[Keith Taylor]

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.

[Keith Taylor]

Hi Christopher,

I’m really pleased you’ve got the answers you need. So, massive thanks to nobody for helping you out. It’s comforting to know that gout sufferers can get answers to questions, even when I’m busy for a few days.

Christopher, I hope you’ll create more new topics with any other questions, experiences, or opinions about your gout. Good luck with your continuing recovery.

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How will you avoid pain during gout recovery?

[Keith Taylor]

Please can you complete the short survey at Mediterranean, DASH, or Alkaline Diet for Gout?

I’ve not included EFSEP, or Zone Diet, in the survey. Because, I want to focus on the food scoring methods I mentioned for Gout Foundation Diets. But, I will include them in the articles I write from results of that survey. So, if you want to see some new ways to manage food changes for gout, please submit the survey.

[Keith Taylor]

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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Let’s learn to fix your gout together. Start today, with personal gout help.

[Keith Taylor]

Hi Rich,

There’s no point in guessing about test results. So, all I can say is, it’s too high, irrespective of gout or not. So, as nobody suggests, now is the time to think about lifestyle improvements.

You said: “i m 31, 64 kgs, with a clean diet, not too much alchool, few beers per week(4,5) not every week. no soda, no processed food (only sometimes)”. But, that’s not necessarily a healthy eating plan.

My absolute minimum standard for healthy eating is the DASH diet. But, I much prefer Mediterranean style eating plans. These are not gout diets. But, they form a good foundation for healthy lifestyle, that can be tweaked for better gout control. At this stage, whether it’s gout or not, you have to assess if your diet is really “clean”. Because, high uric acid is also associated with a host of other diseases. But, most diseases respond well to real lifestyle improvements.

So, if you want a personal healthy eating plan, look at How to start your Personal Gout Diary. Or, we can just wait for your next blood test result.

[Keith Taylor]

you can assess the effectiveness of a UA-lowering intervention by looking at the average duration of your symptoms. If most of your symptoms go away quicker than they used to, you are on the right track no matter how unusual the symptoms are.

That’s a great reason for maintaining a gout diary. Because, as well as recording test results and treatment changes, you can also record symptoms. Especially, if you record days with no symptoms, you have good information to confirm gout recovery.

As humans, we tend to focus on the unusual, then forget all the good days when we are symptom-free.

[Keith Taylor]

OK, Gary, you now have your own personal space to keep your gout information. So, please let me know if you need any help organizing it. Also, let me know if you want me to move your other 2 topics that you started into this personal forum.

As well as organizing your gout information, you can also ask better questions here. Because, you can flag questions as support requests, which I will answer as my first priority.

[Keith Taylor]

It is most likely to be gout. But, you should return for another uric acid blood test once your symptoms have resolved. Because, uric acid in the blood can fall during a gout attack. As dissolved uric acid moves into joints as crystals.

You also need to get gout strength pain relief as soon as you can. Your Ketonal Retard should help with this. It is a Non-Steroidal Anti-Inflammatory Drug called ketoprofen. But, it is unlikely to be strong enough at Over The Counter strength. So, see a doctor or pharmacist about something stronger. In my experience, gout pain resolves better if you can stay mobile, with gentle exercise. Also, opinions differ, but I believe gentle heat is better than ice for gout pain.

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Do you treat gout pain with heat or ice?

[Keith Taylor]

Thank you for those numbers, nobody. They definitely support your notion of not getting tested often enough. We can see that January, February and March are all spent assessing allopurinol sensitivity, rather than controlling uric acid. And even if we allow for vagaries of testing accuracy, this seems too long to me.

So, we have a strong likelihood that d_q’s uric acid is only now getting low enough for old crystals to dissolve in any significant number. Therefore this sounds like exactly what happens to most gout patients during the early weeks of uric acid lowering. I.e. gout flares in unpredictable joints.

Now, to many people, that sounds like bad news. But, it’s only a temporary situation. As more crystals dissolve, attacks become less frequent and less intense. Also, it might be worrying if a patient is already on maximum allopurinol. But, even in that situation, gout patients have improved their rate of recovery by adding probenecid to their allopurinol. So, if my view isn’t obvious, I’d better state it:
Titrate allopurinol from 100 to 200 to 300 mg per day. With test and dose change every 2 weeks. Then, if there are no adverse events, increase to 600 ten 900 (800 in USA). Once you have no symptoms for 6 months, reduce allopurinol slowly to a maintenance dose. There is debate in the rheumatology profession if this maintenance dose should be 300 or 350 μmol/L.

I hope that we get enough data from DECT experiments to allow us to judge when all uric acid crystals have dissolved. I guess there should be an approximate formula based on how long a patient has had gout, and the level they get down to during uric acid treatment.

[Keith Taylor]

The foot pain might have nothing to do with gout. So, if it persists, you should get it examined.

But, let’s assume it’s gout related. If it is, when you’re reducing uric acid, it’s all about the level that you’ve reached. I can’t recall us ever discussing your uric acid targets. But, you should have a target for the debulking period. Also, a maintenance target for when you’ve gone 6 months without any symptoms.

Now, those targets are not strictly related to your foot pain question. But, they put it into a meaningful context. Otherwise, we just end up talking ifs, buts, and maybes. So, can you post your targets if you have them, and the last 2 or 3 uric acid test results?

Moving on to my allopurinol management plan. The truth is, I never really had one. The nearest thing I got was to aim for uric acid as low as possible during my debulking period (which is probably the best plan).

You really do not want to follow my example, d_q. I was spurred into action by a near-fatal accident. 3 and a half years later, I prematurely quit allopurinol because I was too depressed to leave home. Then, I kept making stupid excuses to myself for not restarting. The only good news is, thanks to you, I’m going to make an appointment today, and get back on the allopurinol.

So, I’m not really qualified to give any advice about gout management. Except that, like most teachers, I can explain the theory, even if I have no clue about practical reality. Therefore, my recommendation is to wait until you are fully recovered before you even think about pausing allopurinol treatment. But, I guess it’s good to think forward. So, any break needs monitoring by uric acid tests. Unfortunately, these ideas about allopurinol ‘vacations’ are very new. That means, we have no ideas about how long it is safe to take a break. It would be stupid (like me) to wait until gout symptoms return. So, a year off is probably OK. But, we need DECT for gout before this can ever be a reliable way to manage allopurinol treatment. My feeling at the moment is, once I get back on allopurinol, I’m unlikely to consider stopping it again. But, I can’t guarantee that some foolish action on my part won’t change that!

Reading this back, I suspect I haven’t been particularly helpful. Sorry, I’ll try harder next time.

[Keith Taylor]

I’m pleased that I just published Do you know 9 Golden Rules of Gout Management?. Because, it converts my gamechangers into something tangible that should benefit all the gout sufferers visiting GoutPal in future. Next, I will go through each rule, and create practical guides for people to learn these essential gout rules.

Along the way, I’ll close this Suggestion, and replace it with an “Improving” page. But, there’s no rush for that. So, please keep posting your thoughts on Gout Rules here.

[Keith Taylor]

Hi Jean,

I wonder if you’ve tried varying the time you take allopurinol to see if that has any effect on your digestive problems. For example, you could try one of the following for a few days:
– Take allopurinol before eating.
– Or, take allopurinol during your meal.
– Or, take allopurinol after eating.

Then, if you make a careful note of your symptoms, you can compare strategies to see if any works best. Also, you could vary the amount of time between eating and allopurinol. Or, experiment with breakfast, lunch, or tea.

Also, have you seen the Gout and Antacids topic? We discuss different types of antacid and their possible effects on gout. I haven’t included Gaviscon yet. But, I can see there are different formulas under the Gaviscon brand. So, there could be different effects on gout sufferers. For example, I noticed that one of Gaviscon’s antacid formulas contains Sodium Bicarbonate. Which, is not great for gout sufferers, or anyone else, if you’re taking it every day.

[Keith Taylor]

Today I realized how important these Gout Gamechangers are. Because, I believe there are key facts that every gout sufferer should know. Furthermore, these are so important that:
1. We can interpret them as rules of managing gout. Because, if we ignore them, we will reduce the speed and quality of gout recovery.
2. I need to consider training courses for understanding each rule.
3. I must highlight them clearly so they are easily accessible to all GoutPal visitors.

Also, I’ve identified 2 more Gout Gamechangers:
– Gout management must be personal on a case-by-case basis. So, the common practice of one-size-fits-all gout treatment plans is dangerously outdated.
– Gout is a killer disease. So, the fact that autopsies are starting to consider gout as a cause of death means enlightened gout mentors will stress the importance of early uric acid control.

So, that makes a total of 9 rules, so far. But, I must resist the temptation to number them. Because, they are all equally important to total gout care. Also, we should never forget the unwritten rule of all lists of rules:

Rules are made to be broken! However, you must realize that they can only be broken when you fully understand the rule. Then, you also understand the circumstances that make the rule important. So, you might identify special circumstances that suggest a better way.

Anyway, I’m going to start the process of highlighting the rules of gout management. Because, I’m working on a new article that summarizes these Gout Gamechangers as important rules. So, if you have any rules that I’ve missed, now is the best time to add them.

Please add your comments about the rules that I’ve already identified. Then think about adding any that I’ve missed.

Thank you.

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