellogs special K and skim milk.When I was 16, he and I worked out that diet because he was wastingaway and we reasoned that special K had everything he needed and theskim milk made him feel less pain. He actually started to gain weightagain after a steady loss for 10 years on the special K and skim milkdiet and, in later years, he had actually graduated to whole milk andhalf and half. He was ambulatory but lived in pain for almost hiswhole life after 40. He would tell me how much skim milk helped himand, now, some 25 years later I must agree with him that for me, skimmilk makes me feel better-less joint pain and I have been consideringadding skim milk, that is fat free milk, to my diet three times aday. You know the old advertisement we were subjected to when we werekids, 4 glasses of milk a day…well, it may be good advise to usgour sufferers.
But I stress this, I don’t know from data or from the literature whatour Calcium load per day should be. If anyone knows or has experiencewith it, please advise….