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Hi, glad to discover this forum, some great information here.
I was first diagnosed with gout eight years ago at age 41 after using ill-fitting ski boots for a couple of days. I was able to keep gout at bay by eating mostly vegetables and fruits, eliminating red meat, and decreasing other meats and high purine foods to the point that I only had one really major attack after the first one until 7 weeks ago. All my attacks, major or minor, seem to be triggered by a combination of dehydration, beer (even a small amount), and certain types of shellfish (or injury / joint stress, as with the ski boots), though I would also not get attacks under the same circumstances as well. I’ve treated minor attacks with colchicine (once or twice a year at the most), which has subdued major outbreaks, as the two times I was late to start on colchicine, were exactly when I’ve had major attacks.
While I am currently in little pain, gout symptoms and intermittent acute episodes have persisted for 7 weeks now, which is 5 weeks longer than any other attack I previously had (even the highly painful 1st attack), though I have really only been in pain about 4 days of this time, and more minor pain about another 4 days of this time. I did go full vegetarian at the onset of this attack in order to just reduce higher purine foods, lose 30 lbs of extra weight, and be healthier. This has resulted in weight-loss at a rate of about 5 pounds per month (which may one factor prolonging this current episode).
Nevertheless, the duration of this recent attack, movement of gout through a number of joints during the attack, and multiple acute episodes over this period (1st time it has moved around substantially and the 1st time it has flared in multiple joints for me), and persistent swelling even after the pain has subsided has me agreeing to allopurinol treatment. My uric acid level is 6.8, so it would seem I am still on the cusp of being able to continue to treat my acute attacks with colchicine and prevent attacks through diet, as I had been, and with weight-loss. But I am concerned buildup of crystals may be a key factor in the increased symptoms, duration of this attack, and progression of gout, so will no longer try to treat it without ongoing medication. My doctor and a number of the more respectable web sites on gout indicate that I can dissolve crystals by getting my uric acid under 6.0, but I see lower numbers have been mentioned here. I mentioned this to my doctor and she stood firm on 6.0 saying this was the proven target. Should I be concerned that this isn’t low enough to dissolve existing crystals and eliminate persisting current symptoms? Can you point me to any studies on this?
THINGS THAT HAVE HELPED REDUCE THE NUMBER AND SEVERITY OF ATTACKS FOR ME
– Lose excess weight (less extra weight, less episodes)
– Exercise at least 30 minutes daily 5 times a week (good for everything)
– Treat acute attacks with colchicine early (and for many, the attacks won’t get too painful and will go away in as little as 24-48 hrs)
and most key:
– Drink 2 liters of pure water daily in addition to water you take in, in 100% juice, tea, or coffeeFOODS
– Get 75% of your food intake from whole fruits and vegetables, 15% from proteins, preferably vegetable protein (fake soy meats, tofu, beans, spinach if you can – as they are easier to process than animal proteins), 5% from whole grains, and 5% from fats (including low-fat dairy like non-fat yogurt and low-fat cheese)
– Choose nutrient-dense foods for overall health
– Decrease sugar and salt, and be sure to limit fats
– Don’t binge on meats, seafood, sugars, or coffee
– Eat cherries or drink 100% pure cherry juice during attacks, and 1 8oz glass a day for prevention when not having attacks
– Get a Vitamix or similar high-speed blender to break down the cell walls of foods so you can absorb more nutrients and keep food fiber with your liquids and add a world of tasty smoothies to your diet. I do one of strawberries, blueberries, blackberries, banana, goji berries, cacao, maca, hemp seed, flax seed, spirulina, coconut oil, soy milk, and nuts about 5 mornings a week. And I do one of carrot, celery, cucumber, beets, kale, pineapple, maybe some melon or pear, and water and ice about 4 evenings a week. 2 other evenings I just make one up from different combinations of vegetables and fruits. These are great gout preventers and fighters during attacks
– And of course, avoid fairly universal triggers / risk increasers like organ meats, shellfish, beer, and high fructose corn syrupGood luck to everyone!
The only time you should settle for 6 is if other health problems, usually kidney disease, stop you getting it down to 5.
5 is the safe upper limit recommended by professional rheumatologists in America (http://www.goutpal.com/4235/taking-gout-guidlines-to-task/) and Britain (http://www.goutpal.com/gouty/gout-information/gout-pdf/gout-management-recommendations-uk/). If crystal deposits have left to increase over several years, then it makes sense to aim lower than 5 for at least one year. This reduces the period of time you are in pain.
If your genetics are against you, it might never be possible to achieve 5 with dietary means alone. In my opinion, it is good to aim for beating gout through lifestyle improvements as long as you accept that it might not be possible. It takes many months, if not years, before you can get uric acid low enough. Therefore, it is wise to take allopurinol for a year to clear out as much of the old crystals as possible. The sooner you do that, the more chance you have of joint recovery without surgery.
As far as fluid intake is concerned, it is better to be flexible, accounting for temperature and exercise. You might need less than 2 liters on a cold inactive day, and more on a hot, active day. Coffee is good for gout (http://www.goutpal.com/gout-diet/gout-diet-foods-to-eat/coffee-and-gout/).
There is evidence to suggest that tomatoes are good for gout, and less evidence to suggest that edamame beans are (http://www.goutpal.com/gout-diet/gout-food/).
It looks like there is a difference in approaches in various regions. I notice the American College of Rheumatology (ACR) lists <6mg/dL as the minimum number to target, and that 5mg/dL “may be needed to improve gout signs and symptoms.” Whereas the British Society for Rheumatology (BSR) clearly says 5mg/dL. I will bring the following passage from the BSR to the attention of my doctor and see what she says:
“A number of investigators have examined both threshold and target concentrations of plasma urate in the treatment of gout [129?131]. One rather strict goal has been to reduce plasma urate concentrations to, or below, the median concentration for men [32]. In the UK today this is <300 umol/l (using a specific uricase assay; non-specific colorimetric methods give higher values). The goal of this is to prevent acute gout, tophus formation and tissue damage. Reduction in plasma urate to this degree, has been shown to be associated with reduction or elimination of intra-articular microcrystals of monosodium urate that otherwise persist even in symptomless patients; suggesting some reduction of the total body burden of accumulated urate. Cohort studies [130, 131] have demonstrated a reduced frequency of subsequent attacks in those that achieved lower plasma uric acid concentrations (<360 umol/l). However some patients, even with such low levels, suffer further attacks. Conversely, attacks may remit without reduction in uric acid concentration [132], and in some of those withoutattacks, uric acid crystals are still present within the joint [133].”
Unfortunately, I do not see a specific number from the Mayo Clinic, whose overall gout treatment and diet guidelines I follow, or from the University of Maryland Medical Center, which also makes good recommendations on treatment, diet…
Well, I thought I had been fairly effective in treating the gout with diet, exercise, and lifestyle considerations the past 8 years considering I only had 2 major attacks over this period. Clearly though, the duration of this recent attack, movement of gout through a number of joints during the attack, multiple acute episodes over this period, and persistent swelling indicate that the gout has progressed. Symptoms finally seem to be letting up, but I am reluctant to return to the same treatment plan if crystals are just building up and doing damage while I am symptom-less. So, I am definitely starting on the allopurinol this week. I just want to make sure the target SUA level is correct.
Thanks for the studies. I’m good with coffee and tomatoes and treat soy as protein. But like other gout sufferers, I’m always looking for things that will make a substantial difference.
In an interview that I have lost the link to, one of the rheumatologists on the American guidelines team sought to clarify ‘less than 6.’
He said that 5 was the optimal target, but 6 might be acceptable where kidney disease or other health problems prevented lowering to 5.
If anyone can help me find that interview, I will be extremely grateful, and I will amend my article accordingly.
I am surprised. My doctor actually thanked me for the link to the British Society of Rheumatology gout guidelines and agreed to the 5.0 target. I was going to start on allopurinol this week, but since my acute attack(s) are finally subsiding, I will start next Monday (as the BSR advises). I will also be continuing all the lifestyle changes I made, e.g., going completely vegetarian, drinking more water than I used to… I will report on how tolerable the allopurinol is, if I continue to get attacks, and what my uric acid level is every couple of months.
Thanks @g-man. I look forward to your updates.
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