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Hello everyone. I'm glad I found this site. I read so many threads that I feel like I could be a doctor now! 🙂
Here's my story. 36 years old male with no family history of gout. I have a “so so” (but not that bad) diet (I could eat more fruits). I don't drink alcohol but I eat a lot of seafood and meat (mostly chicken and pork). Red meat is 2-3 times a month but I ate more when I was a kid. Seafood seems to be a common factor with gout…
I started exercising about 1-2 months prior to my first attack. I had my first attack 24h-36h after a gym session and a sushi party (more common cause of gout it seems). I woke up to intense pain and took some Advil. I suffer from occasional ankle sprain so I thought that I had another one…
After 2 days, I knew it was something else. I thought that perhaps I had broken (or chipped) a bone during a gym session so I went to ER.
I was immediately told that it was gout (typical red toe + Uric Acid level of 540 µmol/L – slightly over the limit). I was put on anti-inflammatory drugs (Naproxen + some sort of cortisone). It worked like a charm but 5 days later (once I ran out of drugs) it came back. Went back to ER and got some colchicine and more Naproxen. It's been working good so far and I tried to reduce the dose to just enough to keep the pain away (or manageable).
I can walk but if I abuse, pain starts to come back.
It's been about 3 weeks now… today has been quite painful for no apparent reason. I haven't walked more than any other day…
So while I read and learned a lot, I still have many questions that will surely interest most readers. Here they are…
1. While discussing with my doctor, he said there is little or no link with food habits. He said that in the past, it was thought that there was a link but recent studies are inconclusive. I took this with a grain of salt and I am not sure he's totally right about this one… However, I see that people with excellent diets CAN get gout. Also some people with low uric acid can get it as well, while some with high level might never get it… Then I hear about PH level, which is another factor (other than purine level). So in the end, I do see some truth in what he said but would appreciate some feedback. Can someone here really pin point an attack to a certain type of food that was eaten? If so, is it because your UA level was too close to the “border” ? I read that food causes only a fraction of Uric Acid and that muscle regeneration will cause a lot more..? So is the diet worth it?
2. I guess the 1000$ question is, since I'm still having pain when I walk a lot (or skip my medicine), does it mean I'm still having an attack? Is it a long-lasting attack or is pain related to the aftermath of the attack (walking with crystals in joints)? This is not clear to me.
3. How does gout create long term damage to the joint? By forming more crystals or, in my case, trying to walk on my “crystal filled foot” while using anti-inflammatory drugs? I understand that these drugs do not cure anything, they just get rid of the pain… If I understand correctly, the body wil cover these crystals with proteins. Is it “safe” to use the joint in this condition? I would doubt…?
4. I tried to change my eating habit but other than seafood/fish, I don't really eat the high purine foods anyways. I'm trying to increase my intake of anti-oxidants (via 500mg Vitamin C + Blueberry extract), hoping to help my kidney get rid of the extra Uric Acid. Is this a good strategy? I was already drinking milk on a daily basis and I started to drink more water. I was only drinking about 1 liter per day and recently doubled that – at the cost of waking up in the middle of the night to empty my bladder…! 🙂 It's been only 2 weeks but I notice no effect whatsoever. Has anyone really experienced improvement through increasing anti-oxidants?
5. The infamous Allopurinol drug… My doctor (same dude) said that it's usually prescribed for recurrent cases and that unless it comes back, I shouldn't worry about it. I feel like getting a second opinion on this as I think that lowering the Uric Acid is a good thing. I understand that 36 years of accumulation will require some time…. or does it? What are your thoughts on the doing Allopurinol to lower UA and then following a strict diet? I am obviously a bit nervous about the possible and serious side effects. I see mixed responses to this…
I have many more questions but I don't want to discourage anyone at this point 🙂
What another 36 year old? I am 36 too so welcome to the 36 year old Gout brotherhood
My opinion so take it with pinch of salt-
1. So the answer to that question is yes and no. There seem to be some who are over weight and bring it on with a bad diet and alcohol consumption. Then others who despite top notch diet and fitness regime still get it as their genes seem to be loaded against them. I have been strict veg for 10 years with almost 0 consumption of alcohol before my attack. So from my POV diet did absolutely nothing. I feel so cheated that you won't believe
Maybe it stopped me from getting Gout earlier but I doubt it. It all seems like guesswork.Now the people in the first category might be able to lower SUA by 1mg/dl or so by moving to good diet but I am not full y convinced. Ultimately I feel all Gouty have a genetic time bomb that eventually blows and causes the attack. That said it's better to be fit and not overweight. It's easier on your joints for starters.
Sea food, non veg food, alcohol, organ meats definitely seem to trigger Gout attacks. Recent studies indicate that meat protein is bad but veg protein is not. I am not sure what to believe. Despite my diet not helping me with Gout I won't be ever moving away from my veg diet
2. The needle like crystals in the joint are microscopic in size. You pain is not because needles are pricking you
Your pain is due to how your body is reacting to those crystals. Chemical reaction is causing the pain and not physical pricking or anything like that from the crystals. If someone has huge build up of Tophy then things might be different. Not sure.Normally Gout attack lasts for few days and then goes away. Aftermath is difficult to say. My case is very not typical so I am not the best guy to advice. I had one year of medium level pain before my first attack. Even after the attack the medium level pain did not go away. Although 1+ month of AlloP seems to be starting to help now.
3. http://www.goutpal.com/gouty-tophi/
4. Just eat healthy balanced diet and cut out sea food. Are you overweight? I doubt milk would do anything. Will probably create more problems in my veg opinion. No other mamal drinks other species milk that also in adult life
If seafood is a definite trigger as has been documented by many then why take it? You continuing to take it is equivalent of saying that I don't consume all known poisons of the world but only one poison
5. I doubt you started accumulating anything for 36 years. Which would make it from the day you were born as you are 36. You need to lower your SUA to under 6 and preferably to 5mg/dl level. Your 540 µmol/L on the day of the attack = 9Mg/dL. Probably higher as SUA readings generally drops during Gout attack. AlloP is a brilliant drug in my opinion. For a minority it's not but it works very well from what I understand and have personally seen so far.
Looks like 36 is magical number. I got my first Gout attack about 10 years back, when I was 36 plus but less than 37.
Interesting thing to know is that it had classic symptoms of gout. The doctor gave me 200 mg of Allopurinol on the 3rd day of attack, when my foot was like hot baked potato and gout attack at its peak.. If I had read the forums( there were none at that time), I would not have taken it. But ignorance is bliss at times. The Allop worked like magic, 2 tabs a day and with in 2 days, the pain was gone 95% and within a week, the foot was like there was never any attack.
I took Allop for few months and then stopped it. Next 10 years, I did not follow any rules of diet, drink, exercise or wait loss….and my SUA was always 7.5 to 8.2…and against all the odds, I did not get another attack till time I injured / fractured my toe last year.
I am for sure an exception to the lifelong Allop medication committment we generally talk about….donot know how would it work in the coming days if I get away from Allop.
Utubelite said:
I am for sure an exception to the lifelong Allop medication committment we generally talk about….donot know how would it work in the coming days if I get away from Allop.
I think Gout can take as much as 20+ years before fully unleashing it's fury
Get off AlloP but get back on if your numbers start climbing specially as you are a confirmed Gouty (1999).The other thing could be that you never had Gout now or in 1999 🙂
vegetarianGuy said:
Post edited 3:27 am – March 31, 2010 by vegetarianGuy
I think Gout can take as much as 20+ years before fully unleashing it's fury
Get off AlloP but get back on if your numbers start climbing specially as you are a confirmed Gouty (1999).The other thing could be that you never had Gout now or in 1999 🙂
So it means what I got last year was unleashing half way only
but that was painful enough and lingered on for long…I know that my SUA numbers will go up if I stop Allop as I always had high SUA levels( I have 4 or 5 records of SUA in last 1o years and they are all 7.8 to 8.2….
If I talk of the docs that have treated me, they believe I never had gout either before or now.
Personally, I am convinced I had gout as both times, Allop worked very well….Gout as we all know is very complex to understand….I may be of Type that may not be getting that many attacks or trigger an attack on Allop….it is like many people get Flu every year while many do not for years…..though Gout is different than flu but probably similar theory can be applied to it as well….some people can look North when they encounter virus from Southern Nigeria
I am not sure I am understanding you correctly
> Personally, I am convinced I had gout as both times,
Ok so you are convinced that you had Gout in 1999 and recently too. Fine I dig that.
> I may be of Type that may not be getting that many attacks or trigger an attack on Allop
Ok this part I don't understand
Isn't that normal for lot of people with Gout who are on AlloP that they don't get any attacks? Isn't that the whole point of being on AlloP? vegetarianGuy said:
Post edited 6:51 am – March 31, 2010 by vegetarianGuy
Isn't that normal for lot of people with Gout who are on AlloP that they don't get any attacks? Isn't that the whole point of being on AlloP?
There are 2 types – ones who get Gout attacks when they start Allop due to fall in SUA levels which results into crystal dissolving and the attack…then there are those who do not get the gout attack though their SUA levels fall dramatically like in my case it fell from 9.2 to below 4. There are other factors that play role while we take Allop and SUA levels fall….that's why few get attacks while few do not…over a period of time, most are supposed to get rid of the painful gout attacks…
Though clinically my Gout is not proved, I am convinced as when in doubt, I believe in taking route of what can prevent the adversaries than wait for them to happen and conclude….
Sorry about the delay, I was away from home for a few days…
Thanks all for your help, it's really appreciated! I feel supported 🙂
vegetarianGuy said:
Post edited 4:42 am – March 30, 2010 by vegetarianGuy
What another 36 year old? I am 36 too so welcome to the 36 year old Gout brotherhood
I noticed that many people are in their 30's too…
Are you overweight?
I think so but it's relative I guess. I'm 6 foot high and weigth 92kg (roughly 200 pounds I think?). Not that much but I carry a small belly 🙂
I doubt milk would do anything.
I saw somewhere that milk is good actually. Sorry that I don't have any link pointing to any evidence…
My point I guess is why worry about the diet if it only influences so little on the acid level? Is it worth it or should I get the bazooka (Allopuriol) and kill the beast (at least temporary) ??
Do (can) people take the drug just a few weeks per year, creating some sort of roller coaster effect? (taking it when the acid level gets too high?)
Or am I saying nonsense? 🙂
Other question, how long does it normally take to lower the acid level, and once the crystals are “melted”, are you considered “cured”, at east at that moment? I understand cyrstals will eventually re-form in the future, but Allopuriol will disolve the crystal over time right?
Sorry the post is messed up but my comments are up there? 🙂
I think your doctor is treating you as a statistic! What you need is a good plan for managing your gout, not a doctor's ignorance.
It helps to know what is causing your gout, but sometimes it is just impossible as there are so many factors. If you are genetically programmed for gout, diet has little to do with it. In your case, there could be some scope as your BMI is 27.5 (92 kg is just short of 203 lbs). According to the studies on my gout diet page (much overdue for a makeover, but still relevant), you are about twice as likely to suffer gout as if you weighed between 155 and 169 pounds (approx 70 to 77 kg). Though medically recommended, this type of weight loss is not always socially acceptable. Also, this is just a statistical observation, so you will not know for sure if it reduces your uric acid low enough until you try it.
Of course, calorie control (combined with exercise) is only one aspect of diet. Nutritional balance is also vital. This is a massive subject, but the key points are:
- Good variety to ensure all recommended nutrients are included, but not excessively. Nutrient shortages or excesses can cause increased uric acid production.
- Restrict animal purines (more on this soon – purines are definitely not made equal, so even my excellent purine table needs rewriting)
- Restrict iron intake. Exposure to other toxins like lead can also raise uric acid, but iron is quite hard to avoid as it is added to so many foodstuffs.
- Liberate intake of milk proteins, vitamin C, and coffee, all of which have been shown to reduce uric acid.
Having said all that, I have serious doubts that dietary measures will get you from the very high (540 is not slightly higher than 350!) uric acid level to safety. Certainly you should consider immediate urate lowering therapy to reverse the crystal invasion. This will stop further joint damage, then you can see if dietary improvements will work for you without the continuing danger from uric acid deposits.
The length of time to dissolve uric acid deposits varies enormously, but the longer you leave it, the harder it gets as tissue envelops clumps of crystals, isolating them from the blood stream. It also depends on how low you get your blood uric acid with allopurinol or similar. The lower the better, so aim for 200 µmol/L.
After around 6 months with no gout flares, you can relax the dosage to maintain your level around 350, but you cannot just stop and start it becausa as soon as you get to 400, the deposits start again, and you are back where you started.
Utubelite said:
There are 2 types – ones who get Gout attacks when they start Allop due to fall in SUA levels which results into crystal dissolving and the attack…then there are those who do not get the gout attack though their SUA levels fall dramatically like in my case it fell from 9.2 to below 4.
Yes I am aware of all that but was not clear what you were trying to say. Now I know
So basically I am like you in that sense as AlloP has not caused a Gout attack for me either (so far).
I started allopurinol 400 mg. a week after stopping a horrific acute attack, my fourth. I never had another acute attack of frank gout (that's the official term
) and that was nearly 20 years ago. For this I am eternally grateful.I think those that get attacks after starting allopurinol usually are those who started with too low a dose or those with large tophi and a ready supply of lots of urate. It's also hard to ever say with certainty whether allopurinol has triggered an attack or whether the attack started IN SPITE OF the allopurinol.
The infamous Allopurinol drug… My doctor (same dude) said that it's usually prescribed for recurrent cases and that unless it comes back, I shouldn't worry about it. I feel like getting a second opinion on this as I think that lowering the Uric Acid is a good thing. I understand that 36 years of accumulation will require some time…. or does it? What are your thoughts on the doing Allopurinol to lower UA and then following a strict diet?
As much as I love allopurinol I wouldn't recommend it until someone has had at least one killer attack and several limparound attacks. (Or someone finally makes the definite link between UA and heart vessel disease.) Since it's a lifetime drug it would be a shame to get someone on it because of a misdiagnosis. Take it when YOU are sure you have gout and that you don't want to live with the inevitability of crutches two or three times a year.
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