I’ve just seen some more out-of-date medical advice on a doctor’s website, and it’s making me seethe.

Everybody trusts these guys to give sound, current health advice, but what do they churn out?

Disproved speculation that at best does no good.

At worst, it condemns you to years of pain and discomfort. Years of low quality of life.

I’m tempted to name the offending site, but that would only single out one miscreant among the many – online and in their consulting rooms.

Instead, I’ll analyze a few quotes, and allow the diligent among you to guess where the site is by virtue of GoutPal’s Worldwide Search Engine.

The Symptoms

Our doctor starts with:

severe pain in the big toe…condition affects the age group 30 to 50 years old

So it could be gout. But what about 48% of gout sufferers who don’t get pain in the big toe?

What about the small number of people under 30 and the massive number of people over 50 who get gout? Will they not even be considered for a gout diagnosis?

The Diagnosis

Fatal Flaw #1.

To be sure therefore if your joint pains are due to this disease [gout], a simple blood test called uric acid can easily be determined in any lab

All that a uric acid blood test will tell you is how much uric acid is in your blood.

If it’s high, it suggests that you are at risk of uric acid crystals forming in your blood which may induce a gout attack in the near future (a bad thing).

If it is not high, and you are having a gout attack, it suggests that you might be suffering from a reaction to new uric acid crystals that have formed recently (a bad thing). Or you might be suffering from a reaction to old uric acid crystals dissolving (a good thing).

If it is normal, it tells you that your uric acid level is normal (a waste-of-time thing, but reassuring to some people who don’t understand gout).

A uric acid blood test, though useful as part of a program to reduce uric acid, will not tell you if you have gout.

Because a uric acid test is inconclusive, our inexperienced doctor will prolong the investigation, and repeat the inconclusive test, until he can conclude, rightly or wrongly, that you have, or do not have gout.

Find the last paragraph incomprehensible? At least it’s not in Latin.

Get a rheumatologist to perform a proper test for gout. That way, if you have gout, you can get treated fast. And if you haven’t, you won’t waste your time and money on gout cures when you have pseudogout, septic arthritis, bursitis, or one of the other conditions commonly misdiagnosed as gout (presumably as a result of an inconclusive uric acid test)

Our doctor should learn that:
A uric acid test can play an important role in managing the correct treatment of gout as part of a urate lowering strategy, but plays little or no part in the diagnosis of gout.

Let us assume that, by chance, we have a correct diagnosis of gout. Surely our doctor can prescribe the right treatment.

The Treatment

Fatal Flaw #2

Taking simple steps starting with our diet can go a long way in improving our health

I’m not sure it’s a starting point, but anyway, let’s consider the doctor’s gout diet advice?

NO NO if You Have GOUT or High Uric Acid:

* The NUMBER ONE on my list is ALCOHOL!!!!
* Anchovies
* Gravies
* Herring, Sardines
* Mussels or Tahong
* Internal Organs like liver, kidney
* Dinuguan, Chicharon Bulaklak
* Mackerel
* Patis and Soya Products
* Bacon and scallops

Use in Moderation:

* Crabs, Oysters, Shrimps, and eel
* Poultry and Meat [including] soup and broth
* Oatmeal
* Certain Veggies like asparagus, spinach, mushroom and cauliflower
* Legumes like beans or lentils

Let’s leave the alcohol for another discussion – do doctors always advise less alcohol so there is more for themselves?

The doctor’s recommended gout “diet” is the list of high/moderate purines in food that’s been kicking around since scientists discovered that uric acid comes from a certain type of protein in our bodies called purines. The key here is “in our bodies”, not in our mouths. Uric acid comes from cells in our bodies, not in our food. Whilst it is true that an imbalanced diet, rich in purines, can raise uric acid levels, this is true of many imbalanced diets. Including starvation.

This type of food advice is dangerous nonsense. At best, gout patients will stumble into a healthier diet by considering what they eat. At worst, as frequently happens, gout patients believe gout management is simply a food issue, and so they delay proper treatment.

Our doctor should learn that:
Where gout patients are overweight, but excrete uric acid normally through urine, gradual weight loss can reduce the amount of uric acid produced by the body. Patients who under-excrete uric acid will gain little benefit for gout from dietary changes and must focus first on medication to promote uric acid excretion.

The Consequences

As the above is published on a fairly prominent website, it attracts questions from many gout sufferers and their carers. These questions often give scant information, then are met with generalizations that could mean anything. Example:

[edited for clarity/spelling]
I’m 44 yrs old, 5′ 8″, 188 lbs. I first experienced pain in my left ankle 4 months ago w/c was diagnosed I have hyperuricemia. The pain went without medication. Now my left knee & its surrounding areas ached which sometimes makes walking difficult. What medicines should i take to lessen the uric acid?

My response would be something along the lines of:

I’m not a doctor, and can’t give specific medical advice, but my observations are:

• You are 9lbs away from clinical obesity, and excess weight is a significant factor for hyperuricemia.
• Hyperuricemia simply means higher than normal uric acid levels, though you haven’t said what your levels are, so I cannot confirm that diagnosis.
• High uric acid levels are a common cause of, but do not always result in, gout. You need to have fluid from the affected joint(s) tested to see if you have gout, and to rule out other diseases.
• After you have had the joint fluid test (arthrocentesis), consult your doctor for advice on which uric acid medication, or changes in lifestyle, suit you. He will carry out kidney function and other tests, and review your medical history and other medications. He will discuss this information with you to ensure you get the correct medication to suit your circumstances.

Instead, we get, from a doctor who is presumably qualified to give medical advice:

If the problem is really due to high uric acid and you have an inflammed joint, a specialist like a rheumatologist will do certain tests including getting a sample of your inflammed joint and to look at the fluid if they indeed contain uric acid crystals. Drugs like NSAID e.g ibuprofen, and Colchicine can reduce inflammation; But you may need drugs to reduce the production of uric acid like Allopurinol Talk to your doctor about these drugs.

I think “You need a rheumatologist as I’m not really up to explaining the complexities of gout” is a bit poor for an MD.

It is sad that ordinary people feel that they cannot trust their own doctor and seek information on the Internet. Perhaps the doctors busy lives mean they cannot explain conditions and treatments well enough to give patients the confidence to follow their advice.

It’s sadder still, that where doctors do have a platform on the Internet, and thus the resources to fully explain causes and effects of complex conditions like gout, they still fail to measure up.

Come on doctors. Raise your game.

Take a little extra care to keep up-to-date.

Take a little more time to check latest research.

Take a little more notice of all the needs of your patients.

Please stop killing our health.

Where do you go for gout diagnosis?

In a recent survey of different types of physicians, only rheumatologists are 100% certain that they can diagnose gout.

This supports my advice that you should always consult a rheumatologist if you have gout, or show any gout symptoms.

Read the rest of this entry »

I’ve just read a fascinating study about a substance called L-carnitine and it’s effect on uric acid.

The study is not concerned with gout, but anything related to uric acid interests me. This particular study looks at how uric acid rises after strenuous exercise. The fact that exertion raises uric acid is the reason why I recommend gentle exercise for gout sufferers – exercise is important to aid mobility and help weight loss, but too much can have a bad effect.

L-Carnitine

$5 VITAMIN SALE!! Plus get FREE SHIPPING on any order over $25. No coupon needed. Hurry, sale ends soon!

L-carnitine is currently being promoted widely as an anti-aging / anti-dementia supplement. It is produced naturally in the body if sufficient lysine (an amino acid found in protein), vitamins B1, B6 and iron is available. It is available from diet – mainly muscle and organ meat, fish and milk products.

The study about uric acid, exercise, and l-carnitine (L-Carnitine L-tartrate supplementation favorably affects markers of recovery from exercise stress) uses a commonly available carnitine supplement LCLT, combining L-carnitine with L-tartrate.

In the study, the subjects took the LCLT supplement for a 6 day rest period prior to starting the exercises. Although the study is mainly concerned with the effects during and after exercise, the volunteers on LCLT displayed lower uric acid levels even during the rest period.

The big question is – will it do any good for gout? If you’ve taken this supplement, please let me know how you got on with it.

Here is the answer to your short gout question, “How long between gout attacks?”

As with many gout questions, the short answer is, “It depends.”

The long answer needs an explanation of what it depends on.

First, let me define what a gout attack is. You know it from painful swelling of one or more joints, usually accompanied by redness and/or flaky skin. You might also experience some feverishness.

The gout attack is caused by Read the rest of this entry »

This article answers the short gout question “swollen toes diagnosis”. It also addresses a point raised in a recent comment about infection and gout.

Swollen toes are a common sign of gout, but there could be other reasons.

If you go to the doctors with swollen toes, they will usually start by asking about any possible recent Read the rest of this entry »

The first of today’s short gout questions is graph uric acid level.

It seems a strange question. Graph uric acid level against what? A particular gout treatment? A particular gout diet? Let me explain uric acid levels in general terms, then you can interpret your data against particular aspects of your own gout treatment or lifestyle.

The most important thing about uric acid level graphs is Read the rest of this entry »

Each day I get a new question about gout in my inbox. Gout is very complicated so you keep asking questions about what causes gout, how gout attacks are triggered, and treatments for gout.

I love getting these gouty questions. Many of them set me off to research new ideas about gout.

One of my most recent gout questions is:

Question about gout: A month ago my right ankle was quite red and very warm. But the pain I had was terrible. I woke up with this and did not know what I did to get this. I could not even put a sheet on my foot.

Advil worked wonders and in a few days it was like nothing happened. That is until today. Now my left bit toe although not showing any redness or swelling the pain in my big toe feels like my big toe is not in it’s socket.

When I move it a certain way when I walk oh boy what pain.

I have not seen the doctor regarding this as it does go away. Is the pain in big toe in which I feel like the toe is not in it’s socket sound like gout to you?

I’ve removed a little personal information, as I do not want to make the writer identifiable. I may quote from interesting gout messages occasionally, but I will never reveal personal information. If you write to me, you can mark your message confidential, and I will not quote from it.

Please note that Advil is a particular brand of ibuprofen. I spent a few minutes responding:

This does sound like gout to me, though the only way to be absolutely
certain is to have fluid drawn from the affected joint and analyzed
under microscope. Some family doctors do this, but many are not up to
speed with the latest developments.

I recommend that you see a rheumatologist. If you look at my article
at http://www.gout-pal.com/gout-treatment/2007/01/ you will see a link
to a listing of rheumatologists. You should be able to find one near
you.

It is important to get some treatment as soon as you can, because gout
is a progressive illness and your condition is bound to get worse if
you do nothing.

Whoever you choose to consult about your suspected gout, the most
important thing is to arrange a plan to keep your uric acid level
below 6mg/dL. You will also need some pain relief for a few weeks
until the uric acid crystals that are causing the pain in your joints
gets completely dissolved.

If there is anything that you don’t understand, please contact me
again and I will try to explain it. Gout is a complicated disease, but
it is treatable with the right approach.

And added some personal comments. A minute after sending it I got the message back from AOL saying that the address would not accept messages from me.

Can I beg you, if you write to me, to make sure that replies from goutpal.com are allowed through to you. Most email systems that have spam filters call this whitelisting. Most of my message forms send out an automated reply before I answer the message personally. If you don’t get this automated reply within a few minutes of sending your message, then the chances are that you are blocking messages from me. I will never be able to reply to you if this happens.

The best way to avoid this is to ask your question about gout in your gout forum. Messages appear there as soon as you post them so you have 2 important benefits:

1. I usually check the forum every day – my inbox often takes longer if it is very full.
2. Other people see the forum messages and you might get an answer from them

So please keep the questions about gout coming – but make sure I can answer them.

Yesterday, Paul commented about his gout, and suggested possible causes. One cause of gout that he didn’t mention is sleep apnea.

You may have heard of sleep apnea. Burton Abrams has commented about sleep apnea and gout, and there is a discussion about sleep apnea in my gout forum. [2008 update - old forum lost. If you want more on this topic, please start a new discussion in the gout forum]

Burt has recently published a book about the perils of sleep apnea, which not only looks at gout, but also other health effects.

See other posts about this common cause of gout by clicking the sleep apnea link below.

Your messages.
My research.
News alerts.
Every week I hear about a new gout remedy.
Many are just an excuse to lighten your pockets.
This one is simple – stop snoring.

Well, not quite that simple, but read on…

When we think of gout remedies, we usually think of pain killers and uric acid lowering drugs. Many people look for natural remedies, but these are only alternatives to the standard “treat the symptom” medicines.

What if we could find a gout remedy that treats the cause? Somebody has.

Burton Abrams has shown, conclusively, that sleep apnea is a common cause of raised uric acid levels and gout. As he says at Curing Gout – My Personal Discovery: -

reduction of oxygen in the blood, which results from sleep apnea, has been shown to cause the cells in the body to begin to disintegrate and generate an excess of uric acid in the blood. Also, the percentage of carbon dioxide in the blood increases, which makes the blood more acidic and increases the likelihood of uric acid precipitation in the form of monosodium urate

I won’t repeat everything on the site. It’s a concise summary of sleep apnea with well researched links to gout, including personal experience. I urge you to go and read it now, then come back here and tell me what you think.

You can comment below, or let me know with a private message. Better still, please join the debate on my gout forum. I’d love to here about your experience. I’ll summarize experiences and opinions on GoutPal.com.

Sleep apnea is not always easy to diagnose, but it’s a lot easier to treat than gout. If your gout is caused by sleep apnea, then curing it is a surefire gout remedy.

Is Back Pain Caused By Gout?

Your back pain might be spinal gout. A recent study, that I missed from my December 2006 Newsletter, shows that spinal gout is much more common than previously thought.

In a study by Bhandaru and others, Prevalence of Spinal Gout, 630 medical records of gout patients were reviewed and 64 selected where CT scans were available. The authors found that 9 of the 64 scans (17%) showed signs of gout in the spine.

Spinal gout is much more prevalent than previously thought. The authors note that the number of cases, 9, is small and they recommend further study.

On reflection, I suppose gout in the spine is to be expected. After all, the spine consists of several joints. I occasionally get back pain. It’s never been as severe as gout pain in my joints. I’ve always assumed it is caused by posture change due to me limping with gout in my foot or knee.

Given the prevalence, I think I’d better add back pain to my gout symptoms survey.

Do you have any back pain with gout? Have you had it confirmed as spinal gout? Please share your experiences using the gout forum.