GoutPal Interactive

Hello all,
Doug (a newbie to the site) here. I have beeen fighting a flare up for the last two weeks, pain has moved all around in my right foot and ankle and is FINALLY subsiding…

I visited the doctor last Tuesday and he was ready to put me on an Rx treatment. I told him about what I had been reading up online (mostly from GoutPal) and wanted to try some dietary changes first – much to my suprise,he agreed!

As the site suggests, a gout diet is as much about balance as what we eat. I also see alot of talk about pH balance. I have been drinking distilled water for 30+ years. After reading about the balance of foods and pH, I decided to check the pH of the distilled water and found it to be 6.4! What is the chance of all of the acidic foods + beer, topped off with acidic water are increasing my attacks?

If so, does anyone have any knowledge of how to best turn water alkaline? There is a ton of information on this on the web but it is very contradictory.

Thanks for the help, great site!

I hate to say it, but I added some gout confusion when I learned new facts about coffee, but failed to remember to change old views about diuretics. Thanks to one reader, I’ve looked into this coffee confusion and made a few changes that hopefully make things clearer.

For information about coffee and gout I’ve added some in depth coffee and gout research to reinforce the overview of how coffee affects gout.

I’ve also updated my advice about fluid intake and gout.

Many people are still skeptical about caffeine – fearing a diuretic effect that may raise uric acid levels through dehydration. There have been several studies recently that rebut the notion that caffeine from coffee causes dehydration. One in particular, “Fluid, electrolyte, and renal indices of hydration during 11 days of controlled caffeine consumption“, concludes that:

Therefore, C0 [placebo], C3 [3mg caffeine], and C6 [6mg caffeine] exhibited no evidence of hypohydration [dehydration]. These findings question the widely accepted notion that caffeine consumption acts chronically as a diuretic.

Simply put, the water from making the coffee drink outweighs any mild diuretic effect from the caffeine, so enjoy it as part of your daily fluid intake.

Though most common in men over 40, and women after menopause, gout can strike at any age. I get mail everyday from frustrated under-30’s, including teenagers. They are frustrated because nobody accepts they can have gout at a young age.

Even in the more accepted gout age-group, gout sufferers are frustrated by other medical conditions and a general feeling of being unwell.

Sometimes it’s just a general feeling of being run-down, other times it’s a desire to find natural products to help with, for instance, weight loss.

For whatever reason, many people feel better when taking natural supplements to complement the medical treatment they receive.

Gout Herbal Coupons

I’ve been using a company called Botanic Choice for herbal teas, which I love, and I can see, from their search facility, that they have a range of products related to “celery seeds”, “uric acid”, and “ACV”. It’s well worth a look if you’re searching for natural gout remedies.

Try these and other search words that are important to you, but also notice the important section – Medicine Interactions – near the foot of each page. This free tool helps you quickly lookup medicines that you are taking to check if they have interactions with herbal supplements.

The best news for the New Year is that Botanic Choice are offering GoutPal readers 3 special offers. All you need to do is enter the Coupon Code into the appropriate box when you place your order.

Coupons expired.

If you are interested in seeing more of these, please let me know in the gout wish list forum.

Thanks to chelseacharliwhite at Flickr.
Click on image for more details

Do Not Be Ruled By Food

“What food should I eat with gout?”

“What food should I avoid with gout?”

“Will [food] make my gout worse?”

The gout sufferer’s diet questions are endless, and the gout doctor’s diet advice is monotonous.

No Alcohol. Avoid purines. Lose weight.

Not particularly bad advice, but too general to be helpful, and too restrictive to be accepted.

The real danger here is that gout patients focus on food, and not on what really matters – controlling uric acid.

It’s heartening to see that some doctors are realizing that strict low purine diets are not the right way. “In treating gout, don’t overdo diet restrictions” is a refreshing article from Dr Robert Shmerling. He does not…

recommend strict dietary modifications after an initial attack of gout.

Like me, he points out the research showing weaknesses in strict low purine diets. Significantly he continues:

these studies looked at people who had not had gout before. They did not assess the effect of diet on people who already had gout.

In a nutshell, you need to stop obsessing about specific foods. Eat a healthy varied diet that satisfies you. Enjoy what you eat, but just eat enough to maintain a healthy weight, and exercise as often as you can.

Drastic changes simply do not work, and some can make your gout worse. Small improvements every few days soon make a big difference. Most importantly, you feel better because you’re in control.

To feel even more in control, learn more about gout. When you understand how gout pain is caused, and why uric acid control is so important, you are much better placed to help yourself, and ask the right questions of your doctor.

Your added bonus is that, when you are learning about gout, it helps you to stop worrying about food.

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.

Every gout sufferer wants gout food lists. What foods are good for gout? What foods should gout patients avoid? Generic lists can make your life miserable. Think about what you want first and your gout diet is easy.

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.

Another short gout question, just asked, is gout coffee.

There are a couple of important things to know about gout and coffee.

1. Recent research indicates that coffee drinkers have less chance of getting gout. Now that is not quite the same as saying that coffee protects you from gout, as it is a statistical, rather than clinical report.

   Having said that, the figures look quite convincing. It is also relevant that coffee is a source of antioxidants, so maybe that is the reason that coffee is good for gout.
   Read the rest of this entry »

Now that the latest issue of my free gout newsletter is finished, it’s catching up time once again.

It is time to answer your short question about recipes for gout.

First, a warning. I have seen hundreds of so-called recipes for gout, and books of gout recipes. Most of them simply regurgitate old, out-of-date, advice about foods low in purines. Purines and gout are not that important, and certainly not for vegetables. If you see any of these, and you are not sure about their true value for gout sufferers, please let me know about them, and I will appraise them for you.

You might have noticed that I have started a new Gout Recipes section. Read the rest of this entry »