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No mention is made of a connection between physical work or exercise, which seem to trigger gout for me,right away (24hrs).Why do you not even touch on this?
I have been suffering from gout since I was 21 years old. I am now 45. I have frankly grown tired of trying to identify exactly what triggers my attacks. I have attacks with normal and elevated uric acid levels. I have had attacks on low purine diets. Interestingly, I did the low carb diet for years and during that time I never had an attack.
As far as exercise is concerned, I say exercise is a must in any healthly lifestyle. I have experienced gout attacks because of exercise. However, when this has happend to me, it always occurs after a period of inactivity. When I return to regular exercise, an attack is triggered, usually because I simply try to do too much too quickly. I do not run any longer which has helped me tremendously. I use an eliptical trainer for my cardio workout. I am now just getting over an attack which has lasted nearly three weeks. As I get older, I have less tolerance for treatments like Indocin which, though effective, makes me very sick. I am now back on the allopurinol which has always proved very, very effective for me. My problem has been that I do not like to take a pill everyday when I get attacks a 3 attacks every 4 or 5 years. But this latest attack has prompted me to return to the therapy. This current attack was prolonged by exercise. I treated the attack, thought I was up to return to the gym, but then retriggered the problem which extended the agony.
Thank you for this website. It is very informative. Have you read about the newest treatment for gout which is waiting FDA approval? Fubuxostat?
Welcome Giovanni,
I understand the reluctance of taking a pill everyday just to ward off infrequent attacks, but the real issue is not whether you have a painful gout attack.
Gout pain is due to your immune system responding to the presence of uric acid crystals. It attacks these in the same way as a virus, but cannot kill them – they merely get hidden.
The uric acid crystals, coated with proteins from your immune system build up slowly. They do not always produce the severe painful gout reaction. Often you simply experience a little tingling, numbness or other slight discomfort. But the crystals are still building up.
They are the fuel for more intense gout flares in future. But, worse still, they are the building blocks of tophi that can damage your joints, causing the worst gout pain imaginable.
The reasons for taking allopurinol are twofold. Firstly, to get rid of existing uric acid crystal deposits. Secondly to prevent new crystals forming.
It is for the second reason that you must continue with allopurinol even when the gout pain stops. More importantly, you must keep monitoring uric acid levels.
You might find that a lower dosage or allopurinol “holiday” is feasible, as long as your uric acid level has kept below 7mg/dL for a year or so. But you must continue to be tested as advised by your doctor, even if you are showing no symptoms. If uric acid starts to rise again above 7mg/dL (or you show any other gouty symptoms, as uric acid levels are notoriously difficult to measure consistently), get back on the allopurinol.
Thank you for your kind comments about my website.
I have mentioned febuxostat before. You can see references by searching for febuxostat in the search box near the top of this page. The fullest account was in my December 2006 newsletter, so an update is long overdue.
I'll add a febuxostat review to my list of things to do. I'd love to hear of personal experiences or views of this new gout medication.
Thank you for the welcome and the response. Given this latest gout attack, I have concluded that I must take the medication in order to return to normal. As I have aged, the attacks have become prolonged. This latest is not the worst attack I have ever suffered, but the 3 week period in dealing with it was quite taxing on my nerves and my body. I have concluded that once an attack arrives, my entire body is affected. I do not feel well and I cannot think clearly because of the combinationof the pain, elevated uric acid levels, and the treatment to attack the problem. I am just now, nearly a week after restarting the allopurinol, starting to feel like myself. Therefore I have finally given up and decided to take the medicine in the long term unless my doctor tells me otherwise. My concern has always been residual damage to the body because of the allopurinol. But, I have done enough research on the drug which indicates to me that it is very safe and effective, unless one has a allergic reaction to the medication. Even then, once the medicine is stopped, you should feel fine. Allopurinol has been around for nearly half a century and if there were any significant affects, we would know about it after all of this time. I no people who take one cochicine tablet along with their daily dose of Allopurinol. I do that for the first several weeks after going back on the medicine to prevent an attack while my uric acid levels are being reduced.
Thank again. I look forward to further discussions.
Giovanni said:
Thank you for this website. It is very informative. Have you read about the newest treatment for gout which is waiting FDA approval? Fubuxostat?
Febuxostat now has FDA approval. It is released as Uloric.
I exersise regularly running cycling ect and I feel sure it starts an attack.
I exersise to lose weight but it is a vicious circle.
When ever I up the program I have problems.
I am on 300 mg Alopurinol every day I was on 200 for a long time and it was quite settled but I started doing more in the gym and 200 wasnt enough.
Now I find I am having gout like pains in my foot with out it being anywhere near as bad as it was.
It just reminds me of it.
I think my uric acid level must be high again so I am going to take it easier in the gym.
I am due another blood test in a week or so.
I really dont want to up the Alopurinol because I have a lot of problems when I increase the dose until I get used to it.
Keep at the 300 mg. unless and until you see that your uric acid is too high. I'll bet it will be alright.
Residual deposits from old attacks can causes those twinges for many years afterwards. After all each old attack has slightly (or not so slightly) altered the joint.
Remember, a large component of our serum uric acid comes from breakdown of our own tissues. Two ways to increase that breakdown is extreme exercise and weight loss. So, like the old saw says “Everything In Moderation.”
Thanks for your reply
Its all or nothing with me.
I need to reduce my gym sessions .
I am sure I will be fine if I do that.
The feeling I get in my feet is not pain it is just a reminder of the pain I used to get.
I’ve found an interesting report – “Influence of vitamin C diet supplementation on endogenous antioxidant defences during exhaustive exercise”
It compares two groups, one with vitamin C supplements, and a control. It notes:
Uric acid and lactate dehydrogenase increased after the competition only in the control group.
Unfortunately, there is no mention in the abstract, or first page, of the amount of vitamin C required.:frown:
As you know I am quite skeptical about Vitamin C although I will try to find that study. What is most amusing is that the claim is made in veiled fashoin that Vitamin C acts as an atioxidant to stop uric acid production…but uric acid is an antioxidant. 😀
The Vitamin C people will not rest until there is a citation on the internet that shows Vitamin C cures every possible illness, disease or disorder. How else can one continue to sell shiploads of ascorbic acid.
My fave was the cancer cure that when tested with 10 grams a day showed no benefits, which promted some radio “health” guru, Gary Null, to say that people needed upwards of 100 grams a day INTRAVENOUSLY to cure cancer. It gets too funny. Imagine, a quarter pound of ascorbic acid intravenously DAILY!
As a result of these inflated claims and my own guinea pig research that showed Vitamin C indeed DOES NOT cure the common cold, I give all further claims for Vitamin C short shrift. It's a big con that has been thoroughly refuted…unfortunately none of the old disinformnation ever disappears from the net.
Anyhoo, I would not take mega dosages of ascorbic acid for gout because it is a very STRONG acid which produces a highly acidic urine, which increases the risk of kidney stones.
pagey,
Instead of reducing your gym sessions why not up your allopurinol to 400 mg.?
Maybe those reminiscent little twinges are good, showing that your body is breaking down some old deposits. It would not surprise me if hard exercise, with increases blood flow, and secondary “massaging” of the foot by running, biking, swimming, causes faster breakdown of old deposits.
I have decided to think of my foot twinges after walking far, or running hard in exactly that way from now on. Thanks for making me get that idea.
Now that makes me feel much better. Thank you.
I dont really want to up my alopurinol to 400 because I had great difficulty getting up to 300.
I started on 50 for a month then 100 for a month and so on.
Every time I increased the dose it made me feel so unwell.
I am settled now on 300 and I have to have a blood test this week or early next week
So I will see what the doctor says. If it is low enough I would like to stay here for a while
Thanks for your reply
What a revelation!
I too am caught in the “vicious cycle” or “Catch-22” situation. For years I've been trying to lose weight, so I can get rid of the gout attacks. I'm currently at my heaviest (340's) , and it's been uber-frustrating. I turned 39 on June 26th and made a pledge to lose 100lbs by age 40. I promised myself to at least walk a mile a day to start the quest. Well, I was doing that and lost about 6-7 lbs in about a week, then went hiking, then walked another day, then cut the grass and BAM! Ankle flared up HUGE and not the worst flare ever, but still painful. Dealt with it for about 3-4 days, pain went away, but the swelling remained. It gradually worked it's way to my opposite knee and I've been fighting this thing for about a month.
I just got the prescription for Allopurinol again (I had it once before, but told myself I'd work out more so I wouldn't need it) and I aim to actually stay on it this time. My doctor told me before, and now I have you guys' opinion too, that I'll always need this drug, thin or not. Just wish I'd have been doing it sooner. Sorry to ramble, but this was like a godsend for me. I had no idea others got it from exercise.
A tip that MAY help…I think that doing pool work (both swimming and running laps) is a great way to fool your body into thinking you're not working as hard (or your feet, knees, and load-bearing joints anyway) so you can go “balls out” and not flare? It also makes my feet and knees have “bounce” like they used to sometimes.
Good move on the allopurinol – geet your uric acid down below 6mg/dL first, then focus on weight loss. The allopurinol will hold your uric acid down and stop exercise / weight loss sending it back up into the danger zone.
Be very aware that the allopurinol will do nothing for pain relief. It will stop new uric acid crystals forming which is exactly what you want (part 1).
It will also do exactly what you want (part 2) by helping old crystals to dissolve. That, my friend, is a double-edged sword. You need to do it to get the uric acid crystal deposits out of your joints and other tissues, thus reducing the risk of long term joint damage. The downside is that you might get occasional gout flares. Never stop taking the allopurinol, but keep colchicine available and take two at the first sign of a twinge.
You need to think long-term about this. Keep taking the allopurinol, and as I said before, focus first on keeping uric acid below 6mg/dL (better to aim at 5). Continue to get uric acid tested regularly.
Weight loss of around one pound a week is the best target. It is more sustainable and less shocking to the system. After 100 weeks, you MIGHT be able to lower the allpurinol dose. If not, take another 100 weeks. It doesn't matter how long it takes, just keep the allopurinol going as long as you need it. If that's forever, so what – at least your quality of life is improved.
I HATE swimming because I am denser than water…do not float, thus it takes more energy out of me than most people.
That said, it has LONG been known how good an exercise it is for people with ANY kind of joint pains (well except maybe rotator cuff issues…got them) becasue it takes the weight off the legs…and more important to goutiies, THE FEET.
So swim your way slim and pain free.
DeGoutMe,
I'll bet at 340# you have NO problems staying afloat (I just couldn't resist!)
Good luck with the weight loss…100 pounds in a year is extremely tough but not impossible. My guess is that about 1800 calories per day will do it with continued hard aerobic work.
Exercise during Gout Attacks Update
As this topic is especially for gout sufferers who care about exercise, you should check out 2 other website pages.
1. Keith has updated Gout and Exercise to reduce Uric Acid to include new evidence to show that aerobic exercise for 45 days can reduce uric acid.
2. I have grouped new exercise discussions for gout sufferers into the Gout and Exercise Forum. So please join those discussions and add your own questions, experiences, and opinions about exercise during gout attacks.
Please remember if you want personal help with any aspect of gout, the new place to ask is GoutPal’s Gout Forum. So we look forward to chatting with you about exercise and your gout.
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