Forum Replies Created
-
Posts
-
“My question, is this a long term build up of crystals dissolving causing the pain it hit instantly within a minutes. ”
It’s impossible to answer that question without knowing your uric acid level at the time. If forced to give an answer, I’d say “highly unlikely.” I say this because, nothing you’ve described will cause uric acid crystals to dissolve.
You say you first noticed gout during 2015. I strongly suspect you had high uric acid levels long before that. It takes years for uric acid crystals to buildup. If you have more than one attack in a year, you should act immediately to get uric acid safe. If you do nothing, uric acid crystals continue to grow and multiply. They spread round your body so you get attacks in more places. There’s very little you can do to stop that.
It is possible to control the pain, but you have to have a personal pain control plan that works for you. Your “normal emergency gout diet” is a mess! I know that’s a bit rude, but I want you to change your ideas.
Gout attacks are usually related to what you ate and drank years ago. That certainly applies to purines, and potentially to alcohol. I have to hedge my bets with “usually” and “potentially.” Everybody is different, so the only thing that makes sense is a personal plan.
In fact, you need at least 2 personal gout plans – one for uric acid control, and one for gout pain control. I’ll be very happy to work with you on these plans. Also on a diet plan if you want. Doctors often get overwhelmed with the details of effective gout management plans. I only get overwhelmed if you have medical problems alongside gout that I don’t understand..
All I’ll say about alcohol is this: it has very little to do with gout. However, if you are drinking excessively, alcohol will lead to depression. Never drink more than two days in succession! That’s not gout advice, but I’m slowly becoming an expert in controlling alcohol-related depression.
You say: “Sure hope I dont create other problems by this method”
I strongly recommend that you see your doctor about this as soon as possible.
The effects of baking soda (sodium bicarbonate) can be frightening. I never recommend baking soda for gout: http://www.goutpal.com/8110/dangerous-baking-soda-for-gout/
Thanks Jason,
I like “Hydration is your friend, diuretics are not.” You can be sure I’ll be using that phrase!
Coffee helps by lowering uric acid. I haven’t seen any conclusions about the mechanism. There have been suggestions that it might reduce uric acid production, like allopurinol. Or, it might increase uric acid excretion, like probenecid. It might even do both. Any way, coffee is good for gout. There have been suggestions from certain unreliable sources that diuretic qualities of coffee make it bad for gout. That is wrong, as studies have shown that the slight diuretic effect is insignificant compared to the volume of water used to make coffee.
Hi Paul,
I’ll try to explain what is happening so you understand why you are getting gout pain after starting allopurinol. Then I’ll explain how to minimize it.
Gout attacks start when uric acid crystals have built up over many months and years. Allopurinol eventually gets rid of these crystals, and that stops you getting gout pain. But, this will take time.
Professionals refer to removing the burden of uric acid crystals, or sometimes “de-bulking.” It is your recovery period. During your gout recovery period, you need pain relief, which can either be preventative, or as you require it. Before I explain that, I’ll explain a bit more about your gout recovery period.
Gout recovery is one of the most badly managed aspects of gout. I listened to a leading rheumatologist recently who explained that only 10% of patients get effective gout recovery treatment. This means that we have to take control, and ask for the correct treatment. Fortunately, unless you have other health problems, recovering from gout effectively is quite easy.
The essence of good uric acid lowering treatment is to get uric acid as low as possible. That shortens the recovery period, and minimizes the time you are at risk of gout flares. I can help with a specific personal plan to manage allopurinol in a way that suits you best. It’s impossible to say how long that time will take. Therefore, you also need effective gout pain control.
Ibuprofen is very effective at reducing gout inflammation. Usually it needs to be at maximum prescription strength to be effective. Though it can be used as a preventative, the best gout pain prevention is colchicine. I understand why many people want to avoid colchicine. However, if you want to use it, it can be incorporated into an effective gout pain control plan. In addition, for extreme attacks, you might also need a pain-blocker.
I believe personal gout pain plans are important at the start of allopurinol plans. I’m happy to help you and your doctor to get the best gout treatment for your gout.
Paul, if you want help with gout pain control, allopurinol plan, or both, please just ask.
That’s very interesting.
I’ve only come across chia seeds once in relation to gout. That was during some research into Free Fatty Acids (FFAs). I recall a suggestion that the omega oils in chia could help reduce inflammation in certain genetic types. However, I was unable to find specific research. Does anyone have any knowledge of relevant research.
I cannot find anything about hemp in relation to gout inflammation.
Obviously, if these work to control your pain, then that is good. However, it is not good to avoid controlling uric acid. If excess uric acid is left untreated, the burden of uric acid crystals becomes increasingly dangerous. I strongly recommend that you start a uric acid lowering plan immediately.
I’m left wondering what your doctor has suggested now that your uric acid is 5.8?
Your situation doesn’t make sense to me. I’m not really sure what you are asking me to help with. Sounds like your doctor is suggesting Krystexxa. This is very effective at shrinking tophi, as shown in Tophi Removal Without Surgery.
Please could you explain exactly what you are asking for assistance with?
Hi Marcus,
I can see from your questions that I’ve made a piss-poor job of my page at What Gout Foods Can I Eat? It’s not unusual for me to waffle on so that the main points get missed. Not unusual, but not good enough!
I’ve started putting a TL;DR (Too Long; Didn’t Read) caption on some pages. I can see I need on for that page, so I’ll test one out here, then publish it later:
TL;DR What Gout Foods Can I Eat?
1. Gout diet should follow a gout treatment plan.
2. Excess calories, excess iron, and excess purines (in that order of importance) should be controlled in keeping with your uric acid target.
3. Binge eating, starvation, and Free Fatty Acids (especially stearic acid) should be controlled in keeping with your gout pain management plan.
4. If you can’t be bothered with gout treatment plans, your best action is to follow a Mediterranean style diet, or Alkaline diet.
5. It’s never about what you should eat, or should avoid. Gout diet must balance your personal eating preferences (e.g if you like beef, balance it with lots of veg and a pint of skim milk).So please stop reading all the stupid nonsense about beef, cheese, legumes, and alcohol. It’s pointless.
Marcus, let’s get some management plans in place to get proper personal gout control.
Everybody else: that 5 point summary still looks long-winded to me. How can I shorten it?
You cannot plan a uric acid lowering diet without your uric acid test result history.
Please post your latest uric acid test result, and as much history as you can manage. When you get the results from your doctor, please ask them to include the measurement scale used – e.g. mg/dL, mmol/L etc.
Once we have that, we can plan a diet based around the food you want to eat. I have to say though, a diet of fish and beans is not a healthy balanced diet. Antoine, what vegetables do you like? What fruit do you like?
With uric acid over 7mg/dL, your health is at serious risk. Uric acid crystals are growing in your body every day. You will have some pain free days. But, gout attacks will spread to more parts of your body. They will become more frequent, and more intense.
As you are only just over 7, you might be able to improve your diet. Diet changes can take a long time to be effective, so you can also consider uric acid lowering treatment from your doctor.
I have to say that your current diet is terrible! No fruit! No vegetables!
My immediate advice is to start eating fruit and vegetables. They should be at least half of your total daily calorie intake. After that, post details of your usual weekly food and drink intake, plus your height and weight. Then I can assess where you can make more improvements.
‘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/
Wow, this is very interesting to me ๐
First, you’ve highlighted one of the mystery areas of high uric acid. Why does high uric acid develop into gout in some people, yet not others? It’s a fascinating topic, though it probably only affects a small number of people. The medics call it unsymptomatic hyperuricemia – i.e. high uric acid with no symptoms.
That’s wrong to me, as they should really say no measurable symptoms. Advances in imaging are now recognizing crystal deposits long before they cause gout. We know that these deposits interfere with natural joint renewal and replacement. Bone, cartilage, and tendons start to suffer, but it takes decades for this to show as joint damage.
And, we have cases like yours where kidney stones form before there is noticeable joint pain. As medical techniques improve, I expect that heart-based tophi, a hidden cause of heart disease, will become more recognized.
In all these cases, simply reducing uric acid with allopurinol is an effective control, though not a cure.
I really wish that you would share your research into allopurinol vs Uloric. If it’s the same research that I’ve read, it infuriates me. Obviously, Takeda’s marketing staff have achieved their goals if you say “many studies find that Uloric is slightly better in helping with Gout.” That’s one of the lies about febuxostat/Uloric that is becoming yet another Gout Myth! It just makes gout treatment harder than it need be. Having said that, we wouldn’t get new gout drugs if pharma companies didn’t line the pockets of their investors, so fair play to them if the licensing authorities are so stupid.
As for toxicity, where has the idea come from that allopurinol is bad for the kidneys? Show me a report that suggests allopurinol hurts your kidneys, and I’ll show you five more that says allopurinol improves kidney health. The real toxicity issue concerns Uloric and the liver, made worse because the FDA put the onus on the patient to check this, rather than the doctor.
In the medical profession, I believe allopurinol is well recognized as a treatment for kidney stones. I’ve seen plenty of research into differential diagnosis for kidney stones. It’s vital to match the right treatment to the right type of stone.
The last sentence worries me –
“most stones are caused by the food you eat, such as cheeses.”
Is this another Internet Health Myth, or is there some believable research?
I’ve always thought that the presence of all kidney stones is due to an imbalance in one or more metabolic systems. Far more complicated than eating cheese. Yet, often easy to treat once the stone composition has been analyzed. Even allopurinol can caused oxypurinol stones if it’s taken with insufficient fluids.
Anyway, please let’s have a proper debate with references back to the research. I’d like to review the page that prompted this discussion, so any contributions are very welcome.
The first thing to understand about a gout attack is that it is an immune system response to invading uric acid crystals. Your immune system does not like foreign matter in it’s domain, and it’s job is to kill it. That works nicely with bacteria, but inanimate uric acid crystals cannot be killed.
Instead, your white blood cells engulf the crystals, and eventually they become hidden. When exposed uric acid crystals reduce in number, your immune system settles back down, and inflammation disappears.
Everyone’s immune system is different. One or two weeks is typical, and usually no more than three weeks. This time can be shortened by anti-inflammatory meds. I’d recommend to keep mobile, but not to stress your ankle. Keep it wrapped to avoid exposure to cold. It sounds to me like it’s almost over, but there is more to this story.
This sounds like your first attack, or at least the first flare that you’ve recognized as a gout attack. The crystals that caused the attack have been slowly building up for several years. They will continue to build up until your uric acid levels stay below 6mg/dL. You are unlikely to qualify for uric acid lowering treatment on your first attack. However, it is very useful to start recording your uric acid levels now. The more data you have, the easier it is to manage gout treatment in future. I can help with that whenever you are ready, but for now, I’ll return to your current gout pain.
As I said, you should be back to normal in a few more days. However, once gout starts, it will return faster and stronger until uric acid is controlled properly. Therefore, there is an outside chance that pain could continue beyond the three weeks I mentioned. This happens when a new attack starts before the old one is completely resolved. It feels like one long attack, but in reality it’s a series of more than one. If that happens, all you can do is return to your doctor for more pain relief. In that situation, you would definitely qualify for uric acid reduction treatment.
Finally, you should be aware that most gout is genetic, so there is little you can do about it. On the other hand, it might be caused, or worsened by controllable factors such as poor diet, exposure to environmental toxins, or meds for other health conditions. If you would like me to help you review your situation for controllable gout factors, please just start a new topic.
If you do not understand any of the points I have made, please ask for clarification. Sometimes I miss an obvious point that I’ve taken for granted.
Hi Steve. It’s great news that you’ve got uric acid down to 3.0
Can I confirm this is 3mg/dL? If so, you are well set to control your gout completely. I can’t say much more, as I don’t know what your uric acid test result history is. I’ll just assume for now that you and your doctor are happy with progress. Let me know if this is not the case, and I can help you with any issues and ensure you get a safe allopurinol treatment plan.
Allopurinol encourages old uric acid crystals to dissolve, as it reduces uric acid levels in your blood. Crystals dissolve faster at lower uric acid levels. This process takes time, and until it is mostly completed, dissolving crystals might trigger a gout flare. This has almost nothing to do with diet.
Today’s gout flares are caused by crystals that formed years ago. Some of that uric acid might be from meat that you ate at that time. Most uric acid comes from meat that is your own human flesh. As your uric acid is low, nothing you eat today will cause new crystals to form. Old crystals dissolving might cause flares – but that is a good thing.
Obviously, it is not good that you are in pain, but the flare is good because it is a sign you are healing. It hurts to get the bullet out, but leaving it in will kill you. The correct approach is a good pain management plan. Your doctor should have arranged this for you. If not, I can advise you on the different components you need. By combining 2 or 3 sensible pain-control meds, we can ensure that any discomfort during this part of your healing process is bearable.
As for diet, just eat a good healthy balance of a wide range of foods. EFSEP!
Eat Food. Sufficient. Especially Plants.That is:
Food, not highly processed food-like substances. Read the labels, and avoid additives wherever possible.
Sufficient, not over-eating or starvation. Maintaining a healthy body weight is always great for gout. Socially, you’ll be regarded as thin. But medically, you’ll be healthy.
Especially Plants, doesn’t mean becoming a vegetarian, unless you want to be. It means that most of your calorie intake should be from plants. Meat is good as an occasional treat, and as a flavoring. Fish is better if it’s oily, such as tuna, mackerel etc. The only plants you’ve mentioned are tomato (possibly highly processed in a commercial soup?) and a few grains. That is not a healthy diet! Where’s the fruit? Where’s the veg?To summarize, Steve, we need:
1. Clarification that your allopurinol treatment plan is safe and effective.
2. Pain relief until sufficient uric acid crystals have dissolved.
3. Optional healthy eating plan.With all that in place, there is one potential diet tweak that might reduce gout flares. Eventually, it won’t matter, but it might be useful until the bulk of old uric acid crystals have dissolved. Remind me to tell you what that diet tweak is.
Steve, I hope all this makes sense to you. If not, please tell me, and I’ll try to clarify. If it helps, on the face of it, you seem to be making excellent progress. Your only downside seems to be that you are linking inevitable gout flares with current diet. There is almost no such link, so best not to beat yourself up if you know you are eating healthy. Just enjoy your gout recovery.
I look forward to hearing more from you soon.
Hi Dave,
Thanks for sharing your experiences about your gout with diuretics for high blood pressure.I can’t say I agree with just stopping blood pressure meds. We’ve had lots of discussions about blood pressure and gout over the years. Recently, one GoutPal member reported that his gout was cured after changing from one BP pill, to a different one.
That’s the right thing to do – changing, not stopping. We know that there are some BP meds that increase uric acid for some people. Others decrease uric acid for some people, and there are also some that have no effect on uric acid.
Your doctor prescribes blood pressure pills for a reason, so simply stopping them isn’t wise. Dave, I really hope that you can discuss this with your doctor. Hopefully, you will become one of the people who cures gout completely, just by getting better blood pressure pills. The main thing is to be safe, and if I can help with that in any way, all you have to do is ask.
As for other meds, the same safety rules apply. If you cannot avoid a drug that raises uric acid, it is very easy to balance the effects with allopurinol. It is vital that you discuss these issues with your doctor. For a starting point about some of the meds that can cause gout, please see Beware Gout Cures You Do Not Need. The opposite of that are medicines for other diseases that help gout.
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.
Hi Nigel, and thank you for your feedback. Originally, this was a comment on Allopurinol And Alcohol, but I thought it deserved a new topic.
It’s a shame that you couldn’t tolerate allopurinol. Some people cannot, and that used to be a disaster, as allopurinol was the only treatment for uric acid lowering that could be used by all types of gout sufferers. It is still the preferred option on cost and safety grounds. But now, febuxostat gives us an alternative to allopurinol.
Unfortunately, some of the bad prescribing procedures that haunted allopurinol, have continued with febuxostat. The only reason for prescribing either of these two drugs is to reduce uric acid safely below 5mg/dL. Uric acid must be tested regularly to achieve this. To ensure this is happening safely, uric acid tests must be accompanied by kidney function and liver function tests.
Nigel, I’m alarmed by your “seems to be OK” remark. If your blood is being tested as it should be, you should know exactly how well febuxostat is working for you.
If you were just commenting that there is an alternative to allopurinol, then thank you for your comments. If you are not absolutely certain that febuxostat is lowering your uric acid safely, then you must check with your doctor immediately.
Both febuxostat and allopurinol are fantastic at making gout simple to control. But, unless safe dosage and testing procedures are used, it could be just another gout disaster waiting to happen.
Nigel, if you are wondering why I’m worried about your comment, or not sure about anything I’ve written, please let me know. I’m happy to clarify any points, as I want to be sure that febuxostat is definitely controlling your gout safely.