Gout Triggers: What Triggers my Gout Attacks?

[Lowell Andrew F.]

Hey Keith et al., do we know of a list of potential triggers?
I’ve been so careful about eating and brought my uric acid down to 4.9 (from 6.4) within 6 weeks. Now it’s been 8 weeks and I was awake with the pain I originally had 8 weeks ago. All I can think of that I’ve had in the last week is a serving or two of “no sugar added” ice cream or quite possibly one serving of wheat pasta with vodka sauce, and a LOT of black beans and quinoa which I don’t think would do this. Then I’ve seen other posts on the Internet which indicate black beans are actually triggering gout attacks?!
Daily diet for the last week:
breakfast:
1/2 c. all bran buds w/ skim OR 1 tofu-based protein bar
1 banana
lunch:
salad with ACV only, no dressing
1 veggie – cucumber/pepper/carrots etc.
2 squares of 90% dark chocolate
cherry juice, lots!
dinner:
quinoa with corn/black beans/veggies in coconut oil
fresh fruit portion
greek yogurt

Prior to this I ate complete junk and drank lots of IPA. 🙂 So I have completely transformed my eating but haven’t seen much of an effect. Still on 100 mg allopurinol and don’t want to increase as I have a very annoying side effect where my limbs have major pins/needles/pain and I can’t sleep. For those on allopurinol 200 mg, do you take one pill in AM and one in PM, or together?
Thanks!

[Patrick]

Lowell,

I’m not Keith, but I’ll tell you what happened with me. Like you, I had a major Gout flare before I was finally given Allopurinol 100mg to start. I took this for 3 months and was already eating right, long before I started on the medication. After 3 months of 100mg Allopurinol, I went back for my 3 month blood work evaluation and found that my Uric Acid went from 7.8 to 7.6. I thought, “are you kidding me? I have been doing everything right and my Uric Acid only went down 0.2? That’s BS.”

So don’t be discouraged. It’s only been 8 weeks on the medication, and you may find out that 100mg hasn’t really done much for you. You may need a higher dose. I know you are concerned about the side effects. That’s a legitimate concern. But for me, the pain of major Gout flare ups was more of an issue than the side effects. With my line of work, I can’t be having Gout attacks. Especially the ones that keep you down for days or weeks.

With your Uric Acid hovering around 5.0, that doesn’t sound very high, but Uric Acid flucuates. That’s why in the early fazes, blood work should be done almost monthly to gauge where you are.

As for particular triggers, you diet seems fine. It might not even have to do with “triggers” in particular. It might just be that you are predisposed to the condition and it’s going to take time for the medication to be adjusted and for it to start to take hold. Be patient and keep doing what you are doing.

Also hydrate and exercise as much as possible. That helps also.

[Lowell Andrew F.]

Thank you, Patrick! One really can’t think about gout logically, can they?! At least I can’t….but your perspective really helps. I just keep thinking it’s way too long term and too much pain fluctuation to make sense. But I suppose nothing says it has to make sense, to me. I can appreciate Keith’s interest and enthusiasm for understanding it better…

[Lowell Andrew F.]

PS for anyone reading, I didn’t link this, but I have a long rash 6″ near my hip that isn’t getting better (probably worse) that just magically appeared one day, now there is a 2nd circular area at the top of my leg. I will be getting this checked asap, I just figured it was something I picked up in the woods last week but now I notice it’s a side effect of…allopurinol! 🙁

[Keith Taylor]

Andrew, this isn’t a complete response to your situation. I’ll just handle your main question. Then, if you need clarification, we can get the fundamentals right before tackling other issues. So, here’s my response to “do we know of a list of potential triggers?”

List of triggers for gout attack:
1. The immune system sees too many uric acid crystals than it can handle, so it sends out signals for reinforcements (more white blood cells needed).

There is only one trigger for a gout attack. Creating white blood cells is a painful process for most people. White blood cells are very good, but they can’t kill inanimate invaders like uric acid crystals. They engulf the crystals, which hides them from our immune system, so inflammation slowly stops.

So, another question is: what triggers uric acid crystals to become visible to our immune system? That’s a list of 2:

1. New crystals grow. This can’t happen if your uric acid is 4.9mg/dL. So, we’ll forget it, unless you are exposed to prolonged intense cold. Uric acid crystallizes easier at lower temperatures.

2. Old crystals dissolve.

You absolutely need old crystals to dissolve. That is the only way to recover from years of excess uric acid. Everything we do to control gout has to involve lowering uric acid below the crystallization point. That has consequences. Just like recovering from a toothache, there’s a process that’s probably going to hurt. That’s why good doctors warn you that lowering uric acid can trigger a gout attack. Good doctors prepare you with gout pain therapy for as long as you need it.

What are your gout triggers?

As old crystals dissolve, they shed the coating that hid them from our immune system. Often, this goes unnoticed. Sometimes, there are enough partially dissolved uric acid crystals to trigger a gout attack. That’s why we need gout pain therapy until most of the old crystals have dissolved.

That’s the logic of gout triggers. Like the logic of gun triggers, you have to ask the right question. It’s nothing to do with the size or shape of the gun. It’s nothing to do with what the gunman ate for his dinner.

Is there a bullet in the gun?

[Lowell Andrew F.]

Thank you once again, Keith! That is a fabulous explanation that will be helpful to a lot of people.
I don’t think we have any “good” docs in my little town, I’ve been through a number and they’re all generalists who refer you out – which is fine, except there’s no gout specialist.
But my current doc thinks it’s odd that I’m still having pain and it doesn’t feel like joints, it is in the pads/soft tissues of my fingers & toes. I believe I’ve seen on here you can feel it in your bloodstream and not just around your joints, but not sure how that works. Anyway, I’m seeing a Rheum doc next week so that should maybe help. It took my brother 3 years to figure out his problem was RA so although this doesn’t feel like RA, I have to rule it out. If it’s gout I would think it’d be gone very soon as I’ve been at 4.9 for a few days shy of a month and it hurts more now than it did back when I first started having pain.

[Keith Taylor]

Thank you for your kind words, Andrew.

Here’s another example of my logic. It’s incomplete, because I don’t have all the facts. So, let’s call it a possibility. The most important missing fact is how long uric acid crystals have been building up in your body.

Usually, it takes a few years before uric acid crystals make their presence felt, as your first gout attack. Let me guess at five years.

Typically, it takes at least a year from the first attack before gout patients start uric acid lowering. So, I’m now guessing 6 years of uric acid crystals.

I have a rough ‘rule of thumb’ that it takes a month for every year of uric acid crystal buildup, to remove the risk of gout flares. There’s no real science to that. It’s just a general feel after 20 years of reading and writing about gout. You can shorten that period with lower uric acid, e.g, 3mg/dL or lower. You can lengthen it if allopurinol dose isn’t enough to get below 5.

My logic is that the most likely explanation, of what you are experiencing, is a usual reaction to lowering uric acid. And, it’s likely to continue for a few more months. Of course, you might be unlucky to have another arthritic disease running alongside gout. But, I think the most likely explanation is old crystals dissolving. In your position, I wouldn’t worry about other diseases just yet. Personally, I’d increase allopurinol to speed the debulking process. But, that’s just my personal choice.

I think your doing fine, Andrew. But, it’s perfectly natural to be apprehensive. Just keep posting about your concerns. It should make recovery easier.

[Carolyn Poulter]

I am on 300 mg Allapurinol, first prescription. I can’t believe the difference it has made. I can walk again. I might not be the prima ballerina in this year’s Toronto Nutcracker but I am moving again and anyway even though I do actually love the ballet and have been a number of times to see that particular one and others in London I can never really get through any ballet performance without seeing Morcambe and Wise https://www.youtube.com/watch?v=p6wMWdxXXvo doing their ballet skit… ahem, sorry, I am easily distracted.

Any old how, I can move again. I had a rash in the first few weeks but that has gone. I also seemed to be running some kind of fever for about 3 weeks – over 101F but that has also gone. I have noticed…… how do I say this and still maintain the illusion of being a lady……… urgent need to rush to the loo and things can be somewhat loose? Only once a day and as I tended towards to opposite all my life I think this is evening things out.

I head back to the doctor next week and I am going to try to be brave and insist on staying on the Allapurinol. I am not very good at insisting but I really don’t want to slide back. I just know he’s going to take another armful of blood, the vampire….

I have noticed I am a bit tired and not as strong as I was, we live in a funny shaped house and the main living area is on the middle floor, so steps up to our front door, stairs down to basement with things like washing machine, freezer, spare bedroom and stairs up to our bedroom… right now I am doing the one-step-at-a-time thing. But then, I am 62 so who knows, might have done that anyway.

So in my usual long-winded and peripatetic way I am saying to everyone else here, hang in there, we really DO feel your pain and go with your own instincts. Yes take doctors advice but you know you best.

Gosh I am really not explaining this well!

[Lowell Andrew F.]

Hi Carolyn, congrats, glad to hear this and remember (I think I read this here) it’s always good to give blood as it removes some of the acid!

I stopped allopurinol as the rash was bothering me and the doc advised stopping because my level was 4.9. The rash was very similar to some others who have posted here in that it was a thin horizontal line right along the belt line and expanded to a few other round patches nearby. I think I can adequately control it with diet now that I’ve disciplined myself 😉 I have had the pain in fingers/toes since stopping 2.5 days ago but it’s manageable enough with ibuprofen and cherry juice.

Anyone else notice that “acid” feel in your urine after cherry juice? Holy cow. I hope that is the uric acid I feel coming out and not the feel of the (basic?) cherry juice. Has anyone ever had too much of that stuff? I drink the syrup but there’s never a dosage mentioned so I do 1/4 – 1/2 cup of the 32 oz bottle that says “juice from 2,000 cherries”.

Also, I’ve been lifting a lot of weights in an attempt to use up some protein by building muscle, who knows if it helps but at least it gets me moving. I’d like to run but I think my feet would hurt too much afterwards.

Keith, thanks again for all your attention, you are obviously a great guy, I doubted the site at first thinking someone was at it to turn a profit, and I sincerely apologize for that!! It was the untrusting westerner in me I suppose 🙁

Nothing urgent here so don’t feel obligated to keep writing, there are many others to get out of pain and I read all the posts so will continue trying to help when I feel qualified…

[Keith Taylor]

No apology necessary Andrew! On my to-do list for longer than it should be is a note to explain my business model better. I’ll make an effort to do that. But, It’s Your GoutPal. I encourage members to question me directly about it. I want to be open, but my first concern is to give gout advice. That is primarily through general guidelines on GoutPal.com. But, gout management has to be personal, so I give personal help in these forums.

I have a lot of work to do. I published GoutPal.com to learn about my own gout. So, it’s heavily criticized for being hard to navigate. I don’t need it anymore. But, rather than close it, I’m trying to turn it into a better gout resource for everyone. I started that by identifying types of gout sufferer. Now, I’m reviewing every page to identify which gout group the information is relevant to. I’m also creating plans, lessons, and therapies that guide gout sufferers on a step-by-step journey to gout freedom.

It’s very exciting. Especially this week, as Carolyn has offered to start spreading the word in social networks.

I’ve never made a secret of the fact that GoutPal is funded by advertising. I also get product commissions from Amazon, eBay and similar. I haven’t kept that up-to-date. It’s another mini-project on the todo list.

So, money is certainly involved. I have to live. I’m proud that 2016 is, so far, the longest I’ve been able to sustain 100% income from my websites. There’s a huge “But” missing from that sentence. I won’t bore gout sufferers further with my personal situation, here. However, if you are interested, please ask in General Discussion. I want to explain to any doubters how this works. You are right to doubt. I am not your usual gout exploiter, and you deserve to know more about me.

Getting back to gout. Andrew, you’re the second GoutPal member today to worry me.

You’ve started recovery with allopurinol. But you stopped it without an alternative plan. You’ve taken up body-building, which brings me more visitors than any other pastime (explanation available for the asking).

[Lowell Andrew F.]

Ugh, ok thanks Keith. I read some bad, scary stuff on the rashes and figured if I just control the diet I will continue to heal, although maybe slowly. The weightlifting I’ve done plenty in the past but didn’t realize it could have an effect. Oops. Time to do some more reading 😉
I’ll try to do the diary, I looked at it several times, but again it’s hard to decipher what to do and I’m still not sure which group I’m in! As I never had tophi etc it doesn’t seem as bad as it could be.

I’m totally fine with the adverstise-based income, you can’t get mad at some one providing a service like this without some kickbacks, I just figured you could potentially be getting more from one-on-one help. I wouldn’t blame anyone for making a career out of this, I just wasn’t in enough pain to fork out lots of money – I’m sure some would be though! Do you get paid when we click the links or buy products on amazon? If so, I should do that sometimes 😉 I’m interested in in the uric acid test kits but didn’t know what to get.

[Keith Taylor]

Hey, Andrew, don’t get me wrong. It’s absolutely correct to be worried about rashes. But, only your doctor can test you to assess what is going wrong. Then, you can put it right. Switching from drug control to diet control might be the right thing to do. But, you have to make that judgment based on appropriate test results, and weighing up pros and cons of different approaches.

Where doctors don’t provide that level of personal guidance, I can suggest the right way to move things forward. Some doctors still stick with a ‘one-size-fits-all’ approach to gout treatment. All I can do in that situation is help you ask for specific tests, etc.

And, personal treatment should include your interests and preferences. So, if you want to improve muscle mass, your treatment plan has to allow for that. With treatment options, the current state of your gout, and personal preferences, we soon end up with hundreds of possible ways forward. That’s why I introduced Gout Groups to try and reduce the number of choices to manageable numbers.

I’m very concerned that you say “I’m still not sure which group I’m in!” We can still move forward without that. But, I really need to know why the 5 questions in Which Gout Group Am I In aren’t working for you. (Now replaced by Questions for Gout Sufferers)

Obviously, it’s easy for me, because I wrote it! But I’m trying to see it from your point of view. Please, can you tell me where I’m going wrong with those 5 questions? Then, I can try to improve it to make it easier to use.

[Carolyn Poulter]

I had a more generalised rash. I was concerned at first because I have had Stevens Johnson Syndrome twice in my life – penicillin when I was a teen and anti-anxiety drug more recently – so I get very jittery with symtoms like ever and rash. But my platelet count was fine which is one of the ways of diagnosing SJS and I kept going with the Allapurinol. I am so happy I did. My left heel and toe joint were stiffenign up with morning but I am hoping it won’t turn into another attack.

Keith? Can you drop me a line [email protected] – to anyone wondering no I am not a witch though I am sure I have been called that from time to time! It was an old programming joke. Bck to Keith, happy to help out, just need to set up separate accounts just for that side of things.

Also! I might just have picked up a contract for some real paid work, everyone cross fingers, toes, eyes for me, gout twinges allowing of course!

[Lowell Andrew F.]

Thanks Keith, please see my latest post in a new thread. I don’t fit into a group because I thought I had gout and have now been told by two docs that I don’t. I’m not the waffler, it’s them! 😉 Honestly I don’t see what else it could be, but they say it could be b12 or nerve damage. Do you think that’s possible with your knowledge? My pain is in the fingertips/toes, not joints. I definitely “feel” things moving around once I take the allopurinol. One doc, my best friend who visited from out of town, claimed I exhibit zero of the signs so doesn’t understand why my normal doc diagnosed it as that (other than I told him I thought I had it.
They have me down for being allergic to allopurinol now because of the huge rash it caused, so I don’t know if I’d even be able to take it again if I wanted to.

[Keith Taylor]

“I don’t fit into a group”

I just spotted this. I feel it’s important that I explain my view. Every GoutPal reader needs to know this. So, it’s not a personal message to Andrew. It’s a message for all gout sufferers.

I rely on GoutPal Gout Groups to organize my gout facts. Increasingly, I’m using them to improve my personal responses to casual gout help. I absolutely need them to focus my structured help plans. So, I feel it is very important that all my readers can identify with one of the groups.

Maybe I should use a better word than Group? ❓

Anyway, they are groups of GoutPal readers. If I’ve got the logic right, every gout sufferer must fit into one of the GoutPal Gout Groups. If gout diagnosis is uncertain, then you’re in the Arthritis Sufferer Group.

Actually, I didn’t quite get the logic right in Which Gout Group Am I In. But, I’m actively working on putting that right. Hopefully, I’ll have it finished today (see Questions for Gout Sufferers). But, I’m also adding individual guides for each group. They will point each gout sufferer in the right direction. With 9 individual group pages, plus a new group summary, 10 pages a day will be a new record for me.

Sorry for the interruption. Gout Groups are playing on my mind at the moment.

[Mark]

I was just reading through this and saw Andrew’s post about the pain in the pads of the fingers. I have that too. My knees hurt, so I noticed the pain trying to push myself up to stand. I had the pain in my knees, ankles, elbows, wrists and fingers all at once (no feet) and then after one day of Naproxin the knees were OK. Now about a week, it’s mostly confined to my left elbow and left thumb joint at the palm. I bought a home test kit and immediately took two tests 7.4, 7.2. My blood work a week ago was 6.8. I haven’t had anything to drink except water and coffee in almost 2 weeks and I have been nearly vegetarian. I am 44 and do a lot of cycling, jogging, etc. I am very guilt when it comes to my alcohol (especially beer) intake levels in the past and that has stopped. Not skinny, but in the last two years, I’ve lost about 60 lbs. I am going to start doing the test in the morning after waking up and following the advice I have been reading here. I tried to talk to my doctor, but got an assistant and was simply told to call back in a week if the NSAIDs haven’t eliminated the problem. Keith, you already gave me a good response on the “normal” level of 6.8 and thanks for the responses the other day and thanks for running this forum.

[Keith Taylor]

You’re welcome Mark. I hope you’ll keep returning, and keep posting.

[Lowell Andrew F.]

Wow – thanks for adding that – we have a lot in common with symptoms. I don’t have anything in my elbows or knees (yet) but am 45 and also did plenty of alcohol (especially beer 😉 and have completely given that up and strictly vegetarian diet as well. I’ve lost 30 lbs from 170 so my wife is a bit worried as I look gaunt already, but I feel ok other than the PAIN. Seeing Rheum on Friday so will report back. I suspect they’re going to tell me it’s not gout, like the last few docs…at this point I WANT very badly for it to be gout, as that will mean it’s not Rheumatoid arthritis.
BTW, I don’t know if you saw my other thread about saturnine gout, but there are some studies that say elevated lead levels cause gout. I was exposed to a lot of lead in the last 6 months and my blood is at least 6 ug/dL if not higher. The studies say even levels of 1.2 can cause gout. “Normal” range is a whopping 25, go figure. Mabye that’s the point at which you switch from alive to dead.
Anyway, you may want to get that checked too as our symptoms are very similar. Best wishes!

[Mark]

When I woke up this morning, it was hard to get out of bed. My elbows and wrists were especially bad. Both thumbs felt broken. I took some naproxen and started moving around, walking the dogs, etc. I felt good enough to go mountain biking, but took it easier than normal. I did 70 minutes with some good climbing and had the heart rate probably around 160 average. I made sure I drank 3L of water during the ride and two bottles on the car ride to the trails. I felt really good. Still a bit stiff and tender, but I don’t know if is the adrenaline, the naproxen, the water or just moving around, but it helped. I went home and tried my new test kit. In the morning (fasting test) I was 6.8 which was exactly the doctor result a week ago. After exercise, I was 9.0. That had me a bit worried. I kept hydrating and going to the bathroom and in 2 hrs I tested again. 10.4. I have to think exercising breaks down body fat and causes a spike, but I could not have been more hydrated. I am going to keep testing and try to figure more out about my metabolism. Sleeping seems to be the worst part. I have been eating only fruits and vegetables for several days and drinking only water and a few cups of coffee. The lead thing is interesting. I work in the metals industry, but used to get Pb tests annually as part of the work safety program. I have never even had a spike. As a metallurgist, I can’t help but think that if 6.8 is the saturation point, the level you are above that would be a driving force for crystallization and maybe because I seem to be right on the saturation point, my crystals aren’t as needle like as some people. I am not getting the extreme burning and redness some talk about, but rather real stiffness and feeling like joints are sprained or broken.

[Keith Taylor]

The 6.8 crystallization point for uric acid is a lab value at standard human body temperature. But, as well as temperature, there are many other factors that affect crystallization. Anything over 5mg/dL is generally considered bad. But, if you are exposed to prolonged cold, even that could be too high. Just part of the reason why gout management has to be personal. We are all unique!

The shape of uric aid crystals is completely irrelevant (unless you are trying to identify them under a powerful microscope). Gout pain is an immune system reaction. White blood cells exhibit some extremely “clever” properties. But, shape recognition isn’t one of them. They will react to invading foreign bodies irrespective of shape. Volume of crystals is significant. But, most significant is personal status of your immune system. Sometimes you just get a bit of itchy discomfort during a gout attack. Sometimes, you get a slight fever. Sometimes, it’s full-blown agony. Just another part of the reason why gout management has to be personal. We are all unique!

Am I repeating myself? Time for bed!

[Lowell Andrew F.]

Mark, I stumbled on something this weekend that helped me immensely. Ask a Dr first if you’re on other meds of course, but I am off uloric and took Magnesium as I read that it can hurt your fingertips if you are deficient.
Nearly all of my pain went away this weekend. Now, uloric for a few weeks may have helped, but Mg citrate powder (500mg) ultimately took away the broken glass feeling as well as the sharp pain in the very tips of my fingers.

good luck!

[Keith Taylor]

Andrew, that’s very interesting about the magnesium.

I keep banging on about safe uric acid levels. But, gout pain is very complicated. Scientists are only just starting to understand how gout pain usually needs other factors besides uric acid crystals.

Of course, the bottom line is, if you get rid of the uric acid crystal burden, you cannot get gout attacks. But, until that happens, there’s many things that trigger each attack. So, there’s many things that can help prevent it. The hard bit, is finding the right treatment combination. I guess, I’m lucky, because I respond well to the standard gout pain meds.

As you’ve shown, with some perseverance, it’s often possible to find non-standard ways that work.

[Mark]

Thanks Guys!

My flare up is 95% gone. Right now, my only real sharp pain is in my left wrist. Other than being a bit stiff in the elbows when I wake up, I am feeling better. I will look into the Mg. I have not had a drink in 17 days and other than a little bit of chicken a few nights, I have been strictly vegetarian and very hydrated. I have been riding my bike and it seems to really help. I have a home test kit now and it is a bit discouraging. I am doing a regular morning test and was at 9 this morning. So, I vary from 6.8 to 10.5 (the 10.5 after exercise). I was hoping with the big load removed of the beer and meat that I would have seen a drop. I am going to stick with it. I am hesitating going to a doctor until I get back from a 4 week overseas trip. If I wind up on a UA lowering medicine I am worried it will trigger attack while I am working overseas. I cannot afford to miss work. I feel good now, so I think I will set an appt for my return. Am I overtesting with the home kit and expecting too much too soon? The diet change has caused about a 10lb drop. I know you are not supposed to crash diet, but I have to admit, removing all of the beer and meat must be a shock to my system, but unavoidable. I am hoping to even out here weight wise soon.

[Keith Taylor]

I’m really pleased your gout flare has almost gone, Mark.

I hate to be the bearer of bad news. But, chances are, it will come back.
Worse, as you’ve never had a uric acid test result below 5.

Every sentence of your latest message resonates with me. I have lived your gout life! You are doing many things right. But, you have some fundamentals wrong.

Uric Acid Testing
Uric acid testing is a good thing. But, it is only relevant when you have a safe uric acid target. Then, you can test to target, and adjust your regime accordingly. Before I realized that, I’ve played exactly the same games with uric acid meters. In the right circumstances, they are useful. If you are committed to using one, my best general advice is:
Look for trends and averages with uric acid test results from home meters, rather than specific results. If you are home testing more than once a day, keep separate data for each time slot. Analyze moving average of at least three results. Ignore especially high and low results (or record them separately from your trend analysis).

General advice is one thing, but much more important is specific advice. Interpretation of results often depends on where you are in the symptoms-diagnosis-treatment-symptoms cycle. And, quality of data depends on the consistency of your testing procedure.

Uric Acid Burden
Plant-based diets and hydration are good. But, current diet changes have limited impact on gout attacks. You can’t ignore that. But, more importantly, you cannot ignore the uric acid crystals in your body that have been building up for years. That uric acid burden is what gives you the foundation for a gout attack. While you have that burden, you have a gout risk.

For some reason, I tend to think of fire-fighting analogies for gout, these days. Imagine a buildup of litter in your yard. Passing smokers flicking their butts over your fence keep causing fires. Yes, you can hide by your gate, and shoot the bastards. But, wouldn’t it be better if you cleaned the litter?

Gout Pain Control
When it comes to gout pain, “shooting the bastard” is a very wise strategy. And, you need to get good at this before the overseas trip. Trust me on this one. Those sneaky foreign gout attacks are flicking their butts from directions you never expected.

Or, to break my analogy, and put this a more sensible way. Starting uric acid lowering treatment might cause a gout flare. Continuing unsafe uric acid levels will cause a gout flare. Your uric acid burden is highly likely to show itself in the unfamiliar environment of an overseas work trip.

You need an effective gout pain control plan. That takes the worry from your overseas trip. And, when you chose to start your uric acid control therapy, you can tackle that without worries about gout pain.

In your shoes, Mark, I’d see the doctor to get an invincible gout pain control package that will cover you for your overseas trip. Also, start the preparations for uric acid lowering therapy. Time spent now, means you can be prepared to start uric acid control as soon as you return. See what your doc says. I’d start with a 24-hour urine test. Other recommended preparatory tests depend on ethnicity.

Let us know what your doctor says, Mark. Best in a new topic – we’re moving far away from gout triggers.

[Karsten Pedersen]

Gout triggered by ammonium chloride?

I love candy, but when I consumed candy with ammonium chloride in Denmark called Turkish pepper, I got my first attack my left the big toe joint. I reduce sweets and sugar drank 2+ liter of water as I read in your page. Thank you for a most helpfull page. A month mater I was tempted by the Turkish paper and consumed 100-150g and got the gout once more.
I wonder Is it ammonium chloride that triggered gout?
Best regards Karsten

[nobody]

Ammonium chloride is an acidifying agent which is known to trigger gout. But is there enough of the stuff in Turkish perpper? I don’t know.
Ammonium chloride seems to lower the amount of uric acid excreted by gout sufferers who aren’t on a low-purine diet. The extra uric acid retained by the body doesn’t en up in the blood but in the cells (and possibly the joints?) as the acidifying effect of ammonium chloride alters the transfer of uric acid from/to the blood.

[GoutPal Feedback]

Learned a lot about the dimension of the problem. Will need Dr’s help with a more effective pain & swelling plan. On 300mg/daily dosage of Allopurinol. Diet, water, exercise, and weight loss programs in place.

My 1st blood test should be back next week. Just needed to set my expectations.

This site helped with that.

Regarding GoutPal, Read all the comments, questions and responses. Good stuff.

[Author]

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