# Gout



## blackcountrytone (16 Sep 2016)

I have for the last 10 year's or so suffered from Gout.I was massively overweight with very little exercise,as i was driving for all day in my job,so turning into a couch spud. I had all the blood test from the doc's and was diagnosed with the GOUT and now take Naproxin & Allopurinol. My weight before i decided to start cycling was 19st 10lb or there about, and i did find that drinking sugary pop i.e. coke was the trigger factor,but not alcohol (thank heavens).I am now weight wise down to 16st 8lb and have noticed that i aye had a bout of GOUT for about six month's or more.so my question to someone who may be medically informed is (*is loosing the body weight along with being reasonably fit anyway related to staving off the GOUT*), as i was led to believe that gout was due to not having the kidney/kidney's not working to there full potential in the getting rid of the Uric Acid, that then build's up and forms crystals in a joint (usually around the big toe area.) Also i have been drinking the dreaded coke not for long but had a few glass's when out with the wife and friends recently and no gout where as i used to have one mouthful and next day bang GOUT. hence my post.
regard's tony


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## Oldfentiger (16 Sep 2016)

11 months ago I had an attack of gout. Not particularly heavy, 5'8" and circa 12st.
I took naproxen for a week and it cleared up. No further occurrences so far.


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## alicat (16 Sep 2016)

It has to be good to be active, stay off chemicals in a bottle and reach a normal weight (ie less than 16 st 8 lb).

Beyond that a doctor may be more help than a bunch of cyclists.


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## Broadside (16 Sep 2016)

I've had it for 5 years, used to get 6 attacks a year and was 13st at the time (I'm 6ft). 

It is not a well understood problem, i saw a few GPs about it and none could help so I got referred to a consultant rheumatologist who prescribed a high enough dose of allopurinol to stop all symptoms. It took about 10 blood tests over 2 months to get the allopurinol dose right. If you are on the right dose you will not need to use Naproxen. 

The dose you are on is not enough to stop the crystals forming, it's quite common for GPs to prescribe Allopurinol at too low dose which is just pointless as each attack is excruciating and also causing joint damage. 

The consultant I saw knew how to stop it but said it is not well understood and said that some people are simply excess uric acid excreators.


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## Fab Foodie (16 Sep 2016)

Congratulations on making lifestyle changes that have given you a valuable health benefit!
Gout's nasty!
If you can quit fizzy sugary crap altogether even better.

Keep up the good work and take care not to slip back into bad habits.


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## 3narf (16 Sep 2016)

Wow, you don't hear much about this these days! I assumed it was rare since the 19th century...


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## bozmandb9 (16 Sep 2016)

Gout is getting quite common now. I've suffered since I was 22 (23 years ago). When I initially got an attack, it was not diagnosed for two years, I was probably in the best shaped of my life (in the T.A., extremely fit, skinny), my first flare up was on a forced march, carrying 30kg burgen, on a very hot day, with very little water (we were only allowed our one flask, no refills), the morning after a massive p*** up in the mess hut. I (and the directing staff), assumed I must have broken my toe, due the the inflammation.

It went away when I left the TA, until I got overweight in my 30's, and was drinking quite a lot. I was told I would be on the medication for years. I would say the medication contributed to weight gain though. Eventually, at 35, I just decided to go cold turkey on the meds (which weren't fully preventing attacks anyway), and address it through lifestyle change. I stopped drinking altogether, started working out, watched what I drank, and generally transformed my lifestyle. Long story short, lose three stone, and was no longer troubled with gout for a few years. 

Then I suffered again, this time, what you might call 'athlete's gout'. I discovered a lot of what I was doing to be healthy, had the effect of triggering gout. From lots of green tea, to high protein diet, to sprint sessions, creating massive lactic acid loads!

Last year in January, it was quite bad, and a scan found a little bone erosion due to the acid (right metatarsal). However I'd say since switching from sprinting to cycling, it's no longer a problem. One thing I've found can really help is concentrated montmorency black cherry juice, daily. It's a great anti-inflammatory. Also Omega 3 daily I'd say is a must (unless you're a big fish eater, and must be oily).

Bottom line, I'd say lifestyle is a much better way to treat it than with drugs.  The drugs can be essential during an acute attack, but to prevent attacks, they're pretty much useless, compared with lifestyle change which effectively prevents the cause of the attack. Hope this helps (oh, and you're cetainly better to ask here rather than just ask a doctor. A young doctor, who has not personally experienced gout, will know virtually nothing compared to me. They may be able to diagnose the correct meds, but they will not know the effect of the meds, or the lifestyle alternatives or coping strategies.


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## Oldfentiger (16 Sep 2016)

I must have a 19th century big toe then.


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## Aperitif (16 Sep 2016)

I have been 'sidelined' for, probably, two years thanks to the nasty gout. Incredibly painful, debilitating and offering no respite - even if you don't move a muscle. I am averagely fit and used to deal with the occasional attacks thirty years ago or so, by the use of Naproxen. I was above average fit in the early days... and about a 200 miles+ regular bimbler when the latest seance took hold. My weight hasn't changed - hair doesn't weigh much anyway. About 105 kg this week...never above but usually 100kg I feel a bit fat at the mo, but generally have never been slobbily overweight.

The affliction really took a 'grip' on me whilst playing percussion; meaning that I had no power in my fingers, swelling and all sorts of sundry things. No more percussion as the pain was/is too scary. No gripping handlebars or casually hanging out at night visiting the Coast etc...couldn't even twist my wrist to pick something from a back pocket in my cycling jersey.

Broadside is correct about finding the right dose of Allopurinol. I was referred to The Royal Free and the evaluation process took about 18 months - each time increasing, testing, increasing etc until the uric acid level in my blood had reduced to 'an acceptable level' ie: no pain!!! And bozman's bone erosion experience is a typical discovery..my thumb/ fingers broken playing rugby etc offered a sort of gateway to this pollutant - x rays of damaged and eroded bone are welcome when one's hand is the size of a bath mitt!

Allopurinol is a tablet a day for life, which I am totally happy to do - maybe because I'm a bit older and have had enough pain? - and all I wanted to do was feel strong and confident on my bikes again, as well as hold pencils, pens properly etc. This is happening, and I'm back to the normal 30 miles a day commute and even tried to ride my geared bike the other Sunday...wow, what a difficult thing! The only thing I notice is that I have a larger appetite, and consequently, being off the bike for so long, lost my conditioning. At the outset of taking a dose, the gout attacks may initially become more severe, and colchicine is taken in conjunction with allopurinol.
Anyway, back to Naproxen, and apparently it is not the ideal treatment for gout (in older people particularly) these days. I'm 62. I was prescribed Colchicine after the heavyweight attacks of recent times when I was fully expecting to get the Naproxen bombs, which can attack your stomach. Colchicine reduces the white blood cells that carry uric acid to the joints and helps 'break' the flow of uric acid into the joints.
After that, the crystals within the joints gradually disperse with the long-term use of Allopurinol. I'm happy with that so far, and have been totally relieved of pain and swelling since the end of July...who knows what is in store..?

Any form of cherry product can help with alleviating the symptoms of gout too. I did try it but it didn't do the trick for me. I have never smoked. I drink plenty - particularly red wine. At one point, I thought I had a 'trigger' in mycoprotein - mushrooms etc or perhaps tomatoes...hang on...spicy food and red chilies - as I was vegetarian for 27 years. Our little body engines are all slightly different I guess, and the best thing to do is listen to it, not go too mad, and get help if and when you need it. Stuff like gout does not go away.
Good luck and happy riding.


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## Aperitif (16 Sep 2016)

[QUOTE 4468623, member: 259"]Only time I've ever had it I wasn't overweight at all. It's bloody agony, so I really sympathise. I did take allopurinol for a bit, but then let it lapse, but it's never come back again.[/QUOTE]
Yet, Mort. Yet.


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## Paul Bromley (16 Sep 2016)

I have had gout attacks, luckily, fairly infrequently. Being a fair weather cyclist I usually stop cycling in the dead of winter. My attacks have usually coincided with resumption of cycling in March. Over the 30 years or so I have noticed the correlation. However, I have had it at other times too.

Blood tests have shown high uric acid levels but not in all cases

The way the medics put it to me was that there were 2 ways to get an increase in uric acid concentration in the blood. One was for the uric acid to really go up and the other was for the blood volume to go down

So it sort of made some sense to me that dehydration in the early weeks of resuming cycling was the trigger

A couple of years ago I tried an experiment - taking hydration tablets with my water - just the High5/Wiggle sort - thought it was working but got an attack early this year too !


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## bozmandb9 (16 Sep 2016)

Paul Bromley said:


> I have had gout attacks, luckily, fairly infrequently. Being a fair weather cyclist I usually stop cycling in the dead of winter. My attacks have usually coincided with resumption of cycling in March. Over the 30 years or so I have noticed the correlation. However, I have had it at other times too.
> 
> Blood tests have shown high uric acid levels but not in all cases
> 
> ...



Do you feel that when cycling you are suffering from a build up of lactic acid Paul? Check out this article, it seems to summarise that strenuous exercise can inhibit the ability of the body to excrete uric acid.

http://www.jbc.org/content/110/1/107.full.pdf


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## Paul Bromley (18 Sep 2016)

bozmandb9 said:


> Do you feel that when cycling you are suffering from a build up of lactic acid Paul? Check out this article, it seems to summarise that strenuous exercise can inhibit the ability of the body to excrete uric acid



Perhaps some considerable years ago that may have been true. However, I have tried to hydrate properly and haven't suffered from aching legs for a number of years. Most of my cycling have been 30 mile round trip commute to work so not too strenuous.

My episodes of gout, probably less than 10 in 30 years, haven't been classic big toe. They have been confined to the little toe with a small amount of swelling but painful none the less . Lately Colchicine has been prescribed rather than naproxen diclofenac. Seems to work.

Interestingly, I had a heart attack and subsequent cardiac arrest some 3 years ago now. I was in intensive care unconscious for 3 days. On leaving hospital I had a gout attack coming on. This compounded my belief that it was yet again sparked off by dehydration

Sorry for the late reply. Got T boned yesterday by a BMW ! bike totalled ! Am ok though -new bike time !


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## Crackle (18 Sep 2016)

As said, Cherries, cherry extract can help massively, also find your triggers and trigger foods, they will exist. Dehydration, rich seafood and soy for me. beer doesn't trigger it except if I drink regularly which is rare. It probably has caused some joint damage over the years as my toes often feel achy and if it gets bad, drugs, like alupurinol and colchicine are a must. No anti-inflammatories for me as they destroy my stomach.


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## PK99 (18 Sep 2016)

I used to suffer occasional gout attacks 20 years ago - Achilles tendon and big toe ball joint most often. Diclofenac worked to control attacks and I learnt to spot and attack 2 days out and prevent the painful crisis.

They became more frequent so went on Allopurinol. 100% effective for several years then acute attacks were almost weekly. I looked at what had changed and realised that I had recently started using a new local farmers market and it was asparagus season. I had never before had asparagus and became addicted - buying it most Saturdays. Googling identified asparagus as a high in purines. I stopped eating asparagus and have never had an attack since - still on allopurinol.

########

A "Not may people know that" fact about gout.
Three groups of people suffered from excessive gout.
The Romans
Georgian gentlemen
Americans during prohibition.

The link?
Lead - which interferes with kidney function and blocks uric acid excretion.

The romans used lead pipes and, more significantly, lead salts as a sweetener in wine.
Georgian gentlemen drank copious quantities of port kept in lead crystal decanters
During prohibition, lots of illicit small scale distillers used lead soldered car radiators as condensers


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## bozmandb9 (18 Sep 2016)

Paul Bromley said:


> Perhaps some considerable years ago that may have been true. However, I have tried to hydrate properly and haven't suffered from aching legs for a number of years. Most of my cycling have been 30 mile round trip commute to work so not too strenuous.
> 
> My episodes of gout, probably less than 10 in 30 years, haven't been classic big toe. They have been confined to the little toe with a small amount of swelling but painful none the less . Lately Colchicine has been prescribed rather than naproxen diclofenac. Seems to work.
> 
> ...



Sorry to hear of the accident, hope you're Ok. I believe that all sorts of medication has the potential to trigger an attack. I often used to get an attack after having a cold. This could be down to dehydration, but on investigation I also discovered it could be due to Lemsip!


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## Paul Bromley (18 Sep 2016)

bozmandb9 said:


> Sorry to hear of the accident, hope you're Ok. I believe that all sorts of medication has the potential to trigger an attack. I often used to get an attack after having a cold. This could be down to dehydration, but on investigation I also discovered it could be due to Lemsip!


I am ok thanks for asking. Just bruised. Could have been a lot worse. Let's not do the helmet/no helmet debate . BMW bonnet was vast acreage to land on and bounce off
Lemsip - that's an interesting observation. I haven't found my trigger other than perhaps dehydration as the attacks are happily infrequent


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## doog (18 Sep 2016)

I get this in the arch of my foot of all places...every now and then.......Naproxen nails it very quickly.

I get it when I eat Tuna.


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## lutonloony (19 Sep 2016)

My fairly infrequent attacks are usually big toe. However as I suffer from arthritis( rheumatoid ) I suspect that some of my previous "arthritis flair ups" may have been gout. My last wrist attack saw me getting an emergency appointment with consultant, who decided to draw the fluid out ( suffice to say I thought steroid injections in the wrist were painful, until I experienced that). Having pronounced that the fluid looked like an infection as is was milky green, after tests decided it was gout. Have never suggested alupurinol though. Am due a visit to rhummy clinic so may enquire


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## lutonloony (19 Sep 2016)

Paul Bromley said:


> I am ok thanks for asking. Just bruised. Could have been a lot worse. Let's not do the helmet/no helmet debate . BMW bonnet was vast acreage to land on and bounce off
> Lemsip - that's an interesting observation. I haven't found my trigger other than perhaps dehydration as the attacks are happily infrequent


Glad to hear you bounced, although obviously not that you hot a chance to try.


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## Aperitif (20 Sep 2016)

I might add that, for a new dosage/ regime etc I stopped taking an Allopurinol at 'night' and instead started taking first thing in the morning. Coupled with this would be a massive increase in the consumption of...
water, In amateur physician mode, I might think that drinking water - even when you don't fancy - can help. I used to do a 200 miler with barely a bidon, or seven hours in The South of France with hardly anything. Water is THE drug that cures.


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## MickyMickster (30 Sep 2016)

I have suffered with gout. Doctor finally put me on Allopurinol ! I need to shed some pounds aswell. Also drink lots of water.


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## Daddy Pig (1 Oct 2016)

I am also a gout sufferer, having gone to the doctors thinking I had a broken toe!

Since losing weight 18.12 to 16.10 (6 foot 1 inch tall) over the last 6 months I have not had an attack. I used to get them quite often, at its worst probably twice a month, and for me I think that dehydration and disturbance to the big toe plays a significant part in my episodes. I used to play badminton 3 times a week and go to the gym regularly and spend time on a treadmill - this was when I had the most attacks.

I was on allopurinol but have lapsed and not had any issues for the last 3 months (when most of the weight has come off). It may also be the new healthy diet plan... less ale, red wine, red meat and eating more veg and lean protein and drinking plenty of water. I have also massively reduced adding salt to food (thanks to a little one at home) which is also a possible help.

For me, cycling has been great as it does not disturb my big toe joint like other sports and along with the new diet... a change in lifestyle has helped significantly.

I also have ibs which means that anti inflammatory and colchicine are not great (unless I want to lose weight quickly!)

You need to find what your triggers are, but if there is room to improve your diet then this will help. Good luck...


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## Salty seadog (13 Oct 2016)

I have gout attacks in my big toe on my right foot, infrequent, maybe once a year or so. It starts with a strong dull pain under the big toe and then after a day or two with a progressivly worsening limp I could hardly walk anymore. These attacks lasted about 3-6 days. I saw the doctor four times before they diagnosed gout (albeit without any testing) and gave me colchicine. Now as soon as I feel an attack I start taking them and the symptoms never get to those levels and it is just a dull pain which is gone by the next morning. I only feel the pain when walking on the foot and there has never been any noticable swelling or redness which I am glad about when I hear about the never ending pain some people experience.


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## cycletechuk (22 Oct 2016)

Hi, I also suffered from gout for nearly 20 years, now I only have pain from long walks, cycling has helped. as I not had gout flare up in 3 years 
Can I ask some questions?

Do you suffer pain anywhere else? (fingers, shoulder, knee, hip etc.....)
Do you suffer from migraines? 
Any numbness? (pins and needles)
Do you suffer from gum disease? (Bleeding gums) 
Diabetic? 

Thanks for your time
I would like to hear back and also I will give you my findings, from what I learnt 3 years ago


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## galaxy (26 Oct 2016)

My first Gout attack woke me up in the night, i had to through the duvet of my knee it was so painfull. Holding my hand about a foot away i could still feel the heat. I had a few attacks prior to becoming type 2 diabetic, so, yes mine was self inflicted, but not everybodys is. 
I was on holiday in the Cotswolds when the next attack came on, it was so severe i had to go to the Dr. He prescribed a old cure that is very severe, you basically take 2 tablets, every hour untill you throw up, apparently clensing your system, then the Gout eases.


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## mikeymustard (27 Oct 2016)

I had a couple of episodes of gout in my left big toe that I thought was a mechanical injury, until about ten months ago it came on so bad it was obvious what it was; naproxen helped but once I stopped taking it, the gout would come back again.
I finally got rid and haven't had another episode so far, though I think there's a little damage in he joint. I don't know what triggered it if anything.
@galaxy when you say 2 tablets every hour are you referring to colchicine?
You might want to look at this


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## T4tomo (27 Oct 2016)

This comes highly recommended 

http://www.cherryactive.co.uk


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## Crackle (27 Oct 2016)

T4tomo said:


> This comes highly recommended
> 
> http://www.cherryactive.co.uk


I mentioned cherries earlier: There is actually a decent study which showed that cherries in conjunction with alupurinol cut down the risk of a gout attack by a percentage, I forget what but it was significant. I have found that cherry extract just by itself is a huge help. I don't always take it but if I feel an ache developing I do. Anecdotally, I find it makes a difference, to the point that if I hadn't discovered it, I'd probably now be on alupurinol permanently, though it was a close run thing this summer.


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