How I wish it were so simple.

But it’s my job to make it simple.

So here is a simple explanation of gout and food.

Gout has always been associated with food, but there is no simple link between food and gout. No matter how many people, often qualified, try to claim there is.

Gout is a disease caused by too much uric acid in your body.

Your body produces uric acid. Very little, if any, comes direct from food, though your total food intake will influence the amount of uric acid your body produces.

First, you must know your uric acid level. You need regular blood tests to do this.

Second, you must realize that food affects people differently due to several factors. Your uric acid test results will help you understand how your body is responding to changes in your diet.

Third, ignore pain. Easier said than done, but we all try to link food with gout pain, then try to avoid that food. This is pointless, as you have no way of knowing if the pain is coming from increased uric acid (bad) or reduced uric acid (very good).

So keep it simple.

Eat what you want.

But only enough to maintain, or slightly lower, your body weight.

And always enough variety to maintain a healthy supply of minerals, vitamins and other antioxidants. That’s where it gets a bit more complicated, and that’s where the gout diet forum comes in. Ask your gout food questions, but think about yourself first.

What food do you like? What are your diet goals? How do you like to manage your gout?

There will never be a gout diet that suits everyone, but with the right questions, you can soon build your own gout food lists.

Gout sufferers know how good water is.

1. Water reduces uric acid concentration, lowering the risk of pain-inducing crystals forming.
2. Water helps flush excess uric acid, and many toxic gout treatments, from the body.

Two - Nil is brilliant.

Where’s the third one coming from?

I’ve had a recent email exchange with a long-term gout sufferer who reckons he has found a new way to combat gout with water.

You can read extracts from this exchange in the Swimming and Gout forum topic.

In fact, this is not really about swimming, but the possible effects of water. Specifically, how immersion in water can cure gout.

The biggest question in my mind, is it it purely water, or is it purification products in the swimming pool water that bring this benefit.

Why not try it out, and let me know. Lounging in the pool might be your best gout experiment yet.

Now aspirin has driven me insane.

First, let me refer you to my article about aspirin and gout. I thought this was a great piece of news for gout sufferers who have been worried about low-dose aspirin, commonly taken to reduce the risks of stroke and heart disease.

I always intended to research this further, and add it to the gout research section at GoutPal.com. Today I learned that my link to the original presentation abstract was faulty. I decided to complete my review of aspirin and gout and improve my report.

That’s when aspirin started driving me mad.

I looked on PubMed for the original research, and found that the presentation I reported was part of a wider ranging study of prevalence and risk factors for hyperuricemia. The research was filed as a translation from Chinese. It concluded:

Male gender, non-Han Chinese ethnicity (Muslim), renal dysfunction, diuretics, overweight/obesity, hypertension and hypertriglyceridemia are associated with increased risk of hyperuricemia. Retirement is associated with reduced risk of hyperuricemia.

Hardly inspiring, and hardly anything to do with the aspirin presentation that caught my interest.

Not quite bad enough to test my sanity, but annoying enough to leave me frustrated, and a little confused.

Madness Begins

I decided to report on the presentation I had used originally, but find a more reliable version or link to it. My starting point was the American College of Rheumatology who organize the meeting at which the presentation was made. Searches revealed not one, but two presentations about low-dosage aspirin relevant to gout sufferers.

Madness Prevails

Sure enough, my star presentation was still there with its favorable conclusion that

Low-dose aspirin use was not associated with increase of serum urate levels.

So aspirin is OK?

The other presentation, complete with lots of data and a chart of results, concludes that:

Low-dose [aspirin] users, versus non-users, appear to have higher levels of [Serum Uric Acid] and increased prevalence of hyperuricemia

No, it’s not!

Aaaagh.

I’ve gone mad.

I wonder what’s so special about Monday and gout.

Is it due to weekend excesses?

More importantly (to me anyway) is will it repeat this week?

Is it a result of more diagnosis of gout on Monday as it’s the first chance that sufferers have had to see a doctor?

So if it’s still Monday, and you’re looking for gout information, why not let us know what’s so special about Monday to you.

Boring affects on my gout sites are:

• Can’t access email at blueyonder. If you’ve sent anything to that address recently, please send again via goutpal.com. If you don’t have my private email address, send a message via my contact form (but see next point also)
• My internet access is hit and miss, so I can’t answer private emails everyday. Public emails are also slow (e.g. contact forms, forum private messages), simply because I don’t have much internet access time
• Comments may take a few days for me to approve, but if you register, they should appear straight away.
• Gout Forum posts may take a few days for me to approve, but if you register, they should appear straight away.

Most unfortunately, I will probably not have time to do any research. If your question is straightforward, I’ll try to answer it straight away. If not, it will probably get caught up in the backlog. If you don’t get an answer within a couple of months, please try again. Remember, it is always best, and quickest, to post your gout questions in the Gout Forum.

You might think that any qualified doctor could tell if you have gout, but even your doctor is not sure.

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.

The gout diagnosis information is part of a large survey into many aspects of “Leg Disorders: Patient Behavior & Physician Effectiveness”. You can read the full report at legdisorders.org.

I will extract some more data relevant to gout patients. In the meantime, please feel free to discuss your experience of gout care in the gout diagnosis forum.

In the article, Mathilda refers to some recent research about uric acid as a potential cure for Alzheimer’s, or at least a way to hold the progression of the disease.

The research in this article follows on from a piece I did last year explaining how uric acid could reduce nerve damage. The researcher, Professor Firestein, pointed out to me that maintaining an adequate level of uric acid in the body is important.

There are a few more important points about uric acid, Alzheimer’s disease and related medical conditions and treatments.

The research reported by Mathilda also advises uric acid levels from 0.5 up to 6mg/dL. 0.5 sounds very low, and I would love to see the original research to confirm this value. The upper level for gout sufferers should be 5.5, but 6 is probably much better than most gout patients achieve.

Mathilda’s article gives a link to Neurology Reviews. I read some interesting stuff there, but could not find the original article. I did find the abstract for Inhibition of Iron-Catalyzed Oxidations by Attainable Uric Acid and Ascorbic Acid Levels: Therapeutic Implications for Alzheimer’s Disease and Late Cognitive Impairment on the Gerontology site, where you can also buy access to the full report. If you get a copy, can I have a look?

The author of the earlier report, Professor Firestein, has also produced a report summarizing Altered Uric Acid Levels and Disease States. The report does warn that many links between diseases and uric acid are not fully understood. Significantly, we do not know in most cases whether uric acid levels change as a cause or effect of an associated disease.

It is encouraging to see that some real life research is taking place into the specific links between uric acid and other diseases. I believe a fuller understanding of all the roles of uric acid in the human body can only serve gout research well in future.

If you have any insights on this, please feel free to comment. If you have questions about this research, or any aspect of uric acid, please ask in the Uric Acid section of the Gout Forum.

I would really love to know if doing all the things that are bad for gout sufferers will really help banish Alzheimers.

Join the forum discussion on this post

You see lots of gout information, but how much is written just for you?

You might not realize, but the whole of GoutPal.com is driven by your needs and desires.

I like to analyze visitor numbers, but mainly I respond to your requests - especially when you write them in the Gout Forum (now no registration required).

It is by far the easiest way to communicate, and I really missed it when my ISP let me down. Now that I’m back in business on a new server, I will continue to manually transfer old popular gout information. I will also try to catch up on the avalanche of emails I received during the time my server was crippled.

My priority will be to respond to your forum requests, but I am also interested in what my visitors find interesting, even if you leave no comments.

I plan to add a weekly and monthly summary of popular gout information from GoutPal.com. For the first week in April, these are:

Page	Description
Never Mix Biaxin (Clarithromycin) And Colchicine	Biaxin is a great antibiotic, but what about adverse effects? For gout sufferers, the worst side effect is that it increases colchicine toxicity.
Which Of Your Swollen Joints Has Gout?	Swollen joints often mean gout. If you thought it was only the big toe, think again. See which joints are most affected by gout. I need to update this survey with hundreds of more responses. I’ll do it ASAP, possibly quicker if you ask on the Wish List.
Worried about a Gout Symptom, Treatment or Any Aspect of Gout?	If your gout symptom is causing you concern, or if you need to clarify some information then GoutPal has the answers.
Latest Uric Acid Answers	Here are all your uric acid answers. If the answer to your uric acid question is not here, it soon will be. This page is really in need of some serious updating.
Are Tingling Swollen Hands A Sign Of Gout?	Tingling swollen hands can be caused by many things, and you should not rule out gout. There are many gout symptoms besides painful swelling. Another page needing updating for some survey results.

Please tell me about the gout information important to you.

I’d never heard of Polycystic Kidney Disease (PKD) until a recent question from a gout sufferer suggested a link with gout and PKD.

Coincidentally, I spotted a PKD article on my Gout Related News Page, entitled “Potential New Treatments For Polycystic Kidney Disease”.

As you may know, the Gout News Page contains an automatically updated feed from Medical News Today. As well as gout news, I include other topics of interest to gout sufferers. As PKD has been mentioned recently in the Gout Forum, I was drawn to this article.

Polycystic Kidney Disease is a condition where cysts grow in the kidneys, impairing their function. There is no known cure for this disease, and this new treatment does not bring a cure. In fact, the study does not indicate a cure, but it does suggest that a new area for research may produce more effective medication for slowing cyst growth.

The researchers also point out that their research has been done using mice, and clinical trials on humans are needed to test and develop appropriate inhibitors.

Not a cause for immediate hope then, but certainly a step in the right direction. You can read the full text of the news item, Potential New Treatments For Polycystic Kidney Disease, on Medical News Today.

Do you suffer from gout and PKD? Why not share your experience, or ask questions in the Gout Related Forum?

Not only am I still alive and kicking, but I’ve resurrected this blog.

There’s hope for a bright future on a new server. Thanks to all who’ve helped with this - I’ll write more soon.

In the meantime, there are a few bugs that have crept in during moving this site. They may also affect links on GoutPal.com.

If you spot anything, please let me know.

Also, please let me know what is most important to you. I always give priority to your needs.

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.

If you feel there is no hope for gout sufferers, or if you feel that there is hope, please discuss in the gout forum.

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 your reaction to uric acid crystals in and around the affected joint. A common misconception is, because these microscopic crystals are needle-shaped, the pain is related to needles being stuck in you. This is not true - the crystals are too small to cause physical pain in this direct way. The pain comes from your bodies immune system reaction to fighting the invaders. Similar to the pain you feel when your body is fighting a flu infection.

Unlike a viral infection, your immune system cannot kill uric acid crystals. White blood cells surround the crystals, and your body no longer sees the uric acid crystals, so it stops fighting, and the swelling and pain subside.

If nothing else changes, the formation of crystals lowers the amount of uric acid in your blood, and so no more crystals will form. But things do change. Whatever caused the uric acid to rise has probably not gone away. If your uric acid rises again then new crystals will form, and you will get another attack. If your uric acid level falls, old crystals will start to dissolve, shedding the white blood cell’s protein coating and revealing themselves to start another attack.

Not all attacks are the same. Some are so violent than you can hardly move. Others so mild that you notice only numbness or pins and needles. There is no standard rule here. You can get one gout attack after another, so that it feels almost continuous, or you might go many months without an attack. It all depends on how stable your uric acid levels are. Anything that triggers a rapid change in uric acid, up or down, can lead to an attack.

They will only stop if you manage your uric acid levels so that they remain below 6mg/dL. My last newsletter had some important information about managing uric acid levels. If you missed it, subscribe now, and you will get a confirmation message that tells you where the back-issues are.

That’s the best way I can answer, “How long between gout attacks?”

There is no definite answer, but you should be in a better position to manage your gout. If you still have questions, the Gout Questions page tells you the quickest way to get answers

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 injury. Often swelling can happen a few days after an injury, and this is one of the most common causes. Very tight footwear is another common cause of swollen toes.

Swollen joints have many causes, and if gout is suspected, the procedure is the same for all joints - not just swollen toes.

If there is no obvious trauma explanation, the best diagnosis comes from testing fluid from the affected joint. Some family doctors will do this themselves. Others will refer you to a specialist. In either case, the procedure is quite painless, and not nearly as bad as it sounds.

The procedure is often referred to as aspiration, or arthrocentesis. The doctor draws fluid from the joint with a very fine needle, and arranges for the fluid to be tested.

Where gout is suspected, the lab should be looking for 3 possible outcomes.

First they should rule out infection. Septic arthritis is often mistaken for gout, and vice versa. If septic arthritis is ruled out, the fluid must be examined under microscope for existence of crystals. In fact, this test should always be done as septic arthritis and crystal arthritis can coexist.

The crystal tests are for uric acid crystals (monosodium urate or MSU) and for calcium crystals (Calcium Pyrophosphate Dihydrate or CPD). If the tests show MSU crystals, you have gout. If they show CPD crystals you have pseudogout.

If you are very unlucky, you can have two or even all three of these conditions at the same time.

This should tell you all you enough about swollen toes diagnosis so that you can find out exactly what is wrong and start getting the correct treatment If you need to know more, see the Gout Questions page.

I have produced a table that lists foods high in potassium. Most gout sufferers should not worry about potassium. If you eat a healthy gout diet (see my Gout Diet Section), you will get adequate amounts of potassium.

The right amount of potassium is important for good health, but you must not eat too much. You must get advice from a doctor before trying to adjust potassium levels through diet. Some health conditions benefit from above average potassium, but some are made worse.

If you have been advised to lower your potassium intake (especially diabetic or kidney impaired people), treat the following list as foods to avoid. If you fall into this category, and would like to see a list of low potassium foods, then please let me know.

Note that potassium is a factor in the PRAL calculation, so many high potassium foods are also high alkalizing foods.

The table gives potassium values in milligrams per 100g serving. In many cases a typical serving is much less than this. To work out the amount of potassium in your food, divide the value from the table by 100 and multiply by your portion size in grams.

Current US recommendations are 4700 milligrams per day (www.health.gov/DietaryGuidelines/dga2005/document/pdf/Chapter8.pdf). This is an updated value on the FDA labeling standards 3500 milligrams per day (same as UK Recommended Daily Allowance). If you see any US food labels with % Daily Values for potassium, these are probably understated. UK & US recommendations are for all adults. Australian recommendations are gender specific - 3800 mg for Bruce, only 2800 for Sheila.

The table should tell you all you need to know about food list high in potassium. If it doesn’t, see the Gout Questions page for the quickest way to find out more information.

Every week, I get messages from gout sufferers, and their carers, about problems with allopurinol. Most of these show that absolutely no thought has gone into the treatment.

If you bought a car with only two wheels, would you accept it and drive round in a shower of sparks?
If you called a plumber to fix your leak, would you be happy to pay a weeks wages for him to merely turn the water off?
Would you pay an optician who grabbed the nearest pair of specs and said, “Here, these will do,” without testing your eyes?

Why take allopurinol without checking that it is doing it’s job?

Allopurinol for gout has one purpose - to lower uric acid below 6mg/dL, so that you can rid yourself of uric acid crystals. If you do not get rid of these crystals, they will build up and do one or both of two things:

• Erode cartilage and bone in the joint causing permanent, crippling, damage.
• Develop into tophi that often burst through the skin and get infected, risking life threatening blood poisoning.

If you do not get your uric acid tested regularly, and the dosage adjusted to ensure the level falls below 6mg/dL, you are wasting your time. At best you are delaying the crisis, but this only means that you will have to cope with it later in life, when you are less able to deal with it.

I’m stunned by the latest gout forum post from a caring reader worried about a gouty father. The poor guy has been on allopurinol for a while, but clearly the dosage has been inadequate, and clearly the explanations he has received have been worthless.

Worst of all, the primary health care physician has ruled out consulting a rheumatologist.

So after years of inflicting suffering, the pompous b*st*rd won’t admit his mistakes and turn to the only source of proper gout treatment and advice.

Oh, if I could get my hands on him.

Sensibly, it’s best left to the lawyers, but nowhere near as satisfying as a swift elbow to the nose.

Here in the UK, we had a Dr Shipman, jailed for killing hundreds of his patients. Is giving shoddy medical care, to people who trust you, any worse? Given a choice of quick painless injection, or years of crippling agony, I know which I would chose.

But why can’t we just have proper medical care?

Strange that you don’t get many people looking for “home heart surgery” or “home laser eye treatment”. There’s something about gout that makes us want to cure it at home.

Let’s face it, if your standard of gout medical care is the same as that described in some messages I get from disgruntled gout patients, then I don’t blame you.

But, you know, you should never look for a home cure for gout. Any gout cure, whether medication or herbal remedy, must consist of two entirely different, separate, distinct parts.

2 cures.

Not ONE cure for gout.

Two.

I have never seen any so-called home cure for gout that makes this distinction. The marketing men are happy to persuade you that all your troubles will be over, but never tell you why. Or how.

This is why you need two cures:

1. Something to lower uric acid
2. Something to relieve pain

For the first one, you can start with my previous post, natural uricosuric agent.

For the second, take your pick from herbal pain relief, natural pain relief, natural anti-inflammatory etc.

Just don’t confuse the two.

1. Lower uric acid to below 6mg/dL and keep it there - the only way to get rid of gout.
2. Take pain relief, usually anti-inflammatory, as you need it - may take a few months.

That is true whether you are looking for a gout cure at home, at your doctors, at hospital, or wherever you are.

That should tell you where to start looking for a home cure for gout. If it doesn’t, see the Gout Questions page for the quickest way to find out more information.

I think I’m like many other gout sufferers - a little wary of taking too many medications. But it’s funny how our reactions change to so-called natural products.

Colchicine is a common gout medication. It’s derived from autumn crocus, yet few people would regard it as a natural product.

Many so-called natural, or herbal, gout remedies are far removed from their natural sources. Most are pounded, processed and packaged to a form far removed from anything that might be regarded as natural. The truth is, for most natural gout remedies to have any noticeable effect, the gout relieving compounds need to be extracted and concentrated. These processes, though necessary, render products which are as highly processed as medications, but without the safety controls that cover drug licensing in most countries.

Leaving that aside, it still begs the question, “Are there any natural uricosuric agents?”

First, you have to understand what a uricosuric agent is. It is simply something that promotes the excretion of uric acid. There is more information about this in the Treatment Section on GoutPal.com. My research has found little evidence of natural uricosuric agents. Not surprising really, as very little proper scientific research is done in this area - no drug company sponsorship, I guess.

As far as gout treatments go, there is a separate type of treatment. Xanthine oxidase inhibition (or blocking) is a common form of medical treatment, usually administered in the form of allopurinol. I am researching natural alternatives to this, and I have found many. Whether they can be turned into effective treatments remains to be seen. I will be reporting my findings on natural xanthine oxidase inhibitors soon. Could do with a catchier title though - how about natural allopurinol?

I hope this gives you some good pointers on where to look for natural uricosuric agent information. If you need more, consult the Gout Questions page.

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 that they will fluctuate. Uric acid levels rise and fall throughout the day, and from day to day. The graph shows a typical uric acid profile - up and down, but if you are managing your gout properly, the average trend should be downward, bottoming at 5mg/dL.

Even then, you are not getting the full picture from a uric acid test. You only measure the amount that is dissolved in blood. Other uric acid that has crystallized in your body goes unmeasured. In fact, uric acid levels from a blood test often fall during a gout attack as uric acid has moved from your blood into your joints or under your skin as tophi.

Bear those factors in mind when you interpret your own results. Then you can assess how much benefit you are getting from a particular gout treatment or a change in your gout diet.

If you are using your doctor’s results, you should discuss them and ask for explanations of any significant changes. More importantly you should ask for advice about how you can keep uric acid levels below 6mg/dL. At this level, you will gradually get rid of any uric acid crystals in your body, and stop forming new ones - the nearest thing to a complete cure for gout.

If you are using your own results, as I mentioned in yesterday’s newsletter, try to test at the same time each day, and make note of any significant diet or treatment changes.

Remember, once you have had gout, even if you get uric acid levels back down, you need to monitor your uric acid levels at least twice a year to ensure they are not creeping up again. Anything over 7 mg/dL is dangerous. Best to take action at 6.4 mg/dL - the level below which uric acid crystals do not usually form.

If you have more questions about graph uric acid level see my Gout Questions page for the quickest way to get answers.

First of all understand how allopurinol works.

It is all to do with uric acid. Uric acid is a good thing, but, when you have too much, it can form uric acid crystals (commonly called urate). These crystals build up in and around your joints causing gout. The only way to get rid of them is to maintain your uric acid level below 6mg/dL.

Allopurinol slows down an enzyme that causes uric acid production in your body. It does this immediately, but each dose does not last very long. Once you stop, your body will start producing uric acid again. That is all it does. It has no pain killing properties at all, and it does not do anything to change whatever causes you to produce too much uric acid.

It sounds as if it is not doing much, but in fact it is saving you from longterm joint damage and tophi - as long as you are getting the right dose. It is vital that you have frequent uric acid tests to ensure that it stays below 6mg/dL. Your doctor will advise you how frequently these tests should be. If you want more frequent tests, easily carried out at home, see yesterday’s gout newsletter (if you missed it, subscribe now, and you will get a link to the back issues)

So, the general rule is that, once you start taking allopurinol, you must keep taking it every day. If you stop, you will soon be back where you started, and you will put yourself at risk of overloading your system with uric acid.

There is an unfortunate side-effect of all urate lowering therapy, not just allopurinol. Anything that is effective at lowering uric acid will cause uric acid crystals to dissolve. As they are dissolving, they are exposed to the immune system and you can get a gout attack. Often this is more widespread than the familiar one or two joints that are affected by normal gout attacks. There is not much you can do about this - just make sure you have painkillers handy, and if these don’t work, go and see a doctor for something stronger. The gout attack won’t last for long, and as you continue to take your allopurinol they will become less frequent and less intense.

If you get a gout attack (often called gout flare) while you are taking allopurinol, you must continue. Missing a dose will do nothing to make the pain go away - it will just prolong the length of time that you have uric acid crystals in your body.

But that does not completely answer the question, “Can I stop taking allopurinol?”

If you are a good gout patient and keep taking your allopurinol daily, and keep checking that your uric acid level is always below 6mg/dL, a wonderful happens.

All uric acid crystals dissolve.

Your gout is gone.

You dance with joy, but still you ask, “Can I stop taking allopurinol?”

And still I answer, “Maybe.”

You really need to consult a rheumatologist on this. I have seen a report somewhere that indicates that you can take a rest from allopurinol once all urate has been dissolved. Sorry, but despite searching, I can’t find where I read this - please let me know if you spot it. Anyway, I’m sure your rheumatologist will know best. Of course, it is vital that you keep checking uric acid levels if you stop taking allopurinol.

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.
   
   Because of the risks of over-exposure to caffeine, it is probably better to stick to decaf, especially over two or three cups per day. Decaf has a similar statistical relationship to low gout incidence that is not as pronounced, but still significant.

   For more information, check out my report on the coffee and gout study from a few weeks ago.

2. Coffee is mildly diuretic, but still counts towards your fluid intake each day. I cannot overemphasize the importance of hydration. Do not think it just has to be water. Keep drinking all day - tea, coffee, fruit juice and milk are all good fluids, and will stop you getting bored with plain water.

   For more information about the importance of hydration, see my water and gout page.

This post answers a short gout question in the gout diet section. If you still have questions about gout coffee, see my Gout Questions page for the best way to get answers.

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. Over the next few months, I will be adding new recipes here - all of them with a full nutritional assessment showing the likely effects on gout.

Do you have a particular recipe that you love to eat, but not sure how it will affect your gout? Just send the recipe to me, and I will assess it for you. I will publish the best of these in my gout recipe section.

Those of you who read my newsletter will know about my new club. I will be publishing extra gout recipes for club members. If you are interested in this, but missed the August newsletter launch, it’s not too late. Sign up for the newsletter (see links above) and you will get a message that tells you where the back issues are.

This post answers a short gout question in the gout diet section. If you still have questions about recipes for gout, learn the best place to get answers on my Gout Questions page.

The key thing to remember is that all gout medication falls into two groups:

• Pain Relief
• Urate Lowering Therapy

I have given full information about all common Gout Remedies
for Pain Relief">gout pain treatments and all common urate lowering therapies at GoutPal.com.

The most important of all medication for gout is treatment to lower uric acid. The most common, and currently most effective, urate lowering therapy is allopurinol. It is important that you study all the information about allopurinol on GoutPal.com.

When you start taking urate lowering medication, it is vital that you keep taking it every day. It does not matter if you are having a gout attack or not. Stopping the uric acid lowering treatment will not help the pain of that attack. If you stop taking it, you will increase the chances of more pain in future.

You need pain relief medication until the urate lowering therapy has done it’s job and all uric acid crystals have gone from your body. There is a wide choice available, and you should discuss different ones with your doctor. Do not put up with taking colchicine if it makes you sick. There are many alternatives, and you should be able to find one or two that suit you.

This post answers a short gout question in the gout cures section. If you need any more information about medication for gout please see my Gout Questions page.

Though PRAL is a precise calculation based on certain nutrient values in foods, it is not an exact measure. It is a shortcut measure to assess the affect of foods on the pH of the body. Experiments have shown that it is a reliable approximation of the acidifying or alkalizing effect of foods.

PRAL=0.49 Protein + 0.037 Phosphorous - 0.021 Potassium - 0.026 Magnesium - 0.013 Calcium.

This gives a positive value for acid forming foods and a negative value for alkaline forming foods. To ensure adequate nutrition it is important to chose a combination of foods with positive and negative PRAL values.

Many nutritionists and health-workers believe that a diet that has an overall negative PRAL total is healthiest.

For gout, an alkalizing diet reduces the chances of kidney stones forming, and helps to dissolve them if they form. It is important to also drink plenty of water to flush the dissolved salts from the kidneys.

A second effect of gout is that uric acid is more soluble in alkaline conditions. Though the pH of the blood is tightly regulated by the body, a tiny percentage increase in alkalinity is probably enough to dissolve slightly more uric acid. Again, it is vital to keep hydrated to ensure that the dissolved uric acid can be flushed from the body.

I have calculated PRAL values for all the foods in the USDA National Nutrient Database. I present these as tables for each food group in my Gout Food Section of my gout information website.

This post answers a short gout question in the gout diet section. If you still have questions about Potential Renal Acid Load, see my Questions page on how to get the best answers quickly.

Some fantastically tasty fruit and vegetable juice recipes are heading for my website as I write. But, sometimes, a simple tomato juice drink is all we want, as one of our fellow gout sufferers explained:

I love to have a glass of tomato juice at breakfast, but I’m having difficulty in finding tomato juice products that are low in sodium, maybe close to zero.
Hope you can help.

Oh, yes - I can help. In my fridge lies a lovely litre of delicious tomato juice containing a mere .4g salt (.2g sodium) per 150ml. The recommended daily amount of salt is 6g, so this stuff certainly qualifies as low sodium. Just nip down to your local Co-op.

Now I suspect that the person asking about low sodium tomato juice is not UK based, home of the historic Co-operative Wholesale Society. No worries (at least if you live on US mainland). I have found a source. And you thought Amazon was just for books.

Make your selection from the two offerings on the right, and we will both be happy. Both these low sodium juices contain 140mg per 8oz serving. This is less than a quarter of the sodium in standard tomato juices.

It would be nice, if your try either of these juices, if you let us all know how good they are.

If you are not in the UK or USA mainland, please let me know if you need a low salt tomato juice source (I’ve always been a huge fan of tomato sauce).

Similarly, if you know of a good place to buy low salt tomato juice - or anything else that gout sufferers might enjoy, please share.

One final idea that you might like to consider - make your own. I’m not sure how easy this is, but my friend Sara from Juicing-For-Health.com is bound to know. I’ll ask her for some tips, and in the meantime, you might like to learn some juicing lessons for yourself.

When I started developing my gout diet plan, I deliberately shied away from creating a fixed menu, for two reasons:

1. It takes up more time than I have available.
2. I do not agree with telling other people what to eat.
3. I feel it is irresponsible to plan a diet for somebody if you know nothing about them

Despite being unable to count, I try to explain how food might affect your gout. Most published dietary guidelines for gout are based on disjointed scientific facts (occasionally fiction) by people who have never experienced the agony of gout.

For most gout sufferers, weight is a major factor, and for many of these, getting down to normal weight will cure their gout.

Many gout sufferers have a genetic tendency to gout, or other problem with uric acid metabolism. If getting down to normal weight, and maintaining a gout-friendly diet, doesn’t cure their gout, then uric acid lowering medications are the answer. With these, they should be able to eat anything, though I still recommend a well balanced healthy diet to avoid other health problems.

If anyone wants to pay me to prepare a personal diet, then I am happy to work for them. I really don’t expect anyone wants to do this, so I have not begun to think about what charges should be.

I have thought about a private club where I would give individual dietary advice for members to share with other similar members. I guess the cost of this would be around $17 (£10) per month. I have not taken this idea very far because, again, I doubt that enough people would be interested to make it worthwhile.

Now, I would love to be flooded with offers of money, to prove me wrong, but it aint gonna happen. Is it? Go on, you know you want to click that button.

I believe that most people do not adapt well to sudden changes in diet, therefore I recommend that gout sufferers assess their own situation and gradually exchange poor habits for good ones. I have tried to put enough information on the websites to allow all gout sufferers to make healthier choices.

Very soon, I will add some recipes to the GoutPal site that highlight key points about healthy eating for gout. These will go a long way to answer “What foods can I eat for gout?”

If you are still stuck with ideas for how to improve your diet, please post details in the gout forum about yourself, and what you currently eat. I need to know age, weight, height, gender, how much exercise you get each day, and details of your daily diet. The more information the better. I will suggest what foods you should think about changing to help your gout.

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:

The trouble with simple explanations is they lead to simple gout solutions. “Stop eating high purine foods and your gout will be cured,” is one of them.

In real life, eating a low purine diet has been shown to have a minimal effect on uric acid levels and on gout. A study⁽¹⁾ of 60 gout patients showed a 1 mg/dL reduction after 7 days, though they note that no significant reduction occurred after 5 days. What we don’t know from this study is just how the diet changed. What replaced the purine foods? Could this account for the reduction?

Even that study was just a preliminary to determine the number of days of diet change required to have a significant effect on uric acid. The main part of the study, and several other similar studies show that changes to the purine content of diet has a much bigger effect on the amount of uric acid excreted in urine than it does on uric acid in the blood.

Not only that, but there are several different types of purines. Nearly all published information about the purine content of food, including my own purines in food table, relates to total purines. Each of these follows a different pathway in our bodies. The presence of different enzymes controls if and how these purines breakdown to uric acid. Some become reabsorbed at different stages. Finally, the kidneys reabsorb or excrete uric acid according to mechanisms in our bodies that are not fully understood.

Several studies have taken place, and no doubt more will continue, to try to understand the protein and uric acid connection. Many of these studies show, that by introducing artificial diets (necessary to achieve scientific control points), then adding different oral purine compounds ⁽²⁾, there is a direct connection between protein and uric acid.

The problem with this, is that it does not help us gout sufferers in the real world. The interaction between food and body chemistry is too complicated for simple “No Purine” rules. What about naturally occurring antioxidants in foods in our diets? Do these have a neutralizing effect that might help prevent the formation of excess uric acid? What about compounds in food that restrict the activity of enzymes that cause the breakdown of purine proteins to uric acid - a kind of natural allopurinol?

Many questions reveal themselves as the protein and uric acid connection gets more complicated. I don’t have answers for all of them, but I’ll be revealing some significant aids to understanding over the next few weeks.

Best make sure that you are subscribed to my newsletter, this gout blog, and your gout forum to make sure that you don’t miss anything.

⁽¹⁾ URIC ACID PRODUCTION IN GOUT By J. E. SEEGMILLER, ARTHUR I. GRAYZEL, LEONARD LASTER AND LOIS LIDDLE. (From the National Institute of Arthritis and Metabolic Diseases, Bethesda, Md.)

⁽²⁾ Effect of Oral Purines on Serum and Urinary Uric Acid of Normal, Hyperuricemic and Gouty Humans
A. J. CLIFFORD,1 J. A. RIUMALLO, V. R. YOUNG AND N. S. SCRIMSHAW
Department of Nutrition and Food Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139

Dr David Heber is well known for his “What Color is Your Diet?” book. I found some fascinating information from him about nutrition and antioxidants. He has grouped food by color, and I think the plan is to try and eat something from each color group every day. Well, if he can do it, why can’t I?

The color groups are Red, Green, Green/Yellow, Red/Purple, Orange, Orange/Yellow, White/Green. Before I continue with these groups, I’d like to share some of Dr Heber’s comments, as they are very relevant to healthy gout food.

The first is very relevant to those gout sufferers, like me, who are trying to lose weight:

Another advantage of a diet rich in fruits and vegetables is that it reduces the number of calories per bite or “energy density.” It is only possible to eat a certain volume of food until you get full (at least