# Gout



## martint235 (1 Oct 2012)

So, I've suffered from gout for around the last 5 years or so. I quickly discovered the myth about port/red wine etc causing gout (it doesn't) but I found that lager/beer could bring on an attack if drunk in sufficiently large quantities (around 24 pints/cans in a weekend). However I haven't had any alcohol for over 2 months and have just suffered one of my worst gout attacks (in my wrist/hand) which put me off work for two days.

A visit to the doctor and some internet research has suggested that my recent intake of sugar (large bags of Haribo, Jamaican ginger beer) could be the cause. Depending on the website you read, fructose may or may not be a trigger.

Now having given up alcohol, being asked to also give up sweets seems a tad harsh (all I've got left is coffee!!). Does anyone else suffer gout attacks and have advice on other triggers etc. At the moment, allupurinol is out (I manage each attack as it comes).

TIA


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## ClichéGuevara (1 Oct 2012)

I get it in the joint of my big toe. 

It's only this year it's flared up enough to the point I had to work out what it was, before that I now realise it'd been building for a while and I ignored it.

It's trial and error, but I reckon fizzy drinks are a trigger, which isn't a problem as I only drunk them out of laziness when my daughter leaves them kicking about, but the other trigger seems to be chilli's, which I love and think helps with my diet.

When I feel the gout coming on, I have a spoonful of bicarbonate of soda a couple of times a day and that seems to ease it off.


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## Linford (1 Oct 2012)

You might be interested in this article

http://www.bbc.co.uk/news/health-19746453


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## martint235 (1 Oct 2012)

Linford said:


> You might be interested in this article
> 
> http://www.bbc.co.uk/news/health-19746453


 Yep seen that. I actually have a cherry tree and have eaten cherries as a mitigation in the past. However one website (typically one I can't find now) claims that the fructose in cherry juice can bring on an attack of gout.



ClichéGuevara said:


> I get it in the joint of my big toe.
> 
> It's only this year it's flared up enough to the point I had to work out what it was, before that I now realise it'd been building for a while and I ignored it.
> 
> ...


 Yeah I've had a lot of fizzy drinks since I gave up alcohol and think it may be a trigger. Not sure about chillis as yet as I've not had any recently but do tend to add chilli powder to quite a bit of stuff.

Btw in case you didn't realise, just because it affects your toe now, I've found it change to other joints although it does favour the ones in your feet. I've had it in my hip and this last attack in my wrist.


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## buddha (1 Oct 2012)

Another gouty here!
Started 10 years ago. Never been excessively overweight, and reasonably fit.
Though, thankfully, have been free from an acute attack for almost 2 years.
As well as beer, dehydration is your enemy. Cherries, strawberries and apples and suchlike are your friends. I'm sure you've seen the stuff all over the interweb.

edit: I've read it's the stuff just under the skin of red fruits that's good - forget what it's called. But that's what things like Cherry Active tablets are made from IIRC. Never tried them though,

"An apple a day", as they say. And lots of water.


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## VamP (1 Oct 2012)

You don't say why alupurinol is out, but the way I manage is VERY irregular use of alupurinol, probably less than one tab per month on average, as a way of occasionally lowering my body's concentration of uric acid. This works very well and I have not had an attack in over three years. Previously I would have an attack once or twice per year.

Mind you I have also lost a lot of weight, and dramatically improved my diet, and cut back on alcohol over the same time, so my evidence is purely anecdotal.

How do you manage attacks BTW?

I used to go to GP and get anti-inflamatories prescribed, but a physio friend suggested rather than waste time that way, best just to hit it as soon as it materializes with maximum dosage ibuprofen and paracetamol combined.


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## Linford (1 Oct 2012)

FIL has gout. IIRC He said it was caused by the formation of uric acid crystals in the tissues. Sopunds painful, and that good hydration levels will help


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## martint235 (1 Oct 2012)

VamP said:


> You don't say why alupurinol is out, but the way I manage is VERY irregular use of alupurinol, probably less than one tab per month on average, as a way of occasionally lowering my body's concentration of uric acid. This works very well and I have not had an attack in over three years. Previously I would have an attack once or twice per year.
> 
> Mind you I have also lost a lot of weight, and dramatically improved my diet, and cut back on alcohol over the same time, so my evidence is purely anecdotal.
> 
> ...


 Alupurinol is just me really. It just doesn't seem right to take a tablet every day when there are other ways to prevent it. I know this probably doesn't make sense but I see it as a "Because I take alupurinol I can eat whatever I like" rather than changing what I eat.

I have stocks of indometacin and meloxicam that I start taking as soon as I feel the onset. Meloxicam has so far been pretty effective for clearing it up in a couple of days. However I didn't initially register this last attack as gout due to the change in joint (it was the same when it attacked my hip at Xmas)


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## martint235 (1 Oct 2012)

Linford said:


> FIL has gout. IIRC He said it was caused by the formation of uric acid crystals in the tissues. Sopunds painful, and that good hydration levels will help


 It is incredibly painful. Hydration does help and I know I'm bad at it. Coffee also helps as being a diuretic it keeps the fluids moving around the system.


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## GrumpyGregry (1 Oct 2012)

Shouldn't you be taking daily NSAIDs by way of prophylaxis?


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## martint235 (1 Oct 2012)

GregCollins said:


> Shouldn't you be taking daily NSAIDs by way of prophylaxis?


 See above Greg. It seems like a cop-out (probably completely irrationally) to take a daily tablet if I can manage it in other ways. My brother takes alipurinol daily and seems to get by ok although he does still get the occasional attack


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## PK99 (1 Oct 2012)

martint235 said:


> So, I've suffered from gout for around the last 5 years or so. I quickly discovered the myth about port/red wine etc causing gout (it doesn't) but I found that lager/beer could bring on an attack if drunk in sufficiently large quantities (around 24 pints/cans in a weekend). However I haven't had any alcohol for over 2 months and have just suffered one of my worst gout attacks (in my wrist/hand) which put me off work for two days.
> 
> A visit to the doctor and some internet research has suggested that my recent intake of sugar (large bags of Haribo, Jamaican ginger beer) could be the cause. Depending on the website you read, fructose may or may not be a trigger.
> 
> ...


 

I've been on a daily tab of allopruinol for 10+ years after a series of very painful gout attacks - the weight of bedsheets on my foot was impossible to tolerate, walking was impossible etc

Since then, I have rarely had an attack except for a period when i had one a week for several weeks - a bit of googling identified asparagus as high in purines and a trigger for some, and i had just discovered asparagus at the loacl farmers' market as was buying every weekend. I cut that out and the gout dissapeared again.

Prior to allopurinol, i learned to recognise the first symptoms (vague but distinctive tingling around the affected joint in my foot) and was able to reduce the severity of the attac using diclofenac 75mg.

I drink too much beer and red wine and main line Lion midget gems - none have any affect on the gout. if you read the interweb you will find almost everything identified as a potential trigger but for each individual there are specific triggers - giving up alcohol and sugar my for you be entirely futile!

Incidentaly - the romans sufferd from gout, so did Georgian Gentlemen and so did many booze drinkers in the US during prohibition - the link?

The romans had lead pipes and sweetened their wine with lead salts; Georgain gentlemen kept their port in lead crystal decanters; bootleg distellers used car radiators for cooling and the raditors had Lead soldered joints. The cause: Lead disrupts the kidneys' excrtetion of uric acid, the build up gives gout!


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## GrumpyGregry (1 Oct 2012)

martint235 said:


> See above Greg. It seems like a cop-out (probably completely irrationally) to take a daily tablet if I can manage it in other ways. My brother takes alipurinol daily and seems to get by ok although he does still get the occasional attack


Aged P was on allopurinol and a daily dose of 'profen when he had it. He changed his diet for other reasons and he hasn't had an attack in years.


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## martint235 (1 Oct 2012)

Cheers PK. Alcohol has been given up for other reasons. Similar to your asparagus though, if you look back through my diet over the last couple of months, the sugar intake has climbed and climbed whilst everything else has remained fairly static hence the finger pointing at sugar. It could be brown bread too and that's next in line for the chop (can't say I'll miss it, I prefer white but SWMBO prefers brown). 

I agree with what you say about the interweb. About the only thing it's consistent on (thankfully) is that coffee is relatively good.


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## Broadside (1 Oct 2012)

I have been on daily Allopurinol for the last 3 years, prior to that I was suffering a serious gout attack every 2-3 months. I figured that daily medication was better than joint damage following each attack. I don't fit the profile of what gout sufferers used to be pidgeon holed as - I am 6ft and 75kg.

I never got to the bottom of the cause of my gout though I did try a lot of elimination stuff, I completely cut out things like alcohol, tomatoes, red meat, cut back on fructose, all the usual stuff really. After I went on the daily Allopurinol the attacks cut back to once or maybe twice a year, treated with a heavy weight NSAID, ibuprofen does not come near to touching the pain or reducing the swelling. Since that I have practically cut out yeast from my diet, i was previously a big fan of Marmite and lots of crisps a lot of which are flavoured with yeast extract. Since cutting right back on the yeast I have not had an attack since so it is staying out of my diet, but I can't say I have proved it for sure.


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## martint235 (1 Oct 2012)

I've heard about the possible link to yeast extract (which corresponds to drinking lots of lager too I suppose) but apart from beer I've never been a particular fan of yeast.

I'll be seeing how things go with the sugar reduction, then as I say brown bread is next on the list.


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## PK99 (1 Oct 2012)

dmoran said:


> I have been on daily Allopurinol for the last 3 years, prior to that I was suffering a serious gout attack every 2-3 months. I figured that daily medication was better than joint damage following each attack. I don't fit the profile of what gout sufferers used to be pidgeon holed as - I am 6ft and 75kg.
> 
> I never got to the bottom of the cause of my gout though I did try a lot of elimination stuff,.


 
Genetic predisposition is the *root* cause.

Yep, marimte/yeast extract is a trigger for some - but not foe me, fortunately as cheese, cucumber and marmite sandwiches are to die for


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## Dommo (2 Oct 2012)

I've suffered from gout over the past five years and the main trigger I've found is dehydration. I can't stress enough how much of a difference it makes to knock back a few litres of water each day... Another important point, fizzy drinks have loads of CO2 which is acidic but I also found that diet versions of these drinks are far worse... After I suspected it, I swapped from Coke Zero to full fat Coke (and dropped the amount) and found it lessened the attacks considerably. Nowadays I try to avoid fizzy drinks in general - except beer and cider - another point there - Cider is much more gout-friendly than beer.

I'm of the same mind that I'm trying to avoid allupurinol since I do seem to be *mostly* able to control it by ensuring I stay well hydrated. If I detect the tinglings of a flare up I hit it with NSAIDs.


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## martint235 (2 Oct 2012)

Dommo said:


> Cider is much more gout-friendly than beer.
> 
> .


While I was still drinking I did look into these things. Guinness is apparently the worst thing you could drink if you suffer gout. Cider is very good though, very little purines and yet enough fluid to keep all the plumbing ticking over at a healthy rate.


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## mrandmrspoves (2 Oct 2012)

Gout is a really distressing condition that Is often assumed to be caused by indulgent living. As has already been indicated dehydration will trigger gout which is caused by build up of uric acid. So as alcohol causes dehydration it is best avoided.....or at least mitigated. By this I mean work on the basis that if you drink 2 pints of beer you will pee out 3 - so aim to drink at least a pint of water for each 2 of beer. This is not very exacting and different beers have different alcohol contents - so just a rule of thumb. Apply the same for other alcoholic drinks. The biggest cause of gout that I add are diuretic tablets such as Furosemide....same effect of causing dehydration. So bearing this in mind think about your hydration regime when out on your bike.....and don't make the mistake of thinking you don't need to hydrate in the winter months....all that steam coming from your breath is moisture lost! Allopurinol is quite effective at preventing attacks of gout....but paradoxically can worsen an attack if initiated during a flare up. The rule is, if already on it stay on it...but if not already on it, don't start it until the attack has resolved. Non steroidal medicines such as Diclofenac or Ibuprofen are very good at damping down an attack of gout but these Medicines are very acidic and can lead to gastric ulceration so should not be taken long term unless prescribed for a chronic condition. Hope this is helpful....


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## Enigma2008 (5 Oct 2012)

I had an attack in my second toe just over a year ago. Not nice at all. After the customary research into the triggers it would seem I hit most of them just before the attack.
A hilly time trial on Sunday morning, fructose in the event and post event drink, beer in the evening followed by red wine with dinner which was a lovely Lamb Shank (red meat) all of which contributed to dehydration of some degree. Early hours of Monday morning, ignored niggly pain in toe and got up for a pee!!!
That was it folks, no more sleep that night, trip to A&E next day thought I'd broken my toe somehow. Sent to Docs for blood test and pain killers, two weeks later the diagnosis was 'probably gout', without drawing fluid from the inflamed joint a firm diagnosis isn't possible. Bugger that!!


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## PK99 (5 Oct 2012)

Enigma2008 said:


> That was it folks, no more sleep that night, trip to A&E next day thought I'd broken my toe somehow. Sent to Docs for blood test and pain killers, two weeks later the diagnosis was 'probably gout', without drawing fluid from the inflamed joint a firm diagnosis isn't possible. Bugger that!!


 
my GP said that a good diagnostic tool for gout is to lie the patient on the bed and the doctor moves his hands toward the sore bit - if it is gout the patient flinches long before the hands are anywhere near the sore bit!


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## martint235 (5 Oct 2012)

PK99 said:


> my GP said that a good diagnostic tool for gout is to lie the patient on the bed and the doctor moves his hands toward the sore bit - if it is gout the patient flinches long before the hands are anywhere near the sore bit!


You've not met my doctor. I tend to flinch even when I've just got a cold! 

Seriously, gout is very, very, very, very, very, very painful!!


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## ASC1951 (5 Oct 2012)

I've had three crippling attacks in the last five years. i'd never had it before, nor had any relatives. In my case dehydration and excessive protein tipped me over the edge, but a change in diet plus losing a few pounds has seen me gout-free for nearly two years and possibly forever.
As KP99 says, it's fundamentally a genetic predisposition. So if you are marginal, as I was, a normal weight and diet should see it off, without resort to any magic/Satan food mumbo jumbo. If your genes are against you, though, you can alleviate the symptoms but it is an incurable condition. Useful summary here, of course http://www.nhs.uk/Conditions/Gout/Pages/Introduction.aspx


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## PK99 (5 Oct 2012)

martint235 said:


> Seriously, gout is very, very, very, very, very, very painful!!


 
You are understating it!


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## SteveBM (7 Oct 2012)

Fellow gout sufferer here, although I haven't had an attack for 3+ years now

My "cure" is Cherry Active tablets, taken in a high dose shortly before and during an attack and 2-3 tablets per week at other times. In common with others, dehydration is my trigger. I try to drink 6 pints of water per day as well as alcohol only in moderation

I've also found that shoes/trainers with poor instep/insole support are a cause too, so get seine moulded insoles, which are readily available on the web

I can really sympathise with you. I know how painful this is for you. I hope what works for me might work for you too


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