Gout Diet Blog

I have just started with another attack after drinking whisky!!Is it OK to take more than 300mg of allo per day to alleviate thepain? in other words can you overdose on allo?

My husband has had gout for about 8 years now, due to being prescribed amedication for Chron’s disease (which he didn’t actually turn out tohave). He has been on Indomethacin for less than a week at a timeduring attacks which works great to clear it quickly. The last thinghis Dr gave him was Celebrex, which did no good whatsoever. He had tohave a shot of a cortosteriod (we think) in his foot twice to combatmajor attacks. This worked, too. He has since discovered that rawgarlic works to prevent and reduce attacks. When he feels the goutcreeping in, he takes one clove a day, chopped extremely fine in a halfcup of plain yogurt. Sometimes he adds sliced cucumber, sometimes mixesit with rice and raw vegetables as a meal. Luckily, we enjoy garlic,and it seems to help quite a bit! We haven’t had any comments aboutbeing “offended” by our breath yet! Hope this is helpful information foryou!

I queried my Dr’s about this..and a close friend who works(nurse)a lot with gout patients..the Dr.s said that that “twinges” or the socalled beginning of attacks are next to impossible to analyse..theysaid that the twinges could be either the beginning of an attack..i/ewhite blood cell activity..the white blood cells mobilizing..oractually starting their work..OR it could be that the white bloodcells are returning to the scene of the crime..a previosully damgedarea.I then asked iis it not possible that a crystal for whateverreason..got dislodged/moved..and irritated an area..the white bloodcells came to repair it..recognized the intruder..you know the rest. They agreed and said that tight fitting shoes/abrasions..havebeen the begining of some pretty monstrous attacks.

Dehydration..the chemical makeup of your body..uric acidlevel..should be such that you can tolerate..additional loads..ofuric acid..from whatever source..meat/alcohol..sweating. I know personally that I simply cannot go prancing through lifewith a uric acid level of about 4 or higher..I have to keep it at3..this gives my system a “cushion”..for additional loads. As for alcohol..my rheumatologist says..well..it is not thealcohol..but the dehydration caused by it..he says he would love tosee a medical research study where people have had x amount ofalcohol..AND they have also at the same time drank enough water tocombat the diuretic effects of it..ok ok..I guess it is thealcohol..because who in their right mind would drink a LOT of waterwith their alcohol..HEHEHAHA..what then would the point of drinkingthe alcohol be..

For those of you in that situation I suggest you make a copy of thispost and give it to your physician.

They treat your gout attack by trying to relieve the gout symptomswhich involves some kind of non-steroid anti-inflammatory drug, andusually culcchine is included in the treatment regime. Sometimes adaily maintenance dosage of culcchine is perscribed although thatparticular treatment seems to be fading because of the now provenlink of peripheral nuropathy, nerve damage, to prolonged use ofculcchine.

Any and all treatments that relieve and or stop the pain andinflammation that is associated with gout, are ignoring the fact thatthe underlying cause of gout is excess uric acid. Ask your physicianif this is not what he or she believes. Do they believe that thefundamental cause of gout is that your system has too much uric acidand that it is not able to get rid of it. When they treat you withpain relief, they are only treating the symtpom and they are failingto treat the cause of that symptom.

The next question must be, what have you, the patient, done to reducethe uric acid load on your system?

The reply will be, that you must reduce or eliminate the foods thattrigger an attack and that by reducing your intake of foods thatcontain purene you can reduce your exposure to a gout attack.

That last statement is where I want to question the logic of you andyour physician.

The fact is that you got gout because your system is not disposing ofuric acid as fast as it is accumulating it. Whether you accumulateuric acid because you make too much or because you just don’teliminate enough doesn’t matter. The fact is that the rate of buildup is greater than the rate of loss and that small differential willcontinue to tilt against you, that is, in favor of more and more uricacid for the rest of your life.

Here is the problem with the treatment logic. After your firstattack, your body will probably provide you with a period of graceduring which you will not have another attack and this period canlast for one to two and even three years. It is true that some peoplewill experience only one episode and then remain gout free for therest of their life. Based on this possibility, the medical communitywaits for the second attack before perscribing allopurinol and to myway of looking at it, it is terribly illogical.

Medicine is a practice of applied statistics and the statistics arethat more than 96% of the people who suffer an attack will have asecond attack within the first year and after 3 years that figuregoes up. The numbers after a year are not accurate but statistically,very few of us escape the second and third atatck and among those whosuffer the second attack, there is just no escape. You will continueto get attacks.

So, logically, I suggest that it is more statistically prudent totreat the first gout attack agressively with allopurinol. You willget at least 6 months to a year of no gout attack after the firstepisode anyway and if you are on allopurinol during that time, youwill be reducing your uric acid and 96% of the second attacks can beeliminated within tha first year.

If you approach it like someone posted earlier, and I am sorry Idon’t remember who, but approach it as a three year treatment period,that period will be a time during which you are seriously reducingyour overall uric acid load and during which you will be removinguric acid that has been accumulating in your system for 10 to 15years. Moreover and most important, statistically, there will be veryfew, if any, attacks of gout among the people who go on allopurinolafter the first attack.

Let’s then look at the result. With aggresive allopurinol treatmentafter the first attack you will have 96% or more of the people notsuffering the second attack during the three year treatment period.Moreover, if allopurinol is discontinued after the third year, itwill probably take another 3 to five years for most of those peopleto accumulate enough uric acid to start having gout attacks again. Inother words, three years of aggresive treatment with allopurinolafter the first attack will result in 96% of the patients being goutfree during that three year period and most of them will remain goutfree for at least another three years after the allopurinol isdiscontinued.

Those of you who have been forced into alloppurinol by your rentlessseries of attacks, go back and consider what life would have beenlike. You take the same pill that you are now on but you would nothave had the gout atatcks, the disfigured joints, the bulgingknuckles, the clawed hands the weak ankles and toes.

The only problem is that you will be taking a pill and you would beliving gout free.

“Gosh darn, this stupid pill, why am I taking it anyway. I only hadone attack and it was three years ago.”

It is very difficult, indeed, to appreciate what the value of a goutfree existence is when you have not lived through the opposite and Iknow that many will need the bad time with gout to appreciate thegood time without it. My treatment regine should buy 50% of thepeople freedom from gout for about 10 years. Moreover, by agressivelymeasuring uric acid level every year, you would be able to monitor ifand when a patient needed to return to some level of allopurinoltreatment.

What I am suggesting is that once a person has presented with a goutattack, from then on, the physician needs to treat the uric acidlevel and not the gout. The problem, the real illness if you will, isthat the patient has too much uric acid and that uric acid must beremoved. The fact that the patient also happens to get pain from thatexcess uric acid is not the issue. The issue is that the excess uricacid needs to be removed and there is a safe and effective treatmentfor that excess uric acid. From day one of the attack, the urateshould be measured and that level should be driven as low as possiblewith allopurinol treatment. When the uric acid level has beenreduced, and only when the uric acid level has been reduced, thepatient can reduce or perhaps stop, for a while at least, takingallopurinol.

Why does the physician need for you to go through a second episode ofpain to perscribe the cure? Does he or she really need to see yousuffer? Statistically, 96% of first time gout patients will suffer asecond attack within the first year, do they need to see that attack.Do they need to have you go through the pain? If you have had anattack your uric acid level is measurable and it is treatable and itis my considered opinion that from the day of the first atatck, thething that should be treated is the uric acid level and not thesymptoms of a painful attack. The second and third gout attack happenbecause the systemic uric acid level has continued to climb to wellabove what it was after the first attack. Start treating the rootcause of the gout attack, that is start a treatment program aimed atreducing uric acid level, and most of your gout patients will neversuffer another gout attack again.

I’m new to this board. I’ve just experienced my second (verypainful) attack of gout. After three and a half weeks it stillhurts but the pain is now receeding. I’ve had this before and knewwhat to take, ie. Indomethacin, drink lots of water etc. and I cutout all alcohol and high purine foods. However, the attack did notsubside and if anything got worse the longer it went on. Aftervisiting my GP I found out that a common food supplement GlucosamineSulphate was to blame. This supplement I took to aid, ironicallyenough, a joint problem (achilles tendonitus) in my right foot as ithelps to repair cartilage.

Glucosamine Sulphate tablets are made out of the shells of shellfishand just one 500 mg tablet a day was enough to raise the uric acidlevels and bring on an attack.

The onset of gout came on after about three weeks of taking thesetablets and as soon as I ceased taking them the pain began to ease(slowly).

I’m sure that there are other reasons why gout came on such asexcess Real Ale (!) and a love of prawns and cockles (I don’t eatfish) but the food supplement was the trigger.

Just thought I’d pass this on.

Moral of the story: always check the contents when you buysomething!

Your recovery after 3 month attack from hell was very similar to mineafter 6 weeks attack from hell. But low dose Colchicine and highdose Indomethacin triggered the termination of my problem. I thinkthat the word “trigger” might be relevant.

Although it took you and me several days to recover fully (exactlythe same recovery rate) how much of that is attributable to straightforward recovery of damage to the joints and how much to the goutflare-up diminishing? What I mean is that I wonder if termination ofa gout attack is not in fact remarkably sudden, like turning off of atap, but that the recovery of the actual foot lags the termination ofthe gout attack because of recovery of the damaged joints.

This might seem nit picking but with much lesser attacks in the pastI have felt gout literally ebb away, over a three of four minuteperiod. I had assumed that the crystals were simply dissolving, butcould that be right ? I have seen another comment like this on thisnotice board in the past but in that case the writer assumed that itwas the deposits being removed flushed off I seem to remember werehis words. But as you explain (and I completely misunderstood)deposits aren’t like that. Deposits are as mono sodium urate, uricacid, in the fatty tissue (which I had read several times and thencompletely forgot !). Clearly such deposits in the fatty tissuecouldn’t just flush off.

But in my case I have neither put on nor lost weight so where did thedeposits go to or come from. My shoe size has not altered from 9.My feet were swollen (the gout moved from one foot to the other)during, and for a period after the major gout attack, but they haverecovered to their normal size. Could the deposits really accumulatein the fatty tissue of your feet just because that is where the goutis ? Could the deposits be clearing from around the body (as otherssuggest) ? So that, as the deposits near the other foot (in yourcase) clear, so gout is initiated in that foot ?

Of course the crystals could be just dissolving, as I had previouslyassumed, but I really wonder if it is the crystals causing the pain(as Arnold believes) or if it is a chemical reaction caused by therelease of the enzymes from the phagocytes (I have to go back to myschool biology days to remember these words). It certainly feelsmore like a chemical burning sensation to me. If there are crystalseverywhere in all the joints and it is the physical broken glassnature of the crystals that causes the pain, then why don’t we havepain everywhere ?

Also how can the crystals dissolve ? It is possible, thoughunlikely, that my serum urate level could have been tripping aroundthe magic figure of 416 (the approximate level at which urate issupersaturated in plasma) in my previous attacks but as Arnold pointsout, so what ? The only place that matters is in the synovial fluid could the ph there have been changing so rapidly ?

Maybe I just dreamt this ebbing away thing.

But also, as I say, I have had several minor gout attacks over theyears, what caused this to be the Rottweiler of all attacks. None ofthe normal descriptions of acute gout talk about Rottweiler attackslike your three monther ? But I now discover that it is not rare.

Worst of all your comment that “while taking your Allopurinol youain’t out of the woods by a long site” is prescient. I had a funnyfeeling that that was going to be the case!

I suffered my first major Gout attack at age 55 in my big left toe 8months ago. I went to ER cause of pain and lack of sleep got aindustrial shot of indomethicine, immediate temp pain relief. Startedtaking indo tablets daily but after a couple months they were rippingup my stomach. Switched to Colchicine and added 1/2 tab of Bextradaily That Dr retired (quit). She said I would probably have anotherattack within a year,, she was right. Then 3 weeks ago second attachoccured,went to my GP, gave me tylenol/cod #3 for pain but that really onlyhelped a little to be able to sleep,, started Google ing andsearching,,,and researching what is available on the net,,,,

So a couple days ago after reading all the info that search engineshad yielded to me, I start thinking — all the meds are just solvingone thing but side effects and secondary gout (caused by meds) maybeanother,,, what was the cause???

one of the sites that seemed to pull things together with little biaswas here

http://www.health911.com/remedies/rem_gout.htm#top

I printed it out and read it twice highliting what applied to me inmy diet and meds. I felt informed somewhat.

I see pros and cons for diet,, butI saw a couple touts on Cherry juice,,, real juice not flavored.better just fresh cherries or frozen. I do remember that about 2weeks ago we had a big Shrimp dinner and I am thinking this may havecontributed to my second attack. So what do I have to lose?

I bought a bag of frozen dark cherries, frozen strawberries,and a pound of grapes. Started the cherries 36 hrs ago,,, 22 cherriesto start. then 6-8 cherries in between meals, ate some strawberriesand a few grapes as snacks and VIOLA pain and swelling is almostgone as predicted. The pain started dropping off in 12 hrs and Iwasn’t sure but I had a better nights sleep.One other variable, I started adding vitamin supplements C 1000 mg E400 IU and Fish Oil 1 gram a day. I ran out of the tylenol 2 daysago. I also tried to increase my water intake.

In 2 -3 months or years I may be able to testify more about thesedark cherries if the results hold up.

Any other success stories about cherries?

One web site touts Tart cherry juice,,, I didn’t try that.Many sites want you to buy their vits and mins but I took those witha grain of salt. $$$$

Today I ran up the stairs and was not contrained by any pain in ankle.Had steak last night!

An old southern gentlemen told me that his mother had always saidjust eat a bowl of cherries and sitback.

Google gout cherry and you come up with some stories.

For a week now I have been recoverying from gallbladder surgery. I am suppose to be on Allpurinol, Colchicine and 2 NSAID (diclofenac) pills daily. I am on the NSAID daily becuase I started Allpurinol several months ago and my doctor noticed and increase in gout attacks. But I stopped everything right after my surgery since I was very concious about taken any drug during the healing process. Both my reumatoligist and surgeon said to stop the NSAID becuse of the blood thinning properties, a week before surgery. Which I did. Well 6 days after surgery I came down with a bad gout attack in my left foot which forced me to use my cane to get around that day. For my severe attacks I have a prescription from my reumatologist for the a steriod dose pak. I have figured out that if I do on the first day four 4mg doses then tapper of with 3 pills the next day and 2 pills the day after and then one more pill on the fouth day. I normally have full results by the second day but still have to do the tapper process. I have not tried a 3-2-1 series thinking I want the pain gone, why risk it. In a four day series I consume 40mg of steriod. I compare that to my spouse that has Multiple Sclerosis. When she has an attack she get 1gram a day for 3 to 4 days thru IV. So I am not sure what side affect I am suppose to be worrying about with my 40mg dose compared to 3 to 4 gram doses that she gets. Does anyone else use steriods for severe attacks? I have tried the NSAID for attacks for several years now but it seems to take maybe a week to get the same results that I get from the steriod. My thinking is that the pain causing more tissue damage and relieving the pain faster is better in the long run. When I have used a NSAID it tends to relieve the pain but then pain would move the next day to another area of the foot prolonging the attack. So could the steriod be doing other things to prevent more attacks since I must be in a higher state of uric acid levels. By the way comparing results…my Uric Acid level was 13.5 mg/dL back in 2/28/2003 when I saw my regular doctor. My reumatolgist resently tested me in June and I was at 4.1. That about two month into my Allpurinol use. Well I tried to get my surgeon to suck out some fat while he had me cut open that would have been an ideal way to remove those uric acid filled fat cells.

I am now coming to six weeks on AlloP. In the last couple of weeks Ihave started to feel some relatively minor side effects that othersmight be interested to know about.

Feet feel like lead when I wake up. I started to get this feelingafter about 2 weeks. The experience is not painful - and the feelinggoes away as soon as I start to walk about. It just feels as thoughthe muscles of my feet are very tired (both feet both feeling thesame).

Pain in the muscles of my legs (both sides top front) and my buttockswhen I walk a distance (say about a mile). I started to get thisfeeling after about 4 weeks. I have an exercise routine which is todo 30 sit ups, 20 press ups and some other exercises each morning assoon as I get up and then to walk a couple of miles in a round abouttrip to my office. As far as the pain in my legs is concerned itfeels like what you hear athletes going through on a long distancerun. As soon as I stop walking the pain goes away in about 5minutes. The pain goes away if I simply remain standing withoutexercising. The pain is quite severe and I can’t walk more that mycouple of miles but, as I say, as soon as I stop the pain goes awayand I feel fine for the rest of the day.

However I was getting a bit worried when I started feeling lower backpain so I went to have a back massage. Sure enough I had one musclein spasm, which the masseuse was able to get rid off in one half hoursession.

I think that what is going on is that my body is trying to sort outmy metabolism under a new regime of lower levels of blood uric acid.I think that this is a good thing so consequently I will try toextend my walking and live with the pain a bit longer each day. AlsoI will continue to have massages when necessary. Hopefullyeventually a) I will get fit enough again and b) the pain will goaway. I should point out that since having a severe gout attack atthe start of the year I have not been doing much exercise (and Inever was a serious exercise enthusiast anyway).

Indications of near-gout. I feel that I am teetering on the edge ofgout all the time and have felt this way ever since starting my dailyregime of one 300 mg tab of AloP and 3 small tabs a day of Colchicinetaken six hour apart (when I started I was also taking one tab a dayof Diclofenac (Voltaren) but I have stopped the Diclophenac for thelast three weeks). Mostly in the evenings I feel I am teetering onthe edge of a gout attack but it never actually turns into anything(each morning I flex my feet around and give a little prayer ofthanks to the great Gout god, who as we know is a very difficult godto placate!).

This teetering on the edge thing is a real motivation to stay off thebooze but it has also given me a chance to experiment. I am tryingto see if there is something that I am specifically allergic to whichwould cause a real flare up (I appreciate that this is a clear signof Gout madness!). So far nothing dramatic but I have chickened outof the anchovies test so far. Shrimps, hot curry, fish and chips,tinned tuna, do cause classic visible signs of reddening of my bigtoe joints (interestingly both feet at once), but not pain. Meat andall other foods have no effect. Interestingly the reddening effectoccurs very quickly, before I could have properly digested the food.I call this a trigger effect and I personally do not believe that itis much to do with purines.

However, apart from stress, the one thing that I now know to be asignificant influence (though not a trigger effect as such) isalcohol any form of alcohol, beer, wine, whatever. I promised myspecialist complete abstention from alcohol for the first 8 weeks ofAlloP but, as I say, I have been experimenting. Truthfully I startedhaving a couple of pints of beer every two or three days startingabout three weeks ago. I had taken to drinking a pint of water withthe two pints of beer but I find that it doesn’t make any difference,within a couple of hours of drinking either two glasses of wine ortwo pints of beer I see some reddening of my big toe joints and feelsome twinges of pain on some parts of my feet or ankles. Now that Iknow what is going on I can “feel” that my blood uric acid has risento a dangerous level. This is a shame but there you are.

However I have found a solution literally a “solution”. I havetaken all of your advice and I am drinking lots of water. I havefound a brand of acetic acid supplement (available here in the UK atleast) called PLJ (PLJ stands for pure lemon juice). It takes a bitof getting used to but my favourite tipple now is simply water lacedwith PLJ. I haven’t found that I have a craving since having givenup regular beer drinking at the start of this year but (and thissounds sad) I do have a habit of regularly lifting a glass to mymouth and hanging round pubs with low company (OK maybe the companyonly lowers when I turn up!). But I really don’t like sweet drinkslike orange juice and nor do I like alcohol free beers. I can tellyou that PLJ and water has now rendered me sociable again, it is muchcheaper than beer and I feel a lot better for it. I wish that I hadfound this drink earlier.

[For reference: I am 53 years old, not overweight, otherwisereasonably healthy, but not a health faddist, regular beer drinker,genetic predisposition to gout throughout the family. I experiencedvery major gout attack at the beginning of this year after five yearsof minor attacks that went largely untreated].

i await a return call shortly from my doctor, but would like to askfor thoughts about the atkins diet since i have actually tried realhard to limit meat since my last attack (which was not a prettypicture .. very ouch) .. please tell me of your experience andrecommendation