Gout Diet Blog

I’m on various medication that keeps my gout in control. I get gouton my fourth toe of my foot..the pain is totally gone no attacks in awhile. But my toe still looks like a purple vienna sausage. Why is itnot returning to a normal appearance? Will it happen in time? Or isthere deposits which will have to be surgically removed?

My mother was reading The Washington Post (so, you know, it’s gottabe true)! and there was a bit about how more and more younger peopleare coming down with gout due to diet, etc. (I’m 31). It said thatsomething that helps is exercise, something about it seems to breakup the uric acid and then you can seemingly “flush” it out of yoursystem with water (something we all know that helps).

This is all I know, ever since New Year’s I’ve been swimming andhitting the gym, not like every day or anything, but I try toexercise at least a few times a week. Granted, my gout isn’t nearlyas bad as some described here (I’ve only had a couple of outbreakswith only the first being bad and I mean “bad” as in “Jesus, justcut off my foot” bad).

Anyway, I thought I’d pass that on. And for any impendingquestions, yes, I know it’s hard to exercise when you can’t evenwalk or much less put on a shoe. I’ve been there myself and itsucks. Just wanted to pass this on…

My initial thoughts about this question of peoples attitude to goutsuffers was that I can now have lots of sex. After all if gout iscaused by MEAT, RICH, FOODS, and ALCOHOL (as per Arnold’s comments)that still leaves me with SEX. OK so meat, rich, food and alcoholhave lead me to gout after 53 years but I’ve had a bloody good 53years and now I can look forward to plenty of sex in my old age.

But is this not just denial ? The fact is that I love meat, I lovebeing rich (by any sort of world standard), I love good food and Ilove alcohol lets face it I’m addicted to effete western society !

I take point about curing uric acid at source withallopurinol primarily to get me back to meat, rich, food andalcohol - but this might be a bit of a cop out. The real point isthat “90% of people with high uric acid levels never get gout”. Welllots of people who smoke cigarettes never get heart disease YEA BUTSOME DO and so it is still worth cutting out the fags.

I remember my grandfather used to buy tins of 50 cigarettes at a timeand used to smoke about 70 a day, it never seemed to do him any harmand he died in his 80’s of something totally unrelated. Yet I can’tsay that I am unhappy that my daughters don’t smoke.

Also although I am not (very) obese (I am six foot and weigh 85kg)and I don’t have symptoms of chronic alcoholism (in that I canabstain for the last two months without any craving) but I do Imean did - drink beer regularly. The fact is that I am a typicalrich (by my parents standards) under-exercised middle-aged man who,amazingly, has never skied at all and therefore I am probably afairly typical gout sufferer.

If 90 percent of people with high uric acid levels never get goutthen 10 percent do and that 10 percent apparently includes me !Maybe I should face up to the fact that that’s just the tough shitway things work out in life.

Maybe gout sufferers like me can’t expect much sympathy andtherefore not the investment in medical research that this diseaseobviously calls for - unless we first face up to that fact the meat,rich, food, alcohol do actually play a big part in this. In factmore and more (especially as I read Walter’s post), I am beginning tosee this as a liver dysfunction (crazy enzymes) and that the kidneysand those white cells have just got a lot of bad press.

But hay, drugs weren’t on that list either ! I still get sex anddrugs that can’t be bad.

In my experience, 90% of all homeopathic/ herbal medicine is crap.If all this stuff is so good for you, why does everybody who worksat health food stores look like they are dying of AIDS? I had an ex-girlfriend who was an herbalist guru, as well as my sister-in-law.Both had literally DOZENS of so-called cures for gout, which costbetween $20 and $40 a bottle, that supposedly take about 8 weeks ofuse to “work”. Bullshit. None of them work, and there is nosubstantiated evidence to prove otherwise- not only that, but thereis no information available on the long term effects of taking thisstuff. Why would a rational person turn down a single course oftreatment with steroids (with proven benefits AND risks), then leapheadlong into cramming their bodies full of UNPROVEN herbaltreatments at the recommendation of a pale hair farmer in a hempshirt who earns $5 an hour stocking shelves at “Whole Foods”????

The herbal/ homeopathic community directly accuses the medicalcommunity of deliberately endangering our health for the sake ofmonetary gain. The herbalists appear to have the “agenda” if youask me. When you tell them an herb made you sick, they tell youlies like “You’ll get sicker before you get better because it’s yourbody ridding itself of toxins”. I guess if you happen to DIE fromthe herbs, it’s your own fault for being so toxic to begin with.Lies lies lies lies lies.

Steroid treatments DO have their associated risks, but for manyindividuals (like myself) the adverse side effects seldommaterialise. I have had three different steroid treatments for nmygout over the years- Medrol, Decadron, and Prednisone. All threecompletely knocked out the inflammation within three days (and yes,the reduction of the inflammation IS a “masking” effect to a degree,but when I am in the throes of a severe gout flare-up I really don’tcare, I just want the pain gone).

If you do not effectively treat your gout, it WILL cripple andeventually kill you (directly or indirectly). Once you get gout, itonly gets worse if you do not treat it. This is proven.

So the current teatments are a little risky, but they do work.Colchicine knocks my gout right out, which is good so I can get tothe bathroom to deal with its side effects (anyone who hasexperience with the stuff knows what I mean). Allopurinol works,albeit a bit tricky to get started on sometimes. NSAIDS andsteroids do treat the inflammation and pain effectively, though younaturally do not want to take them all the time.

Sorry if this rant was a bit dogmatic, but I have wasted alot oftime and many on herbal/ homeopathic crap. I use this metaphor asan example: All you have to do is get bit by ONE poisonous snake tomake you want to avoid ALL snakes. As far as I am concerned, snakeoil vendors are all venomous. Go for what really works.

I am experiencing my first attack and wonder ifswimming would be helpful either in warm or colder water? I see whenI am on my foot too much the swelling and pain gets worse. But I liketo swim at my health club and thought maybe an easy swim in the coldwater would feel good on the painful area, since it is hot?

I would be certain that you do have gout ratherthan merely some other form of arthritis. Wasthere a confirmatory bichromatic lab test?

Did you have any synovial fluid aspirated andtested for microbial agents such as P. multocida?

You may need to monitor your Uric Acid levels andperhaps take a larger dose of meds for a brieftime period to bring those levels down.

Had my first attack of the gout last year (lucky me) and it’s beenjust over a year and just had another one. This wasn’t as bad as Iwent to the doctor and they took blood.

Just got back the other day and turns out my uric acid level is a 10(which she described as high). I was like “no kidding”.

Anyway, she tells me that if I only have one attack a year to keepcoming back and she’ll give me the indomethican (probably spelledthat wrong), however if it gets more frequent then I’ll have to goon some medication to regulate my uric acid levels.

Anyway, my question is this…I seem to have a sort of bunyonforming on my right big toe (my mother has these as well, as doesher sister and her mother) (I’m male, by the way). My doctor notedthis and told me I could get it removed whenever I wanted. Nowpersonally I don’t care about a bunyon, as long as thre’s no painand there’s not really, but the area is still a bit tender.

Anyone else have this, or am I just lucky?

As far as a “cure” goes, I really haven’t changed anything in mydiet, except that I try to drink a lot more water during the day.Anyone have any ideas to make things better?

Over and out…

My wife is convinced that smoking pot triggers gout attacks. Shebases her claim on the fact that I tend to get gout attacks whensmoking heavily (when actually I smoke heavily during an attack todull the pain). I suppose it can have a secondary effect in that Itend to eat more of the offending foods (pizza, nachos, etc) when Ihave the munchies, combined with the dehydration that being stonedcan cause. Anybody have any similar stories/ experiences? I DOknow that cannabis indica is a better analgesic than cannabis sativa.

I went back over the literature again to confirm that there is noevidence I could find to suggest that allopurinol has any affect onuric acid that has already formed in your body. The mechanism ofaction of allopurinol is to stop the formation of new uric acid.While reading various references, I ran across several very recentreferences that are very important to us.

Earlier medical literature has noted the relationship between goutsufferers and hypertension-(high blood pressure) as well as asimilar correlation with corronary heart disease. Until veryrecently this was thought to be a co-effect of gout, perhaps, it hasbeen suggested, that gout and hypertension are caused by the same, orat least similar, metabolic conditions.

I would suggest that you read at least the first reference I willgive because it is a startling result.

1) http://www.rheumatology.hss.edu/phys/specialReports/uricAcid.asp(July 1, 2003) Theodore R. Fields, MD, FACPInternet Project Director, HSS Division of RheumatologyDirector, HSS Rheumatology Faculty Practice PlanAssociate Professor of Clinical Medicine, Weill Medical College ofCornell UniversityUric Acid and Cardiovascular Disease - Chicken or the Egg? New AnimalData Suggest Possible Pathogenic Role of Urate.

2) Hypertension. 2003 Jun;41(6):1183-90. Johnson RJ, Kang DH, Feig D,Kivlighn S, Kanellis J, Watanabe S, Tuttle KR, Rodriguez-Iturbe B,Herrera-Acosta J, Mazzali M:Is there a pathogenetic role for uric Acid in hypertension andcardiovascular and renal disease?

3) Hypertension. 2000 Dec;36(6):1072-8. Verdecchia P, Schillaci G,Reboldi G, Santeusanio F, Porcellati C, Brunetti P.Relation between serum uric acid and risk of cardiovascular diseasein essential hypertension. The PIUMA study.

4) Hypertension. 2001 Nov;38(5):1101-6. Mazzali M, Hughes J, Kim YG,Jefferson JA, Kang DH, Gordon KL, Lan HY, Kivlighn S, Johnson RJ.Elevated uric acid increases blood pressure in the rat by a novelcrystal-independent mechanism.

In order to keep from upsetting anyone as to why I say these things,I will quote from the first reference cited here.

Dr. Fields writes:

“Recent animal studies, however, suggest an independent risk statusof urate.3 Rat data in this study suggested that urate appears to bepathogenic of hypertension, arteriolar wall thickening, andendothelial dysfunction. Mild induced hyperuricemia (using a uricaseinhibitor which does not lead to crystal deposition in the kidney andpreserves renal function) causes hypertension in the rat withinseveral weeks, with stimulation of the renin-angiotensin system andinhibition of NO synthase (and renal injury and fibrosis).

In this model, blood pressure changes were prevented if allopurinolwas given early. Chronically hyperuricemic rats showed salt-sensitivity and thickening of the afferent artery of the glomerulusand tubulointerstitial inflammation and fibrosis - which did notreverse if allopurinol was given late. Hyperuricemia stimulated ratvascular smooth muscle cell proliferation and induced endothelialdysfunction.”

That may be hard to absorb but the bottom line is that when theyartifically induce high urate levels in rats, those rats develop highblood pressure and they develop hardening and thickening of thearteries. More importantly, when those rate were fed allopurinolearly in the test, the hypertension symptoms did not appear. If thesymptoms were allowed to go too long, they were not reversible.

The excess uric acid that we are accumulating from our gout conditionis much more dangerous than just the pain we feel from the attacks.

The high levels of urate in our blood is causing severe andeventually non-reversible cardio-vascular problems.

Based on this finding I plan to get my physician to increase mydosage of allopurinol to a level known to stop urate productionaltogether and then titrate my system back to the optimum level. Thatis, I will move the dosage level down, slowly, based on any badreaction to the drug, based on serum urate levels in the blood andbased on how my gout attacks are progressing.

Some of you have stated your reservations about taking allopurinol,as I did, but allopurinol is indicated for gout sufferers and to myway of looking at it, this is cardio-vascular implication is the mostpersuasive of all the information I have read. I can live a long timewith a pain in my foot, I cannot live very long if my heart and myarterial system are compromized.

how often would you suggest doing tests? Is 6monthlyenough?

I eventually saw the rheumatologist in Dec after being diagnosedwith a gout attack last March. The GP tested at the time and thelevels were normal (as you would expect during an attack). The GPwas convinced it was gout as were a number of others who hadsome experience of gout who saw my foot.

The rheumatologist - who didn’t see me during the gout (if that’swhat it was) attack - tested again in Dec and levels were normal soshe doesn’t think it was gout I had last March. Didn’t give me analternative diagnosis either. From what I have learned I feel prettypositive it was gout regardless of what the two tests showed. Shealso x rayed my feet and said they looked fine. She also said itwas so unlikely because I am a pre menopausal female - age 45.The GP was only interested in me watching the purines I ate andprescribed Vioxx if I felt another attack coming on.

So my question is: how often do I request the uric acid levels betested to hopefully avert another attack?