What can I do when I feel Gout attack is coming?

Gout is very special that you can "feel" it's attack before it arrives. Can we do something to prepare its arrival?  How to prevent it from happening or to reduce the pain?  Here is one of my experiences.

On night, while on the way home after attending a banquet,  I felt that the Gout started attacking my left foot.  Thanks for the the great food served on the table. Actually I just can do nothing as I did not have any pill at home.  I just prayed that the attack would not be so severe.  Nevertheless, I did the following that night before I went to sleep.

1.  Drink a lot of water immediately.

2.  Try to keep my foot as warm as possible by covering it with a blanket while sleeping.

3.  Elevate my left foot using a pillow while sleeping.

Then hoped for the best to come.  Fortunately, my left foot was in good condition in the next morning. I have tried this several times. And it seems to work most of the time.  

Why did I do such 3 things? 

1. Drink a lot of water.  

It is never too late to drink water even you start feeling the gout attack.  As mentioned in my previous post, drinking more water can help not only diluting the uric acrid concentration in blood but also discharging the purine inside the body.  So I will drink water until I go to washroom for around 2 times before I go to sleep.  But bear in mind that one should not drink more than 0.7L (24 ounces) per hour.  Our kidneys cannot handle that much in a short period of time.

2. Try to keep my foot as warm as possible.

That is related to the gout attack formation process.  Gout attack is actually an joint inflammation caused by needle-like urate crystals depositing in the joints.  The crystal is formed when the uric acid concentration is so high that it reaches its saturation point.  This saturation point is temperature dependent.   The lower the temperature, the lower the saturation point.  This is the reason why gout attack usually occurs at the extremities , especially the big toe.  While sleeping, our body temperature is low and the extremities is even lower.  Hence, the winter night is most favorable for gout attack.   Therefore, to keep the foot warm while sleeping is important to prevent or improve the attack.

3.  Elevating the foot using a pillow while sleeping

While keeping the foot warm is crucial, good blood circulation is also important.  Elevating the foot should help the blood flow away from the extremities and reduce the chance of the crystal sticking into the joints.  Most importantly, elevating the foot should reduce the swelling and the pain if the Gout attacks!

I hoped this experience can help the others.  So, if you have any idea of how to prevent Gout attacks, please feel free to share.

Suggested Reading

1. With Gout, how much water should I drink?

2. Urate Crystallization is temperature dependent

3. Gout attack form at lower temperature

4. Formation of Gout attack

Gout pills side effects......?

As I mentioned in my other post, I believe my gout is genetic as my mom also has gout.   Here is one of my mom's experiences which I think it's worth of sharing.

Two weeks ago, my mom was having a flu-like pain symptom.  She felt so bad that she could not sleep at all for 2 days.  Her doctor said it could be flu so she just gave her some pain killers.  The drug did not kill the pain and her blood pressure went up 170mmHg.  So we got her to the emergence room in hospital.  The doctor there could not have an exact diagnosis for her symptoms neither.  Then, my mother went home and she felt better for 2 days.  She also went to a Chinese Physicians for acupuncture.  We thought she was getting better by rest.

Then she had the pain again.  She said that the pain is indescribable.  Her blood pressure was also high.  So, she went to hospital again and stayed for 2 days for a detailed checkup.  The doctors said all the reports showed she was normal in condition. And they wondered if the pain was caused by depression.  We just didn't know what happened to her and felt pretty desperate.  With nothing we can do, she was discharged from the hospital.  We just hope resting can make her better.   Gradually, the pain had gone for almost one week.

Tonight, my mom told me that she suspected it was her Gout pills causing her the pain. She said she felt a little bit pain again after taking the pills "Allopurinol", which she had stopped taking for around 2 weeks. The  "Allopurinol" was a new prescription by her doctor recently and she was told to take 100mg per day.   I checked the side effect mentioned on the box. It just tells skin rash, exfoliate, urticaria, and pururic lesions etc.  Nothing related to pain she got.  

So I did a search again for the information of the drug. The function of Allopurinol is to block the production of uric acid in the body.  There is a webpage mentioning a detailed side effects list of Allopurinol.  I spotted some of the effects are  joint or muscle pain,  and general feeling of discomfort or illness.  That’s similar to my mother’s case but exactly. So I further check the drug’s box and found a leaflet inside.  It mentioned the following side-effects as well:

"pins and needles", loss of feeling in part of the body, high blood pressure.....

That is exactly what my mother felt!  We guess we have found the cause of my mother's lately sickness.   Why did none of the doctors ask my mother for any prescription of drugs she has been taking?  That’s unacceptable!

As a kindly reminder, it's better to check the side effects first before taking any drug for Gout.

Suggested Reading

1. Allopurinol Side Effects

2. Allopurinol for Gout

MSG/Additives, causing Gout Attack?

What makes me think MSG (Monosodium glutamate)/Additives could cause Gout Attack?  It takes me almost half a year to sort that out.  

Here is some of my experience that I could not explain.

1.  My honeymoon was in Hokkaido, Japan.  During that week, my diets had different kinds of seafood, such as prawns, fishes, and scallops. Some of them are Sushi and some are well cooked.  These are high purine food.  No gout attack happened.  WHY?

2.  Although having the risks of Gout attack, I enjoy Beef and Lamb steaks in nice restaurants around twice a year. The steaks there are pretty good and fresh.  Again no gout attack.  WHY?

3.  I usually bring my lunch box to work and have dinner at home. However, I inevitably have meals outside more than often, especially when I am busy at work or family.  Of course, I would keep control of what I ate for the meals.  Nevertheless,  I found that some of my Gout attacks arrived whenever I ate outside more often, even with food control.   WHY?

4.  After a Gout attack, if I keep eating at home and bring lunch box, my swollen foot would heal faster.  On the other hand, if I eat outside, the gout attacks again easily. WHY?

I tried to summaries these experiences and see if they have anything in common.  Freshness and additives-free!  Food in Japan, the steaks in the restaurants, my lunch box and meals at home are almost all fresh food and no/very few additives added.

So I started to search the web about MSG/Additives and Gout.   I found that the “MBM food additives guide” mentioning that some of the flavours enhancers should be avoided by people suffering from gout and ashematic people, but not MSG (E621).  Among the list,  Guanylate (E626, E627, E628, and E629), Inosinate (E630, E631, E632, and E633), and their compounds Ribonucltides (E634 and E635) are metabolised to purines.  They are mainly used in soups, sauces and seasonings.  Guanlyates also can be used as a substitute for table salt.  Based on what I found, I strongly believe that these additives are added in many food products.  According to GMO, there is no labelling requirement for these additives.  Hence, we don’t know how much is in the products.  That could be the answers my questions!  MSG does not cause gout attack while some other additives do.  

In Chinese, we call all additives generally as “MSG”.   It is well known in Hong Kong that restaurants use “MSG” in most of the dishes.  I am not sure what additives they are actually using.  In addition, most preprocessed food such as ham and sausage have different kinds of additives.  That could be reason why eating outside will increase the chance of gout attack.

So, the answers is bit surprising.  MSG is not responsible for the gout attack while some other additives are.  As there are so many additives in our foods, it is hard to know which kinds we should take or not.  So, the best thing is to take fresh or non preprocessed food.

Suggested Reading

1. MBM Food Additives Guide

2. Comments on MSG, Guanylate, Inosinate , and Ribonucltides

3. More info on Inosinate

4. More info on Guanylate

With Gout, how much water should I drink?

Everyone knows that water is important for improving Gout.  As mentioned in my previous sharing, loosing water can trigger gout attack.  However, how much water should we drink each day?  Especially during Gout attack? Some say 8 glasses. Some say 10.  That’s what I used to follow.  Although I thought I was drinking enough water each day, I found my Gout attack had not improve so much.  What is the problem? Is my gout so serious that it would not be improved by during more water?

I did a search for how much water exactly we need.  The Institute of Medicine says that an adult male needs 3.7 litres and female 2.7 litres per day.  They call it adequate intake which includes the water coming from different sources, such as beverages and food.   Food contributes about 20% of total water intake.  That means a male needs to drink 2.96 litres (3.7litre x 0.8) and female 2.16 litres (2.7 x 0.8) of beverages.  Assuming 8 ounce (237ml) per glass, that is 12.5 glasses (9 glasses for female) per day.  It is 50% more than we have been told.  In addition, there are other factors affecting how much water you need each days.  For a health person, the amount of exercise and temperature also play their part.  Some website even accounts your body weight to calculate the amount of water you need.  No wonder why my gout did not improve very much!  I bet I need more than 3 litres each day.

So, how to drink enough water each day?  For a health female, the 8 8-ounces glasses reminder, which so called “8x8 rule” should help.  However, this is somewhat misleading for male.  To be honest, it is kind of difficult to count how many glasses of water each day.  Even harder is to drink 12.5 glasses a day!   That is 1.5 hours per glass!  It is easier than said, especially when you are working.  I used to drink water only when I was thirty.  One of my friends said he would use a larger cup (375ml) in order to drink more water.  That’s not a bad idea.   

As a person with Gout, I think the focus should not be how much I drink, but how much I discharge.  This is because the aims of drinking more water are to dilute the uric acid concentration in blood and to discharge the purine.   Hence, I would not count how many glasses of water I drink but rather how often I go to the toilet.  While no attack, my target would be once per 2 hours.  While during Gout attack or high purine period, I would drink more water until I go to toilet around once per hour.   Besides, I also monitor the color of the urine.  If it is yellow, that means I definitely need to drink more water.  Of course, this is just my goal.  I have to admit that sometimes it is not achieved.

One final remark. The Institute of Medicine stated that the fluid handling capability of the kidneys 0.7L (24 ounces) per hour. So, we need to have a better control of the intake frequency at the same time.

Suggested Reading

1. Hydration calculator

2. Institute of Medicine

3. Dietary Reference Intakes : Electrolytes and Water

4. Water: How much water should you drink ?

5. Do you really need to drink eight cups of water a day?

Sports causing Gout attack?

Well, it depends on what kinds of sport. I am talking about the kind of activities that is heavy enough to make you sweat, not the light one. In summary if you have already had gout/high uric acid, it could triggers an attack which makes your joint painful.

If you are interested in my experience, please read on.....

Introduction

To many people,  Gout attack and sport injury share similar symptoms. Both result in painful swollen joints, inflammation, and restrained physical mobility. That is why when many people having their first gout attack, they usually think it is an injury, either by sports or accidents. I remember when I got my first gout attack, I had the same thinking. When my big toe was swollen in the morning, I thought I was hurt somehow until the physician said it was a gout attack and the joint pain was not caused any other reason. 

My experience.

When I was diagnosed with gout, a friend of mine who also suffered from gout shared the Dos and Don’ts with me. One thing he told me was to drink a lot of water, especially after doing sports. His advice suggested that sports can trigger a gout attack. I took his advice in heart but did not ask for the reason. I just tried to drink as much as water as I can.

Recently, I had a furious basketball game with my colleagues and of course, I sweat a lot. Unfortunately, I forgot to bring water to the court and hence did not drink much water after the game. I started to worry if I could get an attack that night.  It didn't but a couple days later. As usual, I reviewed my diet during that period of time (before and after the attack). To my knowledge, it was pretty balanced as usual. Hence, the only one reason left in mind is the game without much water. I believe this is the cause for the attack.

Theory behind

The reason of sports could trigger gout attack is easy to understand. Gout attack is related to uric acid concentration in blood. When the uric acid concentration is high, it is easier for the purine to crystallize. So, even if we have a balanced diet, sweating can increase the chance of the attack. Therefore, to be exact, it is not the activities or sports that causing gout attack. It is the sweating, which dehydrates the body, pulling the trigger.

Conclusion

So, it is all about sweating! Therefore, please drink more water after sweating, especially if you do exercise, such as jogging regularly. You need to drink much more water than the others. This is a good for everyone, even people not having Gout.

To a regular person, it is a good advice to avoid any injury during sports by doing warm up and cool down. To a person having gout, there is one more advice and that is, try to avoid any injury after the sports as well. This can be done by drinking much more water!

Is Gout genetic?

For me, it is not difficulty to conclude that Gout is genetic, at least in my case. Just like other illness such as cancers, the gout gene increases the risk of getting attack. With the right amount of high purine food, it triggers the joint pain in an hour or two.

If you are interested in my experience, please read on.

Gout in my family

Believe it or not, I had not heard of gout until I got the first attack. It is understandable as none of my family members had suffered from it before. I was fortunate enough to be the first one, with the only known reason of eating high purine food, of which my favorites were mushrooms, tofu, and broccoli. My younger brother was the second victim. Both of us got the first attack in our early thirties. My mother was around sixty when she felt the pain as female usually has gout attack after menopause. Even though gout had become a common suffering for we three, we did not think of it as genetic. Food was the only to blame.

Explanations from two doctors

Until one day, I went with my mother to see her doctor, who was also a friend of mine, for her body check report. She told us the report showed that my mother's uric acid level was high. When she knew that both of us had gout attacks, she said my gout could be genetic from my mother. That was the best answer for me. It also explained why both my brother and I got the attack earlier than the average. I/we did nothing wrong to get gout.

Since then, I got a chance to talk to a Chinese medical doctor about Gout is genetic as there were three people in my family having it. She seemed to disagree with that. Her explanation was family members usually share the same diet habit. So, if the whole family have high purine food a lot in the diets, the chance of the members to have gout increase. It seems reasonable as well.

The Exception

Wait a minute! How about my father? It seems that we forgot the other member who shared the same diet habit with us. No, he does not have Gout at all and he drinks beer almost everyday for more than thirty years. Should this is a very strong case to defend the food as the prime suspect? One family has three non-alcoholic members suffering from gout and the only alcoholic member is gout free! Amazing!

Case in Family Trees

How about the other members of my parents' family trees? On my father's side, none of my father's siblings has gout. On my mother side, out of seven siblings, two brothers, who lives in the US and Australia, have had Gout for a long time. Apparently, this is somehow related to the gene of my mother side. Including my mother, the chance is one out of four. That coincides with my friend's conclusion.

Now, my brother and I have got married and do not live with our parents. My uncle is living in the US and certainly does not share the same diet habit with us. Living in different places and different diets with the same gene, we all have gout.

Finally

For me, it is not difficulty to conclude that Gout is genetic, at least in my case. Just like other illness such as cancers, the gout gene increases the risk of getting attack. With the right amount of high purine food, it triggers the joint pain in an hour or two.

Suggested Reading

1. Gene linked to higher gout risk. (BBC)

Green Tea Causing Gout?

In summary, I believe it was the "strong" green tea got me immediate Gout attack.  I believe the  "youth papaya green tea" should work for Gout.  We just need a light dose of green tea.  Also, there are many kinds of green tea. We may need to pick "Longjing Tea"........

If you are interested in my experience with Green Tea, please read on.....

In Chinese diet, we have many different kinds of soups or foods that serve the purpose of making us healthy.  These diets are not medicine.  They are not supposed to cure your sickness but to help you getting better.  The interesting thing is we do not know exactly if they work or not.  We just trust them and they are in our culture.  In my opinion, some of them actually work while some work psychologically.

Nevertheless, my family had been searching for such a diet that helps Gout for a while.  There is nothing to loose for trying.  Of course, we got many suggestions in return.  Among them, "youth papaya green tea" was heard from different sources.  First, a Chinese MD in South Africa had told me about this.  Also, my brother heard of it from another source (I don't remember the source).  One day,  I read some advertisement on the newspaper mentioning the function of "Youth papaya green tea" to improve Gout.  So, my wife and I believed this was worthy to try.

Last month, I got Gout attack again. So, my wife bought a "youth papaya" and some "green tea".  At first, she boiled two green tea bag with the "youth papaya" for about a hour.  Then she thought two bags were not strong enough and added one more tea bag in it.  At the end,  it was a bowl of very strong "youth papaya green tea". The taste was so bitter that I had to mix some honey with the tea.  It took two hours for me to finish it.  Before drinking the tea, I had only egg sandwiches with cheese for breakfast. Since then, I had eaten nothing except the "youth papaya green tea".   Around two hours after during the tea,  the Gout started to attack again.  It was painful!

My question was, is "youth papaya green tea" supposed to get Gout better? So I searched the web.   Surely, I got articles that suggesting  "youth papaya green tea" for gout.  However, I also found some sites also mentioning "Green tea" is not good for people with high uric acid.

Puzzles solved!  Just like drugs, the dose does matter! Strong tea is the real problem!

In summary, I believe it was the "strong" green tea got me immediate Gout attack.  I believe the  "youth papaya green tea" should work for Gout.  We just need a light dose of green tea.  Also, there are many kinds of green tea. We may need to pick "Longjing Tea".  By the way, strong tea could be bad for stomach. So make sure it is not too strong for drink.

Suggested Reading
1.  Recipe for preparing youth papaya green tea(in Chinese)
2.  'Youth papaya green tea' is good for gout and health (in Chinese)
3.  Green tea not good for people with high uric acid (2nd article) (in Chinese/can be translated in English by Google)

Oatmeal causing Gout attack?

In summary, Instant Oatmeal have medium level of Purine and is not good for gout. One cannot take too much especially during gout attack.  Nevertheless, other types of oat could be good for gout. 

If you are interested in my gout experience with oatmeal, please read on......


Will oatmeal cause Gout?  My doctor said "No".  That was what I believed.  Here is one of my experiences.

One Monday morning, my foot got swollen suddenly.  I knew that it was the gout attack again.  So, I tried to recall the food list of last couple days to see what was causing the attack.  The food list was:

Thursday : Hotpot (only very few pieces of meat and mainly vegetables)

Friday : Bread/Curry beef rice/Fish ball noodles.

Saturday: Oatmeal/instant noodles/Vegetables+Tofu/Stream Chicken

Sunday: Sandwiches/Lunch mainly with vegetables and little meat/dinner is similar+2 pieces of Mushroom.

Based on the list, it should be the last two pieces of mushroom triggering the gout attack.  My question was  "Which food on the list made my uric acid level so high?".  Usually, two pieces of mushroom should not trigger the attack.  Yes, I know there were some food with higher Purine level.  However, I had controlled the food intake quantities quite well that such little amount should not be a big problem.   And I had been managing that quite well over years.

After reviewing the list several times, I spotted "Oatmeal", which everyone tells me it is ok to eat.  It is supposed to be the "healthy food", which can lower cholesterol level and good for heart.  I recalled that I took a very large bowl of it on Saturday morning, since I had had hotpot and Curry on Thursday and Friday.  I thought Oatmeal should help keeping my uric acid level low.  "Would Oatmeal be the killer this time?".

Then I searched for oatmeal and gout on the internet.  Some say oatmeal is good for gout and some say bad.  The information was very confusing.  Reading it over and over, I spotted the word "instant oatmeal".  Why was "instant" so specifically mentioned?  With some more articles,  I started to realize that there are different kinds of oats, "whole gain oats" and "instant oats".    "Instant oats" is fast cooking processed oatmeal.  "Whole gain oats" is slow cooked oatmeal which could be good for gout......

Finally, I got the conclusion.

"Instant Oatmeal have medium level of Purine and is not good for gout. One cannot take too much especially during gout attack.  Nevertheless, other types of oat could be good for gout."

The oatmeal I took on Saturday was instant Oatmeal.  Finally, I found the killer!

So next time, when looking for oat, we need to look for "whole gain oats".

Suggested Reading

1.  People have similar experience

2.  Which kind of oats are good for Gout?

3.  Quick-cooking oatmeal can be bad for gout

4.  Oatmeal with high and moderately high purine level

5. About Oats

About this Gout blog

Hello Everyone,

     I started this blog about Gout as I have been suffering from Gout for many years.  I found that many of my friends and relatives have Gout too.  Knowledge and experience have been shared around us.  I found that different people have different Gout experience, some better, some worse. I hope this blog can help people who are interested in this topic.  For each post, I will try to include some references as suggested readings.   And if you have any Gout experience you can share, especially about any food, drink, or drug, please feel free to leave some comment.

Here is the list of the blog so far, feel free to visit.

Oatmeal causing Gout attack?
Green Tea Causing Gout?
Is Gout genetic?
Sport causing Gout?
With Gout, how much water should I drink?
MSG/Additives, causing Gout Attack?
Gout pills side effects......?
What can I do when I feel Gout attack is coming?
Soup causing Gout?
How much water should I drink after exercise?
Cherries Good for Gout?