Comment by lwansbrough | Hacker News Reader

Comment by lwansbrough | Hacker News Reader

I had my first gout attack on August 14th 2018 at just 24, following a night filled with liquor and red meat. Though I’ve gone through periods of continuous activity, it’s safe to say I lead a somewhat sedentary life. Today, at 26, I have been free of major gout symptoms since my first attack 2 years ago. Though I occasionally get mild inflammation in my gout-prone foot if I stray too far from my diet, I’ve been effectively symptom free since immediately course-correcting my diet following my diagnosis. My new diet is mostly plant based, though some fish and occasionally chicken seems to be safe from causing any symptoms. I’ve even been able to pick up running again.

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.

I had mine at about the same age or maybe a little younger - my foot was so swollen, and so sensitive that doctors couldn't believe it was anything other than a break, sprain or some other gross damage. When the X-Ray came back clear, and a blood test showed high Uric Acid they were stunned.

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.

> 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.

See my other post in this topic. Try cutting way down on fructose.

Wow! Until I read the last sentence, I was going to suggest using a walking stick as a visual way of signalling to others that you have some sort of disability and can’t just quickly move out of their way. As a (mostly) healthy and regular pedestrian, I come across the groups you mention – and those who walk with their eyes glued to their phone, expecting others to move out of their way. I really would’ve thought that they’d show more consideration to older people or others, such as your uncle, who are obviously less sprightly. :(

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.

> I come across the groups you mention – and those who walk with their eyes glued to their phone, expecting others to move out of their way

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.

I do not want to squash your hopes but with dietary changes alone it is not possible to stop progression of gout. In a few years you will probably start having more frequent attacks. Lossing weight is little more effective. Keeping your uric acid well below 6.0 mg/dL is when the process starts very very slowly reversing.

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/

Thank you for sharing this. I'll definitely be more aggressive managing my gout.

Allopurinol works for most people (but sadly not everyone), my gout kept me in bed for a month of agony, but once I was able to start allopurinol my uric acid levels have dropped and been managed for over a decade without issue, or gross dietary changes.

> I do not want to squash your hopes but with dietary changes alone it is not possible to stop progression of gout.

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.

Given the frankly enormous variances in medicine, saying that it is entirely impossible that their situation has improved in the way described just because you can't see it seems a little small-minded. Such strong claims are something that might have been acceptable and expected thirty years ago, but not now.

That doesn't seem quite right. If your diet consists only of things that do not metabolize into uric acid, how can you experience gout? It might require a very strict diet, but surely this is possible?

It's not just direct metabolism of stuff in the diet. Your body indirectly makes stuff that is then metabolized into uric acid (e.g. your DNA). Could be making too much, could not be excreting enough.

"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.

I don't believe the current scientific consensus has meat consumption as a risk factor for gout. I read a paper recently that specifically mentioned that simple sugars (glucose, fructose, sucrose) and purine. Purine is present in quantity in certain organ meats, but not meats that most people eat frequently, and you're more likely to get it from legumes.

See e.g. the Arthritis Foundation:

https://www.arthritis.org/health-wellness/healthy-living/nut...

EDIT: Coffee good! https://www.sciencedirect.com/science/article/abs/pii/S00490...

A quick search on the internet shows the opposite. Most popular legumes don't have high levels of purines despite having high protein levels.

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."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939435/

Why the down votes for an alternative opinion?

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.

"alternative opinions" are not science.

All opinions on a forum are "alternative opinions". We can't tell if somebody is a scientist here, or whether they're talking shit or not, or whether the consensus (like in many cases) are old wives tales (like "fat is bad for you").

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".

Agreed. I take new, exciting findings with a hefty dollop of salt. I’m prepared to wait for replication of findings and/or a meta-analysis of a large body of work before taking medical or health-based research too seriously.

It's not an alternative opinion, that's the prevailing concensus

> There are a lot of papers on the fact that beans and nuts increase chances of gout.

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)

I'm not concerned what scientists think about meat. This is not a theoretical problem for me and cutting out red meat has kept my uric acid levels nominal.

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