Once the disease of gluttonous aristocrats, gout is now tormenting the masses
nytimes.com
nytimes.com
Once diagnosed, doctors are quick to get you on daily drugs for the rest of your life. While these help, there's a price to be paid in liver damage from chronic medication.
I spent the next ~8 years bouncing from attack to attack despite the drugs, sometimes every few weeks, sometimes months would go by. Finally around 2012 I stumbled on the work of Robert Lustig (UCSF medicine professor) and particularly this talk (not about gout, but touches on it):
https://www.youtube.com/watch?v=dBnniua6-oM
Fructose is processed by the body into: uric acid. Finally light bulb moment! I hardly ate any of the things traditionally associated with gout (red meat, shellfish) so couldn't modify my diet based on those. But fructose? Yes, turns out I was consuming way too much.
I drastically cut back on fructose, limiting myself to no more than 10g/day. I have been gout-free now for 7 years. I don't take any gout drugs anymore. Just avoid fructose at all cost.
Replacing some fruit with vegetables instead, and choosing less sweet fruit like various berries or melons may be a good idea for most people.
Meanwhile, almonds and bananas aren’t the things making people fat. Looking at my own fat friends, some tasty fruit is the only fiber they even get.
And vegetables aren’t even on the menu of most fat people I’ve lived with. Don’t discourage the only healthy habits people do have.
Look at the the actual diet of an obese / fatty liver / type2 person and you’ll see how silly this advice is. It ain’t the fruit.
And I know it's not the same thing, but the number of times our small kids get offered juice as a "healthy" option when it's got almost as much sugar as soda... I think it's a real phenomena that certain things have a reputation for being much healthier than they are and it causes problems.
However, some fruits and vegetables are particularly important for their fiber content even if you can't get rid of the fructose.
Things like inulin or resistant starch are very important to avoid having too many Bacteroides and too few Bifidobacterium, which is one of the big differences in westernized human guts vs more traditional ones.
If you've got someone eating an unhealthy diet, but sticking some token fruit in, then that means that even their token nods towards good diet aren't as good as they think, and they should be made aware of that.
This thread isn't about being fat, it was about gout.
I've never been fat but had plenty of gout attacks. Back when I was getting my worst gout attacks I was in the best shape of my life but the problem was I was consuming too much fructose. From a combination of drinking fruit juices (a single glass can have more than my limit of 10g/day!) and not paying enough attention to sugar content of regular foods. When I finally started adding it all up I was easily reaching 100g of fructose per day.
Yes! Juices and smoothies are bad for you. Eat fruit in solid form only, to make your digestive system work harder (as designed), and slow down your rate of calorie ingestion.
It's getting harder and harder to find fruit that hasn't been bred to maximised sugar content, though.
I always assumed he ate healthy food, since he always made an effort for it.
When his medic reviewed all his food choices... the issue was actually fruit, in particular various kind of oranges, my grandpa just loves oranges and will eat them often, several per day.
Fruit juice contains a lot of sugar; Oranges contain a lot of sugar;
Make sure you check how much calories you take in regardless of the food.
A good understanding of food healthiness is to understand what you are eating.
It’s far harder to go wrong with whole fruits.
"Make sure you check how much calories you take in regardless of the food."
It's such a shame our reflex is that if somebody responds to something they must be disagreeing.
I think a more precise way to say this is:
Due to the water and fiber in fruit, they tend to be more satiating than eating something like a chocolate bar on a calorie normalized basis.
But in the case of fruit w.r.t. gout, the missing variable here is that while fructose increases the production of uric acid, potassium promotes the excretion of uric acid [1], and fruits are generally an excellent source of potassium while soft drinks contain little to none. The net effect of fruit on gout risk seems to be inconclusive [2] but it's clear that fruits are much less concerning than foods with added fructose. Since a significant fraction of Westerners do not consume enough potassium [3], and potassium is key to preventing hypertension and stroke [4,5], it is bad advice to suggest reducing fruit consumption for most people, unless you're already eating like Steve Jobs.
1: https://www.sciencedirect.com/science/article/pii/S008525381...
2: https://academic.oup.com/rheumatology/article-abstract/58/7/...
3: https://www.sciencedirect.com/science/article/abs/pii/S02709...
4: https://link.springer.com/article/10.1007%252Fs11906-011-019...
5: https://www.thieme-connect.com/products/ejournals/abstract/1...
Specifically glucose, fructose, sucrose, are worth treating differently for the purposes of diet management.
>> That’s a very simplistic way of looking at things which isn’t supported by medical science.
I agree with you on this one but from what I've heard, it is likely that fruit juices and smoothies are not fruits either. If that is correct, the message can get very muddied.
>> Specifically glucose, fructose, sucrose, are worth treating differently for the purposes of diet management.
Now we need to not only treat different sugars differently, we also need to treat the delivery methods differently as well. At some point, the message just becomes too complicated.
Not really. The original comment in this chain talked about processed foods vs unprocessed. Fruit juices are fairly obviously processed so this rule works for them too.
When people talk about sugar like this they are talking about fructose. Bringing glucose into it confuses people since it is scientifically sugar, but not what people mean when they talk about eating sugar, which is just eating sweets, soda, juice, etc.
I believe people are actually usually talking about sucrose, which breaks down into equal parts fructose and glucose v early in digestion.
Glucose is also a monosaccharide.
"sugar" (table sugar, maple syrup, etc) are mainly sucrose, which is one part fructose and one part glucose (joined together, into a disaccharide)
I agree that fructose is the troublesome part of this pair. But when people say "sugar", they aren't referring to fructose, they're referring to sucrose.
If you eat apples, you hit limit soon. Apples also do not work all that much if you actually need quick energy when doing something straining. It does not have that "immediately feel better" effect (which motivates you eat more and more).
Fiber with sugar is not the same as pure sugar.
I’m not sure there are any studies demonstrating what you claim.
Its 'healthier' to consume the same amount of sugar through fruits than through pure sugar due to its being easier for your body.
It does not change your calorie intake at all as its the same amount.
Glossing over what an insulin spike makes your body do with those calories is a bit disingenuous.
The most common and pervasive misconceptions about nutrition use the extremely simplistic view of it, believing that in the end all matters is that you end up with N grams of say sugar.
The effects on the body of consuming an apple versus the equivalent two table spoons of raw sugar are not even remotely similar.
That is the point i made and still make.
There isn’t a study that shows the outcomes are equivalent . I have no idea where OP got his conclusion that fruits are an issue.
Yes, keeping an eye on glycemic index or FODMAP for people with metabolic disease works but I can’t find studies showing that you can eat so much fruit to get diabetic or gout.
Here
> I drastically cut back on fructose, limiting myself to no more than 10g/day. I have been gout-free now for 7 years.
This is starting to resemble a political thread.
> Studies also have shown that high-fiber foods may have other heart-health benefits, such as reducing blood pressure and inflammation. Helps control blood sugar levels. In people with diabetes, fiber — particularly soluble fiber — can slow the absorption of sugar and help improve blood sugar levels.
Seems like it impacts time to absorb
If you want some idea of how bad it is: monkeys get diabetes from bananas now
https://www.independent.co.uk/news/uk/home-news/monkeys-bann...
Edit: I just did napkin calculation. Sedentary 170cm high male weighting 66kg would need to eat 20 apples a day to keep his weight. Or 3600 grams per day. The shocking high sugar content still means nearly uneatable quantity of apples just to get enough calories for rather small office worker who does no sport.
And we are talking about people who are obese, they are consumgint oo many calories per day, every day.
Now lets take a real example: obese people tend to drink juices and replacing soda with juice because they assumed juices are healthy.
I can easily drink 2 liters of water or 2 liters of juice/soda every day. 470 calories for 1 liter -> 900 calories additional.
easy
I am 100% confident that pearl clutching over need to replace fruit by vegetables else people will be obese is really not even close to why people get fat.
I myself stoped drinking soda because of it; Its surprsing how quick you consume extra calories due to needing caffeine.
I see people drinking smoothies thinking they are the healthy choice not realising a smoothie has more sugar in than a Coke. They are not even a good post-surf recovery drink for the surfers who invented them and gave them the infantile name!
Also, it would be 350g of dark chocolate for my hypothetical guy.
Challenge Accepted.
While vegetables are often superior to fruit for the reasons you indicate, if your diet contains neither then you could still consider fruit a 'step down' from the ever-popular refined carb snacks. Most fruit contains enough fiber to help you feel more satiated than a refined carb snack would.
Here's one list of fructose content per type of fruit. I mostly stick to the ones with least fructose:
http://nograiner.com/ingredients/fructose-content-common-fru...
Thanks for sharing.
Fortunately, vegetables are even healthier for you, and don't have significant levels of fructose.
Suppose I'm from a country that does not have fruits. How do you convince me to start eating them from a health perspective? Fibre is in vegetables and I'm not too keen on increasing sugar intake for no reason.
The overall quantity of sugar may be roughly equivalent, but the glass of juice is going to hit your blood stream almost as fast as a can of coke. Probably as fast since a typical bottle of fruit juice is running about 20 calories more than a soda.
Also PSA: Watch out for apple juice in your 100% fruit juice. It is at this point a very old industry trick to use apple juice that's concentrated, increasing the sugar content drastically. If you got a press and juiced your own apples, it would taste like flavored water to you compared to the 'worst' case in bottled juices.
When all you really need is an 8oz glass of tart cherry juice per day [0]. If you have "trigger" foods [1], then those still need to be avoided, but the cherry juice will allow you to enjoy a normal, non-excessive diet of pretty much everything else.
[0] Sweet cherry juice works too, but you need a lot more of it, to the point where it would be excessive and unhealthy.
[1] By trigger foods, I mean those that will cause a gout attack regardless of how much is consumed. For me, it's spinach - as little as one leaf will make my toe sore for a couple of days. Most people never learn their trigger foods, so consider yourself lucky if you know yours.
I had my first gout attack in my mid-40s - I'm pretty fit and not noticeably overweight (lots of cycling) and got a foot pain that I thought was a small broken bone or some-such. My GP had one look and realised it was gout (red inflammation is a giveaway). Anyway, I just took Ibuprofen and lots of liquid for a few days and it went away.
I've had a few minor bouts of it that seem to be brought on by either eating asparagus or mackerel or not drinking enough water, so I tried the cherry juice for a while which seemed to work. After a year or so of that, I thought I'd just try drinking more water instead - that works most of the time though I did have a minor gout episode just last week.
Also, it's not precisely advice for gout, but cherry juice has also been studied [2] for pain relief.
My long term outlook however remains uncertain, and I will likely be doing semi-annual hematology profiles for the foreseeable future (my rheumatologist wants to have long term data on uric acid levels.)
I hope this serves as some relief for anyone who has been recently diagnosed and is looking for positive reassurance about the changes they’re considering for themselves. YMMV.
Still, I had no further symptoms for several years. Then I had another, then it became a yearly thing and now I'm on Allopurinol permanently.
My doctors insist that I cut down my drinking (I don't drink), my consumption of red meat (some, but not much) and a variety of other things which mostly don't apply to me.
It's in the family history - everyone on the male side of my family going back generations has had it. A great-something grandfather had attacks so bad that anyone even walking near his bed was threatened with a grisly end. I can certainly sympathise.
Trying to walk with a gouty foot is painful enough, but it's made worse by how inconsiderate so many people are - so many people will walk into you, people on bikes, skateboards, one-wheels, etc ride directly towards you. Which makes you brace, slightly in the event they don't swerve-away, which triggers another burst of pain from the bracing.
An uncle who has to use a walking stick at times complains of the same problem of appearing to be invisible to people on the streets, and of people brushing past and knocking against the walking stick.
See my other post in this topic. Try cutting way down on fructose.
I love going for walks and every now and again, I have to remind myself that I’m lucky to be able to do so and shouldn’t take it for granted. Best wishes to you and others who don’t have the same luxury.
The folks who don't move or alter their path for the elderly and those with crutches or walking sticks are all over the spectrum.
But it's not just phone users, people will look up, see an older person, and then look down or away and not alter their path at all.
Bags and strollers are frequently used as battering rams. Some of those big trendy bags have extremely sharp corners, as well as metal clasps and other items that also cut and/or bruise.
Groups of people expect that others will get out of their way - members of the group directly in your path will look up, and then back to the rest of their group.
Couples are particularly bad at this - yes, you're together, you're clearly deeply in love, but that doesn't grant you the right to occupy the centre of the footpath and force everyone else to go around.
Fortunately there is a better understanding of the dissease and more new therapies in the pipeline.
> Dedicated gout research, going on quietly in the background of other breathtaking advances in rheumatology, is now paying off. This comes at a time when the number of patients affected by gout continues to rise, mainly due to an epidemic of obesity. An effort to improve lifestyle choices as a society and better management of the disease by clinicians should have a positive impact on gout incidence and outcome in our lifetimes.
> Importantly, prophylaxis may prevent the acute inflammatory response to crystals, but will not alter crystal deposition and ongoing joint damage, so the patient may well be unaware of progressive tophi formation and destruction of cartilage and bone. Therefore, prophylaxis should only be employed with effective ULT.
> Treatment is lifelong with a dose sufficient to maintain the serum urate below 6.8 mg/dl (404 μmol/l), preferably below 6.0 mg/dl (357 μmol/l). Anything short of this does not reverse the process, but merely slows the rate at which crystal deposition continues. The lower the serum urate achieved, the faster tophaceous deposits will resolve [1]
Latest evidence on gout management: what the clinician needs to know - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539261/
We all might get gout for different reasons but the generalization of "with dietary changes alone it is not possible to stop progression of gout" is not true. I have completely stopped my gout attacks by cutting way back on fructose.
"Many factors contribute to hyperuricemia, including genetics, insulin resistance, iron overload, hypertension, hypothyroidism, chronic kidney disease, obesity, diet, use of diuretics (e.g. thiazides, loop diuretics), and excessive consumption of alcoholic beverages. Of these, alcohol consumption is the most important."
"Causes of hyperuricemia can be classified into three functional types: increased production of uric acid, decreased excretion of uric acid, and mixed type. Causes of increased production include high levels of purine in the diet and increased purine metabolism. Causes of decreased excretion include kidney disease, certain drugs, and competition for excretion between uric acid and other molecules. Mixed causes include high levels of alcohol and/or fructose in the diet, and starvation."
https://en.wikipedia.org/wiki/Hyperuricemia#Increased_produc...
Purines and pyrimidines make up the two groups of nitrogenous bases, including the two groups of nucleotide bases. Two of the four deoxyribonucleotides (deoxyadenosine and deoxyguanosine) and two of the four ribonucleotides (adenosine, or AMP, and guanosine, or GMP), the respective building blocks of DNA and RNA, are purines.
https://en.wikipedia.org/wiki/Purine
Could just be a bad roll of the genetic dice with a dash of lifestyle.
Also "higher total dietary protein intake from mainly poultry and fish/shellfish was associated with an increased risk of gout, while dietary intake of soy and nonsoy legumes was associated with a reduced risk of gout."
There are a lot of people who saying the same thing. There are a lot of papers on the fact that beans and nuts increase changes of gout.
Edit: I will just add, it seems to be the last half century of nutrition "science" has largely been wrong. I hope more people keep exploring things for themselves instead of getting our top down advice from the experts.
I can't find any, link?
Sounds like there are vegetables which are high in purines, which are suspected to be related to gout. But studies consistently show that those vegetables do not have an effect, whereas meat, fish etc do.
(Also I suspect the downvotes are because the comment claimed that this was the "prevailing opinion", which it is not)
Even peer reviewed papers are "alternative opinions".
Unless it has been peer reviewed in several papers, repeated, empirically proven, and got into textbooks, I wouldn't consider anything a "solid scientific truth".
https://www.arthritis.org/health-wellness/healthy-living/nut...
EDIT: Coffee good! https://www.sciencedirect.com/science/article/abs/pii/S00490...
High fructose corn syrup seems to me the strongest contender for "single biggest cause" – it ties in nicely with the obesity epidemic, and the two surely snowball together. That doesn't mean that other factors (the same as 18th century's) can't bring gout on, like a comment elsewhere here reports, but I just cannot believe that high fructose corn syrup's ubiquitous stance in our food isn't met with some pernicious and hard-to-trace effects on our health.
I shy away from blaming high-fructose corn syrup as some sort of subtle poison. A gram of HFCS is anywhere from 42–55% fructose, which is the same as what you’d get from an apple.
But I think there may be something to the dose of HFCS.
Fructose has to be metabolized in the liver, and there’s an upper bound of how much it can break down at once. (I believe 50 grams.) Which, if you’re eating fruit, is fine; the fiber slows down digestion, and also you’re probably not eating like 6 apples at once.
But oh man, look at an energy drink, or a sugary coffee drink. I am from Midwestern white trash stock, and during my obese younger years, I would frequently drink a 44oz Big Gulp of Mountain Dew. That’s a shotgun blast of fructose, and my gut instinct (hah) says that there’s a dose-response curve going on here.
https://en.wikipedia.org/wiki/Fructolysis
Unlike glucose, which is directly metabolized widely in the body, fructose is almost entirely metabolized in the liver in humans, where it is directed toward replenishment of liver glycogen and triglyceride synthesis. Under one percent of ingested fructose is directly converted to plasma triglyceride.
Sucrose is 50% fructose 50% glucose and most high fructose corn syrup is 55% fructose 45% glucose. They are almost identical.
The scientific consensus is pretty much there won't be any significant changes to your health if you replace sugar with HCFS or vice versa.
Gout isn't caused by what you eat, it's an underlying problem with your kidneys/liver/body and an inability to extract uric acid. It can be exasterbated by drinking beer, dehydration, red meat etc.
Saying it's caused by what you eat is a bit like saying peanuts cause peanut allergies, or eating gluten causes coeliacs. You already have the condition, the things you eat makes it worse.
I've been suffering with it since I've been a teenager.
Gout is caused by excessive levels of uric acid, which is an end-product of purine metabolism. You can get uric acid via two pathophysiologic mechanisms: under-excretion of uric acid, or over-production.
Under-excretion is by far and away the most common cause of gout (think ~90% of cases). Causes for this include things like chronic kidney disease or an inborne/hereditary problem (like you mentioned), but can also be caused by extrinsic factors such as some medications (common ones include cyclosporine, most diuretics, a few of the TB drugs) as well as more general problems (alcohol decreases UA excretion by itself, dehydration can contribute)
Over-production is a whole other kettle of fish. This is most commonly secondary to some problem of increased cell turnover (think leukaemia, lymphoma, haemolytic anaemia etc.), Again alcohol and obesity can contribute.
You'll note alcohol was in both groups. Alcohol excess (especailly beer) can lead to gout without any other contributing factor. Excess alcohol + excess red meat is an especially bad combo which can lead to gout without any other contributing health issues.
So, gout can certainly be caused by what you eat. It's not the ONLY cause of gout, though.
My buddy was a beer drinker and had an almost 100% beef diet, on his bi-yearly checkup they found out that the uric acid levels were too high. He switched to turkey/chicken meat and wine, got rid of the occasional brawn (as in meat jelly), and he is pretty much okay now.
Anecdotally, I drink a lot of beer but only twice a week. The rest of the week I may very well be a monk. Not a drop. Does the quantity I consume on weekends count as excess? On what scale or timeline?
In my case, I had what I thought was a persistent toe sprain for years and only later realized it was gout. I'm sure alcohol contributed, as did dehydration, poor running form, the keto diet I was on, and sudden weight loss.
Does that include caffeine and phenylalanine?
>Purines are also found in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).
You can temporarily increase your uric acid levels by eating purine rich food/drink beer etc. But if your body is excreting it, as it should be - the levels won't remain high enough to build up crystals.
It takes years of persistent high levels, it's always caused by your body. But you can reduce attacks by changing diet, loosing weight or taking medication.
If your body was functioning properly it wouldn't matter how terrible your diet was.
I explained all of this in my original post.
Certainly can imagine other cases can be aggravated by diet choices.
Bingo. People would rather find anything to blame but themselves. Change is also hard. People can change; most wont. You see it far too often in "fat acceptance" and "healthy at every size" communities.
It can be aggravated by diet if you have it.
You can't seriously tell me you don't see the difference?
Lots of research link gout to different makeups of gut bacteria:
https://www.nature.com/articles/srep20602
And I certainly changed my diet over the past 10 years, and my gut bacteria has become more diverse and presumably more healthy as a result. I've verified this through various stool tests and 3rd party microbiome trackers over the years (uBiome, Thryve)
I don't want to get into pseudoscience or offer anyone advice, but I can tell you that my experience with increasing specific bacteria that increase butyric acid within the gut has seemed to work for me. In theory, one could do this by eating butyrate promoting foods such as almonds, apples, barley, kiwifruit, and more, or take a bifidobacteria-enhancing fiber such as GOS.
https://en.wikipedia.org/wiki/Galactooligosaccharide
https://www.webmd.com/vitamins/ai/ingredientmono-1462/galact...
How? Gout is caused by a buildup of uric acid, which is created in the body as a byproduct of breaking down purines. Purines are essentially broken down pieces of DNA.
This makes sense when you discover that beer can cause or worsen gout, because of the large amount of yeast present, but other fermented beverages such as wine do not.
Obviously there are other factors that go into gout, and other causes too, but the primary cause is eating DNA!
That is not a useful generalization if it's actually a small sliver of broken down DNA that causes the issue. It's like saying "all food-borne illness is caused by eating DNA." It may be literally correct, but is general to the point of adding no value in understanding the specific cause of the problem.
I came here to say just that.
I have never experienced gout but years ago I was very interested to learn, and then dramatically oversimplify: gout comes from eating DNA.
Presumably that's how beer is such a catalyst for a gout attack: all that dead yeast ...
Sometimes just as little as a change in the spatial configuration of a compound (cis/trans isomers for example) or the addition of a carbon can dramatically change the effect of a molecule on a living body...
To make a long story short I discovered the next year that the culprit was pistachios. So long as I don't eat too many of them while dieting, my foot is fine.
Turns out genetic metabolic problems have always been around and modern simple "life hacks" like a fad diet product or an exercise product aren't always the cure.
Or, yeah, maybe they were just dumb lifehacking sheep.
https://www.hcplive.com/view/why-is-colchicine-so-expensive-...
Unfortunately it is a short lasting treatment as after a few times it quickly becomes less effective and it has side effects such as mood swings.
But take a 50mg pill when you can't walk and an hour later you're dancing.
So I guess if I was a time traveler I would probably try something like making an alcohol based serum from pigs adrenal glands?
He started intermittent fasting 18:6 and religious intake of ~3 litres (250 ml per kg). He reduced 20 kgs in last 8 months.
He is totally off allopurinol and the gout seems to have vanished. His uric acid levels and the SGPT SGOT levels are back normal.
But at 49 I quit drinking, lost almost 50 lbs over a year period, and almost completely stopped having gout attacks.
Interestingly, I still get occasional attacks (once or twice a year at most), and they are all almost totally associated either with dehydration (to which I seem somewhat prone) or stress; particularly the stress of flying for 4+ hours on a business-related trip. I board the plane feeling fine, and step off with that little tinge in my left-big-toe joint.
Intake of what? (I'm guessing water?)
Huh? Olive oil was known to at least the Greeks and Romans, and some disputed citation on Wikipedia even says that olives were harvested even 8.000 years BC.
But a lot more salt.
My partner consistently shows low sodium in their blood work, yet eats way more salt than I do (my blood results are normal) and craves saltier things. They will put salt on already-salted foods that I consider too salty already.
Anyway, the person I was thinking of also seems to take in less fluids and get less exercise than I do on average, further compounding the difference for us in particular. That's part of why I mentioned our case, it's more extreme the closer you look.
1. There is at least one study showing Lemon Juice it can lower uric acid levels in humans[1] seemingly by lowering PH of urine.
2. Tart cherry juice is mentioned a lot as a cure. There are a quite a few studies[2]. Make sure and get the tart cherry (Montmorency) juice, you can get it in a concentrated syrup. My uncle says he has not had an attack since he started drinking a generic supermarket tart juice every day. I have never had an attack whilst taking cherry juice but i haven't been taking it consistently.
3. Interesting article linking fructose and gout which matched my intuition a lot more than the link with meat - https://tim.blog/2009/10/05/gout/
4. Hot bath with epsom salts seems to temporarily ease symptoms.
I personally haven't noticed a correlation between eating meat / fish and gout attacks. I have gone from eating meat twice a day to about once a week now and there has been no noticeable change in the gout.
[1] https://www.sciencedirect.com/science/article/abs/pii/S03044...
[2] https://www.fasebj.org/doi/abs/10.1096/fasebj.25.1_supplemen...
Tart Cherry Extract capsules are another option. Gout pain relief within hours. (Note, there is a drowsy/melatonin side effect with big doses)
Creams with high concentrations of menthol and methyl salicylate seem to help. Also applied to the ankle and knee (along with massage) to help stimulate circulation away from the big toe.
I get it roughly 2-3-4 times a year now, and it is always after the following pattern:
- Not drinking enough water
- Eating too much chicken
- Drinking too much beer
Often in combination. Luckily, that makes my gout incredibly predictable - and I have found meds which work. As soon as I take meds fast enough during the onset, I'm fine.
I have a similar story and have treated through diet successfully. Haven't taken steroids in almost 2 years.
I'm sure I made other changes to my life during that period of time so I can't say for certain that it wasn't some other change that caused the pain to go away. I also know that wrist pain can go away on its own without any intervention. I wanted to leave this comment here in case it helps others; I would have been very grateful if simply modifying my diet would have helped me as I tried many things during that period of time.
I'd also be interested in getting feedback from those more knowledgeable as I don't have much of a medical background. I did find a study - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4101606/ which may support what I'm saying, but I might be completely wrong.
Is it possible that a doctor does not know about this medicine?
Or is this such a new treatment that it didn't exist about 8 years ago?
However it cannot be taken during an acute episode of gout or it will worsen it. Ie it is a preventative not a treatment.
I’m presuming you went to your family doctor rather than the emergency room so your gout flare (relatively speaking, not necessarily from your perspective) probably wasn’t so bad which is why they gave an NSAID and sent you on your way. Ideally they should have told you that if you get more flares and dietary/lifestyle modification don’t help then you should take a long term preventative
Anyway, the right place to go is rheumatologist. Urgent care or ER in the meantime, but insist that you get steroids or at least colchicine if you need pain relief.