December 7, 2015 at 11:40 am #2514
These are old posts from the Gout Seeker Discussions. For an explanation of GoutPal Gout Seekers, please see Plan for Gout Seekers. As discussions get old, we collect interesting points from those discussions here.
You can reply to them if you wish. However, it is better to start a new gout forum topic.
I show as the author on some of the posts shown below. Because the Original Poster has left the forum. In that case, I take over the post, where it is useful to other Gout Seekers.
December 7, 2015 at 11:40 am #548
December 7, 2015 at 11:58 am #551
Hi Joseph. Thanks for sharing your opinions about gout, alcohol, and allopurinol.
I welcome discussion of all aspects of gout in these forums. I especially love it when people discuss my articles, as it gives me a chance to improve them.
You’ve given us a great example of why it’s important to take a personal approach to gout management. For people who feel that alcohol is adversely affecting their gout treatment, then it’s best to avoid it. Or, some people might be happy to simply reduce alcohol consumption – it’s a personal choice.
Whatever your views on alcohol consumption, it is very important to make sure that your allopurinol treatment plan is safe.
So, Joseph, what else do you do to make sure your allopurinol treatment is safe? Stopping alcohol is one thing, but are you also ensuring that you get the right blood tests at regular intervals? Are you certain that the allopurinol dose you are taking has lowered your uric acid to safe levels?
In my opinion, these safety issues are much more important than moderate alcohol intake.
Unfortunately, most of the allopurinol plans that I see are not safe. Joseph, for you or anyone else, I can review your allopurinol treatment plans, if you wish. Just post a new topic with your allopurinol plan details, and I will review it.
December 16, 2015 at 1:36 am #571
[feedback from Normal Uric Acid Levels]
i had gout before 1 year when i was in qatar.. and then i go back my country nepal while me in my country i dnt feel any pain on my joints and i thought i am fine now.. then i come saudi arab now i am in saudi arab and i feel pain again in my joints and the pain is very hard some time i cnt walk because of pain under the feet.
i went to hospital too doctor test my blood and he said my uric acid is normal. he said 3.5 to 7mg/bl is normal and my blood test show 6.6mg/bl. but i feel stil pain.
what do i do to get painless walk???
December 16, 2015 at 2:07 am #585
‘Normal’ is a statistical way of saying ‘average’ or ‘not unusual.’ If you take 1000 people, a 20-30 will have gout. That means that the 3.5 to 7 range includes people who have gout. Statistically, the normal range is not unusual, but personally, the upper end of that range is unacceptable.
Medically, it is meaningless, and the doctor you saw should know better. Unfortunately, 3 out of 4 doctors in my experience do not understand this. I get so angry about meaningless ‘normal uric acid.’ I even started a campaign NUANT – Normal Uric Acid: No Thanks! Unfortunately, I can’t get people interested in it.
To stop gout pain permanently, you must get uric acid below 5mg/dL
Tell your doctor that you want this immediately. It takes a few months for uric acid lowering treatment to get rid of old uric acid crystals. So, you probably need pain control for a few months.
If you need help with a personal uric acid lowering plan, or help with a personal gout pain control plan, please just ask: http://goutpal.net/forums/forum/help-my-gout/gout-management-plans/
December 23, 2015 at 6:26 am #651
[feedback from Stop Gout.]
I had gout in 2012 a couple of times and I was prescribed Colchicine and I was allergic to it and had severe diarriah.
I had it again in Feb. 2015 and ended up in emergency because of the severe pain. That time they did not realize it because I had twisted my knee and they thought it might be arthritis.
It came on again on June 8th and this time in my thumb and I realized it was gout and saw a doctor on the 10th. It then went to my knee. I had such unbearable pain that I ended up in Emergency again with heavy duty pain killers.
The next day I had to go back because of the pain, I have tried Colchicine again but but I found that I was still allergic to the med.
Do you think I can start taking Allopurinol even though I still have some pain?
December 28, 2015 at 10:16 am #685
My immediate thought is: “what dose of colchicine were you prescribed?”
There have been some very bad dosing practices. They should have died out by now. Also, colchicine by itself is rarely enough, especially once a gout attack has started.
It is perfectly wise to start allopurinol immediately, but you must do it right. Back in 2012, I published Start Allopurinol Quickly, But Carefully. Scientists had just proved that allopurinol could start during a gout flare. It makes no difference to immediate gout flares. But, the sooner you start allopurinol, the faster you get rid of gout. Unfortunately, there are also bad dosing practices with allopurinol. I mention them in that article.
With gout, it is never good enough to “have tried colchicine.” It is never right to simply “start taking allopurinol.”
Dose is vital.
Get dose right, and gout is easy to manage, and quickly controlled. Get dose wrong, and it might be useless, or even make gout worse.
Joy, I urge you to post more information about your doses of colchicine and allopurinol. Also, colchicine alone is not sufficient once an attack has started. What other pain relief has been prescribed?
November 8, 2016 at 4:04 am #2239
hey there – so, while I’ve never had my gout diagnosis confirmed, I’m somehow confident that I’ve had flares over the last 10-12 years. I’ve always been able to correlate the “events” with heavy drinking and binge eating of many high purine foods. this time (10 days ago) was no different in that I traveled a couple times over a 10 day period and ate terribly and drank a lot of alcohol.
I was traveling as my foot exploded in pain (and swelling) over a 2 day period that involved lobster and massive cocktails and I didn’t know what to do. I iced it for the next 5 days (apparently a bad idea?) and also began the herbal route with celery extract, black cherry juice, magnesium, and fish oil. immediately upon returning home, I went to the doctor and had my blood tested and had him look at my foot.
as somewhat suggested on this site, my doctor wasn’t sufficiently knowledgeable to confirm my self-diagnosis and was confused when my blood came back with a 5.9 uric acid level. fortunately, he still wrote a colchisine prescription which had a fairly significant positive impact within 2-3 days. it’s now been 5 days and the swelling and pain have subsided somewhat but I still can’t get a shoe on.
I’ve started taking allopurinol on a daily basis and I’m going back to have my blood tested again this week. I’m watching my diet, I haven’t had a drink in a week, and I’m still taking the herbs mentioned above. I really need to get this all the way gone and keep it gone: so here’s my question: now what?
November 9, 2016 at 2:51 am #2240
Hi Bertram, and welcome.
Keep taking your allopurinol every day.
Take colchicine as needed for a few weeks.
Return for more uric acid blood tests every 2 to 4 weeks.
Post your uric acid test results here.
Recover from gout.
Live a happy life.
Whenever you feel unsure, or need more information, post here.
Bertram, it’s going to take a few months to recover from a disease that’s been building for 10-12 years. But, you can expect a complete recovery. I’m here to help, whenever you need it.
November 13, 2016 at 7:43 pm #2241
hey Keith – first, thank you for this site – I think it’s about the best thing I’ve seen relative to a comprehensive understanding of gout and support for those who suffer from it. next, I really didn’t specify a couple of additional questions.
I couldn’t get to a doctor until 6 days into my attack, but began an aggressive course of celery extract, black cherry juice, magnesium, and fish oil on the evening of the 4th day. question: could that explain my relatively low uric acid level of 5.9 (after day 6)?
if yes, my next question is if it’s advisable to continue the herbal approach “in addition to” or “instead of” allopurinol. I’m planning on getting my level checked in the next couple weeks but I’m also wondering how much difference it made going 4 days without alcohol before the test.
the good news is that the colchicine was a miracle. I took that stuff for about 10 days (just finished the course) and I’m about 95% mobile. bad news is that I’m struggling with diet. there are purines in everything so not sure what to eat. anyway, thanks again and I’m seriously dialed into your site.
November 13, 2016 at 9:55 pm #2243
Thank you for your kind words. And, for your extra information.
The usual explanation for uric acid falling during a gout attack is to do with what happens during the attack. Uric acid crystals forming in the joint reduce the dissolved uric acid measured in the blood. But, other explanations re possible.
The main thing is to establish routines for uric acid tests so that you have a history. Then, we can look at how your uric acid changes over time, and in response to various treatments. Herbal medicines can reduce or remove allopurinol dependence. But, you need monthly uric acid measurement to know if this is happening safely. Allopurinol might be avoidable, but testing isn’t. Uric acid tests should always be accompanied with kidney function and liver function tests.
That gives you a safe environment for testing your herbal products. Remember, if they are any good at lowering uric acid, they are potent enough to have side-effects. Herbal does not mean safe. That is why I strongly recommend the kidney and liver tests.
If you are also struggling with diet, you might consider a combination of herbal medicines and diet improvements. You are absolutely right that it is impossible to avoid purines. First, there is no need to avoid vegetable purines. Second, animal purines should never be significant in a healthy diet. So, twice-weekly fish and twice-monthly meat should not significantly raise uric acid levels.
The easy way to manage gout is to take the correct dose of allopurinol that makes uric acid safe. Usually, safe means below 5mg/dL. Once you move away from the easy option, you have to investigate, measure, and plan in more detail.
I’m happy to support anyone who wants to lower uric acid with herbal medicines and/or lifestyle changes. It’s rare to find a gout sufferer who is prepared to put the time in to manage diet and herbal supplements in enough detail to make a difference.
If I were doing it, I’d start with a gout diary. Then, I’d commit a set amount of time to measure and manage my gout.
I realize that doesn’t really answer your specific question “could that explain my relatively low uric acid level of 5.9 (after day 6)”
I’m afraid it’s impossible to answer that without more uric acid test results. That’s why I’ve fallen back on the most common explanation. But, it’s better to have good data, rather than guessing.
May 14, 2017 at 7:49 pm #3651
New Guy to Gout needs Gout Tips and Help
I just logged in and it brought me here. I guess my topic is super general right now.
I am 41 and been dealing with gout since I was 36. and actually even earlier but at that time I had no idea what it was and only came once a year kind of thing.
Are there any fast, good tips I can get right now? I try to use apple cider vinegar once in a while. I notice no real change or benefit but it has a slight placebo affect. I’ve only been prescribed Indomethecin and Colchicine before, haven’t tried anything else. I think I need better doctors, or better educate myself and pursuade the doctors myself like you did.
I recently had the surgery on my left foot so now the joints at least work again. It’s been 3 weeks and still painful. Worried the gout will now attack my right foot. I think I feel the beginnings of one.
That’s it for now, thanks. Marc
May 15, 2017 at 12:58 am #3653
Gout is something which ought to be managed with a longer time horizon but until you get serious about that…
Colchicine and indomethacin do not address the cause of gout but are effective to manage the symptoms if taken in sufficently large doses.
Watch for side effects getting worse over time. Should that happen to you, you’ll be better off in the long run if you don’t ignore it.
Outside of drugs, hydratation and blood flow matter. Also, best avoid cold. You ought to drink lots of water (within reason) and relax as much as possible. Support your foot to relieve your muscles if needed but make sure to keep moving your foot regularly. If at all possible, occasionally get your heart pumping with whatever exercise doesn’t hurt your foot or perhaps with hot showers. Some people bathe their foot in hot water which addresses several of the aforementioned concerns.
Last but not least, people who have untreated gout, aren’t monitoring their liver and kidneys and take drugs such as indomethacin should be very careful with alcohol.
May 15, 2017 at 2:22 pm #3666
All I can add to nobody’s comments is to suggest you get a uric acid blood test as soon as possible. Because, every day, your gout is going to get worse, until you get uric acid safe. Of course, we have to consider gout pain relief until you get uric acid under control. But, your uric acid numbers are everything now.
So, if you have had blood tests, can you get the history from your doctor? Then post the numbers here. We need dates (can be approximate), and exact uric acid level with unit of measure. But, if you haven’t had uric acid blood tests, can you arrange one soon?
Then, we can work out if you prefer drugs, herbal gout medicine, or lifestyle improvements. So that we can finally end your gout problems.
May 15, 2017 at 2:45 pm #3671
No doctor to date has tested my uric acid nor blood nor joint fluid.
They say Canadian healthcare is free, but it comes at a price. I will have to educate myself and nag these doctors and keep looking for the right one to get me started and help me along. I have an appointment with my podiatrist tomorrow to evaluate the healing from surgery.
Thank you so much for this website I now have renewed hope. I will get those tests done asap and I’ve written down all the drug treatments you have listed, a few of which I’ve never even heard of.
A major problem is that my work is often quite physical and if I go back to the same job I was doing, that means steel toe boots all day everyday. Should I just give up on that and try harder to find jobs that don’t involve my feet so much? Or keep hope alive and beat this thing and do whatever I want with my feet like I used to?
May 15, 2017 at 8:12 pm #3684
Okay I got a new family doctor today and got the blood work done today as well. I will post Thursday when I get results of my uric acid. I’m getting her to get me started on Allopurinol on Thursday (hopefully).
I’ll be browsing around on this site a lot. I heard spinach is not the best due to purines? but I just had a whey protein shake with a handful of spinach and milk. Am about to eat broccolli and then some chicken breast.
I am serious about a long term plan to control my gout and getting my life back.
May 16, 2017 at 8:41 am #3698
Before I address the individual points you’ve raised, I’d like to clarify how I offer my gout help services. Either, you can continue with one-off questions, as they arise (I call this Casual Gout Help). Or, you can start a gout diary. Then, follow that up with step-by-step plans to manage different aspects of gout (I call this Structured Gout Help).
“steel toe boots all day everyday”. Boots are great for supporting gouty feet. But, the issue is standing all day, which would be much more painful with less supportive footwear. So, I suggest we fix your gout. Then, you can make job choices based on what you prefer to do.
As for diet, you have to step back, and look at the big picture. Because gout diet is about managing weekly meals in total, not individual foods. Spinach, broccoli and milk are great parts of a good gout foundation diet (please checkout that survey). Also, chicken and moderate amounts of other meat and fish have a healthy contribution to make. And, supplements can have their place in a healthy diet. In which case, there are strong pluses, and some minuses, with whey protein for gout. But, if all you eat is spinach, broccoli, milk, and chicken, you do not have a healthy diet. So, for the best gout diet, you should only think of individual foods when you are looking to tweak your diet to meet your goals. For instance, you might ask if you can get nearer your uric acid target by reviewing your chicken consumption. Then, in the context of your weekly meal plans (or shopping cart), you could consider changing some of your chicken for something else.
May 17, 2017 at 10:58 pm #3756
d qParticipantŦallars: Ŧ 367.22
Just a few points to add;
1. Spinach is a vegetable purine and doesn’t really count much so don’t worry too much.
2. Lean chicken (breast) I believe is less purine rich then other meat food. Keith has a list on he’s site if you search.
3. As stated by nobody, once on allopurinol and things improve you can plan for a healthy diet more then just a low purine healthy diet.
4. Get tested for kidney and liver function on all changes to your allopurinol regime.
Good luck 🙂
May 15, 2017 at 6:00 pm #3683
It seems premature to give up on your job but I have no idea how easy it would be for you to find something else, how much of a setback you might expect by losing whatever seniority you’ve got and so forth.
Beating this thing might take time and might possibly involve being less physically active for a while but it’s way too early to tell. It doesn’t sound like your gout problem is as of yet very bad so let’s not assume you’ll be one of the ones who has a hard time beating it.
If you had test results and an experienced doctor, you might have a clearer picture of the road ahead. The appropriate medical specialist for gout is called a rheumatologist but having a piece of paper with a job title is of course not the same thing as having skill or experience…
May 15, 2017 at 9:17 pm #3685
Spinach is OK. Sure, it’s not ideal from the purine perspective but on the other hand it’s the kind of food that helps your kidneys deal with uric acid. And if you take an adequate dose of allopurinol or similar, purines aren’t going to matter much while the helpful effect of spinach will remain relevant.
People who drink milk seem to have an easier time with gout than those who don’t.
Until you know what’s going on in your body and are taking effective medication, I think you ought to be careful with stuff like protein supplements.
If your supplement is plain whey without dodgy ingredients, it should be OK in moderation but excessive protein intake isn’t great for untreated gout or your kidneys.
Good luck finding a long term solution!
September 2, 2017 at 9:01 pm #5587
Newly Diagnosed with Gout! Where do I start?
I’ve been diagnosed with gout in my left foot, but after I got home from the dr, it (again) spread to my right toes and arch. This was about the fourth attack since the beginning of 2017.
I didn’t realize all this mess was gout. I thought I injured the left foot, then caused problems in the right because I was either hopping on the “good” foot or, after a few days, limping, and causing more weight and stress on the right foot. So in my mind, it was related.
I also blamed the right foot on a bunion and giant hammertoe. I’ve had the hammertoe for years, but it never hurt until gout moved in, and now it swells up double, plus turns purple and red. Looks like it was run over. The bunion, I just thought that because that’s where it hurt, got red, swelled, got hot and skin peeled like a sunburn. Apparently it’s not a bunion. LOL.
I went to my foot and ankle surgeon on this fourth attack, day four (because I could not walk until then). He pretty much knew the moment he saw it that it was gout. Sent me for blood tests (also blood counts and metabolic profile) to rule out infection and check uric acid.
I went back and wham! 9.4 on the uric acid.
“You have gout.”
Dang! I was so sure he was wrong, too. I thought it was a bad sprain.
He referred me back to my GP for drugs. He had already prescribed Indomethicin for pain, and then my GP has now added 100 mg to start of the allopurinol, and the colchicine to use in the beginning of the next attack. Oh, and foot guy offered me a cortisone shot, but I declined. Am afraid of those.
My GP said after the next blood test, he’ll probably up the allopurinol until we get the uric acid under 6. (The next blood test I had, after the attack was mostly over, was 7.9)
This all happened over the last month.
Now I’ve come to realize the gout is in multiple areas. Left foot: top and bottom towards the front, ball of the foot. Right foot: big toe, second toe (the hammertoe), ball of foot and arch.
It’s all the same kind of pain, plus red, hot and swelling. But the left foot seems to be worse and starts first. At least they don’t go full force at the same time!
The first or second attack caused an inability to walk. When the left foot finally started to calm, the right foot went nuts and I was like “You have GOT to be kidding me.”
Now all the gout stuff makes a lot of sense.
The good news, I guess: I don’t have to change my diet. I don’t eat any of that stuff, except spinach. I’m not vegan or anything, I just stopped liking meat except some chicken. I don’t drink, so I don’t have to give up beer or wine.
I naturally drink a lot of water, always have. The foot dr. thought it was mostly genetics in my case. (Grandfather had it, perhaps others…dunno) Also, I had been taking hydrochlorathiazide, my thyroid is out of whack (and being difficult to get under control), and I think my aversion to meat has caused me to be protein deficient.
I have so many questions, and I guess so much to learn. :::sigh:::
My main question to start: I’m trying to figure out WHEN to take these two drugs (the allopurinol and colchicine). I’m supposed to start the all. when my flareup is done. And do the col. when a new one begins.
However, I’m not sure the one that started a month ago is over. I keep getting mini attacks in both feet. They hurt like mad for 15-60 seconds, and then go away. Maybe a few hours later, another spot lights up. It’s goutish pain, and in the gouty areas of both feet. But is it considered actual gout?
Should I start the allopurinol now, or wait until this ALL stops? I’m afraid it won’t ever stop.
And then there’s the other med…I’m supposed to take that within 12 hours of a new attack. But this is all just blending together.
I don’t want to do the wrong thing and cause my feet to explode into millions of crystal daggers!
September 3, 2017 at 3:13 am #5588
Have you discussed alternatives to hydrochlorathiazide with your doctor? If not, I recommend doing so without delay as that drug is known to increase the amount of uric acid in people’s blood. There are gout-friendly alternatives.
If the amount of uric acid in your blood was ever tested before you started taking this drug, it would be helpful to know the results.
Now, as to your question about allopurinol and colchicine…
You shouldn’t wait very long before taking allopurinol. Yes, it would be best if you could start it when you are well but waiting for the ideal time to start is often counter-productive.
That said, I would recommend testing other unfamiliar drugs first (it’s not clear if you’ve already tried indomethacin) in order to get a feel for how they work and the side effects they cause. That’s not a reason to delay taking allopurinol for long however, only a few days to a week. Inasmuch as possible, I would recommend trying any unfamiliar drug without mixing it with other drugs. And since allopurinol will affect your system 24/7 once you start taking it, I would recommend trying that last.
Allopurinol should be taken every day.
Colchicine is most effective when it is taken every day to prevent attacks. So people often take it every day when starting allpurinol. It is less effective when taken after an attack has started but can also be used that way.
Indomethacin is sometimes taken every day to prevent attacks but is usually taken to stop swelling and pain after an attack has started.
If you plan to take a drug when an attack starts, don’t wait 12 hours. That’s way too long. Take a few pills with you when you’re away from home just in case.
It’s important to get frequent blood tests to monitor some of the side effects of these drugs. Once you get used to them and stop adjusting the doses, blood tests need not be so frequent.
Finally, diet: if you are indeed not getting enough protein, that would be a serious problem and could potentially contribute to your gout. Fortunately, it’s easy to get enough protein without eating any animal flesh.
If you can safely (I have no idea what’s going on with your thyroid for instance) drink lots of skimmed milk or eat lots of yoghurt made from skimmed milk, that would be ideal for gout and help remediate any protein deficiency.
Also be aware that consuming sugars contributes to gout. So I’m not recommending sweetened foods such as most flavored dairy products.
September 3, 2017 at 4:28 am #5589
Wow, thank you for such a thoughtful, detailed response!
I should have been more clear: I’ve been off the diuretic for about two months in favor of a small dose of Linisopril. My blood pressure was barely high, but I’ve gone along with it because my mother has vascular dementia, and she also had slightly high BP, but refused to take meds in favor of a quack who laid hands and tapped her head. (Not kidding, sadly)
I’m trying to be a little bit more compliant than she was, to head off vascular dementia.
I have taken the indomethacin, a couple of times. The foot guy gave me that. It made me feel horrible, but it did help with the swelling and pain. I had an upset stomach (severe nausea to the point of retching a few times) and the worst: it made me dizzy and loopy, the way opiates make me feel. Despite that, I thought I would give it another try and see if those side effects lessen, or at least I can learn to tolerate them. It really did help a lot.
But I’m afraid I couldn’t stand feeling like that every day. BTW, the foot dr didn’t believe I got so messed up from that drug, said it was just like taking a super aspirin. ::sigh:: He also said that being like a super aspirin (sorta, but not), aspirin causes uric acid (or keeps it from leaving, whatever), so it was okay to take on a limited basis. Therefore I am surprised to hear people take it daily! (Not doubting you, just surprised.)
I agree about trying one drug at a time. That’s been my policy for a long time, because some drugs I tolerate just fine, and others not so much.
What happened with my thyroid: I have Hashimotos (hypo) and have since I was in my 20s. Severe. My levels have stayed fairly consistent for three decades. Now and then, a little bump up or down, but nothing major. Back in Dec or January, my blood showed I was going hypERthyroid. My doctor bumped me down, and then every six weeks I go back, and my numbers are WORSE. He doesn’t understand it either, and just keeps lowering my dose. My hair has been falling out for about six weeks or so, and now it’s really thin. It’s been a really CRAPPY several months, and now I have gout. Sorry for the whine. It could be worse, knock on wood.
I plan to be very compliant on the Allopurinol, assuming I tolerate it well. (And most of what I’ve read seems to indicate it’s an old drug, effective and safe. So I’ve got a good feeling…) And if I don’t, then I’ll try the other meds. But I think Allopurinol will do the trick.
As for blood tests, LOL. Because of the thyroid (and they keep running various other tests to keep an eye on kidney, liver, etc. They are all fine.), I’m being tested every six weeks, and my GP said we’ll just add the uric acid to the list. HA.
I *can* drink milk, but I’d rather not. LOL. I love yogurt, but have been heartbroken to learn how much sugar is in ALL OF IT. And if it screams low fat, then figure they’ll add another handful of sugar.
I actually gave up all sugar several months ago. I was never much of a soda drinker, so that was easy. And I drink my coffee and tea unsweetened. But what I’ve learned is to read labels, and I’ve been horrified at the way they sneak sugar into everything. It’s an eye opener. But yogurt was the one that really hurt me. I like PLAIN non-Greek yogurt. It even has sugar in it!
I just checked my cartons, and plain old yogurt (not vanilla) has 16 grams sugar in ONE SERVING!
I was not aware that sugar contributes to gout. I guess that means I won’t plan a chocolate binge anytime soon.
What I LOVE: lentils, whole grains and beans. Yes I do. And those are chock full of proteins. I’ve been trying to eat more of those, try new recipes. But when I started reading the gout stuff, they kept saying legumes and beans, NO.
Then tonight I found someplace that said yes you can. LOL. It’s CRAZY. I thought I could try peanut butter, and then realized…legume.
It’s the same way with tomatoes: some say RUN AWAY, and others say no, they’re so good for you.
Are there any guidelines for how much protein a gouty person should eat?
You’re the welcome ambassador into Gout Land. I do appreciate the information, ideas and advice you’ve given me. Thank you.
September 3, 2017 at 9:55 am #5590
If I were you I would follow nobody’s advice and start allopurinol as soon as possible. As for diet be very careful what you read. Because protein from plants and low-fat dairy is good for gout. As you eat little meat I think you would be very happy with a Mediterranean diet. But don’t include processed foods with additives like sugar.
It’s not too complicated really. But confusing if you read rubbish from people who don’t understand gout. So if you want good opinions it’s better to tell us where you read rubbish about spinach and legumes. Because then I can explain why they are good for you and where the others got it wrong.
September 3, 2017 at 12:56 pm #5594
d qParticipantŦallars: Ŧ 367.22
In addition to nobodys posts I’d just like to point out a few things.
You need to look at the macro side of this and not just the micro side. People become obsessed with food and their intake of it. It all becomes about purines, sugars, salts, etc. Whilst minimising most of these ingredients will help with reducing uric acid levels you need to also look at the bigger picture which is they will not solve your Uric Acid Arthritis (gout) issue.
Allopurinol, Febuxostat and a few drugs are there for this very reason. What many people overlook when starting these medications is that they are not just there to ‘reduce uric acid’ they are also there to ‘psychologically hold your hand’ whilst you get on with life which means going on holiday, eating what you like, doing the job you like, doing the sports you like, etc.
Now that doesn’t mean you have to take these drugs for the rest of your life as there are medication breaks, take a read of this.
When choosing food, keep a logical approach but also keep an open mind to life.
September 3, 2017 at 12:02 pm #5592
Indomethacin is a dangerous drug which is know to affect some people’s stomach. That side effect causes many doctor and ER visits and can be deadly.
I don’t know if that’s the side effect you got but if so, there are drugs called PPIs you can take with indomethacin to keep that in check. Unfortunately, these drug have side effects too…
I would recommend discussing these side effects with your GP. As you noticed, the class of drug called NSAIDs which includes indomethacin helps a lot with gout symptoms. So even if you barely tolerate these drugs, it can be worth taking a pill or two during serious attacks. Maybe you could try another NSAID. Just be very careful not to damage your stomach and oesophagus.
I would never take indomethacin daily but some people do tolerate it, at least initially (the side effects can get worse over time).
6 weeks is a long time. I would recommend getting an extra blood test or two during your first months on allopurinol (and colchicine if you end up taking that regularly).
Most people tolerate these drugs well but some people do not. You might not notice immediately if your liver takes them badly but a blood test would show abnormal liver function values. Kidney function is also something which should be tested often when starting these drugs.
Thanks for the explanation but as you might have guessed, I don’t understand what’s going on with your thyroid. I don’t know what drug you take for that and how that might affect your gout or interact with gouty drugs or dietary changes.
There is store-brand plain yoghurt with no added sugar in every chain store here. It’s the big brands which tend add sugar into everything. So I would recommend you look around.
I don’t know what your serving size is but yoghurt can have 4-7% sugars when no sweetener is added. The naturally-occuring sugars in dairy are OK. So it’s fine if the dietary information shows a small value in the “sugars” category but you should avoid products which have “sugar” in the ingredient list (often times, you’ll find some maize product such as HFCS instead of “sugar” which is no better).
You could eat other dairy products but some studies suggest you’d do better picking products which contain little fat such as yoghurt made from skimmed milk as opposed to the the ones containing lots of fat such as cheese. Many dairy products are in between these two as far as fat content is concerned. See what’s available in your area.
If you have gout, you need the same amount of protein as someone who doesn’t have gout.
For what it’s worth, I disagree with Keith about protein from plants.
Still, “legumes and beans, NO” is way too strong. Likewise, “yes you can” is simplistic. Of course you can eat legumes and beans. Better eat that than meat. But they’re not necessarily harmless. There are differences between various legumes and larger differences between various plants. Then there is the matter of processed foods made from plants.
Since you mentionned spinach and chicken, I’ll use these as an illustration. Both foods are about as bad for gout if you’re using them as protein sources or energy sources. But of course most people would not use spinach that way because it would require eating very large amounts. Chicken is much more nutritous. If you were to put equal amounts of spinach and chicken on your plate, the chicken would be way worse (like 7 times, possibly more depending on how the spinach was cooked). So spinach is basically harmless the way most people eat it.
Bottom line: you can eat pretty much anything in small amounts and most plants in larger amounts. You should eat lots of vegetables but, ideally, you should get much of your protein from dairy. Grains and legumes are the next best thing. And if you don’t eat dairy, you need legumes to balance the protein mix of grain.
Yes, the above is simplistic (I would not recommend eating large amounts of broccoli for instance) but I dare say my kind of simplistic is better than telling people not to eat legumes or that plant protein is good for gout.
September 3, 2017 at 4:36 pm #5596
Lots of info…thanks!
I only take Synthroid (levothyroxine) for the thyroid. The amount was fine for many years (minor bumps up and down), and all of a sudden it was way too much. Somehow each titration down haven’t been enough, and it’s been an ongoing ordeal.
The thyroid hormone (levothyroxine) takes about six weeks to work through your system, so that’s why the blood tests every six weeks. However, I can call him and ask for more uric acid tests. All he can do is say no. He had said that typically, the ua test is five weeks, but we’d just do it at six because I was already doing the thyroid tests.
Per your comment, I checked my yogurt carton again, and you’re right…there’s no ADDED sugar, just natural sugar from the dairy.
I just googled purine in chicken, because I thought chicken was okay. I came across this very interesting list:
Check out spinach. It’s low, IMO. The FOOT doctor was the one who told me spinach was on the list. Although when we went through my general diet and water intake (and that I don’t drink), he moved on to the diuretic, and oops, was on that for a long time. (Stopped two months ago, nothing to do with gout.) Then I casually mentioned my grandfather had it, and he seemed to place most of the blame on genetics.
This is mostly moot, because for now, I’m going to eat like I have been and try to up my protein with lentils, because I love them. 2-3 times a week. Also some chicken. My yogurt. And I’m going to look into the protein content of cashew or almond butters.
September 3, 2017 at 4:53 pm #5597
So if you want good opinions it’s better to tell us where you read rubbish about spinach and legumes. Because then I can explain why they are good for you and where the others got it wrong.
Haha. It was my FOOT doctor who told me spinach was on the forbidden list. (This was before he learned I don’t eat game meats or gross brain sandwiches, don’t drink, etc.) He’s a foot and ankle surgeon, and I think they mostly do repair work, fungal nails, ankle replacements, and so on. In fact, he said he would diagnose the gout and provide pain relief, which he did, but then would send me back to my GP for ongoing treatment because he didn’t do kidneys.
I’ve decided to start the allopurinol tomorrow. I want to first go to the store and load in supplies, particularly things I can eat without cooking. If I get an attack like the others, I won’t be able to walk, or stand at the stove.
That’s why I’m thinking nut butters to hold me over. They’re nutritious and easy to just eat out of the jar. Plus yogurt, maybe chicken lunchmeat.
Now that I know more about all of this, instead of it catching me off guard and unprepared, I can plan ahead. Kind of like disaster planning, except the disaster is gout. (I live in tornado alley.)
September 3, 2017 at 5:21 pm #5598
The main reasons for getting frequent blood tests early on are:
-the allopurinol starting dose is low so as to minimize the damage in case you don’t tolerate it well but in case your system does handle it well, you’ll want to increase that dose quicker than every 6 weeks in order to minimize the length and severity of the numerous gout attacks people often get after starting allopurinol
-if on the other hand it turns out you do not tolerate allopurinol well, you will want to try an alternative before the side effects turn your system into a mess
It often doesn’t take many weeks for clear clues to show in blood tests.
As to spinach in the purine list you found, it sounds about right. Spinach is only high in purines relative to the amount of protein and energy it contains.
Such lists shouldn’t be used a list of “good” or “bad” foods but as a guide to how much of any food you can eat before it might become a problem in terms of purines. And the amount of purine in the most nutritive foods shouldn’t be compared without adjustment to the amount in the least nutritive foods. Else there would be a way to make anything into a low-purine food: simply add water.
That said, there are issues with the purine list you linked to. There are several types of purines which have a different effect on the body. Most plants do not have the worst purine type. For instance your list might lead you to conclude that soy beans are slightly worse than chicken in terms of purines while they are actually much better.
Unfortunately, I don’t know any comprehensive list of foods which breaks down the purines by type.
November 1, 2017 at 6:11 pm #5884
KELLY WILDERParticipantŦallars: Ŧ -5.78
Managing Gout through Diet and Daily Testing
I don’t have gout but my boyfriend does. His diet lifestyle is so much better than mine (always eats organic and tries to limit preservatives) but he suffers gout attacks fairly frequently. We are going to try to manage his attacks through a change in diet. He already takes allopurinol daily (which is expensive..yikes) but he loves beer. I ordered a Home Uric Acid Test Kit (and that was an experience in itself!) and we are both going to follow a Gout Diet and monitor our uric acid levels. I thought it would be beneficial to have a control (me) to see what causes a spike in UA levels in his system versus mine.
The literature out there on gout friendly food is all over the place. A lot of the advice that you get is counter-intuitive. Do you a particular diet that you recommend? I bought the book – Eat This – Not that for Gout.
Also, who determines the purine levels in foods? Is there standardized testing?
November 1, 2017 at 7:08 pm #5885
As you noticed, there’s lots of nonsense out there about gout and food. And the trustworthy information one manages to find is too often quite vague. There are some things reasonable people disagree about but there are a few things we do know about gout and food. If you really want to, I’d be willing to discuss that with you, tell you where you can find reliable information and so forth.
But if I may… in my opinion, it would probably be a waste of time. Indeed, the most important thing you said was that your boyfriend takes allopurinol daily. That changes everything. Getting allopurinol right is more important than getting food right!
Most people can easily control their uric acid by taking allopurinol regardless of what they eat… on one condition: they need to take enough!
If you think your boyfriend still has too much uric acid, maybe he should be taking more allopurinol. In some cases, it’s more complicated but in many cases the only thing that needs changing in order to fix gout is the daily dose of allopurinol. The typical dose isn’t appropriate for everyone.
A warning though: allopurinol is a serious drug. Your boyfriend should be monitored for side effects and the dose shouldn’t be changed without discussing it with a doctor.
Something else about allopurinol: it’s an old drug and you can stock it for years. It should therefore be quite cheap.
If you’re paying a lot for it, it may be because you’re paying for a brand. If for some reason there is no cheap brand of allopurinol for sale in your locale, perhaps you could plan a short holiday some place where you can buy a personal supply of the stuff cheaply.
Finally, if you want to experiment with your diet and measure your uric acid, that’s great! I’d be interested to know the results of your experiment.
But your experiment wouldn’t help your boyfriend much because taking allopurinol changes the effect food has on your uric acid. Everyone is different anyway but your experiment would be more likely to help someone who wants to lower their uric acid without drugs.
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