Gout Diet Blog

It turns out I might have Psoriatic Arthritis and not Gout after all.I still need to see my doctor to confirm my suspicions. Upon studyingthese conditions I found out that PA is sometimes mistakenlydiagnosed as Gout because with PA you also have high uric acidlevels. You can generally tell if it’s PA rather than Gout if youalready have Psoriasis of the skin and also what is known as “sausagedigits” in toes or fingers have a sausage like appearance. AlsoArthritis of other joints is another telling sign of PA. I can’tfully straighten out my right arm or make a fist. I always wonderedwhy I never had the classic Big Toe attack of Gout. Thank you newfootfor the insight….about PA. I finally put the puzzle together.

This gout is a strange, peculiar type of ailment. I’m 62 yrs old, male, andhave had gout since I was 28. I’ve tried a number of medicines, done a lotof reading, and feel today I know about as little about it as I did beforemy first attack. I take allopurinol, and can woof down all foods exceptliver (I get a moon shot if I eat liver). I can swill booze with no problem(goutwise).

The one certain thing is there are many manifestations of gout, manytriggers, and a number of things that help some individuals. Some peopleare very diet sensitive, others are not. Some people can tolerate certainpreventatives and pain reliefs, some cannot. Certain medicines work wellfor some people, while others aren’t as effective with them.

Gout can hit us just about all over the body. I’ve had attacks in the jointat the base of the big toes in both feet, both ankles, both knees, bothhips, and my lower back. Recently, I read about someone who had it inhis/her wrist. I’ve also had what I thought were gout attacks in mytendon/heel area on my feet. Some reports tell me this is more likelypseudogout. I don’t know.

Gout seems to occur because of uric acid crystal concentration between thelinings of impacted joints. This causes intense pain, some swelling, andinflammation (that’s those hot, pink skin areas where the pain is). The onething I haven’t found explanation of is why, in gout sufferrers, our bodssuddenly begin a runaway overproduction of uric acid. Maybe the why of thisis unimportant. I don’t know.

Now, if you look closely at the timing/sequence of events in a gout attack,you’ll see why, in many people, lab tests of blood drawn during a goutattack can come back normal in uric acid levels. What happens is that, inmany of us, the attack develops so quickly that the spike of uric acid haspeaked and subsided very quickly, and is back to normal while the crystalsprecipitate and gravitate to the joint area they will eventually inflame.By the time you start agonizing, and someone draws blood,voila—-everything’s back to normal. In others, things progress moreslowly.

What pharmacology will help us prevent gout? There is one drug (I’veforgotten the name and need help here) that helps our bods not produce anoversupply of uric acid. Then, there’s allopurinol, which helps our bodseliminate over productions of uric acid. Allopurinol, incidentally, seemsto be tolerated well by most, and has few adverse side effects.

Then there’s the pain of gout attacks. Pain relief falls into three maincategories. One is non-specific analgesics (NSAIDS) [[[can’t remember whatthe full accronym stands for; need help here, too]]]. These includeaspirin, tylenol, etc. DO NOT take aspirin or aspirin based compounds forgout pain relief. The aspirin base fights with the inflammation from gout,and makes the pain worse. I can get fair relief by gobbling lots oftylenol. Others say tylenol doesn’t help them one bit. Another of thesecommonly used is Indomethicin. Indo is very effective in most people, butgives rather pronounced indigestion and tummy upset.

Another category of gout pain reliever are steroids. Steroids, as a class,are pretty good pain relievers. Be aware of prolonged use, though, becausethey tend to have adverse side effects, such as bone marrow attacks, waterretention, etc.

Then there are narcotics. Narcotics are very effective at knocking down thepain, but we all know what trails those can too easily lead down. Narcoticsare rarely prescribed for gout pain.

One of the things that tends to pop up recurringly is the thing aboutcranberry juice. The role of cranberry juice is interesting, but doesn’ttie directly in with gout. What happens is that cranberry juice relieveskidney discomfort in many people. We can get kidney discomfort from manycauses, including gout.

The high uric acid levels during/preceding gout attacks have to be dispensedwith somehow. Well, that overload gets filtered out through the oldkidneys. Is some cases, this causes discomfort to the kidneys. Thus,cranberry juice can help relieve that discomfort in some people. But, ithas nothing per se to do with gout, only indirectly.

I forgot to comment on Colchicine. Colchicine is definitely effective inaborting (cutting one short once it starts up) a gout attack in some people.The problem with Colchicine is that to be effective, the docs have to bringit to a low threshold toxic level in the body before it does it job right.In this process, it makes you ill with stomach upset and diarhea. So, younot only have a hurting hoof or whatever, but then you’re also made sick atthe same time. Of course, if you’re one of those that the Colchicine helps,you then get better. I think the docs taper off on the Colchicine once youstart getting better. Colchicine is an almost archaic med for gout. Itwas the only drug around for years.

I personally don’t like Colchicine. I know it’s effective for some,but there are better ways of getting rid of excess uric acid, for me. Thatis, of course, allopurinol. The reason I don’t like Colchicine is that theyou have to take it to the point of toxicity before it becomes effective.That means diarrhea and stomach nausea. In other words, it has to make yousick before it can make you better. This is typically superimposed on avery painful gout attack, which is no fun at all to begin with. I think Ihave heard that allopurinol may not be effective until you’re pain free fora few days. I don’t see how it could hurt to take it anyway, if you havesome handy. I keep taking mine during any attacks I get. While takingallopurinol, my attacks are much fewer, and the ones I do occasionally getare mild, and are over quickly. I used to have severe pain with my attacksfor two weeks or so.

There is some medicine which helps keep the old bod from cranking up excessuric acid. Can’t remember the name of it. I’ve always felt that it andallopurinol together would be the perfect combo, because allopurinol causesthe bod to eliminate excess uric acid, once it starts cranking it up

One other interesting thing. Some literature says that there is a window inmany gouties from age 45-60 in which you’re essentially attack free. Thisdid in fact happen with me. As soon as I hit 60, the attacks jumped back onme with both feet, and that’s when I resumed allopurinol

Some of the people on this list, and some literature says taking a couple ofspoonfulls of unsweetened cherries every day will significantly help preventgout attacks. Never tried it, but have heard this more than once. It’s notthat hard to do, as you can get cans of these kinds of cherries in anygrocery store. They’re quite available.

The thing I read on the gout email list recently is the first explanationI’ve heard as to why the docs are apprehensive when it comes to havinggouties lose weight. I know that there is a medical consensus that there isa reason to be concerned when they start having an overweight gout suffererlose weight. And, someone on our list finally explained it, and it makesperfect sense. I didn’t know that uric acid concentrations are in all ourfat cells. Given that, it stands to reason that breaking down fatty tissue(weight loss) floods us with uric acid, thereby almost certainlyprecipitating an attack.

It’s ironic. Losing weight is supposed to help ease the joint impact ofbody mass, thereby helping minimize damage from gout attacks. But, losingweight may well precipitate/cause gout attacks (during the weight lossperiod).

And yes, that stuff can attack us just about anywhere in the old bod thereare joints to get inflammed.

OK, as to pain relief. May not work for you, but does help me some. Largedoses of Tylenol. The trick is to take several at once, and then severalmore every 3 hours or so. Like I’ve said, DON’T take aspirin. Aspirin willmake your inflammation/pain worse because the acid base in it fights withthe uric acid

I had to quit taking Indo because it is too rough on the tummy.

A problem with gout is that you can get consumed with trying to managetreatments while the attacks are coming along rapid fire, at times. Trythis, try that, this one doesn’t work–that one doesn’t work, etc.

I finally simplified it all down to taking allopurinol for control, andTylenol for pain. With the Tylenol, I don’t have to worry about seeingdocs, or fetching prescriptions and getting them filled, etc.

Another thing: I always tried to keep trucking along. I didn’t let goutpain stop me from doing things, although it did slow me down at someendeavors. I am very active, and gout was a major irritant to me; a realpain in the patootie, figureatively and literally speaking. I can wellimagine there are some jobs where having gout would be a significantnegative impact on your income. These are the people I really sympathisizewith.

Our gout attacks are caused by a “surge” of overproduction of uric acid.This surge has to finally be eliminated, and is done so through the kidneys.Although the incidence is not common, there is an enhanced risk of theformation of kidney stones as a result of gout attacks in individuals whoare predisposed to them anyway.

The workout our kidneys get can cause mild kidney distress and/or pain.This is where the thing comes into play about drinking cranberry juice.People can have kidney pain from a number of causes, uric acid being onlyone of those. There are credible accounts that drinking cranberry juicehelps alleviate kidney discomfort, in some cases.

But, it doesn’t do anything for our gout.

For some reason, the overproduction of uric acid is statistically linked tooverweight (arrow through my heart). When overweight people start havinggout attacks, the seemingly logical things is for the docs to tell them tostart shedding pounds. There really are two reasons for this. One is thatfew “thin” people have gout symptoms. The other is that unloading thejoints helps minimize joint damge which naturally occurs during goutattacks.

In the case of some overweight people having gout attacks, the docs arereluctant to order a sudden and rapid weight loss. On the surface, thisseems illogical. However, this is sound medical basis for this. Let’sexamine the situation.

Our fat cells are loaded with uric acid. If we start heavy dieting withrapid breakdown of these cells through ketosis, we release a virtual floodof uric acid, and, voila, a gout attack.

So, the docs first want to try and get our gout under control, then reducebody weight s l o w l y.

i am a regular cannabis user and i have found, throughmany months and years of research, that cannabis willnot actually bring on an attack on its own, but if youare suffering an attack, it can make the pain worse.whether this is due to foreign bodies in the bloodstream or due to a heightened sensory level because ofthe effects, i do not know.

my advice would be to puff away until you get anattack, then stop till it clears up.

one more point. there are two basic types of cannabis,there is the solid block (usually called “hash”) thatyou can get, or the dried leaves (usually called”weed”). the hash, i have found, has worse negativeeffects than the weed.

and it was nice to see that everybody completelyblanked me on the “work and gout” issue i raised lastweek. has no-one had a job lost or career ruinedthrough continuous gout attacks? damn.

I spoke to Dr. Raymond Enzenauer, the chief of Rheumatology at theUniversity of Tennesee Medical Center. He has never met me but wasrecommended as someone knowledgable in gout. I came out of theconversation with a few points that I think are important.

First as to a recent post by Newfoot, Dr. Enzenauer also says thatonly 10-15% of your uric acid load comes from diet, as was posted,but, he points out, if your renal system is able to manage 100% ofwhat it makes and cannot handle any more, a 10% overload, every dayof your life, ends up being a lot of extra Uric acid.

The biggest culprit for gout sufferers in his experience is beer.Beer is a double problem for us because it shuts down renal excretionwhile increasing, substantially, the purene load on the system. Hesays that his office knows that Monday after the super bole, therewill be a stream of gout complaints. According to Dr. Enzenaauer,alcohol consumption is a much bigger culprit in triggering goutattacks than diet.

Men and women act very differently when they have gout. Men are morethan 4 times as likely and get gout much younger than wemen. Almostall of the women he has treated are older, 60 and above, and theirgout is related to impaired kidney function. He stresses that hedoesn’t really know but it seems like the attacks in women areentirely different than they are in men.

I need to summarize the conversation more consicely and will do so ina future post.

For now though, I need to go to my exercise. Ond day on the treadmilland I am so much better that I wonder why I waited so long.My attack has almost entirely resolved and I now walk normally.

bout two years ago, I had a relatively mild attack — and had noidea what it was. It hurt to walk, but I managed it OTC NSAIDS. Acollegue suggested it might be gout, but I put it out of my mind whenthe pain went away. I think the “precipitating event” might havebeen the fact that I was trying out the “Atkins” diet to try to losethe extra baggage I’ve gained since high school.

Currently, I’m 32, slightly overweight, a bit sedentary — but, Ireally don’t eat “richly,” and don’t ever drink alcohol.

Anyway, about a year later, (and a rather large serving of some sortof delicious “bean,”) I had an awful attack. Being a nurse, I’veseen worse, but for me — it was god-awful. I had to stay home fornearly a week, at times, the pain was so unbearable that it was theworst thing just to lower my foot to even TRY to walk — much lesswalking itself.

It was a weekend, and having no health problems until this point, hadto resort to going to an ER for treatment. After 5 hours in thewaiting room, I went back home — deciding I could suffer better athome.

Anyway, during the week, I did manage to get professional help, andwas given Indocin. By this time, the pain was a bit better, and theswelling had gone down, and they told me it wasn’t large enough totry and “tap” the joint with a needle. I didn’t care; what I had hada name, and I was given something to help the pain.

A few weeks later, I followed up; this time with blood and urinesamples. I was pronounced as not having gout, since my uric acidlevels were slightly elevated, but not high enough to call it “gout.”

I chose another physician a few months later, and not only explainedmy problems, but other health issues that seemed to arise as well.At the time, I was beginning to doubt if I had gout — due to someother signs and symptoms. I was convinced I was having some sort oftissue disorder; my tongue looked blotchy, my scalp was red andirritable — plus the occasional “gouty” episodes. I had a great-aunt that died with sclerederma — and I feared the worst. Thisdoctor ordered half-a-million labs to rule out a plethora ofdiseases. My uric acid levels were quite high; so she pronouncedme “gouty” and put me on allopurinal. She also stated I just neededa good dandruff shampoo, and that I had an unrelated, benigncondition called “geographic tongue.”

Anyway, within a few days of taking allopurinal, some amazing thingshappened. Though I wasn’t “gouty” at the time, I did notice someother positive improvements. All of my skin and tonguediscolorations completely disappeared! My scalp is perfect, and mytongue looks perfectly normal — though it had once resembled a mapof the Florida coast line and the Keys.

I’ve had a slight gouty attack since then. I was at work overnight,and caught it just as it started — with NSAIDS. It lasted for acouple of days, but it never worsened since I “beat it down” withcolchicine when I got home (and wisely held the allo while it wasgoing on). Funny thing, right before it happened, I had lapsed a bitwith my diet, and my skin had started acting up again.

Though my physician never verified this, it seems that this(especially my tongue) is an early warning sign (at least for me)that I’ve got too much uric acid.

Here goes another lecture about what happens in, either a test tubeor your body.

Take a pile of solid uric acid and put it in a flask. Next, pour 1000ml of water on that pile and in that water put a little salt, youknow, your blood is actually pretty much like the salt water of theocean. Sheke the flask and after a few hours, the water in the flaskwill be saturated with monosodium urate.

Now, go and get a very fancy osmosis machine, mmm your kidneys, andhave it remove all the monosodium urate in the water. While it isremoving that monosodium urate the concentration of urate in thewater will go down. However, if you let the flask stand for a while.more uric acid will dissolve and form more monosodium urate andvoila, you will be back to saturated again.

Uric acid is only slightly soluble in water and at any time it onlytakes a very small amount of monosodium urate to saturate your blood.

Now, I have left out the issue of the acidity of the water and thisis one of the most important factors in the behavior of monosodiumurate. So far, our flask has just been allowed to dissolve pure uricacid and then have it removed with the fancy osmosis machine. Butthose of you who took high school chemistry will say, aaa ha, whenyou remove sodium urate you will leave hydrochloric acid behind. Yesbut I neglected to tell you that we added a fancy acid nutralizationsystem to our flask-a buffering system- that keeps the pH, that isthe overall acidity, constant. But we can in fact modify the overallacidity of the system and that is in fact what most of the snake oilremedies do.

As the acidity of the flask goes up, the tendancy of uric acid is tostay as uric acid and the overall level of monosodium urate in theblood will be surpressed. Thus, tissue soluble organic acids willtend to surpress the blood level of mono sodium urate and thereforeretard and even stop the crystallization process. Water solubleorganic acids like acetic acid-vinegar, ascorbic acid-vitamin C,citric acid-lemmon juice.

Uric acid, in its acidic form, that is as the organic acid, isrelatively harmless to you. It stays as the acid form and it canaccumulate as trophi which can be painful in their own right but nowhere near as painful as deposits of mono sodium urate, the sodiumsalt of uric acid. The point of this discussion is that even if youcould magically remove all the monosodium urate in your blood withina few seconds, your blood would rapidly return to the saturated stateas long as your have the large excess of uric acid to feed theequillibrium.

There is no convenient or economically practical way to measure, ormonitor, how much uric acid you actually have in your body but it isbelieved that you have been accumulating it for at least 10 yearsbefore anyone has an attack.

When you measure your blood urate you will be measuring how far belowthe saturation point you are at any time but if you stop the urateremoval process, your system will quickly come back to saturated. Ifyou are on allopurinol, for example, you will be surpressing theformation of new uric acid and your kidneys will continue to removeold uric acid but don’t forget that you have years and years ofstored uric acid it it will take time to redissolve all that old uricacid and remove it. When I say time I mean that it will take at least3 years and although each person will be different, the few studies Ihave found that track it, show that your permanent uric acid levelwill not actually fall to below saturated until you are in yourfourth year of taking allopurinol.

So, in summary, tracking your blood urate is important but don’texpect that you are going to permanently reduce that level in a shorttime. When the level actually falls to below 4 and stays therewithout allopurinol, then I suggest you discuss with your Doc, thatit is time to reduce the allopurinol dosage.

My mom, who has been on allopurinol for 15 years. She reduced herdosage from 300 to 100 about a year and a half ago and1. her sodium urate level has held at well below saturated,2. she has nothad new gout attacks, and3. the muscle cramping and muscle pain that she was complaining aboutwent away when the dosage was reduced.

I am 29 years old and I had my first attack when I was 26. I havehad 4 attacks in my life, 2 of them in the last 4 months. I know itcould be worst, but I am writing this, just to know if anyone sharesmy history.

What I hate of being sick is the fact that everything that I haveread about gout tells me that I shouldn’t have it. I am in my 20s, Iam not overweight, I do exercise (regularly for the last 6 years), Idon’t take more that 2 alcohol drinks per month (since my firstattack), and I have never smoked. I have always tried to avoidpurines since my first attack. Furthermore, no one in my family hasever had gout.

I have noticed that gout attacks happen only when I try to loosebody fat, even though I never loose more than 1 pound of fat perweek. Also, when I diet I eat a healthy and with the help of anutritionist. Maybe the solution to my predicament is to never gainfat, so then I wouldn’t need to loose it.

Currently my doctor has me on colchicine and when needed I takeindomethacin. I was on allopurinol, but it didn’t work, I had anattack while taking this drug. The prospect on being on medicationfor life frightens me. The doctors generally don’t have an answerabout what I can improve in my life to avoid the attacks. They justkeep me doing blood or urine exams.

What is the role of the various D vitamins in themetabolism of uric acid and in gout?

It is known that there is a distinct seasonalitypattern to gout in the Northern Hemisphere:springtime! But there appears to have been no studiesin the Southern Hemisphere on this issue.

Macrophages in the synovial fluid are believed toexpress high levels of a D3 metabolite in goutpatients.

Certainly Springtime is associated with increasedexposure to sunshine and increased Vitamin D levels.

Anyone able to find data on seasonality of gout on the’wrong’ side of the equator?

Anyone able to find data on D3 in gout patients who donot have hyperthyroidism?

I’ve had gout for approx. 8 yrs. first in all different places in my feet, now in both of my knees, I’ve had bad circulation (hereditary) since my late teen years, my “Q” is, does poor blood flow increase the effects of gout or should I just take my allo and nothing else, blood thinners etc

Colchicine is the spelling that will get you hits for the drug in question.It is a fairly harsh medication that is used to stop a gout attack. It isnot recommended as a long term treatment.

It certainly sounds as if you are experiencing an attack of gout based onyour prior message. In order to conclusively determine whether you havegout, you must have a doctor take a sample of the fluid in the affectedjoint. If crystals have formed in the joint, they will be able to sayconclusively that you are suffering from gout.

What can you do right now?1. Absolutely stay off the joint in question. Moving around on it with anongoing attack can damage the joint permanently. It can also make theattack worse or prolong the attack.2. Drink plenty of water to try to help flush the uric acid out of yoursystem and to hydrate yourself well to decrease the overall concentration ofthe chemicals involved in the precipitation of the crystals.3. See a rheumatologist ASAP. They will likely prescribe a non-steroidalanti-inflamatory drug (NSAID) like indomethacin to take down theinflammation and provide some pain relief. They might prescribe colchicinewhich may stop the attack, but which you may not tolerate very well. Theywill probably not prescribe Allopurinol until you are no longer experiencingan attack, as it could make the attack worse. However, there are differingopinions about this.4. Find out if your current medicines might be contraindicated if you havegout.5. In the short term, avoid alcohol, shellfish, fish, red meat,beans/lentils, broccoli/cauliflower, mushrooms, and maybe evenchocolate/coffee/caffeine. (basically foods that contain purines orfoods/drugs that impair your metabolic processes)

Once you are past the attack you can decide with your doctor orrheumatologist how best to manage your gout in the long term. There are alot of people on this list that can help by experiences with the variousdrugs and other treatments for gout.