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Welcome, @everett-morris1, you’re never alone with gout – at least not here.
Have you joined this forum because you want to control gout without allopurinol? If so, you need to start with your uric acid level. Something I’ve just finished is very relevant. Please take a look at my Uric Acid Levels Chart. I’ve just done 4 sub-pages with general advice for gout patients who are at different levels.
You’ve given me an idea that I could maybe do some similar pages to advise what to do if you are in that situation but want to proceed without pharma.
You can’t just leave it, or you end up crippled or dead. First step is posting uric acid levels, but please start a new post because this is 5 years old!
The contradictions arise because there really is no such thing as good or bad foods – only good or bad diet. You cannot take one food or drink item in isolation and determine it’s effect on gout. There are lots of people that will tell you what is good and what is bad. That is no different from politicians telling you Republicans are good/bad, or Democrats are good/bad. It is no different from religious despots telling you that Christianity is good/bad or Islam is good/bad. People will tell you what they want to believe. I want you to believe that I can help you live a life that is free from gout pain. Do you believe me?
Key food facts for gout sufferers:
- For many gout sufferers, food is completely irrelevant.
- It is often relevant to general health, but not to gout.
Gout is only caused by excess uric acid, but excess uric acid has many causes. It is mainly genetic. It is commonly caused by medicines for other health problems.
If excess uric acid is caused by food, it is not any particular food, but a combination of 1 or more:
- Excess calories
- Excess iron
- Excess animal purines
- Bad eating habits, mainly fasting/starvation, bingeing/feasting, or dehydration.
If you see lists of good and bad foods, which of these 4 gout-related issues are they addressing?
The answer is none of them, because a single food item does not matter.
If all you eat is “strawberries, oats, mushrooms, [and] soy” then you will die before you need to. That diet is too restricted to be healthy. It is absolutely pointless discussing this list of 4 food items, because it has nothing to do with gout.
If those are your favorite foods, incorporate them into a healthy diet.
Don’t use up all your daily fruit calorie allowance on strawberries – get a better mix of micro-nutrients with a variety of different colored fruits.
Don’t use up all your daily grain calorie allowance on oats – get a better mix of micro-nutrients with a variety of different whole grains.Off the top of my head, the only bad food I can think of is anything containing trans-fats (hydrogenated or partially hydrogenated fat). They are so bad for you that the likelihood is you will die from heart disease before gout gets you.
Gout diet has to start with a generally healthy diet. All governments produce healthy eating guides. American guides particularly try to warn against excess calories, too many calories from animal sources compared to plant sources, and excess salt and sugar. All those problems with generally unhealthy diet will make gout worse. They are far more important than purines.
If you eat a healthy diet, and you have a gout treatment plan, there are ways to tweak a generally healthy diet to be more gout friendly. This cannot be generalized – it has to be done on a personal basis, as everyone has different circumstances.
I can provide personal eating plans if required, but you are going to have to commit to sharing a lot of personal information including gout history, other relevant medical history, uric acid blood test results history, food preferences and allergies, typical weekly food and drink intake. Track and post that lot here, and I will be delighted to give you a personalized eating plan for gout that you will enjoy.
Or just take allopurinol and stop worrying.
I’ve hinted at the main thing that is missing here. Gout diet needs the context of a gout treatment plan. In that case, if your plan is to stop pain, you can assess if a food item is likely to increase or decrease inflammation. If your plan is to lower uric acid, then you can assess what part a food item can play in reaching your target. But, you still need the context of the rest of your diet.
Individual food items can be judged against a treatment plan and the rest of the food that you eat. Otherwise, there are no good or bad foods for gout. It’s just food.
By the way, I should have mentioned something about your change from 634 to 448 ?mol/l. Obviously this is an improvement, but it is not enough.
Only getting to 300 or lower will reduce gout attacks. Lowering to 448 might delay the rate at which tophi grow and spread, but it will have no effect on gout flares.
This really is quite simple, now that I know your uric acid level.
At normal body temperature, uric acid forms into crystals at around 400 ?mol/l. In colder joints that crystallization point is lower. The absolute maximum is 360, but for safety it should never be above 300 ?mol/l (5mg/dL). People who are exposed to prolonged cold should aim lower. People who have had a gout for a few years should aim lower.
You can treat gout pain with many different pain relieving medicines and other techniques. But, if you do not get uric acid down to 300, it will keep returning. The longer you leave uric acid, the worse gout attacks become. They get more intense, more frequent, and more widespread.
Every day that uric acid crystals exist, is another day of damage to cartilage, bone, and tendons. It is another day where you risk crystal deposits beyond the joints. Kidney disease becomes a problem. Tophi burst through skin, or damage the heart. These processes take many years, but there is only one way to stop them. Get uric acid safe. That is why I push the recent research that proves it is OK to start uric acid lowering treatment as soon as possible, even if you have a gout flare.
Gout flares can always be overcome by taking the right combination of painkillers. If you do not do anything about uric acid lowering, there is nothing to stop one flare being replaced by another.
It is quite possible that you do have other health problems besides gout. A rheumatologist can test for RA and other joint problems. But as you are not doing anything to stop the gout, why bother looking for anything else at this stage?
I’m sorry if this sounds like a rant. I was foolish enough to delay uric acid control for a long time, even though I knew it was the right thing to do. I now feel that I could have done more to protect my joints. With uric acid under control, I no longer suffer gout, but I occasionally feel the type of creaking joints that make me feel old. Could I have prevented that by acting earlier? I don’t know, but I do regret taking the needless risks.
I’ve had another thought about this.
If you can save the web page from GoutPal.com, and compress it into a zip file, then please attach it to a reply here. If you do not know how to do this, please reply with your browser details (Firefox, Chrome, etc) and I will supply step by step instructions.
You have 45 minutes after posting to edit your post. After that time, the post is fixed, and the edit link disappears. This helps reduce confusion for other forum visitors. The 45 minutes is an arbitrary time. I think it was the default setting when I installed the forum software. I am open to discussion about changing this.
Overall, I recommend carefully checking before you submit. Once the post is submitted, you should immediately read it again in it’s published form, and edit if you spot a mistake.
In this instance there is absolutely no need to change the title. The post is about technical support and is unlikely to confuse anyone who is looking for gout information.
Now, to answer your original questions:
“Where can I email someone with specific questions when I can?t access either of your sites?”
I do not offer email support, except to paying clients. I have considered offering paid support for gout sufferers, but I do not think there is enough interest to make it worth offering. I am always open to suggestions on this, so if you have any opinions, please let me know. In particular, I would be interested in knowing what people might be prepared to pay. I actually discussed this with a friend recently. My idea was to offer a gout support service where you only pay if you are free from gout pain. I am confident that I can relieve gout pain and stop it coming back. If there is genuine interest in this, the service would definitely include email, but I might also consider voice and video connections.Without that service, my support is provided here or through GoutPal on Google+ (https://plus.google.com/+Goutpal). Occasionally people seek support on my Facebook page, but Facebook is not designed for meaningful discussion, so that tends to be a waste of time. It is on my task-list to make this process clearer, and as a result of this thread I have increased it’s priority.
There is no ?feedback? link to report site problems.
There used to be such a link and it got about 100 messages in a 3 month period. All of these were spam, with time-wasting or offensive links to spurious websites. I removed it in favor of this Using GoutPal forum.“When I try to go to email links, I end up at a blue screen with black and white dots and a single line with a google search box. The main goutpal.com site displays the same screen.”
This has also been reported to me by another visitor via Google+. That person sent me a screenshot that showed something similar to what you describe. After several messages and clarifications I was able to prove that the problem was related to the visitor’s computer or Internet connection. There are several tools on the Internet that can capture screenshots. I have used the one at tools.pingdom.com to produce the attached picture.Unfortunately, we never worked out what the exact problem was. The visitor proved he had a problem by accessing GoutPal.com on his sister’s computer, but never told me if he had solved his problem.
I hope I can assure you that I take this seriously. If I knew what the problem was caused by, I would try to find a way round it. Unfortunately, I cannot reproduce the problem. All I can suggest for now is things like clearing your browser cache, resetting your Internet access router, try a different browser. If you have local technical support for your computer, they might be able to help you.
Finally, if there was specific gout problem that you were trying to address, please start a new post with full details, and I will try to provide you with the information you need.
Benzbromarone will not make existing attack worse, but it will lower uric acid so that future attacks will be less frequent and less intense.
Without detailed uric acid blood test results it is impossible to guess if existing attack is gout or something else. Even then, if there is doubt, it needs a rheumatologist to analyze joint fluid.
Personally, I took preventative pain relief for about two months when starting uric acid lowering treatment. I recommend that, but if not, for gout pain you need maximum strength taken at fist sign of a twinge.
It is very common for a “gout attack to start subsiding (not fully subsided) and then come back as a full attack in the same general area within days.” If uric acid is not brought down to 300, it is an almost definite certainty that this will happen – which is why the latest research I linked to earlier advises uric acid lowering as soon as possible.
Is your Oxford study the Facchini one from 2003: Alternative Treatment For Gout ? Blood Letting ?
Your pain sounds worse than mine, but pain is a very personal, subjective issue. I believe two months might be too early to notice the full benefit of allopurinol, but you should notice some lessening intensity and frequency.
In my experience, gout pain deserves more than an Over The Counter pain med. I had a couple of times in hospital, where they really know about pain relief (nurses can’t stand men moaning all night – well not in pain, anyway 😉 ).
If you can’t sleep for the pain, see a doctor, or pharmacist. If it gets no easier soon, suspect something else, because gout can’t live for long with your uric acid levels.
The advice to wait until the pain goes away before starting allopurinol or Uloric is now out-of-date.
Allopurinol dosing guidelines:Allopurinol [or Uloric] should be started as soon as possible. Every day of delay means more destruction of joints and damage to organs. Skin, kidneys, and heart are most commonly damaged, but you will see in the gouty tophi guidelines that all organs are at risk. Specifically, ignore common bad advice to wait until your gout flare has subsided before starting allopurinol. Initiation of allopurinol at first medical contact for acute attacks of gout makes it quite clear that starting allopurinol [or Uloric] dosing should not be delayed.
I had a similar problem at my group practice. 3 doctors saw 0.40 to 0.42 mmol/L and said I was OK. I told them I wasn’t because professional rheumatology guidelines see 0.30 as the maximum (0.36 in exceptional cases). Eventually found the perfect GP who listened, agreed, and moved me up to 900mg allopurinol over a few weeks. I explained I wanted to go as low as possible for a few months because tophi had started to appear on my elbows.
Only trouble now is, I have to move doctor because I’ve moved out of the area. I hope I don’t have to do battle again, but I’m prepared if I have to.
@waterfall-manc, I hope you get to 0.30mmol?L or lower soon.Welcome to the allopurinol club, @jr-poll. 🙂
You’ve reminded me of something for allopurinol takers – good hydration is still important. Allopurinol byproduct (oxypurinol) is excreted via the kidneys. This is not usually a problem, but sometimes, with prolonged dehydration, oxypurinol kidney stones can form. I don’t think this is a big risk, but it pays to stay hydrated.
No need to be scientific about hydration. 2.5/3 liters per day is good. Perhaps more in hot weather and when exercise makes you sweat. The easy test is pee color. If it isn’t light in color then drink more.
That sounds really good, @jr-poll. I hope your doc also understands the need to get down to 5. Many settle for a small reduction in uric acid, but only 5 or below is safe.
Great progress. Please keep us updated.
The latest advice on allopurinol is to start it straight away. It used to be thought that you should wait for the gout flare to go down, but this is outdated: Start Allopurinol Quickly, But Carefully.
Start with 100mg. After 2 weeks get uric acid blood test with kidney function and liver function tests. If all OK, increase the dose every 2 weeks until target uric acid level is achieved. Absolute max for target uric acid is 5mg/dL. I strongly recommend getting uric acid as low as possible for at least 6 months to reduce the time to get rid of old uric acid crystals. This means going to the max dose for allopurinol. Your doctor seems to understand the dangers of uric acid crystals, so he should be supportive with this. If not I can give you references to studies that show why it is the best way.
Meloxicam is similar to ibuprofen, naproxen, indomethacin, diclofenac, and many more. These are Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). They reduce inflammation, and they are often very useful during the first few weeks/months of uric acid lowering treatment. Until you get rid of most of the old crystals, you are at risk of a gout flare, so Meloxicam should reduce the risk of flares. Another reason for maxing allopurinol dose in the early stages. Once you have gone 6 months without a flare, you can slowly reduce allopurinol, but never let uric acid rise above 5mg/dL.
What is your latest uric acid test result? Please could you get the exact number including the measurement scale.
Great stuff @billybuttcheeks. I look forward to seeing your results.
Good for you, @roundtheworld. I hope it is as easy for you to control gout with allopurinol as it is for me. If you get bad days, we’re here to help. When you are celebrating Gout Freedom, please call back here to remind fellow sufferers how much better life is when gout is under control.
If your doctor has any sense, he’ll tell you that allopurinol dose has to be set according to your individual situation. That means getting uric acid to a safe level (5mg/dL) but there are also other individual factors that come into play. It is recommended by rheumatologists to consider 6mg/dL as the absolute maximum if confounding factors (i.e. your nausea) prevent the best target.
They don’t explain that particularly well in my experience. It’s all about risk management. If you settle for 6, you should be ok if you stay warm. Prolonged exposure to low temperature can even make 5 unsafe, so at 6 you have to be especially careful. Shouldn’t be a major issue at 35, but as you get older, it’s harder to maintain body temperature in the hands and feet.
I used to have the same cloudy vision about taking allopurinol every day. Even when I learned that without it, I’d probably be crippled in my 70s. Even when I put my daily specs on that I’ve worn since a child, my allopurinol vision didn’t clear. It took a rather big bang on the head to bring me to my senses. I wish I’d started allopurinol at 35. I know my joints would be in a better state these 20 years later. Do you want to spend retirement on the dance floor or in a wheelchair?
Final point: the nausea might be a temporary thing. I’m half-sure that doctors can prescribe something for that. Please ask your doctor, and let us know what he says. Other people have complained about the nausea issue, so it would be helpful.
I totally agree with your final sentiment. Better get the uric acid level down before they get affected 😮
@twidget, I understand your frustration. You’re in the same place as I was when I started GoutPal. Bad advice from the medical profession, and confusing information on the Internet.
I also mistrust most of what I read, so I take most information from PubMed. It isn’t perfect. I know researchers can sometimes get it wrong, but the quality is way beyond the tittle-tattle that forms most gout pages.
Now I understand your context a little better, I am veering towards suggesting you stop worrying about food. I know you won’t do that, and I don’t blame you, but I’m trying to think of a way to change your thought process.
The only thing that causes gout is excess uric acid. There are many causes of excess uric acid, and food is only one of them. If you do not know your uric acid level, you cannot tell if diet changes are making you better or worse. Pain is not a valid indicator. You can get gout attacks when uric acid is falling due to old crystals. That was the turning point for me. It explains why so many people pick on certain foods as being bad, when scientifically they should be good. You eat a food that everyone says is bad, and you get a gout attack. That reconfirms your fear of that food, but it might be wrong. The only way you can tell if a food item is good or bad is to test for uric acid levels. Most people, myself included, do not have the patience or tenacity to self-experiment in this way. There are too many confounding factors.
I can write volumes on all the factors that can affect uric acid. Besides food, other medications, other health conditions, exposure to toxins, can all affect uric acid. The biggest factor is genetics, so I’ll repeat my favorite mantra: No amount of dieting will change who your parents are.
If you want to remain obsessed about food, why only concern yourself with purines? Excess calories and excess iron are both worse causes of gout. There are few specific foods that you should avoid, but daily gout diets that lead to excess calories, excess iron, or excess animal purines are definitely foods to avoid with gout. Bad eating habits such as fasting, bingeing, dehydration, are all worse than purines.
The only thing that matters is uric acid level. Once I know that, I can advise you about diet. If your level is 7 or 8, diet might be possible. Above that, without allopurinol or Uloric, life is going to be a real struggle for you.
As for the spreadsheet, have you tried the Attachments button below the box where you type your forum submissions? Let me know if the 512KB limit is too small, and I’ll increase it. The best way for sharing spreadsheets is via Google, so if you want help with that, please start a new topic in the Using GoutPal forum.
That’s as much as I can say about food really. You have to plan food in the light of your uric acid levels and a gout treatment plan. The “food first” way is just too confusing. Let me move onto stones and organ damage.
Gout is a progressive disease caused by uric acid crystals. At first, they tend to collect around joints, particularly extremities such as fingers and toes, because these are at lower temperatures. They stop tendons, cartilage and bone repairing itself leading to permanent joint damage (osteoarthritis). They also grow in other tissues. They are usually first noticed in the skin – our largest organ. These clumps of uric acid crystals will eventually spread to all organs. I tend to focus on kidneys and heart, as these bring the highest risk of fatality. I am quite sure that they will eventually affect the gallbladder, though I have not yet seen any specific research on this. Most gallbladder stones are cholesterol (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216212/). However, you’ve prompted me to look at some new research (thank you), and I can see that uric acid is indeed prevalent in gallstones – http://www.ncbi.nlm.nih.gov/pubmed/24377514.
That last report makes the point that alkalizing is good for uric acid stones. That brings me back to food, and reinforces my belief that, if a gout sufferer needs to have a special diet, then the absolute best starting point is a well-balanced acid-alkaline diet supported by urine pH testing.
Thanks for a great discussion, @twidget.
I’d like to explain why sometimes it is important for gout sufferers not to worry about food, but without a link to the specific article, I’m struggling to explain in ways that might be meaningful to you.
I’ll try to address some of your other points.
1. Don’t get gout advice from a chiropractor unless they have some specialist knowledge. Just because he was right, does not mean he knows about treatment.
2. Family doctor is usually OK with gout, but rheumatologist is better if there are complications. I have heard of many doctors, including some rheumatologists who are unaware of latest professional guidelines. Therefore, you must take responsibility for your uric acid levels and never allow it to go above 5mg/dL.
3. I do not think gall stones are anything to do with uric acid or gout. It is perfectly possible to have gout at the same time as gall bladder problems. As far as I am aware these are two different health problems requiring different treatments. I am not a doctor, and even if I were, it would be immoral to diagnose you online. Go and get a proper diagnosis. If your doctor has told you that gall stones and gout are linked, please can you supply me with some facts, as this is news to me.
4. ” IF I eat the wrong thing, I?m doubled over in pain within an hour” I don’t know what you mean by the wrong thing. Fatty foods are bad for gallbladder pain. They’re also bad for gout, but for different reasons. You seriously do need to worry about food, but you need to worry about your total diet, worry about exactly what you mean by “wrong food”, and worry about the relationship of food to the 3 different diseases you mention (gout, gallstones, and hypoglycemia).
5. A low purine diet can often reduce uric acid by one or two points. I have no idea what your uric acid level is. You should know exactly what your number is. If it is over 7, a low purine diet is unlikely to be enough. If you do not get uric acid down to 5, gout will get worse causing progressive joint damage and organ disease.
6. If you want me to help you resolve conflicting data, you have to give me links to the data that conflicts. I cannot guarantee that I can explain the conflict, but I can guarantee that without the data I cannot explain the problem.
7. The reason why you cannot find purine data for the items you list is because they have no purines.
8. Again, I have no idea where you read that protein was your enemy, but it is definitely a friend to gout sufferers. Do not confuse purine and protein. Animal purines are bad for gout. All protein is good for gout, but if high protein food also contains high purines, then gout sufferers should avoid them, or take steps to minimize the effects of animal purines.
On balance, I wouldn’t say you were doomed, but I’m alarmed by three separate health problems and the problems in managing them together. Gout has to be managed on a case-by-case basis, so I’m loathe to generalize and guess at some likely solutions. I’m happy to try and help you find a path out of this, though I don’t understand why your doctor can’t help.
In complicated cases like these, I’d much rather comment on specific advice from your doctor/rheumatologist. I can also help you determine what questions to ask. The first question is “What is my uric acid exact number, and is there anything unusual about my kidney function or liver function test results?”
I believe your doctor is very sensible. You have approached him with a medical problem, and he has given you very sound advice.
The next step, if allopurinol proves to be the culprit, is to switch to febuxostat (Uloric, Adenuric, and various other brand names depending where you live). With any uric acid lowering drugs, you should get blood tests for kidney function and liver function when you get uric acid tested.
Allopurinol vacations are OK, but you have to monitor uric acid levels. There are no clear rules on how long you can stop taking it. Personally, I’d get tested every three months, and make a judgment from the results. If it got to 9mg/dL on more than two tests, I’d be straight back on the allopurinol.
All meters I have ever seen are manufactured in China or Taiwan. I do not know of any importer in the US. Most US citizens order from amazon.com or ebay.com
@cujo, your rheumy needs a refresher course. Colchicine only for gout is so last century.
@roundtheworld, if I were you, I’d start 100mg allopurinol immediately, and get blood tests in 2 weeks. Include kidney function and liver function tests, as these often give an early indication of intolerance. Increase to 300 if all OK, and test every 2 to 4 weeks, increasing dosage until you get below 300.Pain relief is either preventative or as required. Preventative is half a tablet each day. If you get a twinge then follow with another half. For .6g tablets the maximum is two per day, so I guess you should stick to one, though some would argue that 1.5 might be OK. Do not take colchicine if you have any infection or are exposed to infection risks. Colchicine limits inflammation spreading, so take at earliest sign of an attack. Indomethacin reduces inflammation, so take it alongside colchicine for fast gout recovery.
@billybuttcheeks, you need to have serious discussions with your doctor about pain relief. In this day and age, there is absolutely no reason for time off work through gout pain. But, you need to understand that it is different from many other types of pain. You almost always need combinations of drugs to:
- Limit inflammation spreading
- Reduce inflammation
- Block pain signals
For more info, see Pain Freedom.
Dieting without tracking uric acid changes is pointless. You can waste years of your life avoiding legumes. People who don’t understand purine metabolism or uric acid control will tell you to avoid them. Gout Home Remedies: Legumes and Gout explains why that is nonsense. If it doesn’t make sense to you, please ask for clarification.
300 is the maximum limit according to most rheumatologists. However, one reading does not make a medical history, so you need to get a few test results and see what your range is. 325 is only slightly high, but if this is combined with exposure to cold, then uric acid crystals could be quite high. The more data you have about uric acid levels and body temperatures, the easier it is to diagnose gout. Body temperature is the external temperature at the site of the problem, which is often much lower than the usual temperature test.
Though lifestyle and diet can make gout worse, they are rarely the only factor. Genetics, other meds such as certain blood pressure drugs, high iron are common. There are hundreds of less common reasons.
Where gout is straightforward, a family doctor should be able to diagnose and manage it effectively. Your gout is not typical. A simple solution would be allopurinol to get uric acid down to 300 or below. If that resolves the problem, you have your answers. The preferred option is to find a rheumatologist with good gout experience.
I still feel a bit confused about test results. If uric acid has never been over 3mg/dL with no medication, then I don’t see how it can be gout. If it has been over 5mg/dL (or over 4 with prolonged exposure to cold) at some time in the past, then it probably is gout.
Uric acid crystals grow very slowly when uric acid is over 5, but should dissolve very quickly when uric acid is 3 or less. Once lumps (tophi) have become established, they can be very difficult to shrink without surgery, as blood flow is not reaching the center of the lump where it can encourage old crystals to dissolve.
Gout is often perceived as an eating disorder, but many things can cause gout. Common things include rapid weight loss, some diuretics and other drugs, some diseases, exposure to metals such as excess iron or lead in the blood. Most common of all is genetics, but this is difficult to detect from family history. Gout is often missed, so our parents might not have been diagnosed properly. Also, genetic traits are known to skip generations.
Blood test results will be a guide, and I hope you will publish them here for further discussion. The true test would be to analyze samples from the blister site(s), but this is a job best left to a rheumatologist. If you do go for such a test, it is vital to analyze samples straight away.
