I am a new member here, but I am so fed up with gout and doctors. Mad I see an awful lot of questions about gout on the internet, but not many solid answers. And the reason for that, I believe, is because no one really has any idea how to treat gout.

Even the doctors, bless their hearts, preach to me about changing my diet. I can list (from memory) all of the foods that CAN trigger gout. I have drastically changed my diet (over 4 years), but there is no way to avoid all the bad foods. So, at what point do we stop the madness? I have changed my entire lifestyle, but I still get gout. So, what did that advice accomplish?! Confused At what point will the medical community realize that we are simply not putting enough time and $money$ into gout research?!

I frequently have to miss work due to gout (and thank goodness I don't work on my feet all day, or I would have to change careers). Rolling Eyes Yet, when I visit the doctor, he spends 5 minutes with me and then prescribes the same medicines that have not worked for the last 4 years. I have tried home remedies, herbal remedies, but nothing works. What has to be done in order to focus more energy on finding a cure?! Surely, there must be something to stop the pain.
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First Helper painfree
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replied January 23rd, 2008
Especially eHealthy
Diet is the best answer to your gout. I know you said you tried to change your diet, but you say there is no way to avoid all the bad foods. A lot of people feel that way since bad foods are generally more convenient and eating healthier is not as easy and can seem more expensive.

Good luck! I hope you find relief. Don't stop trying.
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replied January 23rd, 2008
Thanks for your response, Ingi. As you can probably tell, I am very frustated and I am in pain as I type. However, I guess what I should have asked was, "What do you do AFTER you have already changed your diet and that did not work?"

Granted, it helped the situation a lot. I only have an attack about 1/2 as often as I used to. But, in my opinion, the whole "change your diet" plan only serves to sweep the problem under the rug. I still have attacks, they are still as painful as ever. The only difference is that now they are not linked to a bad diet.

Yet, that is the extent of the medical advice. Laughing It's laughable, actually. Even a vegetarian has more flexibility in their diet than someone with gout. I cannot even eat beans or too much bread, for crying out loud. Rolling Eyes Surely, there must be something more that can be done.
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replied January 23rd, 2008
monitor uric acid levels
How about a somewhat radical approach: get a uric acid monitoring device. You would then be able to watch your UA level on a daily basis and learn what foods or activities to avoid.

People with diabetes are very familiar with similar devices and monitor their sugar levels every day. Why not gout sufferers?

Unfortunately, unlike sugar level devices, which are very common, it is hard to find UA level monitoring devices. I tracked a company in India and another in England that are willing to sell them (shipping included they are around $100). I have not found anything in the USA.

Stan
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replied January 24th, 2008
I have now changed my diet to help, but there is a prevention pill you can get from your doctor but to get the pill you have to have frequante attacks. I`ve had 4 attacks since the summer so i hope the doc wiil let me have the pill.
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replied January 26th, 2008
Gallego, I think you may be talking about allopurinol? I also tried that, but the sad fact is that it does not work for everyone and (as my luck goes) it does not work for me. You can still have attacks while taking it and my doctor FAILED to tell me that when an attack occurs, you are supposed to stop taking the allopurinol, because it could actually make the attack worse. Rolling Eyes

Anyway, I did not see a reduction in the number of attacks I was getting, so I finally stopped taking it.

In regard to the acid tester, I'd love to have one but it sounds like they are impossible to find. Confused
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replied January 26th, 2008
Experienced User
Hi halfcow,

The purpose of uric acid (UA) lowering therapy is to lower the blood UA level to 5~6 mg/dL. At that level, the number of attacks will decrease. To get there one needs to take an EFFECTIVE dosage of Allopuriol (or Sulfinpyrazone or Probenecid). To find the effective dosage, one needs to use the blood UA tests to adjust Allopurinol dosage up or down.

Allopurinol should not be started when there is an attack because it will worsen and prolong the attack. However, once one is on it, one should not stop it because Allopurinol can trigger an attack every time it is re-started. More info can be found in Common Mistakes section of http://www.ICuredMyGout.org .

According to an internet post, the UA meter gave wild readings. It may just throw in more confusing data to the already difficult problem.
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replied January 26th, 2008
Experienced User
Some of us former gout sufferers have found that our gout attacks while sleeping resulted from sleep apnea, which is the repeated cessation of breathing for prolonged intervals while sleeping. And after we resolved our sleep apnea, we were cured from any future gout attacks. That was my experience 4 ½ years ago, after suffering for 15 years of gout attacks with ever increasing frequency.

There are two physiological effects from the reduction of oxygen in sleep apnea which can lead to a gout attack. Effect #1 is that the cells start to generate excess uric acid which gets dumped into the blood. Effect #2 is that the blood acidity goes up as a result of the increased ratio of carbon dioxide to oxygen, so that the blood is more likely to dump out uric acid in the form of crystals of monosodium urate in order to return the blood acidity to its normal level. When these crystals enter joint fluid, they cause the severe inflammatory reaction of gout.

Gout has been recognized as a disease at least since the ancient Greeks. Excess uric acid as its cause has been known for about 200 years. Sleep apnea was recognized as a problem by the medical profession only about 50 years ago. The physiological effects from sleep apnea that I described were written about in pulmonology journal articles about 20 years ago. It is now recognized that about 20% of the adult US population has at least mild sleep apnea. It is far more common than gout. About 90% of people with sleep apnea have not yet been diagnosed with it.

I am completely at a loss to explain why the vast majority of doctors who treat gout are not aware of the connection of uric acid physiology with sleep apnea. But they are not. Many that I have informed of it seem to be uninterested. A few seem very interested. Maybe their interest will lead to published studies in a few years. If things progress at the rate that new information about other chronic diseases with long established treatments, but no cures (eg. stomach ulcers), has led to a change in medical practice, the inclusion of diagnosis and treatment for sleep apnea as routine practice with gout sufferers will take about 15 years to happen. I bet that no gout sufferer is willing to wait that long.

If any gout sufferer reading this message would like the pulmonology journal references that I referred to, email me and I will email you the list. Maybe you can insist that your doctor read them, and then follow up with that information.
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replied April 4th, 2008
Sleep apnea is one thing I never considered. I considered kidneys, they were fine, I have improved my diet, not that it was all that bad to begin with, nothing seems to help. In fact the attack I am dealing with now is the worst yet, it has been going on for two months now. I have yet to figure why I have the problem so young, it began when I was 25, I am 28 now and they seem to hit every year, and just get progressively worse. If you still have the references I would like to take a look at them

Thanks
Jason
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replied April 4th, 2008
Experienced User
Here are references relating sleep apnea and other causes of hypoxia to hyperuricemia and gout.

[1] Abrams, B. The Perils of Sleep Apnea - an Undiagnosed Epidemic, iUniverse, 2007, available at amazon

[2] Abrams, B. "Gout Is an Indicator of Sleep Apnea," Journal SLEEP 28(2), Feb 2005, p. 275.

[3] Saunders NA, Sullivan CE. Sleep and Breathing, second edition, Informa Healthcare, 1993.

[4] Grum, CM. "Cells in Crisis: Cellular Bioenergenics and Inadequate Oxygenation in the Intensive Care Unit," Chest 102(2), 1992, pp. 329-30.

[5] Hasday JD, Grum CM. "Nocturnal Increase of Urinary Uric Acid:Creatine Ratio: a Biological Correlate of Sleep-Associated Hypoxemia," American Review of Respiratory Diseases 135, 1987, pp.534-38.

[6] Plywaczewski, R., et al. "Hyperuricemia in Males with Obstructive Sleep Apnea (OSA)," Pneumonol Alergol Pol. 73(3) 2005, pp. 254-259.

[7] Plywaczewski, R., et al. "Hyperuricemia in Females with Obstructive Sleep Apnea," Pneumonol Alergol Pol. 74(2) 2006, pp. 159-165.

[8] Ruiz Garcia, A., et al, "Blood Uric Acid Levels in Patients with Sleep-Disordered Breathing." Archivos de Bronconeumologia 42 (10), October 2006, pp. 492-500.

[9] McKeon, JL., et al. "Urinary Uric Acid with Obstructive Sleep Apnea," American Review of Respiratory Diseases 142 (1), 1990, pp. 8-13.

[10] Saito, H., et al, "Tissue Hypoxia in Sleep Apnea Syndrome as Assessed by Uric Acid and Adenosine," Chest 121 (55), November 1, 2002, pp. 1686-1694.

[11] Sahebjani, H., "Changes in Urinary Uric Acid Excretion in Obstructive Sleep Apnea Before and After Therapy with Nasal Continuous Positive Airway Pressure," Chest 113(6), 1998, pp. 1604-1608.

[12] Du, X., et al. "Significance of the Changes of Urinary Uric Acid in OSAHS Before and After UPPP," Lin Chuang Er Bi Hou Ke Za Zhi 19(1Cool, Sept. 2005, pp. 826-827.

[13] Garcia Panchon, E., et al, "Uric Acid and Its Relationship to Creatinine Levels and Hypoxia," Archivos de Bronconeumologia 43 (9), September 2007, p. 523.

[14] Schafer, H., et al, "Body Fat Distribution, Serum Leptin, and Cardiovascular Risk Factors in Men with Obstructive Sleep Apnea (Clinical Investigations)," Chest, Sept. 2002, pp. 829-839.

[15] Silverberg, DS., et al, "Treating Obstructive Sleep Apnea Improves Essential Hypertension and Quality of Life," American Family Physician, Jan. 15, 2002, pp. 229-240.

[16] Brown, LK., "A Waist Is a Terrible Thing to Mind: Central Obesity, the Metabolic Syndrome, and Sleep Apnea Hypopnea Syndrome (editorial)," Chest, Sept. 2002, pp. 774-778.

[17] Jefferson, JA, et al, "Hyperuricemia, hypertension, and proteinuria associated with high-altitude polycythemia," American Journal of Kidney Diseases 39 (6), June 2002, pp. 1135-1142.

[18] Khokhar, N., "Hyperuricemia and Gout in Secondary Polycythemia Due to Chronic Obstructive Pulmonary Disease," Journal of Rheumatology 7(1), Jan.-Feb. 1980, pp. 114-116.

[19] Khokhar, N., "Gouty Arthritis in Chronic Obstructive Pulmonary Disease," Archives of Internal Medicine 142(4), Apr. 1982, p. 838.

[20] Verhulst, SL, et al, "Sleep-disordered Breathing and Uric Acid in Overweight and Obese Children and Adolescents," Chest, May 15, 2007.


These references are listed at my website, along with the tale of my own experience with sleep apnea and gout. But when I have previously tried to post the website address on this forum, the forum administrator bounced it off, thinking that it might be advertising something. It isn't.
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replied April 4th, 2008
Thanks for the information.
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replied April 4th, 2008
Experienced User
Hi Jason,

I read on another one of your posts that you don't have health insurance. Pursuing the diagnosis and treatment of sleep apnea by conventional medical practice can be expensive. But here are some things you can try on your own which may be helpful.

1. Lose excess weight. Excess body weight makes sleep apnea more likely.
2. Make sure that you sleep on your side, never on your back. When your throat muscles relax during sleep, gravity can cause the base of your tongue to close up your airway when you are lying on your back.
3. Watch out for sleep medications, even nonprescription ones. They can exacerbate sleep apnea.
4. Refrain from alcoholic beverages for several hours before going to sleep. They can exacerbate sleep apnea.
5. Don't smoke. That can leave the lining of your airway inflamed so that the air passage is narrowed and more likely to close up during sleep.

Good luck.
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