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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 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.
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[Admin: topic posted from Allopurinol And Alcohol]
Good subject here.
If the patient had gout attacks for more than three times a year then you have to say ”Goodbye” to alcohol intake. Prevention is better than cure.
Take the medicine alluprinol on its own and no alcohol please.
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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.
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[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???
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‘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/
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[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?
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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?
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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?
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Hi Bertram, and welcome.
Now what?
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.
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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.
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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.
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What can I eat to stop uric acid?
Many years ago, possibly 5, I was diagnosed with gout which was treated with 300mgs allopurinol. With the GP’s support, I eventually reduced the dose to 100mgs and was sufficiently confident with my lifestyle changes,(i retired, so no more night shifts,) a major contributory factor, I ceased taking medication altogether. 6 months later, I followed up with a GP appointment, my levels were checked and found to be in the normal range.
Sadly, a mild attack a month ago, which I thought was a pulled muscle, two days ago, I was crippled by an attack in my ankle joint. A trip to the GP confirmed that I had been given the wrong information and that my levels had remained high and not normal so had been eating and drinking for well over two years, oblivious to my high uric acid level Additionally, my blood pressure was sky high. Interestingly, last week I drank beer on several occasions an had a large portion of lambs liver for the first time in many years!
Other than seeking legal advice, I have found this website and am looking where to start. My GP prescribed Prednisolone which has taken away much of the pain already although the ankle joint is still badly swollen. I’m due a follow-up appointment next Monday and will have both my uric levels and blood pressure checked. I anticipate that both will be high so was looking for a diet that would treat both conditions as I believe that should be possible. I am struggling to find my way around the website which, whilst informative, has left me decidedly confused as it contradicts what a lot of other sites says. What I would like is an accurate and detailed list of foods as I need to lose weight, lower my blood pressure and my uric acid levels. I’m 61 years of age and fairly active.
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“I am struggling to find my way around the website which, whilst informative, has left me decidedly confused as it contradicts what a lot of other sites says.”
I started GoutPal as a personal project to understand my own gout. I encountered a lot of lies, half-truths, and ignorance. So, I used GoutPal to record my research. Thus, I learned the truth about gout management:
1. You can only control gout through making uric acid safe. Medical science gives pointers to safe levels. But, ultimately, each gout sufferer must have their own personal target.2. Gout pain starts years after uric acid began to form crystals. It takes many months to reverse the buildup of uric acid crystals. (There are rare exceptions where that period can be reduced to as little as 6 weeks, but I shall ignore that as it does not seem to apply to Malcolm). I usually refer to that time as the debulking period, or reducing the uric acid burden. During the debulking period, gout sufferers need effective personal gout pain control.
Most websites ignore those basic gout management facts. Also, many doctors stay with out-dated custom and practice. From that mess, we read reams of misinformation about gout. People start to believe that gout is an eating disorder. They start to believe there is some type of “accurate and detailed list of foods as I need to loose weight, lower my blood pressure and my uric acid levels”.
Life does not work that way.
Diet can play a part in an individual’s gout treatment plan. For a small number of obese gout patients, it might be the only therapy necessary. But, for most gout sufferers, diet plays a supporting role.
Malcolm, you’ve found GoutPal during a period of transition. I no longer need GoutPal as a personal project to understand my gout. I now understand gout better than most frontline doctors. So, my aim is to turn GoutPal into a resource for all gout sufferers. I estimate that will take me 5 years to complete. It’s up to you how you use my gout support services:
A) Anonymous gout help. Read GoutPal facts, and discuss them with your doctor, or other health mentor. You’re one in a million that’s stepped beyond that, Malcolm. I’m extremely grateful that you’ve taken the next step.
B) Casual gout help. Ask questions, or share experiences and opinions about your gout. That’s exactly what you have done here. For my part, so I can make advice as relevant as possible, I think about Gout Groups. The groups are just my way of providing a logical structure that leads to understanding, and resolving gout. I’ve found that this helps save time. For example, there is no point discussing allopurinol, if you have decided that herbal medicine is right for you. In your case, Malcolm, you might want to be a Gout Dieter. But that involves learning to eat healthily. And it needs you to understand that yesterday’s lambs liver has little to do with today’s gout. It has more to do with what you ate last year, and before.
C) Structured gout help. Ultimately, every gout sufferer needs personal gout therapies. Therapies for uric acid control, and gout pain control, that reflect individual needs, and changing circumstances. So, the Gout Groups I mentioned are just a starting point to help you develop your own personal gout management plans. You can do that yourself, or with your doctor. Or, I can take the role of gout mentor. For me to do that, I have to learn about you, while you learn about your gout. It requires a lot of commitment on both our parts. (That’s time commitment, not money. I don’t charge, but you do have to commit to frequent posting).
The best way to control gout, is one step at a time. It might seem tedious, when all you want is a quick fix. Certainly, I can give you my quick gout fix. I guarantee it will make 2018, and the rest of your life, gout-free. But, is it right for you, Malcolm?
Anyway, I’m guessing you belong to the Gout Recce Group, for now. It’s up to you what you want to do next. Ask as many questions as you like. And, ask for clarification whenever my comments don’t make sense.
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Many thanks for your detailed response. Sadly, although the prednisalone relieved the pain after only a few hours, the pain and swelling returned with a vengence and during the day I have been confined to a a lounge semi recliner chair with my leg elevated since. The pain is nigh on intolerable at times, particularly when I go to bed and have been self medicating my prednisalone with indometacin for the last three days. I take on board your comments re the cause being what I’ve consumed last year, not last week. Because I was wrongly informed by my surgery at the last test that my levels were normal, my diet has returned to ‘pre gout’ days over the last 18-24 months.
I have a GP appointment tomorrow, uric levels and blood pressure, the latter being high enough for the GP to advise medication. I declined this on the grounds that it might have been high having just learned that the surgery had given me incorrect information and had, in effect, jeopardised my future health. Hopefully it will be more settled when taken tomorrow! Am I correct in thinking that I need to find my way onto the Gout Recce group or Gout Group. Sorry for being so vague, Id very much appreciate a mentor to nail my condition asap.
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Malcolm, I’m sorry that my information about gout groups is confusing. I will correct that, but it might take a couple of days. I should make it clear that groups are just my way of organizing gout sufferers. When I know which type of gout sufferer you are, I can make my responses more meaningful. I hope you can be patient. I’m on vacation at the moment (currently New Orleans), so my time is limited.
On your blood pressure, I had a relevant experience. This might not apply to you. But, I have what is often called “White Coat Syndrome”. When someone measures my blood pressure, it rises. For me, this was proved with a 24-hour portable blood pressure testing unit. So, when I need a blood pressure test, I perform my own test on the equipment provided by my doctor.
I’ll answer your other topic as soon as I can, Malcolm. But, you are already in the Gout Recce Group, if you are trying to decide between pharmaceutical, herbal, or dietary gout treatment. In practice, gout sufferers often choose a mix. If you already know which type you prefer, you ‘move’ to the appropriate group. Then, we can determine the best therapies for your gout pain, and for controlling your uric acid.
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You hit the nail on the head Geoff. White Coat Syndrome in spades. Testing myself all week, it was settling nicely, (I have my own bpm), it went through the roof this morning whilst being tested in the surgery. They have suggested 24 hour monitoring but they cannot facilotate it before I go on a 2month vacation. I have been prescribed another 5 day course of prednisolone, (already taken 3 days at 30 mgs, 4 days at 40 mgs + indometacin 25 mgs x 2 prn at night.) already administered. Additionally prescribed paracetamol / codine pain killers to replace indometacin. My ankle is more badly swollen than since the attack started, but the pain has reduced significantly to the point that I can now weight bare if I’m careful.
In terms of treatment, given that I’ve been symptom free for 2 years, I’d be looking at diet and herbal remedies in the first instance, but Allupurinol has worked in the past so that’s a possible last resort. My next worry is that the GP never gave any advice re tapering off the prednisalone, perhaps 12 days is a short enough treatment period to make tapering unnecessary? Nervously I ask, how do I move to the appropriate group? Again, thanks for your input, hope I haven’t disturbed too much of your vacation.
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I have just received the results of my bloodtests. Liver and kidney function normal. Uric acid level 356. Two years ago, when I discontinued Allupurinol, my levels were recorded at 536 although I was informed they were normal at the time. Although much less pain, the ankle is still badly swollen. I will continue the medication as prescribed, but have further appointment to review next Monday. I am overweight so hope a gentle diet will brong the levels down further. GP prescribing colchasine in case of further flare up, but will also refer to rhuematology to rule out one sided arthritis if flare up doesnt subside.
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Sounds encouraging, Malcolm.
On colchicine, it’s good to know how it works. Our immune system fights uric acid crystals. When overwhelmed, immune system cells send out signals for reinforcements. Essentially, white blood cells grow and divide, so our army is bigger. And, this is what produces painful inflammation. Colchicine slows the cell division process. But, it does nothing for existing inflammation.
It’s best as a preventative. Or, at the first hint of a gout flare. It is useful after that, to slow spreading inflammation. But, once a gout attack has started, you should support colchicine with an NSAID. Ibuprofen and naproxen are the most common these days. But, your doctor or pharmacist can advise on different anti-inflammatories to suit your medical history. In extreme cases, you also need a painblocker such as paracetamol/acetaminophen. Again, medical professionals will advise on safe, compatible combinations.
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I saw the GP today and had both bloods and blood pressure taken. Despite taking predisalone for 14 days, the flare up has not been tamed and is giving me considerable pain. I have been referred to a rheumatologist, and will commence the colchicine x2 daily. I have not been prescribed and anti inflammatory although I have both anti inflammatory and pain relief, but GP did not suggest I take either. I’m surprised at this because you seem to suggest that colchicine should be combined with an anti inflamatory plus pain relief, paracetamol, in severe cases.
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Malcolm, the problem with GPs is, they dish out the pills, then send you on your way. The best people for pain control are hospital nurses. They don’t want to be disturbed all night by old men like me shrieking in agony, and sobbing in my pillow.
A wise man of old used to describe how he trained his doctor to prescribe the right treatments. It sounds like we must do that for you.
Colchicine is brilliant at stopping gout pain before it starts. But, for existing gout pain, it does nothing. Of course, our natural anti-inflammatories will deal with existing pain within a week. But, I believe anti-inflammatories should be used to give earlier relief. For relief within hours, anti-inflammatories can be supported with compatible pain blockers.
I understand gout. I don’t understand doctors.
Perhaps other gout sufferers can share their experiences of how they got effective pain control from a GP? โ
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My GP has prescribed me analgesics (including stuff you can’t obtain legally without a prescription) even when I didn’t need them right away. All it’s ever required is being somewhat argumentative and in one instance some talk about getting the stuff from another doctor.
I once let an attack develop before trying to stop it with colchicine alone. It’s very slow but it works. Of course I can’t prove that the attack wouldn’t have gone away on its own but then I can’t prove it was gout to being with. There are lots of things we can’t prove but I don’t know why colchicine wouldn’t work if you give it time. I agree NSAIDs seem to work much faster but what about people who don’t tolerate them?
There is also the controversial matter of how much colchicine is effective and whether that amount is going to vary from patient to patient. As with other drugs, GPs may not be confident prescribing a large enough dose. -
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
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Hi,
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.
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Hi Marc,
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.
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Thanks guys.
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? -
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… -
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.
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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!
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Hi Marc,
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.
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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 ๐
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Newly Diagnosed with Gout! Where do I start?
Hello everyone!
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!
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Hi!
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. -
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.
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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. -
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:
http://www.acumedico.com/purine.htm
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.
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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. -
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.
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Keith wrote:
So if you want good opinions itโs 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.)
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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.
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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?-
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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