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I’ve just reread yours and mine again, to make sure I’ve covered everything.
You had to wait for your first post to be published, but now that is accepted, all posts that you make when you are logged in will appear immediately.
You make some references to gout going away and coming back. It does not do that. Gout is with you every day, destroying your joints, and spreading to skin, kidneys, heart and all your organs. It does not hurt you every day, because your immune system fights it. On many days, you feel no pain, or less pain, but that is no indication of whether gout is getting better or not.
You say that you’d rather chop your feet off. Let me tell you, that will make no difference to gout. Your knees are next. Elbows and hands follow. Eventually, all your joints are affected. If you do not make uric acid safe, then eventually, your extremities will be so damaged that amputation might well be the only medical option. Then it get’s worse. Uric acid spreads into soft tissues in the form of lumps called tophi. These grow bigger and harder. They burst through your skin. They damage your kidneys. they damage your heart. All organs are at risk.
This happens very slowly, so you have many years to go. But each year gets worse. When we control your gout, each year gets better.
The only way to know if gout is getting better is to have lower uric acid in your blood. Please post your test results if you have them. More important, is to realize that you have to worry about those numbers much more than you have been worrying about food.
We can beat this, Gout Boy.
I can show you how to work with your doctor to fix your gout. But besides that, if you’re feeling down, you have someone to share your troubles. Why not make a commitment to post every day for 30 days. After a month, I promise you, you will feel better, and you will know that 2015 is the year you control your gout completely.
OK Gout Boy, time to stop feeling sorry for yourself, and get this fixed.
First off, stop worrying about food. You’ve done everything you can to make your gout diet good for you. Of course, there might be some minor improvements. We can spend some time on daily eating plans if you like, but that is not important. However, don’t let your weight run away again, and keep up the exercise.
Your gout is not a product of your diet. Unless you are exposed to environmental toxins, or take meds for other health problems, your gout is genetic.
You have two important jobs to do, and I’m going to help you every step of the way.
First important job is pain control. See your doctor, or pharmacist, about a pain-killer that is compatible with Indocin and colchicine. I used ibuprofen instead of Indocin, and my pain-killer was paracetamol. Best to get a gout-strength prescription from your doctor.
At the first sign of gout – one colchicine tablet and one Indocin dose.
Two hours later, if still painful swelling, one colchicine tablet and one pain-killer dose.
At four hours, if still painful swelling, another Indocin dose.
At 6 hours, another pain-killer dose.
Repeat Indocin and pain-killer up to maximum daily dose, until pain is bearable.
Do not stay in bed. It is important to get mobile as soon as you can. Push yourself to walk through it, and take control. The meds will help, but every word you have written tells me you’re giving up. Don’t give up! I’ll help you stop the pain returning forever, but you have to learn to control it for a few months.That last paragraph gives you the basics, but you have to make it yours. Indocin and ibuprofen are NSAIDs. At gout strength doses, you should definitely be able to notice a difference after 20 mins. Be mindful of the pain, and use gentle exercise and drugs to make it bearable. If Indocin is not making a difference, ask your doctor for ibuprofen, naproxen, or a different anti-inflammatory. That’s why I say ‘be mindful of your pain,’ because you are the only person who can assess which is working best for you. The same goes with the complementary pain-killer. Ask your doctor about different possible combinations until you find what works for you. Gout strength prescriptions are important – over the counter doses might help with mild gout attacks, but not a full-blown flare.
Also, you can adjust the time between doses if you like, to make sure the maximum dose is spread through your day in a way that suits you. That applies most to the anti-inflammatories and pain-killers, however there might be a trick with colchicine that suits you. Try taking one last thing at night, then if you still pain when you wake, take another. Never more than two per day. Colchicine has no immediate effect on pain, but it does limit inflammation from getting worse. It does this by poisoning your immune system, hence the 2 a day limit. That means you should stop taking it if you have any infection, or might be exposed to infection.
As soon as you feel better about pain control, it is vital to tackle uric acid. I cannot believe that you have written so much about your gout without mentioning your uric acid levels. You need to know your number, and we can then set targets. If you have uric acid test results available, please post them now. Otherwise, get them from your doctor as soon as you can.
I don’t know what evidence your doctors have to suggest that you now have permanent arthritis. Obviously, I’m limited by lack of information about your medical history. All I can say for now, is that there is hope that the damage caused by uric acid crystals is not permanent. The sooner we act on uric acid control, the sooner we stop more damage, and increase the chances of full recovery.
Remember, excess uric acid causes joint damage, and worse, every day – not just the days you are in pain. It can take many months to get uric acid under control, which is why I want you to have the confidence of effective pain control first. Once you can control pain, you can control uric acid. Then you can enjoy your thirties, get a good career, and grow old gracefully. Or disgracefully if you want – that’s your choice.
Sorry, Will, I don’t know how I missed this. And not for the first time. I really must try to find out why my notification system isn’t working.
First off, if your doctor increased allopurinol dose a month ago, you should have had a retest by now. Anytime after two weeks is OK, but leaving it too long just wastes time. The only reason for taking allopurinol is to get uric acid lower, and so it has to be monitored. The test result history makes it much easier to judge what is happening. These are important facts to add to your profile, which helps understand what is happening in future.
Also, I can get easily confused without reminders of these important facts. I know I’ve discussed the risks of exercise and gout-weakened joints recently, but I can’t remember who with. Is anyone supervising your exercise routine? Do they/you have a grasp of the basics of exercising tendons that have been weakened by uric acid crystal damage?
After your update, it sounds like the discomfort is either over-zealous exercise, or the first signs of a typical gout attack. Are you still taking the colchicine? That might have prevented discomfort becoming a full blown attack.
31 too young? I’m afraid not. My nephew, who has gout history on both maternal and paternal sides of his family, started mid-20s.
Gout under 40 is unusual, but not rare.
This, combined with your intolerance of several meds, screams “find a good gout rheumatologist!” I don’t know if you’ve had the 24-hour urine test to see if you are under-excreter or over-producer. That is one of the first things a good rheumy will do. It might explain why losartan has no effect, or it might give you additional treatment options.
You seem overly concerned about side effects of medicines that have safely been used to control uric acid by millions of people. I’m concerned that anxiety brought on by these fears might be the real culprit. However, my main concern is that you might not be getting the right medical support during uric acid lowering treatment. When on such treatment, all uric acid tests should be accompanied by kidney function and liver function tests. The results from these give a skilled doctor the information he needs to make sure that the treatment package is right.
As far as long term concerns are concerned, you seem unaware of the worst effects of untreated gout. Uric acid crystals cause permanent and semi-permanent damage to joints. After a few years, they spread into soft tissues causing skin defects, kidney and heart disease, and damage to all organs. This process is slow, but constant. It happens every day that your uric acid level is over 6.5. On cold days, it happens at lower uric acid levels. It happens irrespective of whether you have a gout flare that day, or not. This is the real danger of gout, and it gets worse as you get older, and less able to cope.
Simply put, a well managed treatment plan that suits you, will save your joints now, so you can enjoy your fifties and beyond. Failure to act now will make your 40s agony, your 50s restricted in mobility, and your 60s less likely to happen.
It’s time to tackle those side effects now.
First off, can we exclude Han Chinese, Thai, or Korean ancestry?
Second, did you start allopurinol at the recommended start dose of 100mg?
Third, do you want to consult a rheumatologist now, or cover some of the basics I have mentioned with your family doctor? If it’s the latter, I can give more detailed help about what you need to ask.
I’ve deliberately avoided diet here. The only bad trigger foods that I am aware of are those high in free fatty acids. They are only one of five important diet restrictions that need to be considered. However, there are also good trigger foods that lower uric acid, causing attacks from partially dissolved crystals. If you have gout at 31, it is unlikely that diet changes will have sufficient effect to control gout. Having said that, I do not know your circumstances. If you want to try dietary control, let’s start with your height and weight, what you commonly eat every day (or photos of itemized food bills), and what you would like to eat, feel you but cannot.
Vimovo is interesting. The active ingredient is naproxen, a Non-Steroidal Anti-inflammatory Drug (NSAID). Of all NSAIDs, naproxen is the one that most people have recommended here for gout pain. However, many people suffer stomach reactions to NSAIDs. Vimovo has a second ingredient: a proton pump inhibitor called esomeprazole. That decreases the amount of acid produced by the stomach, thus reducing the risk of gastric side-effects.
It’s good that you feel better with this, Scott. I’ve often felt that one of the curses of gout, besides agonizing pain, and joint damage, is the way it drags you down. Knowing you can control the pain effectively lets you focus on the important task: getting uric acid safe. It’ll be interesting to see the results of your new blood tests.
I hope your podiatrist is better than those I’ve seen on YouTube. Butchers that allow uric acid to build up for years because they think 7 to 8 mg/dL is acceptable, then charge a fortune to cut the tophi out. I’ve never seen a podiatrist website with any useful information about gout, either.
Maybe yours is one of the unrecognized heroes of gout. If so, please share the details here.
It’s not a specialism we see much of in the UK. I guess the nearest is chiropodist, but they tend mostly to deal with pedicures for the infirm, ingrowing toe-nails, bunions and the like.
What exactly is a podiatrist supposed to do, and who governs them?
Hi Linda, I’ve moved this to a new topic, as the previous one was not pseudogout related.
I’d discuss the massager with your doctor if I were you. Light massage is good for gout, so might also be good for pseudogout. However, you have to be careful to avoid damage to inflamed tissues. Some professional help might show you better techniques for easing your pain without causing damage.
Pain killers are not always the only answer for pseudogout. Your doctor should examine you for underlying problems that might be causing the pseudogout.
Please note that, whilst I occasionally mention pseudogout, I am no expert. Maybe you should ask to see a pseudogout specialist.
Oh dear, Graham, I’m sorry to read about your sickness. I do hope it is not allopurinol related. The only way to tell is to see if it continues every time you take it. Another idea is to try allopurinol before food, or an hour after.
Sometimes, it’s just coincidence. Sometimes it’s anxiety-related. If all else fails, there is now the alternative of febuxostat (Uloric/Adenuric).
Scott, are you sure your result is 4.0mg/dL? Unless you are on uric acid lowering meds, that is too low for gout.
I hope other people join in. I hope Paul can explain a bit more about why he wants this information.
I started statins about 17 years after getting gout. I never have needed meds for high blood pressure.
I can see from your profile that you are taking oral steroids for the gout pain.
This normally resolves a gout attack in a week or so, but yours is going longer.
You need to go back to the doctor for further examination. Either another gout attack has happened before first one has cleared, or there is some other medical problem alongside your gout. When you are there, arrange for uric acid blood tests. When you get the results, be sure to get the exact numbers, then post them here.
I hope you are still visiting here John.
It’s important to realize that the answer to “How long does gout last” varies from person to person. Also, it helps to differentiate between the duration of individual attacks, and the length of time that you suffer from gout.
How long does gout last: duration of attacks
These should last around a week, but as I say, it depends on your personal circumstances. Good treatment that is designed for your unique situation will shorten the duration of attacks. Bad treatment, or treatment that does not match your specific needs will prolong the duration of gout attacks.How long does gout last: total time period at risk
For most gout sufferers, gout lasts for the rest of your life. However, there are certain causes of gout that can be cured. In those cases, controlling the underlying cause of gout can cure secondary gout.These are the reasons why I emphasize the need for personal gout treatment plans. You can get such a plan simply by asking in this gout forum.
Hey, @robpp – it’s been a while.
I was wondering how you are progressing with your gout.
I’ve learned a lot since my last response here, especially about the importance of personal gout treatment plans. It is important to have short term plans that stop gout pain. It is equally important to have long term plans to stop gout from ever returning.
I hope I can help you control gout properly so you do not suffer again. Please let me know how I can help you best.
Hey, @mgmnj – it’s been a long time.
I wondered how your gout is progressing. I’ve also been looking for more information about ACTH and gout. I couldn’t find much.
However, I did learn that ACTH is a treatment that encourages us to produce more natural steroids. This is better, as other steroid treatments inhibit our bodies ability to produce our own natural steroids. So much that, if regular steroids have ever been prescribed, then ACTH is not an option.
Do any other readers know more about ACTH and gout? If so, please start a new topic about your gout experiences, opinions, or questions.
It’s very disappointing Luke.
I’m not sure if it’s a big deal, but it shows a typical “stuck in the mud” attitude of many doctors, including some rheumatologists.
If her only concern is exacerbation of flares, then it shows a degree of incompetence to ignore the wishes of you, the patient. There is no evidence to show that flares increase if you are already taking pain control. If you are prepared to take the risk, you should be allowed the choice, now.
Medically, the dangers to health come from continuing exposure to uric acid crystals, not from acute flares. I hate this attitude that says, “This is how we’ve always done it, and bugger the new evidence.” I hate it so much, it stops me moderating my language!
Saying uric acid is “not that bad” at 7.2 is like saying, after a few weeks, “you’re only a little bit pregnant so carry on with bad habits for a few more weeks.” Outdated claptrap!
Sorry for the rant, Luke. I know I should be helping you better by reassuring you about being patient. It probably isn’t a big deal. Like getting slapped in the face isn’t a big deal compared with getting stabbed. Annoying and unnecessary.
Let me try to put it another way. If you said you wanted to wait 2 months, I would say it is not the end of the world. However, if you get over this flare, then leave it 6 months, I’ll never reply to you again.
Hi Graham,
That plan looks excellent to me. I also like your 6 point summary, or rather 5 of them.
Point 2 is not completely correct. It is true that alkaline urine pH will reduce kidney stone risks, at least from urate stones. However, there is a significant body of evidence that suggests an alkaline diet has many other health-promoting properties. Of course, this inevitably leads to wild claims, often used to promote expensive supplements. My take on this is to avoid supplements, and change my diet to be more plant-based. I setup foodary.com to explore the general aspects of alkaline diets, though I don’t spend as much time on it as I would like. If you are interested in exploring general health benefits of alkaline diets, then I have a forum at foodary.org, and I would appreciate any interest you might show in that project.
Interestingly, Mediterranean-style diets are intrinsically alkaline forming, though not usually tested for effects on urine pH. There is a wealth of information on health benefits and Mediterranean diets. Again, for anyone interested, foodary.com is my place to explain general health benefits of personal eating plans. This goes beyond the gout focus that I discuss here.
On uric acid meters, I do not believe that any one meter is better than another, as I think the basic technology is similar. That leaves us with quality, after sales-support, and price. I’m not in a position to compare quality or after-sales. I now have to tell you that my best price search has been limited to suppliers that pay me a small commission for products purchased through my links. I’m perfectly happy for other people to report cheaper sources here, so long as the links are not self-serving. My best price search found Urit 10 Uric Acid Test. I’ve always had excellent after-sales support from amazon.co.uk but this does not include technical support.
Congratulations on the weight loss. 7 pounds in 3 weeks is excellent. I hope it has given you a basis for better eating habits that will help sustain more improvements to your health.
Thank you for your continuing support, Graham
Luke, my main aim is to help you improve your relationship with your doctor so that you both work together for the prime aim of maintaining your general health the best it can be, and getting you a personal gout treatment plan that is carefully matched to your circumstances.
Many visitors don’t have that relationship. I can offer some general advice on the best way to manage gout. Please do not mistake this for professional medical advice. You must discuss your concerns with your doctor. If you do not know what to ask, I can help. If you do not understand your doctor’s responses, I can help.
I would far rather you asked these questions of your doctor, then report back here with responses, comments, and questions. That makes sure you are getting useful advice from your doctor that respects latest gout management professional guidelines, and respects your health history.
Having said that, my responses to your 4 specific questions are:
1) Allopurinol has almost half a century of safe uric acid management – Uloric is still being field-tested. A doctor’s response to the Uloric vs allopurinol question often tells you more about the quality of that doctor than anything else. Above all, the answers depend entirely on the patient. The general rule is to prefer allopurinol first, and consider Uloric if there is a history of allopurinol intolerance. Uloric might also be considered first for patients of Han Chinese, Thai, or Korean descent. Both allopurinol and Uloric might have side-effects. Uloric’s tend to be liver-related. Whichever uric acid lowering treatment is prescribed, it is only correct if backed by appropriate blood tests. Test frequency is patient-dependent, but must be at least once per year. Blood tests must include kidney function and liver function, as well as uric acid. Reliable old faithful, or hot new thing in town? It depends on the patient.
2) Reducing uric acid is likely to trigger occasional flares, but not certain to. Uric acid lowering treatment without provision for some form of pain treatment is a sign of a bad doctor. Patient preference should determine if pain control is daily preventative or as required.
3) No, that is not right. Nor, is it wrong. Just inappropriate logic. You should start uric acid lowering treatment asap because that is the right thing to do to minimize further joint damage. The fact that you are already taking pain control might be a bonus, but not a good basis for determining a medical procedure.
4) I recommend activity commensurate with a healthy lifestyle. To me, that involves walking in preference to driving, with public transport somewhere between. It involves partaking activity that promotes physical and mental well-being. Social sports, or helping in community projects are useful ways to incorporate gentle exercise into your daily routine. In my experience, that helps gout recovery. Some studies also indicate that regular exercise is associated with lower uric acid, so good for long-term. Tennis sounds great. Gyms are not my style at all, but I respect the right of anyone who enjoys a gym workout. I’m far from an expert on gym matters. The goal for a gout patient is to maintain strength and mobility whilst avoiding excess muscle-mass. My son-in-law is a highly-regarded personal trainer, so I should find the time to talk to him about the best gym routines for gout sufferers. The key points about exercise are:
a) Exercise that encourages blood flow to joints is good.
b) Exercise that helps maintain BMI below 23 is good.
c) Exercise that builds muscle mass (a rich source of uric acid) is bad.
d) Exercise that stresses tendons, cartilage, and bone joints is bad, as these are weakened by the presence of uric acid crystals.
As with gout treatment plans, exercise plans must be tailored to the individual. A good personal trainer should understand the 4 important points about exercise for gout patients, and develop a suitable plan. You need to be aware of the risks of joint damage, and not assume that pain whilst exercising is part of the process. It could be a sign that gout-weakened joints are suffering. Discuss this with your doctor, as it might be wise to get x-rays, ultrasound, or other scans of your joints.Yes, some blood pressure meds can cause gout, but this takes many years. That means that switching meds might not be enough. It’s all about controlling uric acid levels. If gout attack stops, it might still come back if not managed properly.
Remember, any doctor who gives you gout by prescribing the wrong blood pressure pills is not the person who will know how to cure your gout. I’d strongly recommend posting uric acid blood test results here, so we can work with your doctor to get the right treatment package that stops high blood pressure, and gout.
Cauliflower is not a problem. Anyone who says it is, is over 10 years out-of-date, so be careful where you get your gout info from.
Gout isn’t really about diet, though a bad diet can make it worse. Keep meat and fish intake to healthy limits. Once a week or less, and always eaten with twice as much veg.
Gout in the elbow often leads to bursitis which sounds like what is happening to you. The only way to stop this is to get uric acid safe. What is your uric acid level, Michael? There’s a handy uric acid summary on each page here.
I spotted the update before I posted my last response, but I think it is valid.
For all gout sufferers, we need effective uric acid control that brings it safely to 5mg/dL or below. But, we know that this can take months to reduce the years of old uric acid crystals, so we need effective pain control.
The best pain control knowledge comes from nurses in hospitals. They understand the need to provide appropriate combinations.
Appropriate means “right for you.” As I said above, I won’t touch steroids, yet they make gout bearable for other people. It’s about being flexible until you find what works for you, and having a doctor who will work with you on this.
The principles for gout pain control are:
1. Stop inflammation spreading as soon as possible. That means colchicine at the first sign of gout, or as a daily preventative during first weeks of uric acid lowering.
2. Reduce inflammation. Doctors have hundreds of options. Find the one that has least side effects for you.
3. If pain still unbearable, block it with appropriate analgesics. Again, you need to find the one that has least side-effects from the hundreds of options.
So, Luke, if the indo+colcrys+steroid pack works for you, celebrate it with a walk. Then, when you feel ready, get that uric acid down. Despite some common attitudes, there is no need to wait until your attack concludes before starting allopurinol or Uloric. They will not make your current attack worse, and the sooner you start, the faster you gain complete control.
Colcrys (colchicine) is good to stop inflammation spreading, but it doesn’t do anything for existing inflammation.
Indomethacin or ibuprofen are good at reducing inflammation. Note that they are both Non-Steroidal Anti-Inflammatories (NSAIDs), and should not be taken together. NSAIDs often reduce pain as they reduce inflammation, but there are also pain-blocking analgesics to consider.
For severe attacks, analgesics that complement NSAIDs can be useful. It is important to consult a doctor or pharmacist to make sure the combination is safe.
It can take a week to 10 days for bad gout attacks to subside, and you never know if a second attack might prolong the painful inflammation.
Many doctors swear by prednisone or other steroids. I swear at it, having seen bad side effects in other people. It’s a personal choice.
Other things to consider, are protecting affected joints from the cold, and staying hydrated. Dietary improvements that lower inflammation might help. This is a difficult area to get good facts, as there are an awful lot of people selling snake-oil products that have no affect. They get noticed because inflammation will resolve naturally in a few days, even if you take nothing. Switching saturated to unsaturated fats might help, as might turmeric.
I’m a firm believer in gentle exercise to ease gout pain. I proved to myself over many years, that attacks did not last as long if I pushed myself into walking, or similar stress-free activity. It might be the last thing you feel like doing, but that is why you need the combination of colcrys with gout-strength NSAIDs and sufficient pain-blocking treatment.
You’re right in your second paragraph, Graham. Protein foods are acid forming, so keeping these to around a quarter is a good general rule.
Uric acid and urine pH are two completely different subjects. Uric acid is the specific organic substance that is the foundation for gout when it turns into crystals. Aim as low as possible for uric acid. Urine pH is a measure of total acid/alkaline load at your kidneys. Increasing it through an alkaline diet makes uric acid more soluble and helps excrete more. I hesitate to use the word ‘aim’ in this context, but aim as high as possible for urine pH.
A weekly uric acid blood test will certainly help you understand if your strategy is working for you. My only concern is that, until you take the time to learn to test consistently, it is easy to be distracted by the occasional false reading. You can reduce this my being meticulous in cleanliness and have an exact testing routine that always produces the same drop size.
I feel you are doing the right things to promote a healthy lifestyle. Keep posting, and I’ll try to keep encouraging you to improve.
Hi again, Graham.
First off, you are not pestering. I run this forum because I like helping people control their gout. Your messages are exactly what I want every day. If you don’t want to wait for messages to be moderated, you can log in before you post. As you are on Facebook, that’s very easy. Just click the Facebook button and ignore the username/password boxes. The forum software will accept your Facebook details, but it does not see your Facebook password.
The relationship of gout to Omeprezole is not clear. Another gout sufferer asked about it recently, so I looked for relevant research. My results were inconclusive, but there is not very much research. In this situation, I tend to believe that there is no strong link between Omeprezole and gout. As you say, you only take it every other week now, so I can’t see that this would cause a significant uric acid increase. The only way to tell is to get uric acid blood tests without Omeprezole and compare them with tests after taking it.
I know exactly what you mean about the middle-age spread. You’ve passed the biggest hurdle by recognizing you have to do something about it. Now all you need to do is take action.
I understand your difficulties trying to work out alkaline diets. I’m trying to condense the research into something easy to understand, but it’s difficult. I know there has to be an easy way to explain it, but I’m struggling to find it. The closest I’ve got to is a phrase from a nutrition writer who says, from memory: “Eat food, not too much, mainly plants”
I hope I remembered that correctly. His points are:
1. We should eat real food, not the food-like substances manufactured and sold by certain sectors of the “food” industry. This eliminates lots of additives from our diet that might contribute to increased uric acid.
2. By eating just enough food to maintain our personal level of physical activity, we avoid weight gain. Excess weight has been shown to be associated with gout in many studies.
3. Fruit and vegetables are not associated with increased uric acid, whereas meat consumption is associated with increased uric acid.Point 3 is harder to accept for most people. As someone who enjoys meat, and having been brought up to relish it, I automatically rebel against the idea of becoming vegetarian. Yet, I love eating fruit and vegetables. My way forward has been to push myself into reducing meat consumption, in favor of plant-based meals. I love spicy food, so vegetable curry has become a regular feature in my diet. Many meat-based recipes can be improved by adding lots of vegetables. For example, a mince-based recipe such as shepherd’s pie is much nicer to me if half the meat is replaced with mixed vegetables. If you then serve it with a selection of steamed or roasted vegetables, you soon have a tasty meal that is a good part of an alkaline diet. I now avoid buying meat, and I realize that the basis of a good diet starts with changing shopping habits. If you have a healthy shopping basket, you have to eat healthily. In terms of an alkaline diet, this means for every meat/fish product that you put in your shopping basket, you have to add at least 4 fruits or vegetables. As soon as I realized that, I realized how easy it was to make your diet healthy. I also realized that it is quite a challenge to make that change. I have found that gradual change works best.
Shop as normal, then look at the ratio of meat/fish to fruit/veg. Each week, swap one flesh for plants. It helps to seek out some tasty recipes for fruit and vegetable that you enjoy. Always remember that this is not a diet, but a style of eating that promotes good health, without being fixed regime. Gradually, you improve your eating habits, then one day, you realize that you eat to live, not live to eat.
Obviously, this is my personal approach. It might not work for you, but there is probably lots of things you can do. That’s the beauty of this forum. We can all offer different experiences, and choose whichever way works best for our self.
Thanks, Graham, I’m glad my gout website has helped you.
From the uric acid summary below, you can see that 0.35 is the absolute maximum to avoid gout, and 0.30mmol/L is the safe level to allow for natural fluctuations. I don’t know of any diet improvements that can lower uric acid by almost half. My personal advice is that you should focus on a diet that is good for general health. I recommend alkaline or Mediterranean Diets, but you should discuss this with your doctor. As a general guide, most things that are bad for gout are also bad for general health. Avoiding processed food with additives is healthy. I always think that, if there is an ingredient you wouldn’t order as a dish in a restaurant, don’t buy the “food.” Fructose Fricassee? I don’t think so!
It is almost certain that your gout is genetic. Other possibilities are certain medicines for other health conditions, or exposure to lead or other environmental toxins. If it is genetic, the only option is uric acid lowering medicines. I’d advise arranging for a 24-hour urine test. This will help your doctor decide which medicine is best, though allopurinol works in all cases, so most doctors do only do this test if there are complications.
People have accused me of pushing pharmaceuticals. That is certainly not true, as I am a firm believer in natural healthy eating. I simply do not know of natural ways to halve uric acid, just as I don’t know of diets to cure short-sight. I wear specs, and take allopurinol. I also eat healthy most of the time.
On uric acid meters, I tend to side with your doctor, for two reasons.
1) Getting consistent results is hard. You have to be very precise in the way you test yourself. Think of the exact routine that nurses adopt when taking blood samples. Then add the complications of potential contamination from capillary blood compared to venous. It is possible to adopt a strict regime and get accurate results, but you have to be very controlled, and persistent.
2) I used to think that my uric acid tester would help me identify better food choices. It really is not that easy. To link certain foods to uric acid changes, you have to test, retest, and continue testing until you get 50 accurate associations. Your diet has to be boring as hell to do this. To be clear, you have to eat exactly the same food for 14 days, then introduce one change for 14 days, and keep recording your results. To remove any doubt, you have to repeat this 50 times. That is the scientific way, though you might get useful feedback with less rigorous testing. On reflection, I should have got healthy eating habits first, then used a tester to tweak a healthy diet for lower uric acid. I eat healthier now than I’ve ever done in my life, but I still don’t have enough consistency to get accurate scientific data from any changes I introduce. If you are determined to test your own blood for uric acid, I can help you work on removing inconsistencies. You have to be prepared to spend a lot of time on this.
In summary, I think healthier eating is always a good idea. Fad diets are useless, but eating styles that are universally accepted as generally healthy will always be good for gout, especially if you slowly lose weight. Little tweaks like extra coffee and low-fat milk help. This will reduce uric acid, but is unlikely to make it safe. Also, dietary changes take months to have positive effects, and every day that uric acid is over 0.35mmol/L is another day of joint damage, even if you are not in pain. Consider allopurinol as a damage limitation option until diet improves. If all goes well, you can reduce the dosage, possibly to zero, in future. That saves your joints from permanent damage.
I hope this helps you Graham. If anything I have written isn’t clear or helpful to you, please let me know. I’ll try to do all I can to help you work with your doctor to keep you safe from the ravages of gout.
First, John, I think you are probably @john-mcgovern-543 – if you login before you post, you don’t have to wait for moderation, and it ties all your posts to your profile, so easier to find in future.
For gout treatment, you have to separate long-term uric acid control, and short term pain control.
Allopurinol is best for long term uric acid control. You are doing well with this, as the safe maximum level is 300 ?mol/L. At 218, you are dissolving old crystals. This is a good thing, but partially dissolved crystals can cause gout flares. You have to be prepared for that, irrespective of what you eat, so if Arcoxia is what works for you, then take it as required. This is to be expected for a few months.
Increasing allopurinol will surely reduce the amount of time you are at risk of gout flares, because lowering uric acid more will dissolve crystals faster.
When I was in your position, I persuaded my 4th doctor that maximum allopurinol for a year was my best solution. The other 3 thought that 400 was OK because it fell into the “normal range.” I lost faith in those 3, and haven’t seen them since. From memory, it took about 4-6 months to get rid of most of 16 years of uric acid deposits. During that time, I noticed attacks became less frequent, and less painful.
So, consider increasing allopurinol, but keep the Arcoxia on hand for a bit longer. Attacks in your circumstances are rarely caused by what you eat. If they are, it is nothing to do with purines, but everything to do with free fatty acids from saturated fats.
There’s a couple of relevant summaries at http://www.goutpal.com/the-gout/?q=joosten
I was inspired to write them after I read http://www.rheumatologynetwork.com/gout/gout-purine-rich-foods-and-red-herrings
They make most of what is written about diet and gout attacks obsolete. However, John, you can be proud to know that you are on the right road to full recovery. Go a little faster with more allopurinol for a few months if you wish. After 6 months without a flare, you can then reduce it to maintain uric acid no higher than 300.Personally, I’ve never tried it, but other gout sufferers seem to say it works best if you take it at the first sign of a gout flare. Maybe you’ve left it too late?
I’m sorry, I can’t help much with black bean broth. It seems to help gout pain for some, but not for others.
More importantly, it does not do anything to lower uric acid. You need to get uric acid under control if you want to save your joints from permanent damage. What are your latest uric acid test results, Mary?
Gout lasts for life, unless it is secondary gout, and you cure whatever is causing it.
Pain killers don’t stop gout. They just mask the pain. This helps during uric acid lowering treatment, but pain relief without uric acid lowering is very dangerous. The lack of pain makes you think you are controlling gout. However, every day that uric acid crystals are present in your body is another day of joint damage. This can spread to soft tissues, causing damage to skin, kidneys, heart, and all other organs.
It can take many months to get uric acid under control, so the sooner you start, the better.
I’m here to help in any way I can, so please let me know what you want to do next.
Also, I can help with much better pain relief packages for gout. Tell me what you are taking now, and I will try to suggest ways you might stop the gout pain.
Hi Steve,
Thank you for your interesting question. I can’t recall anybody ever asking that before, but I will investigate for you.
The chances are, when I get the information, it will probably depend on something. Most aspects of gout are very personal, and that is why it is so important to have your own personal gout treatment plan. I’ve been saying it for years, and now top gout doctors are recommending the personal approach.
I have to go out soon, so I will probably have to come back to you tomorrow on this. In the meantime, I’d be very interested in some more details about your gout. Especially some background as to why you suspect a link between allopurinol and stomach ulcers. Off the top of my head, I can think of one possibility, but I need a bit more time to research it before I publish the facts.
