A Life Reset

A few weeks back, I went to a specialist to address my ongoing battle with gout. For months, the situation was that I was hobbled by gout of varying severity that it was preventing me from doing the things I like doing especially my photography. Nearly everywhere I went, I had to take a cane with me to walk, albeit with some struggle. Taking painkillers and anti-inflammatory drugs only worked in part. At one time, the gout was so severe that my family doctor mistook it for a potentially fatal situation of deep vein thrombosis that caused me to end up in the emergency room at the hospital. Followup visits with an Orthopedic surgeon wit MRI scans were inconclusive as regards to my gout.

So I went to a rheumologist who examined me, looked at my charts from the hospital and made the declaration that my gout is now chronic and will have to managed for the rest of my life. My uric acid levels were just too high and needed to be under the minimum level which gout manifests itself.

Now, I have tried the standard medication for gout control which is Allopurinol but my experience with it has been less than favorable. Taking the medication regularly always left me in a fatigued state and contributed to a lack of concentration which is critical for the sort of work I do. So the specialist put me on a new medication, Uloric which may have less side effects for me. So giving me first a regimen of steriods to take down the swelling I was experiencing so that I could start to walk again unencumbered, I was to start on a gradual program of taking Uloric.

It has been 4 weeks now since I have been on the new medication and I am feeling fine now. I can walk comfortably and I can reasonably eat a variety of foods now, not just the ones that do not increase my uric acid levels. But I have to accept the reality that I will need to be on this medication for years to come if I want to avoid future gout attacks

But I should not have to rely on medication alone. A strong contributor to my gout attacks is the fact that I am way overweight. Now, I did get the side effect benefit of this recent prolonged attack of gout in that I lost 20 pounds, primarily because I was afraid to eat nothing but carbohydrates to avoid intensifying the attacks. But I need to do more. If I get to an ideal weight of 180-190 pounds, that will lower the chances for future attacks and perhaps lead to a reduction in the dosage of Uloric in future (at $180/month, the medication is not cheap).

So I have to know what to eat in the future as I diet so to reduce weight but not encourage a return of the gout.

The key trigger to gout is when you consume a lot of purines (a form of amino acid) from food. Some foods are higher in purines than others notably organ meats. They are metabolised by several enzymes, including xanthine oxidase, into uric acid which if gets to a high level can crystalise in the tissues near joints giving you gout.

There are certain food recommended to eat and others to avoid:

Low purine diet :
To lower uric acid:

• cherries have been shown to reduce uric acid
• strawberries or blueberries (and other dark red/blue berries) are also reputed to be beneficial
• celery extracts (celery or celery seed either in capsule form or as a tea) is believed by many to reduce uric acid levels (although these are also diuretics).
• limit food high in protein such as meat, fish, poultry, or tofu to 8 ounces a day. Avoid entirely during a flare up.

Food to avoid high in purines, that is, high in DNA:

• sweetbreads, kidneys, liver, brains, or other offal meats
• sardines
• anchovies
• scallops, Prawns and Crabs
• alcohol, especially beer because brewer’s yeasts are very rich in purine (alcohol may also reduce the rate of uric acid excretion).
• meat extracts, consommés, and gravies

To use moderately:

• Vegetables: asparagus, cauliflower, spinach, mushrooms and green peas
• Lentils, dried peas and beans
• Beef, pork, poultry, fish and seafood
• Oatmeal, wheat bran and wheat germ
• diet sodas (these act as diuretics in many people, causing uric acid to concentrate in the blood which can then easily precipitate)

To avoid dehydration:

• Drink plenty of liquids, especially water, to dilute and assist excretion of urates;
• Use sparingly diuretic foods or medicines like aspirin, vitamin C, tea and alcohol.

So any diet I will have to undertake to lose weight will need to factor these foods in mind.

One thing I do have to watch out for is rapid weight reduction. Lose weight too fast and it creates a high uric acid situation again. Remember, I lost 20 pounds in a fairly rpaid fashion which no doubt prolonged and intensified my recent gout attack. I do have time to lose weight gradually.

In many ways, it is like living life as a diabetic. For people with moderate cases of diabetes , you could take medication to control your blood sugar level but keeping a steady weight and watching your diet can provide the same benefit without medication. It’s just a bit harder to do than just popping a pill.

So this is my life now as a chronic gout sufferer. It is not where I want to be in life but I have to make the best of this situation and lead a normal life which is quote possible now with this new medication and some effort on my part to maintain a more healthier lifestyle.