Gout Prevention: Which Type Is Best?

We all want gout prevention.

But do we know what we are trying to prevent?

Modern pain management techniques mean we can prevent most pain. In fact, when I started GoutPal, pain prevention was generally regarded by the medical profession as a valid alternative to uric acid control. However, many gout studies have shown that stopping pain is never enough. So

Unless we prevent uric acid crystals forming, gout will get worse.

Gout Pain Prevention

That’s not to say that pain prevention is wrong. Indeed, I strongly recommend that most gout sufferers focus on mastering their own pain relief and prevention plan first. But that should only be your first objective. Because gout pain gets progressively worse if uric acid crystals continue to form.

On a daily basis, you might not notice the spread of uric acid crystals. Especially with preventative pain control. But eventually the effects of those crystals will overcome your pain control defenses. So plan your pain control as a stepping stone to true gout prevention.

Uric Acid Crystal Prevention

As I said, preventing the awful pain of a gout flare is important. But preventing uric acid deposits from destroying joints is even more important. Especially when you realize those crystal deposits grow and spread until they burst through the skin. Also, skin is not the only organ at risk. My tophi guidelines reveal that tophi can lead to kidney disease and heart disease. All organs can be damaged by uric acid crystals. (~~except the brain~~. See Preventing Gout Brain Damage below)

I understand that, when you are in pain, you just want the pain to stop. We have seen from the investigation into the high cost of Colcrys dosage, that gout pain prevention with daily pain relief is very common.

But it is dangerous to ignore uric acid crystal prevention.

We have also seen that failure to stop uric acid deposits growing leads to horrendous disfigurement. Wounds caused by tophi bursting through skin can become infected. Worse than that, the uric acid deposits prevent joints from repairing themselves. Joint destruction from tophi is inevitable.

For this reason, I do not see preventative pain relief as a valid type of gout prevention. Though it can have an important place in step 2 of good uric acid treatment plans.

Types of Gout Prevention

For gout prevention, of course I really mean uric acid crystal prevention. Now, I’ve identified 3 types of uric acid crystal prevention. But before you consider which of those plans suits you best, consider principles that affect all types of gout prevention:

Gout Prevention Principles

You must know your uric acid number at all times. Test blood at least once per year, and whenever treatment changes.
You must have a uric acid target. Long term, this is 5 mg/dL. Short term, it might be much less than this in order to dissolve uric acid deposits as fast as possible.
You must be prepared for gout flares during the first few months of uric acid lowering. This is the only time you should consider daily pain prevention.
Never stop uric acid lowering treatment once you start it. However, if you have achieved 5 mg/dL consistently for several years, a break from treatment is OK, as long as you test uric acid every month, and restart lowering treatment if levels reach 6 mg/dL (0.36 mmol/L)

Pharmaceutical Gout Prevention

I explain gout medications to lower uric acid in the Gout Treatment section. Allopurinol is the main treatment. Personally, I recommend that you discuss taking the maximum possible for the first year of treatment, then review with your doctor. This is the fastest way (other than using the new Krystexxa) of dissolving the uric acid crystals that destroy your joints.

Herbal Gout Prevention

Herbal gout cures appeal to many gout sufferers. A growing number of herbal products are being investigated for their uric acid lowering potential. Though this is an alternative method of gout prevention, it is only valid if you follow the principles. You must manage by reference to uric acid levels. Pain, or the absence of it, is not a valid measure of successful gout prevention.

Besides failing to monitor uric acid, the other major failing of the herbal gout cures approach is that products can be inconsistent or ineffective. As we see in gout medications, dosing is a big issue that many professionals fail to get right. The herbal approach is very challenging.

Dietary Gout Prevention

There is no single measure you can take for preventing gout through dietary means.

First, I must stress the principles again. You have to monitor uric acid levels.

Second you must assess your existing diet to identify foods that raise uric acid. This means checking your total intake to identify excess calories, iron, or purines. See Foods To Avoid With Gout guidelines for more details.

Third, where you identify any of these excesses, use food charts to replace the worst offenders with better alternatives.

You need to study the gout diet section in detail to take account of all the factors of food that can affect gout.

Preventing Your Gout

Now you understand what gout prevention means, you are ready to start a gout management plan. Note that you can include elements from each of the gout prevention methods. For example, you might require a lower dose of allopurinol if dietary improvements lower your uric acid levels by one or two mg/dL. But I must emphasize that each plan is personal to you. Especially be aware that there are no “set plans”. Because the essence of every gout management plan is that you work with your selected health professionals to prevent gout.

Your next step for gout prevention is to start one of these three uric acid treatment plans:

Or if you’re not yet ready to decide…

Leave Gout Prevention to return to the start of gout plans.

Gout Prevention Comments

GoutPal visitor responses and associated research about preventing gout include:

Starting Gout Prevention

Many gout sufferers delay uric acid control while they investigate their options and plan what to do next. I believe this is a dangerous approach. Because it’s a trap I fell into. So I wasted time when I could have prevented joint damage from untreated uric acid crystals.

Your safest approach is to start a uric acid treatment plan with your doctor today. By all means, check my gout treatment facts to ensure your plan includes the latest professional guidelines. But do not delay your uric acid crystal prevention. Because herbal and diet plans take a long time to establish. So start preventing more damage now. Then you can investigate alternatives for the long term in the knowledge you are preventing further damage.

Gout Brain Damage Prevention

During my fact check review of this page, I wanted to add a reference to my statement: “gout damages every organ except the brain”. Now, I’ve remembered that from a few years ago, and repeated it often. But I can’t remember where I read it. Normally, I would keep searching until I found the reference. Or remove my statement pending verification.

Shockingly, I found that my statement is wrong! Which proves another long-held belief of my that there’s always something new to learn about gout.

Anyway, I must update this gout prevention page today. But I’ve no time to review my first reference to gout brain damage^[1]. And reviewing all the evidence on gout brain damage will take longer. So I’ll release this interim update now. Then I’ll add more on preventing brain damage from gout later.

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Common Terms: Most Helpful Gout Pages, prevent

Gout Prevention: Which Type Is Best?

Gout Pain Prevention

Uric Acid Crystal Prevention