Gout Pal Interactive

Yesterday, somebody asked me “What is the protein and uric acid connection?”
I can sum it up in two words.
Very complex.
But you want more than that, don’t you?

The simplest explanation is that certain proteins (purines) get broken down in the human body to uric acid. Most other animals produce other enzymes (uricase) that continue to breakdown uric acid further, so that it is easier to excrete. Humans do not have that enzyme because we want to keep some of the uric acid. It neutralizes free oxygen radicals in our body that would otherwise cause extensive cell damage. That is why normal human lifespan is greater than many animals.

From that, we can see that the protein and uric acid connection is a simple one:
Read the rest of this entry »

Tags: protein and uric acid connection, _gout, _gout diet, _purines, _uric acid

Gout and antioxidants are closely related. Uric acid is an antioxidant that we produce to help protect our bodies from free oxygen (free radicals) that can harm our bodies. Though we need this antioxidant for life, too much of this particular good thing can lead to gout.

Gout research tells us that food high in antioxidants can help reduce uric acid. My logic tells me that it makes sense for our bodies to produce less of our own antioxidant, uric acid, when we can absorb what we need from our food. One pillar of my gout diet plan is that food rich in antioxidants will help lower uric acid.

Up to now, I have simply advised you to increase antioxidant rich foods. Many of you want more than this, and so I will shortly be publishing a series of free gout recipes that will help you plan your own gout diet. In my next newsletter, I will also introduce a more detailed gout diet planning service for those who want to be told what to eat. As gout affects everyone differently, I will also show you how you can see for yourself, which foods raise or lower your own uric acid.

Antioxidant measuring is a new part of nutrition. Better measurement techniques and new research studies are adding to our knowledge daily. I focus on a simple list of foods that have been generally accepted as being high in antioxidants.

TABLE 4 The 50 foods with the highest antioxidant contents per serving size¹

Product Antioxidant content mmol/serving Blackberries 5.746 Walnuts 3.721 Strawberries 3.584 Artichokes, prepared 3.559 Cranberries 3.125 Coffee 2.959 Raspberries 2.870 Pecans 2.741 Blueberries 2.680 Cloves, ground 2.637 Grape juice 2.557 Chocolate, baking, unsweetened 2.516 Cranberry juice 2.474 Cherries, sour 2.205 Wine, red 2.199 Power Bar, chocolate flavor2 1.875 Pineapple juice 1.859 Latino beverages, guava nectar 1.858 Juice drinks, 10% juice, blueberry or strawberry flavor, vitamin C enriched 1.821 Cranapple juice 1.790 Prunes 1.715 Chocolates, dark, sugar-free 1.675 Cabbage, red cooked 1.614 Orange juice 1.510 Apple juice, with added vitamin C 1.462 Latino beverages, mango nectar 1.281 Pineapple 1.276 Oranges 1.261 Bran Flakes, breakfast cereals3 1.244 Plums, black 1.205 Pinto beans, dried 1.137 Canned chili with meat and beans 1.049 Spinach, frozen 1.045 Canned chili with meat, no beans 1.040 Whole Grain Total, breakfast cereal4 1.024 Chocolate, sugar-free 1.001 Kiwi fruit 0.987 Molasses, dark 0.980 Potatoes, red, cooked 0.956 Cheese lasagna, frozen and cooked 0.942 Potatoes, white, cooked 0.918 Sweet potatoes, baked 0.900 Iced tea, brewed, unsweetened 0.881 Potatoes, russet, cooked 0.862 Baked beans, pork and beans in brown sugar sauce 0.852 Condensed tomato soup, one brand 0.826 Broccoli raab, cooked 0.823 Peppers, red, cooked 0.820 Broccoli, cooked 0.780 Latino beverages, tamarind nectar 0.761

¹ The antioxidant content per serving size was calculated as indicated in Table 6. Mean values are provided for products for which different brands are comparable.

² POWERBAR Co, Berkeley, CA.

³ Ralston Foods, Battle Creek, MI.

⁴ General Mills, Inc, Milwaukee, WI.

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Remember, antioxidant content varies widely with many factors including season, method of cooking, and variety. Do not get bogged down in the numbers, just use the list to try and improve what you are eating now.

There are several methods of measuring antioxidant values, and many different studies. These foods are only a selection, and do not cover all high-antioxidant foods. Another good list is the table of best sources of antioxidants in foods.

If you like a high antioxidant food that is not listed here, but you think it might help your gout, then add a comment, or, even better, discuss it in the gout forum.

Tags: gout and antioxidants, _gout diet, _uric acid

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.

A recent comment from a reader about stubborn gout pain has set me thinking. I started writing a short comment reply, but as I thought about the problem, I realized that this subject deserves it’s own article.

Tom wrote about his stubborn gout pain:

I have used prescription NSAIDS (Ibuprofen,Indicin, etc.) to sucessfully treat a gout attack that affected my toes, ankles and knees.

Second and subsequent gout attacks did not respond to NSAIDS and I tried fresh cherries, dried cherries and cherry juice concentrate. The Cherries worked at first and then failed to give relief.

Next, I tried Colchicine and that worked - with gastric upset side-effects.

I’ve also noticed a difference in pain treatment response to different attacks. The pain is caused by a complicated immune response that scientists are only just beginning to understand.

Read the rest of this entry »

Tags: stubborn gout pain, _acute gout management, _anti inflammatories, _colchicine, _pain relief

Anyone following my gout diet progress will know that weight loss is a key issue for me, as it is for many other gout sufferers. If you suffer from gout, one of the first things you need to do is assess your weight, and body mass index is a good, quick guide.

I have mentioned body mass index (BMI) before. It is best used as an approximate guide rather than a specific measure as other factors are important. I like it because it is quick and easy to use.

I’ve just found a really useful online BMI calculator at whathealth.com. There’s lots of other useful information about BMI there, as well as general health and gout information.

I wrote my personal opinion on gout and alcohol a few months ago. I’ve enjoyed reasonable, and occasionally excessive, amounts of wine and beer since, and my opinion is unchanged. However, I must point out that this is my personal experience, and will not apply to all gout sufferers.

I think I need to do an in-depth article on alcohol and gout. I’ll put it on the list of things to do. Or maybe on the list of things to put on the list

It is actually very confusing, but I fall back on my old maxim - each to their own gout.

Gout is a very complicated disease, caused by different factors. If you combine this with the fact that no individual food item (including drinks) is as important as total diet, then it’s easy to see why there are no simple answers.

As an overweight gout sufferer, I believe that my weight is the cause of my gout. Yes, alcohol contributes to weight gain, but I do not believe it directly makes my gout worse. In fact, as long as I remember to keep hydrated, I feel better after a drink. I am not condoning excessive alcohol consumption - my own or anyone else’s - but here is the place for gout opinions, and that is mine.

For a gout patient whose primary cause of gout is due to kidney problems then the picture is probably very different. It is vital that all gout sufferers have kidney function tests.

Beyond that, there are other things to consider. Do the health properties of red wine outweigh the effects of alcohol? At what point does alcohol stop being beneficial? Is there any point comparing different types of alcohol?

I think it’s too easy to get obsessed with these questions and forget that the best thing for gout is a healthy balanced diet and a healthy, happy lifestyle. Drinking too much or stressing over pleasures deemed to be forbidden will not contribute to those goals.

I will continue to report news on gout and alcohol as I get it. In the meantime, if you have some alcohol related questions or opinions, why not talk about them on your gout forum?

Tags: gout-and-alcohol

Yesterday, I wrote about the guidelines for longterm gouty arthritis cures. I’ve added topics to your gout forum, so you can share your experiences.

The discussion topics for the longterm gout management guidelines (in reverse order) are:

OLD TOPICS NOW DELETED. PLEASE START NEW DISCUSSIONS IN THE GOUT FORUM

Join the forum discussion on this post - (2) Posts

Some of your recent messages activated quercetin interest in me. Or perhaps I should say reactivated.

Ever since I started researching gout, I’ve kept coming across quercetin. I know it’s a flavonoid - a part of a plant that isn’t a classed as a nutrient (like carbohydrate, fat or protein) and isn’t quite a vitamin - though early flavonoid discoveries where classed as vitamins.

I found that quercetin was being pushed as a wonder product, and shied away from it, fearing that it was just an excuse for more snake oil to foist upon us poor gout sufferers. Recently, I found mention of it when I was researching red wine and uric acid, and it also reminded me of my post about morin as a natural gout remedy.

The study that mentioned red wine was “Flow injection determination of xanthine oxidase inhibitory activity and its application to food samples”, and the reference to red wine was so insignificant that I nearly discarded it as irrelevant. Then I read how several natural compounds compared to allopurinol as a xanthine oxidase inhibitor. Chief amongst these is quercetin, though it’s more effective cousin apigenin, is also very interesting.

I didn’t want to waste my time researching this further, if there is nothing significant to report, but I’ve found a lot of very important information, that I want to present soon, including a table of quercetin and apigenin content in food. I need to finish my review of the gout management guidelines, then I’ll be straight on to this. Sorry if it delays responding to emails, but I promise that I will respond as soon as I can. If you have urgent questions, go to the gout forum - that has the greatest chance of a response.

Sorry to post a teaser like this, but I think quercetin and related flavonoids are important enough to warrant a mention. Writing this makes it less likely that I will forget about this important topic. If I’ve activated quercetin interest in you, please remind me to finish this.

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Due to a recent comment, I’ve opened this up as a quercetin discussion. Please discuss any aspects of gout, uric acid and quercetin in the gout forum.

Tags: _apigenin, _flavonoid, _quercetin

Management of recurrent, intercritical and chronic gout

We are all looking for better gouty arthritis cures, but what we need today is better guidelines for using the cures we already have.
British rheumatologists have completed some guidelines for the management of gout, and it is likely that these will influence gout care procedures throughout the world.

I have already reported on the management of the acute phase of gout, which deals mainly with short-term pain relief. This article summarizes the guidance relating to more advanced phases, where the need to cure gout depends on lowering uric acid. The phases that these guidelines refer to are:

Recurrent Gout

Where acute gout attacks occur more than once.

Intercritical Gout

The time between gout attacks. This is, in my opinion, the most overlooked phase. Just because the pain has gone, most people ignore gout during this phase. Big mistake. If uric acid levels are high, you can still get crystals being deposited in the joint and under the skin (tophi). These do not always hurt, but they can build up to the point of serious, painful, chronic gout.

Chronic Gout

This phase is characterized by tophi and severe pain from damaged joints.

The same evidence driven grading applies to these guidelines. The grades are:

1. At least one randomized controlled trial
2. At least one non-experimental descriptive study (eg comparative,
   correlation or case study), quasi-experimental study, or non-randomized controlled study
3. Expert committee reports, opinions and/or experience of respected authorities

Longterm Gout Management Guidelines

The longterm gout management guidelines are:

1. Keep uric acid in the blood below, 300 µmol/l i.e. approx 5mg/dL(C).
   
   
2. You should take uric acid lowering drugs after your first acute gout attack if you have a second attack within one year, and there are no complications(B).
   
   
3. You should also take uric acid lowering drugs if you are a gout patient with:
   • tophi (C)
   • kidney problems (B)
   • uric acid stones (B)
   • the need to continue taking diuretics (B)
     
     
4. If you are not already taking uric acid lowering drugs, wait 1 to 2 weeks after inflammation has gone (C).
   
   
5. If you have uncomplicated gout, you should start uric acid lowering treatment with 50-100 mg allopurinol per day. You should have uric acid blood tests every few weeks, and increase the allopurinol dose by 50-100 mg, until the target (SUA below 300 µmol/l) is reached, but only increase to the maximum dose of 900 mg (B).
   
   
6. If you fall into any of these groups, your doctor may prescribe uricosuric drugs (B):
   1. Kidney function tests show you under-excrete uric acid
   2. Allopurinol doesn’t lower uric acid enough
   3. You cannot tolerate allopurinol

   The preferred drugs are sulphinpyrazone (200-800 mg/day) if you have normal kidney function or benzbromarone (50-200 mg/day) if you have mild/moderate kidney insufficiency (B).
   

7. When you start allopurinol or uricosuric drugs, you should also be prescribed colchicine 0.5 mg twice daily for up to 6 months (A). If you cannot tolerate colchicine, your doctor may prescribe NSAID or Coxib if these are suitable for you, but the duration of NSAID or Coxib should be limited to 6 weeks (C).
   
   
8. If you take aspirin in low doses (75-150 mg/day) to help prevent heart disease, you may continue (B). However, avoid pain-killing doses of aspirin (600-2400 mg/day) as it interferes with uric acid excretion (B).

Tags: gouty arthritis cures, _allopurinol, _aspirin, _benzbromarone, _colchicine, _diuretics, _gout cures, _heart disease, _longterm gout management, _nsaids

To make it easier to understand the treatment for gout guidelines, I have produced a chart showing which guidelines are important for your gout.
Click the small image on the left to see the acute gout treatment chart. You simply follow the questions and recommendations to find the most important gout treatment recommendations for your situation. If you need further information about any treatment for gout guideline, you simply click the link back to the discussion for that guideline.

Please feel free to ask any question about the recommended treatment for gout. If you want to comment on the layout of the chart, you can do so below - I really appreciate your feedback.

I will soon be producing charts for other aspects of the gout management guidelines. If you like this type of presentation, please let me know, and I will think about applying it to other aspects of coping with gout.