SUMMARY This is a page of dealing with gout tips. It is NOT about how best to live a compromised life with gout or how to adjust to a gout lifestyle. It is about winning this. Gout can be controlled by most so that you become gout flare free. The sooner you deal with it rigourously (rigorously) the better. This page is really for people who are relatively new to gout, but experienced gout sufferers can use it as a suggested check list.
This page about dealing with gout was last reviewed or updated on 29 July 2013
The diagnosis of gout is YOUR Waterloo or Gettysburg. Are you the Duke of Wellington or Napoleon Bonaparte, George Gordon Meade or Robert E. Lee? And it’s not only a battle but your Napoleonic or Civil War. Like a famous general in these wars, you face a number of crucial decisions. Here are some pointers to help you make the right ones; win the battle and the war. Read this below and see there is a lot to do! And a lot "to don’t."
And why the military comparison? Because winning this battle and this war requires discipline. Plus knowledge, thought, patience, determination and sometimes courage.
You fight a relentless foe
Your gouty enemy is stealthy, cunning, and full of disguises which can make him difficult to diagnose. He sneaks up on you at night, goes into hiding for months or years, and like a perennial plant returns, not with a sunny smile but with a vengeance. He can shorten your life, encourage other nasties like kidney stones, and make you lose your job. He does not plan on quitting and nor should you. Gout will probably not shorten your life unless it is a cause, or part cause, of something that does. If you are tempted to take gout easy, here’s why you should not succumb to a gout lifestyle.
SO HOW DO YOU FIGHT? POINTERS FOR DEALING WITH GOUT
Attitude Deciding to live a life with gout is wrong because untreated and uncontrolled gout will get worse. Control your gout and you may avoid the co-morbidities associated with it. These include hypertension, diabetes, heart disease, kidney stones.
Be a knowledgeable patient There’s more to being a patient than most realise (realize). Read You – The Smart Patient. An Insider’s Handbook for Getting the Best Treatment. Written for the U.S., but it applies elsewhere too. At the time of writing it can be purchased online from Amazon in any country where Amazon has a website. There is also a Kindle edition. Or look for similar guides.
Be a master The sooner you master dealing with gout, the sooner you’ll know how to control it. Don’t be like those who stumble on for years and never get to grips with it. Then they find they are dealing with gout in a second or third joint, and maybe tophi too. You do not have to get to that stage.
Biggest chores Keeping a food diary/journal; drinking water; learning to diet (or eat differently) and staying with it until old culinary habits and pleasures are replaced by new ones; time spent on cooking.
Don’t forget your medication Programme (program) reminders into your mobile phone.
How do blood uric acid level numbers move as they fall? Visit this page which describes regular and falling uric acid measurements, over months, by a visitor to this website.
Investigate your cause Consider and investigate whether fructose is your gout cause. Insulin resistance, kidney impairment and maybe fructose are the new main causes of gout. They have probably displaced purines from the top spot cause.
Keep meds with you Get used to carrying emergency meds around (uric acid lowering drugs; pain killers that work etc) ; consider where to keep them in your car; think ahead when planning long trips, breaks, business trips, holidays/vacations, including sea cruises for days/weeks, and flying.
Keep records Keep a gout journal/food diary – what and how much you eat and drink daily (including water) along with frequent serum (blood) uric acid measurements; if you want it to be really detailed, record carbs, calories, fibre (fiber) or any other food component you wish to track; keep records of gout attacks and your assessment of their intensity, duration, time between attacks, (getting worse, getting easier).You might learn something from also recording exercise. This is time consuming (30 minutes a day) and requires a daily discipline. But if you can do it, you will get more insight into how your gout behaves and how it responds to your dietary intake, exercise, and serum (blood) uric acid. Some gout sufferers do this. Programme (program) reminders into your mobile phone if you use it regularly.
For links to online or downloadable food diaries visit this page about a gout diet plan. See below – Water – for a neat APP that records water drinking on your mobile phone.
Learn about gout Get your PhD in gout studies. Gather gout knowledge but take your time. Rome was not built in a day. The more you know, the better you can judge the quality of advice you are getting from family and friends, websites, books and printed articles, doctors and rheumatologists.
Lose weight If you are overweight, lose it. This is one of the best things you can do. It can lower uric acid, and help with gout co-morbidities like metabolic syndrome and hypertension. Whatever diet you use, study diets and learn the calories’ and/or carbohydrates’ numbers of everything you eat and drink. Or acquire a carbs/calories counter book to use regularly.
Read this page about a gout sufferer’s diet which did work to lower uric acid. This was a restricted calories and carbs diet (the Zone diet) and it had considerable success. It is one of the very few real life gout diet studies, and it did lower uric acid by a useful amount. And read this study about a low purine diet. Study diets and use a non-fad diet that works for you.
Medications – a very short guide. To reduce uric acid, febuxostat is a better drug than allopurinol, but also consider those that encourage uric acid excretion such as probenecid or benzbromarone (if benzbromarone is available and considered safe). Generally krystexxa is probably the best at lowering uric acid but it is only for advanced difficult cases and it comes with a battery of side and adverse effects. It is currently available in the U.S., and was approved for E.U. nations in early 2013.Try to find out if you are an under-excretor or over-producer of uric acid. Your doctor probably won’t try, but a good rheumatologist might. Ask him/her. Here is a good question – if you are an under-excretor (most gout sufferers are) is it because of insulin resistance? Many gouty folk are under-excretors because of kidney impairment.
Money Spend money on treating gout. Penny wise, pound foolish. There cannot now be much or anything in life more important than learning how to control gout, not merely coping with gout.
Natural remedies The following natural remedies can be taken by most people. They might help lower your uric acid. Most likely natural remedies to help are baking soda (bicarbonate of soda) - note the cautions on the Baking Soda (bicarbonate of soda) page; cherries, Vitamin C, potassium citrate and the pH approach. Always discuss a new treatment with your doctor before trying it. For more details, read our pages about these remedies.
pH and gout Thoroughly investigate the subject of pH and gout. It might pay you dividends. An alkaline diet, raising blood pH, the famous baking soda (bicarbonate of soda) remedy, are all part of this centuries old subject that I think modern medicine should take more seriously.
Purines Know your purines, as you get to know your carbs and calories. You must know which foods and drinks (wine, liquor/spirits, beer) are the culprits. A low purine diet might lower uric acid by enough to control your gout, the more so if you get to your ideal weight.
Rheumatologists Find a good rheumatologist. Has your rheumatologist a few years’ experience of dealing with gout? How successful has s/he been in dealing with gout before? A good relationship with a rheumatologist is one of your best allies.
Trying to deal with this with a GP/PCP is like trying to fly to the moon on the Wright brothers’ prototype. Have gout confirmed with a joint aspiration (aka arthrocentesis).
Smaller portions There are scores of gout diet tips but here’s a simple one to reduce purine intake. Cut down on big servings of meat and seafood. Cut down or out, beers, lagers, liquor/spirits. Wine – two glasses a day maximum.
Take gout VERY seriously There is much more to it than seeing a local GP/PCP doctor and getting an allopurinol and colchicine prescription. An occasional 20 minutes with a doctor is not enough. Ignoring doctors is wrong. Gout is not going away for good on its own, even if it seems that it has.
Ten years from now Untreated and you might be lucky, but don’t count on it. Gout develops to attacks in more than one joint (or even in tendons) to flare ups that are stronger, longer, more often; to tophi and more tophi. Gout may lead to hypertension, stroke, heart disease, a tophi operation, metabolic syndrome, kidney stones. And it may make being old a tougher proposition.
Think correctly If your doctor has prescribed uric acid lowering meds and you subsequently get another attack – this does NOT mean the med is not working. Why? Because uric acid lowering drugs can cause gout attacks as uric acid falls. And because attacks do not usually begin to cease until uric acid is below 6.0 mg/dL.(0.357 mmol/L).
Uric acid meter Get used to using a uric acid meter. You must know if your uric acid is falling (or not rising) and what the level is now. Confirm your readings occasionally with a doctor who either does it himself/herself or orders a uric acid lab test with a sample of your blood. A study learnt that at a doctor's practice, 61% of 125 gout patients had NOT had their uric acid checked, and just 6 of 125 had it checked once a year. But dealing with gout without knowing your uric acid level is like driving blind in dense fog.
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Water Drink water, but not like a camel. Those 8 x 8 fluid ounces daily. You can get used to it. Record water drinking with this APP if it helps you keep an accurate record.