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Thanks Keith! This helps me refine (or better understand) a direction for my medication plan. Must admit I was hoping for a more rosey answer! ๐
Week 6 update
Weight 213 (down 12lbs)
Diet: Six weeks per the approved gout food lists and vegetarian only. 1600 calories per day, 40-30-30 is my goal. Not as hard mentally as I imagined but eating a lot of the same things on a daily basis. In time expect to have a robust meal plan to choose from. As I read more into labels starting to see deficiencies (protein) and blow outs (iron!). Using ‘my fitness pal’ to track nutrients. I like it as it keeps me focused on whole foods I can track. Still learning but happy with progress. Reading “in defense of food” which is inspiring. No exercise regimen yet. Want to get my system used to the diet change-up before I stress it out in the gym.Week 8 update
Weight: 210 (down 15lbs)
No flare ups. Roaming sensations from toes to tops of feet to hands have disappeared.
Next blood test: June 1
Diet: Made it through Easter unscathed, no deviations from my plan. Managed to find several breakfast cereals that have less than 10% iron. Eating 4-6 hardboiled eggs daily, limit to two yolks. Substituting tofu in anything that would normally be chicken. Two TB of Cherry extract daily. Not sure if it helps, but it’s the sweetest thing I’ll eat all day. Bonus! I am eating a few things off the naughty list: Mushrooms, cauliflower and I’d like to work spinach back into the diet. Water consumption still hit or miss to target. Structure 1 pint per hour awake. This helps me keep track but is overkill by most accounts.
Exercise: none yet.Hi John. Sorry to hear about the flare up. I’m of similar age and experienced my first flare up several weeks ago. Ibuprofen took the sting out of a three day attack for me, 600mg every 6 hours. After doctors visits and much research it seems like the first year is light on flare ups but not to be taken lightly. Too many unknowns to know whether I’m in the lucky minority that can call this a one-off. I’m treating my diagnosis like a warning shot across the bow. Not a matter of if but when. Not to mention worse health conditions down the road.
I started with a blood test to measure UA levels and committed to actively managing this on a daily basis. Wasn’t crazy about my primary care physicians approach (wait and see, manage the pain) so will be shopping around. I like Keith’s approach, treat to target and be gout free. Period.
I get a lot out of everyones posts so thanks for sharing!
Meatless Protein for Gout
Hey all! Working through a viable gout diet and running into protein deficiencies several days a week. I’m working a meatless 40-30-30 plan but am coming up light on protein. Does anyone have thoughts around protein powders? I’m conscientious of iron levels and have found some with low iron. Anything else to be concerned with? I know shakes kind of cheat the process but for those days where I’ve run out of other options…
goutpal.com/gout-diet/gout-treatment-diet/40-30-30-gout-diet/
Secondarily once I get my gouty diet on track I’d like to get back in the gym and increased protein will take on a greater role. You can check out my personal diary for more info.
Thanks for any insight!
Treatment Plan
Goal: Sustained UA levels below 5.0mg/dl
goutpal.com/8637/personal-gout-treatment-guidelines-2016/1. Relentless curiosity of condition and ways to improve.
2. Diet Plan. Develop and stabilize diet and exercise plan (90 days)
3. Medication Plan. UA lowering meds to below 5.0 (3 months to a year)
4. Sustain UA <5.0 through diet only.Diet Plan
1. Eat food. Not too much. Mostly plants.
2. Utilize nutrient tracker daily to measure progress.
3. Create data base of recipes for ease of use.
4. Measure UA progress through blood test 90 days from 1st flaregoutpal.com/gout-diet Home base article.
goutpal.com/gout-diet/gout-treatment-diet/40-30-30-gout-diet/
http://www.workingmanfitness.com/2013/03/the-gout-diet-how-to-eat-during-and-after-the-gout/ Mostly hype, but I like the Rocky Balboa/Eye of the Tiger approach. For some reason appealing.Medication Plan
Titration, Debulking, Maintanance
1. Measure UA results through blood test 6/1/17
2. Start UA lowering medication if diet plan shows no measurable progress since 3/22/17 UA level.
3. Allopurinol daily to lower UA level, Ibuprofen or Colchicine at the onset of flares.
4. Start Allopurinol at 100mg/day for 1 week followed by blood test for liver/kidney function. Increase to 300mg/day per doctor recommendation.
5. Have colchicine on hand at all times. .6mg twice daily at first sign of flare up. Discontinue as soon as inflammation subsides.
6. When UA levels of <5mg/dl are reached, discontinue medication
7. Blood test 30 days after discontinuation of meds to measure UA
8. Quarterly then semi-annual blood tests if UA levels are sustained
9. Return to meds if sustainment not achieved.goutpal.com/1629/is-allopurinol-a-lifetime-drug/
goutpal.com/gout-treatment/gout-cures/natural-gout-cures/
goutpal.com/gout-treatment/avoid-gout/allopurinol/allopurinol-dosing/
goutpal.com/gout-treatment/gout-cure/colchicine/colchicine-dosage/
http://www.guideline.gov/summaries/summary/38624Pain Plan
consult Keith. does meds plan cover the bases?goutpal.com/9942/ouch-why-does-gout-recovery-hurt/
goutpal.com/972/allopurinol-medication-why-it-hurts-to-get-rid-of-gout/Food Resources
Alkaline diet aka Alkaline Ash diet
Replace acid-forming foods with alkaline foods can improve health.goutpal.com/2153/alkaline-foods-for-gout
A pH level measures how acid or alkaline something is. A pH of 0 is totally acidic, while a pH of 14 is completely alkaline. A pH of 7 is neutral. Those levels vary throughout your body. Your blood is slightly alkaline, with a pH between 7.35 and 7.45. Your stomach is very acidic, with a pH of 3.5 or below, so it can break down food. And your urine changes, depending on what you eat — that’s how your body keeps the level in your blood steady.
Thanks dq, you’ve covered 3 or 4 questions on my bucket list! I found the UDRP Pain Pathway article helpful in explaining the lifecycle of uric acid in a user friendly way. Anxious to hear the science behind the concepts!
Thanks for the heads up Keith. I suspect I’ll need to be set straight more than once on posting. ๐
I’ve never spent a lot of time in web based forums as I usually get scolded for posting a redundant comment or question. I’ll take your advice though and hit the green button with questions as they pop up…
Thanks for the props on being daring, but the more I read the less confident I am that I can or want to tackle this through diet alone. i.e. Gout Hell?!
Spent time going over articles on diet vs meds for UA reduction. Pretty set on beating this without meds until I read Keiths article on Uric Acid Crystals
“The immune system cannot kill uric acid crystals as it would a virus, so white blood cells surround the crystals to form tophaceous deposits. This process stops the inflammatory response, which is why gout pain goes in a few days unless another attack occurs. However, these deposits grow in and around joints and will cause permanent damage to bone, cartilage, and tendons. Uric acid lowering is crucial to stop this process, and to dissolve existing deposits.”
This led me to read several other GP articles on UA lowering meds and recovery pain and it appears to me that success is more about guaranteeing a happy and healthy future over the satisfaction of saying that I did it without meds.
Key takeaway today: UA reduction by dieting seems to be an effort measured in years. While I may be lucky enough to avoid symptoms during that time, the science is clear that urate deposits take place above 6 and potentially doing damage to my system. How long will it take to go from 7.7 to 6?
Early use of meds can reduce my UA to safe levels at which point I can consider med reduction and try to beat this on my own.Keith gave me some info on the DASH diet that looks promising and gives direction on meal plans (makes my wife very happy). Will look to use this plan either way.
You make some very good points. As a newbie to gout I’m basing my thought process on the initial flare-up and from all accounts it seems to have been comparatively short and mild. I suspect the next will not be as forgiving.
My expectation is to have monthly blood tests run to see what’s working and what’s not. My doc is more of the opinion of every six months to a year. I think I may talk to her more about this…
Thanks for the reply Keith, I’m encouraged by the report you found! I’m going to spend tomorrow reading up on the DASH diet! However, the more I educate myself on gout the less confident I am that a strict diet approach is wise at least until my UA levels are safe. Your piece on Allopurinol is very convincing,
“But if uric acid is still near 7 or higher, the gout patient is not safe. Uric acid crystals continue to grow slowly, often without gout pain. After several years, the burden becomes too big. Gout attacks happen every week, and tophi grow risking fatal complications.”
My question: Reducing UA levels through diet is measured in years rather than months. If true your recommendation of shorter term UA reduction through medication (and diet) to an acceptable level seems prudent. Can I then stop the meds and treat this through diet?
The consensus seems to be once on Allopurinol always on Allopurinol. I’ll admit that I’m in denial that I have something that requires daily meds for the rest of my life. On the other hand I don’t want to be naive about what lies ahead if I don’t treat this with the necessary urgency.
Keith, your site is amazing! Thank you for what you do!
Not quite sure how to add a post to my diary just yet so I’ll reply to it until I figure it out!
Until now been roaming GoutPal with little direction. This morning I’ll start my structured plan per the instructions.
My Gout Group: Arthritis sufferer
I have a gout diagnosis based on symptoms, a doctors visit confirming symptoms, and a blood test indicating a UA level of 7.7. I asked my doc about a referral to a rheumatologist for a synovial fluid test. She felt we could best manage the condition at the primary care level until attacks become more frequent and we need to move beyond pain management with Ibuprofen. I think this puts me in the arthritis sufferer group because I don’t have a conclusive diagnosis. My question for all is whether a wait and see approach is best. Should I see a specialist to a) get a firm diagnosis through a joint fluid test and b) find a specialist early on that I like before things heat up. Am I on the right track?Oh, and if anyone can tell me how to add a new post to my diary I won’t have to keep replying to myself. ๐ Thanks!