Revising the Post

After starting this blog for a year, there is a need to revise the posts which have been published so far. What I am trying to do is enriching the contents.   If possible, I will try to add some suggested readings for posts.  This is to justify my experience with external sources.

That is why there is no new post since late 2013.  Well,  I got only 3 posts left for revising.  There should be more new posts in 2014.....

Cherries Good for Gout?

Cherries are good for Gout!  I have heard that from many different people I know and from the web.  

However, how much and how often should we eat? 

Then I started searching the web and got the following from BBC.

http://www.bbc.co.uk/news/health-19746453

The study showed that eating cherries has 35% lower risk of Gout attack.  If taking the common anti-gout drug allopurinol at the same time, the risk is 75% lower.  It sounds pretty attractive.  However, it also stated that it needs eating up to 3 servings (10 -12 cherries/serving) over the two days before an attack.  Eating more will not gain extra benefit.   

I have not tried this out as cherries are kind of expensive in Hong Kong and are not sold very often.   I can only eat cherries couple times a year.   If you have experience of eating cherries for helping Gout attack, please share your experience with us. 

How much water should I drink after exercise?

Following up my previous post of Gout and Water , a male with gout should drink 3 litres or 12.5 glasses (2.16 litres or 9 glasses for female) of water each day. However, this target is for a person with normal workout.   How about if I do exercise/sports regularly?  As in my other post, sports could trigger gout attack as sweating could increase the uric acid concentration in blood.   Hence, we need to drink more water than the others.   So, how much water should I drink after exercise?   This is the question I used to have no definite answer.    "More" was the only answer.  However, it is very difficult to quantify "more".  

Fortunately, I had a chance to talk with my nutritionist.  "Six more glasses for each hour of exercise" , she said. "Just two glasses before the exercise, two during the exercise and two afterward".  How much water in one glass? "250 ml", she replied.  So, an hour of exercise needs 1.5 litre water. That’s 50%  more than a regular intake.  Her reply also corrected my misunderstanding of drinking water.  I used to think we need more water after exercise. The correct one is to drink before, during and after exercise.  

I further checked this topic on the web and found that there are even suggestions of exactly when to drink water.  The first is to drink water up to 15 minutes prior to the exercise.  Second is to drink water per 15-30 minutes while exercising.  However,  there is no exact time for drinking water after exercise.  The sites also suggest calculate the weight loss after exercise to replace the right amount of fluid. For 1-lb weight loss, 500-700ml of fluid is needed.

In short, here are 2 equations for your reference.

Equation 1 for no exercise:

12.5 glasses x 250ml  = 3, 000 ml = 3 litre per day

Equation 2 for 1 hour of exercise

12.5 glasses + 6 glasses = 18.5 glasses x  250ml  = 4500 ml = 4.5 litre per day

Of course, there are other factors affecting the dehydration.  External factors include  temperature and humidity.  Individual sweating rate and workout intensity also play their parts. Nevertheless, the above equations should give us an idea of how much to drink.  

Same as most people, I used to use “thirst” as an indicator for how much water I should drink after exercise.  Now, with the simple equations, I can easily plan my water intake.  For professional athletes, proper hydration can improve their performance.  As a person with gout, I just need to minimize the chance of  gout attack.  Hope this help!

Suggested Reading

1. With Gout, how much water should I drink?
2. Sport causing Gout Attack?
3. What to Drink for Proper Hydration During Exercise
4. Top 10 Hydration Strategies
5. Rules for Hydration in Exercise and Sports
6. Exercise and Fluid Replacement

Soup causing Gout?

Soup is one of  the favorites in Chinese dishes, especially for Cantonese.  In Chinese restaurant, it is usually served before or in the middle of the meal.  It is also commonly served with noodles.   While at home, we tend to have the soup before and after meal.  Some people even have soups almost everyday.  I used to have soups twice or three times a week.  

There are two ways that Chinese prepare their soups, namely quick-boiled and slow-boiled or called “old fire soup”.  For quick-boiled soup, we just put all the ingredients into the boiled water until everything is cooked.  It usually takes five to ten minutes.  For the slow-boiled soup,  the process is much longer.  It can take up two to three hours.

What do we put in the slow-boiled soups?  Usually, we have many different ingredients such as meats, bones, vegetables, and sometimes Chinese herbs or medicine.   While Chinese believe that slow-boiled is good for our health,  it is  actually bad for gout. The reason is simple enough to understand.  The long boiling process actually dissolves the purine in the meat into the water.  So after two to three hours, the soup has much purine in it.  Having such soup is like having a high does of purine and can increase the uric acid concentration in blood shortly.

One would think that soups in restaurants should be better.  However, restaurants usually would not spend two to three hours to prepare soups.  Otherwise, the cost would be high.   Therefore, cost is also the reason they would minimize the total amount of ingredients in the soups.  How can we have soups that have good favor with a low cost?   Additives is the answer. Hence, additives are usually added to enhance the favor.  As stated in my previous post, some additives can increase the purine level.  The worst of the soups in restaurant is, we don't know what actually has been put into the "soup" for the favors.  Bones?  Seafood? It's just an unknown.  Canned soups and instant noodles share the same problem.   Even in western restaurant, I notice that most of the soups have mushrooms or clam which has high purine.

Soup is something that I did not aware of since it is in my Chinese culture.   In the past, I would have one bowl before the meal and one after.  I would also drink the soup in the cup/instant noodles.  I just did not know it is bad for gout.  Until I read more and more about the gout, I started to realize that soup could be one of the cause of my gout. Now, I would not have soup while eating outside.  Even at home, I have only half bowl of it.  Half bowl seems to be the right amount that I can bare.  

For those who really love soups, I think quick-boiled soup is the only choice.

Suggested Reading

1. MSG/Additives, causing Gout Attack?

2. Chinese News regarding Soups and Gout 1 (need to use google translate to English)

3. Chinese News regarding Soups and Gout 2 (need to use google translate to English)

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