does anyone have gout

@andy604172 Welcome to Mayo Clinic Connect! I also suffer from gout attacks, and have adopted some dietary habits that will help me minimize those attacks. No pork, no shellfish [lobster, crab, shrimp], few processed meats, lower purine foods.

Here is an article from the Arthritis Foundation that can help guide you: https://www.arthritis.org/health-wellness/healthy-living/nutrition/healthy-eating/which-foods-are-safe-for-gout

Do you think you can give this a try?
Ginger

I had gout for many years. Twice in the hospital. Finally, 300mg daily of allopurinol and I stopped drinking beer. Been great for 5 years!

@andy604172
Well the first thing is to talk to your doctor about it, but since you're on allopurinol I guess you did that, but if that's all he has for you, you should ask for a referral to a specialist.

What kind of diet are you on? High purine foods can trigger gout, but there's much more to it, too much carbs and sugar can also do it.

What are you taking for the pain? Avoid aspirin, ibuprofen is much more effective.

Your other conditions and drugs may also count,

Bottom line is that diet should be able to control it for most people, since few doctors, even specialists, know anything about diet - or are willing (or allowed) to talk about it with patients, you may also want to get a referral to a nutritionist, and if possible a nutritionist with special interest and expertise with gout.

@carbcounter I have suffered for years with gout. The best thing I did was get a doctor that understands the way it affects your life. She has helped me with medication and how to deal with my other doctors that don't know enough to help me. Good luck.

I'm not sure why I missed seeing this discussion. I was diagnosed with gout in 2022. Very long post. My apologies.

After a small pan lid fell on my toe from about 4", that toe hurt and was slightly swollen ( not like the photos of gout tophi) for months. I had x-rays taken at about the six month "anniversary of the lid accident" by a Foot and Ankle Specialist whose comment was, " I can't see the break, come back in six weeks." By then, my nephrologist (!!) had deduced that my uric acid level should be measured. Three days later, when I had my quarterly appt with him, he gave me a prescription for colchicine which took care of the pain in quick order. I was tested for allergy to allopurinol, which apparently is common in East Asia (all my grandparents immigrated from Japan) and started taking it shortly after that.

Next came a referral to Rheumatology, the dept at my HMO that "handles" gout patients. The entrance requirement for a gout consultation was to have had a tophus from which uric acid crystals could be extracted and seen by a microscope. I hadn't done that step so I was told to get a Dual Scan CT instead. The (goofy) doctor said she didn't know where I could get that done but to come back when I did. Really?!?

In the meantime, my nephrologist said he'd be happy to help me with gout since I was already seeing him quarterly for my main health threat. I'm one of ten people in the world known to have a CKD called idiopathic ITG. A pathologist at the Mayo Clinic made the diagnosis after pathologists at my HMO and at the Hennepin County Medical Center in Minneapolis were unable to conduct the confirming test because they did not have a reagent the test called for. I searched the medical literature for info about ITG and for papers (if any) published by that Mayo pathologist. She happened to have published with a colleague in Nephology who also practices in Hematology. I think he took me on as a patient because he had never met an idiopathic ITG patient.

As it turns out, that Mayo doctor himself has gout. As he worked with me on the ITG problem he deduced that I might have another form of arthritis (that would make three for me: gout, osteoarthritis (for which I had total hip replacment in 2024) and, the new to me one, pseudogout. The Mayo Clinic must have every available medical test and scan because he was able to arrange for a Dual Scan CT for me the day after I had an appt with him. Of course, I do have pseudogout. I think that it got its name because it is one of only three known maladies for which colchicine provides relief: gout and Mediterranean Familial Fever are the other two.

There is no cure for pseudogout, nothing to prevent it from happening in new joints, just pain relief from taking colchicine which I now take daily. It mostly works but my nephrologist is considering increasing the dose.

The only other thing I should note (sorry for the length of my post! I'm a retired academic chemist) is that I've been told by both nephrologists and the rheumatologist I got to see after "the" Scan that red meat is the worst protein source for gout sufferers. I am told to avoid beef, pork, game, shellfish, fried foods, avocados, nuts, herring, sardines, and a few other odd foods I rarely ate in the past. I struggle with the diet limitations. I eat now not for enjoyment but to avoid the hiccups which come on if I am hungry. Go figure.

@mnsansei
Gout is not hard to diagnose, it can be done over the phone.
It can usually be distinguished from pseudogout that way, too, if the doctor knows his business.
Sure, invasive and/or radiological tests are needed to be 99% certain, but you can be 98% certain without them.

I have had both.
I watch my diet, also take celery seed which is supposed to be a natural alternative to allopurinol and contain an XAOI, the same kind of active ingredient - but one of the chatbots said this wasn't correct, so now I'm not sure, but it seems to help anyway!

Your dietary list is way unspecific, some things are MUCH worse than others and uric acid problems can arise from carbohydrates as well.

Colchicine is supposed to work, I haven't tried it, but ibuprofen can work for moderate cases - and do not use aspirin, it slows uric acid clearing and recovery.

Thank you for your reply.

I believe my nephrologists have both concluded that I have both gout and pseudogout.

I need to be more proactive about my diet but I've had too many other medical issues to work on a problem that is mostly under control (only two flares, neither debilitating, in five years) if a uric acid level of 4.6 is an indicator. I haven't been able to find a knowledgeable dietician. The rheumatologist I saw wouldn't even talk diet beyond "no red meat." I am reluctant to crowd source a problem that could further damage my kidneys.

I take colchicine because as a person with chronic kidney disease I am not allowed to take NSAIDs.

@mnsansei Allopurinol for prevention (not cure), Colchcine for attacks and repeats thereof. I am not medically trained but did this on advice,

@mnsansei said:
"The rheumatologist I saw wouldn't even talk diet beyond "no red meat.""

For gout, that is frightening.
Red meat is far less a problem than sea food.
SMH

Fortunately GIYF (Google is your friend) and you can read about 1000x more information than your rheumatologist shared with you.

How that maps to kidney disease restrictions I can't say, and I also don't know if there's a link between kidney problems and gout. But wait, GIMF too ... yes, Google says there is a two-way linkage, each can cause the other. And a few good dietary guidelines, too.

But best of all Google suggests reviewing this with a "renal dietician".
Do you have a "renal dietician"?
I gather this particular rheumatologist would not well serve that role.

@carbcounter Definitely gout is connected to kidney problems. In healthy kidneys the Purines are taken out by the kidneys. As far as food it is on the internet. I stay away from couliflower and asparagus, no processed meats. The most important thing my Rheumatologist knows is that they can X-Ray you with a special X-Ray to see how much gout is in your joints. I had 2 other ones that had no clue. This was important to me because mine was in my back and these other doctors didn't believe me. Good luck.