Gout flares more often since getting healthier

Stopping Gout Together Forums Help My Gout! The Gout Forum Gout flares more often since getting healthier

This topic contains 11 replies, has 3 voices, and was last updated by  d q 5 months ago.

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  • #5986

    andrew portas
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    Hi

    I hope you can help me with this?

    For the last 15 or so years (i’m 53 now) I would get maybe one attack a year, usually right ankle but occasionally left big toe/ball or left wrist. There appears to be some tophi in my right ear, which appeared about a year ago but does look like it’s getting smaller.

    Anyway, because all my doctor would ever do was to give me Naproxin(?) which even though I point out is only a bandaid and not a cure I’ve decided to stop drinking booze, increase my water intake, generally eat better/more healthier and do some exercise. Although I was not massively over weight (beer gut!) I have lost weight and I do feel much better for it. This was around three or four months ago. But in the last six weeks I’ve had two attacks. One started as a dull ache in my left hand then moved straight to my left ankle the second, a week or so after, started in my right ankle and has now moved ball of my right foot!

    The thing is, I can’t figure why… Is it possible that whilst I’m generally ridding the gout I have to ride the storm of more frequent attacks for a while?

    Thanks for your help.
    Andy (UK)


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  • #5988

    d q
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    Andy, I know this might be a vanilla response but the first thing you need to do is get a blood test to check your uric acid results and post them here. Only then can you really ‘begin’ to find out the cause for these pains. How do you know these are even gout pains? You mention tophi, did you diagnose this yourself? Maybe your doctor is giving you naproxen because he doesn’t think you have gout at all? Naproxen is used in more then just gout problems.

    After answering those questions can you begin to narrow your pains down to their causes.

    Good luck mate.

  • #5993

    andrew portas
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    Thanks for your reply. I know it’s gout because I had my blood tested a few years ago and it was positive for gout/high Uric acid.

    The doc did offer other meds when I pushed them but she told me my gout would probably get worse before it would get better so as I’m a pro musician I didn’t want to risk that, well at the time… I’ve since learned a little more.

    I’ll try and get a blood test sorted ASAP. I need this to end!

    Thanks for you help!

  • #5994

    andrew portas
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    Oh… I’ve seen pic on here of tophi on the ear and mine looks identical, same position same white lumps… But yes, self diagnosed.

  • #5997

    d q
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    No worries mate – your welcome.

    Having a positive diagnosis for gout normally means taking action asap. I know you have taken positive measures to avoid certain foods and beverages however by not knowing how much you have actually reduced your uric acid levels (if any) by will only expose you to further short term and long term risks.

    Definitely get a baseline blood test done before starting any medications and make sure it includes Kidney and Liver function. You’ll be in a far better position to decide which treatment options are open to you once you have these results. If you are sure tophi is present then it may be that a diet change alone will be out of reach and drugs may well be the only option.
    Anyhow, get those results and we can go from there.

    Good luck.

  • #6192

    andrew portas
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    Hello again.

    Well, I eventually got a blood test and my uric acid levels are 479, which the Dr says is moderately high. My last test was in the low 500, and that was done around a year ago, which is when I was hitting the beer really quite hard .

    Kidney function is fine but they didn’t test liver function, unfortunately.

    Since I last posted I’ve had a really bad flare in my left big toe/ball joint, which is a location I’ve never had attacked before, and I also ended up with a skin infection in that area too. For that I had a course of Colchicine and Penicillin for the infection. I now have bunion type thing, but the Dr doesn’t think that’s related to the attack. Although it wasn’t there before!

    Dr agreed it was tophi in my ear… In fact she had a student in the room at the time and I was kinda used as a ‘good’ example of Gout etc.!

    I’ve now been prescribed one a day 300mg Allopurinol.

    I hope this is enough info. I’m kind of happy to take the Allopurinol but I’d much rather control with diet, if that;’s doable that is.

    Thanks
    Andy

  • #6193

    nobody
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    In your situation, I don’t think a diet-only approach would be likely to succeed. And your gout would certainly be more painful for longer if you tried.
    So taking the allopurinol you’ve been prescribed is the most reasonable course of action. Only, if you’ve never taken allopurinol before, starting with 300mg is not recommended. People would normally start with 50mg or 100mg per day and increase their dose every couple of weeks or so.
    If you increase your dose progressively while getting regular blood tests (the tests are strongly recommended!), you’ll learn from the results how much allopurinol you actually need. 300mg is OK for lots of people which is why doctors sometimes default to that dose but it should ideally be tailored to each patient.

    While you are taking allopurinol, you could also work on a gout diet. It will take some time for you to find a good diet you can live with for years on end.
    Once your gout is cured, if you’ve made good progress on the diet front, you could try quitting allopurinol while monitoring your uric acid carefully. Blood tests will tell you if you need to get back on the drug.
    Once you are fully cured, you’ll be able try various solutions over the years without risking your health and sanity because it’s a slow disease: curing it takes time but it also shouldn’t come back very quickly.

  • #6194

    andrew portas
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    Thanks for this… I’ve been told to get another blood test in February to check how things are going.

    As for finding a diet I can live with, what’s the best way of doing that? When I check out ‘ok’ and ‘bad’ foods my head usually starts spinning with all the conflicting information. It always appears that the healthy stuff, green leafy veg, etc. seem to be on the high/med purines list… But then I’m sure I read something about not all high purine foods with cause problems…?! I’ve limited my meat intake to once or twice a week but I don’t eat as much oily fish as I perhaps should due to it being on the high purine list.

    Any help or general pointing in the right direction would be much appreciated!

    Thanks again.

  • #6195

    nobody
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    I think you should devise your own diet-making process. Then ask the questions which would inform your own process or do your own research.
    As you say, your head could easily start spinning with all the information available if you don’t start by deciding what kind of information would be useful or useless.

    Lists of high/med purine foods is only one of the ways to go about it. Such lists do not encompass all that matters about it but if that’s the way you want to go right now, fine. You need to start somewhere.
    But in order to make it a good start, you need to use accurate lists. And in order to have accurate lists, you need to decide on what basis foods are supposed to end up on one list or another… if you watch carefully the amounts you’re eating, you might want to have lists based on weight or volume. If one the other hand you like eating your fill, you would probably find lists based on the caloric content of foods more useful.
    Do I sound like I’m splitting hairs? Let’s look at a “green leafy veg”, spinach: one spoonful of spinach is certainly not high in purines. Spinach has got quite a lot of purines compared to most vegs but it’s still a fairly small amount. There are way more purines in meat. The thing is, how much are you going to eat? If you wanted to live on spinach, you’d have to eat a whole lot of the stuff (you might be surprised how much some people eat) while you could live on a much smaller amount of meat. So if you’re looking at how many purines there are compared to the amount of proteins or energy in a food, yeah: spinach is pretty high in purines.
    And in order to end up with accurate lists, you’d also need to put an actual number on “pretty high”.
    If that sounds too complicated to you, maybe forget about lists and try something else?

    Limiting your meat intake to once a week is simple and does reduce uric acid for instance. But what are you going to eat instead?
    The low-purine answer is simple: eggs, milk and so forth. But maybe you don’t want to eat or shouldn’t be eating dairy?
    The good stuff in oily fish, you could possibly get through complements. Or maybe ditch meat altogether and eat oily fish once a week instead?

    If you’re not eating a whole lot of vegetables anyway, you can ignore their purine content.
    But if you’re going to eat lots and lots of vegs on a regular basis (which would generally be recommended), maybe lookup the ones you’re planning to eat in large amounts several times a week? Any amount of cabbage is fine for instance. Lots of vegs are totally fine.

    Pills are so much easier!
    And in case you didn’t know, allopurinol effectively neurtalizes purines so you can eat your fill of broccoli as long as you’re on that pill.

  • #6196

    andrew portas
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    ha ha… here’s me looking for the simple answer!

    I’m good to eat plenty of veg and to get protein etc. from dairy so that might be the way forward for now. I’ve cut down the amount I eat over the last couple of months, anyway so I imagine that’s helping the cause, if only a little. As I’ve said before, I’d prefer to be not on medication but great if it helps. The only confusion I have now is, if the allopurinol neutralises the purines how will I know if my diet plan is working?

    Just another question, is there any truth in the Cider Apple vinegar can help in lowering uric acid?

    Thanks again for your help.

    Andy

  • #6197

    nobody
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    As far as purines are concerned, you won’t know how well your diet plan is working until you start seriously cutting back on the amount of allopurinol you take. Gout is a lifetime problem so you’ll have plenty of time for that down the road…
    But in the meantime there’s more to diet than purines. Some people get improvements in their symptoms by cutting on sugars, fats or salt for instance (but it should be said that different people report all kinds of things as affecting their symptoms and that it’s easy to be deceived by coincidences). Sugars also affects uric acid proper, not just symptoms. Alcohol too should have an effect separate from purines, as should weight loss. And if you weren’t eating enough vegs, you might see a difference in test results as well after improving that.
    You could spent quite some time reading about all the dietary experiments that have been found to affect uric acid…

    I don’t know if cide apple vinegar helps. All I can tell you is that it’s not generally recommended.
    There are non-drug things which are known to be helpful such as cherries. Your gout problem is bad enough that I would go straight to pharmaceuticals but it’s something to keep in mind if you intend to quit allopurinol down the road.

  • #6272

    d q
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    Believe me buddy, the best way to approach this is to keep it simple.
    Increase healthy foods and decrease unhealthy foods is all you need to do.

    Over complicating your food habits will only cause you to end up with all sorts of obsessive issues in the long run for e.g. when you have; Holidays, Stressful Days, Barbecue Days, Parties, Ice cream family days, etc.

    In the 1950’s Gertrude Elion had pretty much cured gout with the invention of Allopurinol. If you couldn’t tolerate that, the Japanese came along in the late 1990’s and pretty much polished Gertrude’s work with the invention of Febuxostat.

    In short, take the pill for now, eat everything in moderation and live your life knowing gout didn’t dictate it 🙂

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