Next Steps

[Peter Wilson]

Hi
I’m new to the forum but I can see that there is a lot of good advise and knowledgeable people participating here.

This is a long post but hopefully I’m giving some context to the gout issues I’m experiencing.

I am a Male aged 60, weight 14 stone 2 pounds so not obese and reasonably fit.

I have had gout like symptoms on and off for about a 20 year period and in the early years gout attacks were about every 2 to 3 years with moderate pain which was relieved fairly easily by taking NSAIDs.

Over the last five years things have gotten a lot worse as I’m now seeing gout attacks most months. Again, I’m only getting moderate symptoms which means that I can take NSAIDs to relieve the pain but I would like to understand what’s going on.

Over the last 20 years I have consulted with my doctor a few times regarding gout but no diagnosis for gout was ever made. During gout attacks I tend to get moderate to low pain and not the classic big red shiny toe symptoms you often see in photographs which has led my doctors to be hesitant about diagnosing gout and blood tests have indicated that my uric acid levels are within the normal range ( < 7.2 mg/dL). Doctors have just prescribed NSAIDs and advised rest and stated that they do not know what is wrong but were not convinced that I was presenting with gout.

However, I am convinced that I do suffer from gout and that things are getting worse.

I have recently been looking at my historic medical records from the NHS website and blood tests show 2 UA tests in the past with readings of 6.7 and 7.2 mg/dL, these were about 10-15 years ago and I haven’t had any recent tests via Doctor’s clinics.

I have started monitoring my uric acid levels using a finger prick monitor on a weekly basis over the last few months and my uric acid reading is averaging about 7.4 mg/dL which I know is quite high.

I generally get attacks which affects my big right toe and more recently I’ve been getting nighttime attacks which affect my ankle. This often feels like tendinitis but I suspect that it is gout, or gout induced tendenitis. Both big toes can become inflamed with slightly reddish appearance.

I’ve also started looking at my urine pH levels and found that they are slightly acidic which I believe is quite common. This was done using test strips not meters. I would ofcourse like to see a more alkaline reading which would be better for gout management.

Looking at the NHS Gout advice website I noticed that my food sources generally fall within the moderate and low purine categories so I think my purine levels are likely to be moderate as I am not a big eater.
I generally can cope with a low calorie intake and my body feels happier when I’m on a low calorie intake so I don’t really have a problem with this but I was wondering if fasting is known to cause any problems in relation to gout.

I know that dietary changes can be an important part of gout management. Therefore, I have cut out alcohol completely and cut down on red meat and moved more to chicken as my primary source of meat. I have started drinking more green tea and water which hopefully should be beneficial and I feel that I’m getting plenty of hydration, probably drinking at least 2-3 L of fluids a day.

It’s almost as if making these dietary changes has been to no avail and if anything has made my gout attacks more frequent.

One thing I have picked up from this forum is that there may be something which has been called “gout hell” which seems to be where historic UA crystals dissolve and UA is reintroduced back in into the blood and the auto-immune systems reacts to this higher level of uric acid and I was wondering if this could be something I’m experiencing.

if I am going through “gout hell” then at least there is some hope that this may be short term pain for long term gain.

I just do not know where to go from here as I was hoping that diary changes would show less frequent attacks and improvement in my situation.

I’m wondering if only medical intervention can improve this situation.

[nobody]

Hi,
Regardless of the accuracy of your self-testing, 6.7 and especially 7.2 are high enough for gout. The normal range is irrelevant. And not everyone gets the worst-looking big toes (mine were never shiny). Obviously I can’t tell whether you have gout but I can tell you’ve had bad doctors (which is unfortunarely not unusual).
If you’ve had gout for 20 years, I would recommend finding a doctor with a clue and discuss blood tests and potentially a pharmalogical intervention (standard warning: beware of allopurinol if you have East Asian ancerstry). If you actually have gout, diet will probably not work wonders after allowing the disease to fester for so long. Don’t get me wrong: improving your diet would help in the long run if compared with not doing anything. Just don’t bet on that curing your gout at this point.
Yes, people have had gout triggered by weight loss and/or dieting and fasting probably does something similar. But lots of things trigger gout whereas the only way to prevent it is to get rid of the uric acid in your body so I wouldn’t give up fasting if it works well for you and you tolerate NSAIDs well (but you should get medical tests to make sure you are actually doing well when you’re fasting and that you actually tolerate this dangerous class of drugs as well as you think).
The NHS’s dietary advice is probably useless. Chicken is no good for gout sufferers for instance.

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