There are a few studies that show that the vegan diet contributes to the highest uric acid levels of any of the mainstream diets. If you have gout, a vegan diet is something you want to stay away from like the plague...
8
Several years ago, I had a very painful gout attack after eating several large mushrooms (I'm a vegetarian). This is how I stopped that attack and prevented a recurrance -- I eliminated all cauliflower, asparagus, spinach and mushrooms from my diet. I also added ten frozen cherries (from Walmart) to my daily diet. Since I made these changes, I haven't had a single gout attack. I don't know whether my advice will work for everyone, but it certainly worked for me.
8
I have noticed cashews seem to trigger gout. I am not sure about the other nuts. Also, we need to remember we need to drink as much water as out body needs - and the amount is obviously not the same for ever one; so it is better to increase the amount you are drinking.
FYI for kidney donors your transplant center may not tell you this as all they want is your Kidney. They are finally doing data collection on donors and Gout is an short term risk after donation and then increases as the donor ages. We really need two kidneys to function well ,so only give to people you love.
2
The elephant in the room is fructose, fructose consumption raises uric acid levels. I Josh had done his research he would have known that.
3
The author never explains why he had to give up beans, spinach, hummus, etc. Anyone know why?
7
@Sneeral Unfortunately many otherwise healthy foods such as asparagus, mushrooms, peas, beans, lentils, cauliflower, and spinach are high in purines and contribute to gout. My grandma, who has always been very active and health conscious had to give up so many things that I had previously considered healthy when she developed gout. I was quite surprised. I think there is a stereotype of gout-sufferers as over-consumers of rich food and alcohol, but often that is not the case.
8
I'm surprised that this article passed editorial monitoring, for the reasons that others have pointed out. It is misleading and inaccurate since gout is a metabolic condition and the old idea that it is purely diet-related is extremely dated. As a fellow gout-sufferer, I vouch as well for the allopurinol-cherries-hydration-exercise-weight watching-colchicine combined approach contingent to your physician's advice and your particular circumstances.
6
I didn’t notice any references to purines. Is that no longer applicable?
2
The gout article was helpful, text, and especially photo. I thought that perhaps gout was what was happening with my feet - and I can see from the photo that it is NOT. This at least begins to clarify what kind of doctor I should be looking for if the problem gets worse. Thanks. And best wishes to you for relief!
6
I have calcium pyrophosphate deposition also known as Pseudogout. Unlike Gout it's there all the time. I first noticed that both of my elbows had swollen to the size of golf balls. I went to my GP and he used a needle to drain the fluid from them. We had to do it twice over a three month period. The swelling has not returned though there is some pain in my elbows. The fluid sample has to be studied under light to see that the crystal are different than the ones from gout. There is no discoloration of the skin. It wouldn't matter because you wouldn't be able to see it under the Psoriasis.
Pseudo-gout's difference is that it is a form of arthritis not from your diet.
Getting old is so much fun.
5
Thank you for writing this! My partner is a former Vegan from CA who loved juice fasting. We transplanted to the Midwest. Like you, the attacks were sudden and surprising. I know that in his heart of hearts, he blamed the $2 fresh Angus beef steaks and abundant pork sausages. However, when he went to the doctor, he too discovered that it was something that he had suffered with during his vegan days in a milder form. The illustration is perfect for this article. Cherry juice and Apple Cider vinegar are his go to items.
5
I use, and always keep on hand, tart cherry concentrate. I had an attack in my big toe and could see the uric acid crystals under the skin. Within 20 minutes of drinking some of the cherry juice I saw the crystals disappearing along with the pain.
3
I am disappointed that the New York Times would run this misleading article. Gout is a genetic disease. Diet does not affect it very much, and dietary changes will not help very much unless you eat an extremely gout unhealthy diet (all beef all the time, for example). It is cured by allopurinol. You take enough allopurinol to get your uric acid level below 6.0 mg/dL. During the next twelve months the gout is likely to get worse before it gets better. However, after a year at that level it is extremely unlikely that you will ever have another attack. You do have to continue the allopurinol and continue to keep the uric acid level below 6.0. Allopurinol, like many drugs, has a very small chance of bad side effects, and of course if you are the unlucky one, this solution will not work. Go to a medical doctor, not a podiatrist.
4
@Ken Krich gout is a combination of genetics and environment ( diet).
5
The author would have been much better served by seeing a real physician, i.e. a M.D., not a podiatrist, who is not a doctor and did not attend medical school nor do a residency in Internal Medicine. That would have led to a quicker and more permanent resolution, using the correct and appropriate medications. And it would have saved him from the unnecessary (and possibly expensive) testing such as the MRI. Even the painful injection was probably unnecessary. And a real physician would give him correct advice about dietary changes needed or not needed.
16
Could it be that undereating complete proteins (animal protein) and a high level of physical exercise could force the body into breaking down its own muscle, contributing to high uric acid -- among other things?
I'd appreciate feedback from anyone for whom this makes some sense.
6
@Mayda the idea of "complete" proteins is antiquated.
The process of digestion breaks all protein, including those that come from plants, down into amino acids, and our bodies maintain a store of these and reassembles them as needed. A healthy vegan diet provides all of the amino acids we humans will ever need.
Think of it this way: that cow you think is made of such complete protein? Where do you think they got –their– proteins? They got them from plants! From a far smaller variety than the diets of most vegans you will ever encounter.
Time to go take General Biology at a reputable school. I suggest your local community college. Get your information from scientists, not from food gurus. They are probably selling you something overpriced along with the misinformation.
9
I just finished Josh Max’s article When a Vegan Gets Gout. I sympathize with Josh because I too was diagnosed with gout for years and suffered with intense pain not to mention strong anti gout meds. I finally ended up with a renown Boston doctor who, after much testing, told me I had never had gout, but an unusual disease that mimics gout called palindromic rheumatism. I was successfully treated by this brilliant doctor with no recurrences.
15
I've had gout for about 10 years. When it first hit me 9my big toes) the pain was so bad, I was crawling around my apartment. When it let up sufficiently so I could leave the apartment, I went to a hospital. I was diagnosed with gout. I was not given a shot of cortisone. I was prescribed allopurinol, also indomethacin for joint pain. I also, occasionally, use a cain. The pain is on again, off again. But I must admit, I love summer, when I can wear open-toed shoes. My grandfather got gout when he was in his sixties, as I did, & a believe that heredity, rather than what you eat or drink is the most important factor in getting gout.
7
Great to hear that Mr. Max's gout has faded, but I'd suggest that the emphasis of the article be a little different, to help dispel a lot myths about gout.
First: This article might be best called "An Ode to Allopurinol” – since he took this medication, and after some time it essentially stopped his gout from happening. That’s what allopurinol does almost all the time, if it’s taken regularly in the right dose to get the uric acid level below 6.0. Gout does really well, with the right regimen.
Second, diet is surely important in gout, especially before you have been on a medication to lower the uric acid for a good period of time. The wrong foods, e.g. red meat, shellfish, and alcohol can certainly set off attacks. But gout is a genetic condition, so the vast majority of sufferers need a combination of diet and medication control.
Third, many options for managing gout flares do exist beyond the injections that were mentioned, including oral corticosteroids (such as prednisone), non-steroidal anti-inflammatory agents (such as naproxen or ibuprofen) and colchicine, with different medications safer and more effective for different people.
I’d recommend readers to a Patient Gout Guideline that I helped edit, as a rheumatologist, at https://creakyjoints.org/. This guideline proposes a diet and medication approach individualized to each person, doesn’t advise specific medications but rather gives ideas for people to discuss with their providers.
19
@Theodore Fields MD
Fructose is metabolized to uric acid. So it is wise to avoid table sugar and high fructose corn syrup etcetera.
4
As a one time gout sufferer, I found 20 cherries a day (sour is better but sweet ones work too) and two celery seed capsules (600 mg each) work wonders as a preventative. There are actually some double blind tests that support this, so it is not just anecdotal. Cherry juice or extract in pills also works, as do dried cherries which are easier to get year-round. Of course, diet and weight control are also important. A bonus is that the cherries help with arthritis.
https://www.sciencedaily.com/releases/2012/09/120928085354.htm
8
I had a friend who suffered from occasional gout attacks. He said diet soda would set it off. He consumed an extra large diet soda at lunch. Once he stopped that, his gout didn’t return. Coincidence?
6
The best description of gout I have seen....no rhyme or reason to it...no blaming the victim for gluttony...just episodic pain.
Good news is that the exercises for total knee replacement are giving me back motion in my gouty foot ( yes, only one foot affected for 20 years or so). Thanks.
1
I hope you carried a cane during your flare-ups not only as an aid in walking but as a signaling device letting people know you have a problem. I like it's potential as an unconcealed weapon but that's another story. People can be just wonderful to someone with a cane -- just lovely. (not everyone, but many)
12
I am glad to hear the author’s condition has gotten better, but this article is misleading starting with the title. The implication is somehow a vegan diet should have proffered immunity to disease, a ridiculous claim. What isn’t ridiculous however is the large body of research showing that vegetarian and specifically vegan diets are health promoting.
The Academy of Nutrition and Dietetics in its position paper of 2016 said:
“It is the position of the Academy of Nutrition and Dietetics that appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases…. Vegetarians and vegans are at reduced risk of certain health conditions, including ischemic heart disease, type 2 diabetes, hypertension, certain types of cancer, and obesity.”
So based on the available research I would say statistically one is still far better off with a plant-based diet. Again, not a 100% guarantee; you can still be hit by a car when crossing the street even if you looked both ways. Still, I prefer my odds over not looking, or trying to cross blind-folded.
Beyond that, and also of great importance, is that diet is not the only factor in health. Exercise, proper sleep, and stress levels can all play a factor in health outcomes. The author didn’t make scant mention of these other important factors and how they may have played into his malady.
6
I've had gout episodes for over twelve years, perhaps contributed to by genetic kidney disease. This same disease prevents me from using NSAIDS or the pharmaceutical gout options.
First thing to know: gout is only predicted by serum uric acid levels 50% of the time, meaning there are other factors. Also, uric acid is created and spikes when ATP decomposes in your body which happens every night. Oddly enough, the best thing I've found is to get enough sleep-more exactly to go to bed when you first feel tired and not push your body which creates more ATP to break down. I believe stress also increases your body's creation of ATP, again spiking uric acid levels when ATP is broken down during sleep.
Gout causation is so much more complex than the rote diet advice that is usually the only recommendation from the internet or health professional.
11
"When my gout blessedly receded a year ago, in what I hope is for the last time..."
If the author has the genetic metabolic disorder of gout, he is not done with the flare ups. On the other hand, when I was in my twenties, I worked waitressing at a hotel in the Catskills: three meals a day, 7 days a week. It was fun but grueling and everyone got sick one way or another. I developed an arthritis of my feet and wrists and a trip home had my GP family doctor diagnosing gout and putting me on gout drugs: one for the acute episode and a new one then to prevent the build up of uric acid crystals.
Bottom line, i took the medications for nearly a year and -youthfully - decided I didn't want to deal with a chronic illness and stopped.
I have never again had an elevated uric acid level and I'm in my 70's. The sheer physical stress of the job caused my body to break down protein faster than ususual, something that sometimes happens with chemotherapy, too.
Final word: please go to a medical doctor, not a podiatrist. The pain may be in the foot, but the disorder is one of the metabolism.
Retired RN
23
a suggestion in case you have to hoof it with the cane again, which i hope you won't need to remember:
if you use the stick in your left hand, as i have had to for over 30 years, walk as far over to the curb as you can. they may bump into you, but they won't get the cane out from under you causing you to fall...cane in your right? hug the opposite side of the sidewalk.
let the lemmings flow around you.
10
I was diagnosed with gout as a teenager (30+ years ago), tested withhigh uric acid levels, but never a serious attack, a few mild ones, but it is manageable.
It's important to understand the mechanism of gout. It results from preferential metabolis of protein, so if you have the trait you need to be careful about protein intake; a high-protein diet is not for you - metabolising protein creates uric acid, which if it accumulates in the bloodstream at rates higher than your kidneys can eliminate, precipitates as crystals, typically on the rougher, more damaged areas of joints, especially those with poor circulation. You stop your toe a lot, there are a lot of joints in the hard working feet, and circulation is lower there, ergo, a prime site for gout.
Think of gout as like a little sand in the gears, a tiny number of crystals irritate the joint massively and cause inflammation as a response. The best treatment is naxproxen (brand name Aleve), take it at the first slight twinge. Also effective as a preventative is tart cherry juice.
So how to reduce attacks: first drink lots of water - it helps the kidneys eliminate uric acid; second, avoid foods that provoke it (red meat, shell fish, red wine, the list in this article, ales), especially don't combine them (surf & turf with red wine, asparagus and spinach!) Finally, walking improves leg and foot circulation, so walk a lot when not having an attack, but stop if you have a twinge, so as not to grind the crystals in the joints.
10
This article has a catchy title, but is seriously flawed. As one of the earlier medical commentators noted, gout has a well-known biochemical origin. Uric acid crystals form in joints when the concentration increases above a threshold level of approximately 6.8 mg/dl. The only remedy is medication whose goal is to keep the uric acid level in the blood below the threshold. The notion that gout can be controlled by diet alone is an old wives tale that has no scientific support.
22
I should have been more forthcoming with my own experiences with gout. Over the 20 years that gout has provided some variety in the severe advanced osteoarthritis that is my daily companion, I have been blessed with the well-intentioned and misinformed recommendations of friends, co-workers and experts of every stripe. None of them ever having cracked a medical text.
That old folk medicine cure, sun-dried cherries, cherry juice, tart cherries; must be on somebodies greatest hits list. I hear about that almost every time I develop a limp more distinct than my usual awkward gait. If that worked, gout would have been banished from the face of the earth by now.
No sign of that.
In my experience, waking up and doing laundry at 2:45 AM works every time! In the inconceivable event that doesn't work for you, run (don't walk) to any GNU at least 1/2 mile away and ask for their 2 lb container of Placebo Effect. Mix a full table spoon of the bright green powder into an 8 oz. glass of warm sour milk.
You will never complain about gout again.
If you've had enough patience to wade through my sarcasm, I do have a real honest & effective suggestion. Uric acid crystals are most likely to precipitate out of the blood-steam whereever a body part is relatively cooler than your core temperature. Hence the increased incidence of attacks at the ends of limbs, hands & especially feet. Wear the warmest comfortable socks you can find to bed. EVERY NIGHT! This wll help, it's basic physiology!
10
The main reason gout tends to afflict the feet is not coolness (if so it would effect the hands and ears too) but rather the simple mechanism of crystal precipitation.
If you set up a saturated solution in a beaker - and then introduce a rough surface, crystals will usually precipitate in the rougher area - stir and the areas with less circulation is where the crystals from fastest. It is as you say "basic" physical chemistry.
In your body the joints that accumulate over years the most damage and roughening are those prone to impacts, your toes, the tarsals, metatarsals and phalanges - and your ankles and knees - so rough surfaces. To that add the lower circulation in the feet, and it becomes more likely that crystals will form there.
Tart cherry juice does definitely work for some gout sufferers, but not all. If it does not work for you, that is no reason to condemn it. Gout attacks in many people are triggered by specific foods - indeed while gout afflicts primarily men, dieting women living on "diet shakes" which are very high in protein have experienced gout attacks. So diet does matter for many sufferers.
11
B.S. in biochemistry here. You’re both correct. Although I don’t know the exact mechanism of or ideal circumstances for crystal formation in gout, both lower temperature and surface irregularities can precipitate crystal formation. Salt or sugar crystals dissolve faster and more completely in warm or hot water than cold, for example, and crystallization in labs is often induced by warming a solution and allowing it to slowly cool. There are a plethora of other factors that influence crystallization (particularly in an environment as complex as the human body), but temperature could very well be one of them.
5
Chemistry, physics here - the temperature difference in feet is rarely so great as to be significant. The surface roughness (stubbing your toe, jumping, running) and lower circulation is a big issue.
It's weird in that walking help prevent attacks, but once they get going exacerbates them.
It reminds of a friend that her father ate healthy and exercised regularly , got a pancreas cancer and no longer with us . Meanwhile her mother does everything the opposite but still alive and healthy, even thou eating pizza and drinking Diet Coke is her going out for dinner menu. Anyway, I think it’s all about family history. And luck has something to do with it.
Thank you for sharing and making us having this conversation.
9
My heart-felt sympathies, I'm sorry to hear that even just one more person has been afflicted with the cruelty that is gout. For many individuals, a full-blown gout attack represents a first experience with pain approaching the extremes of human experience. While not true for every patient or for every attack, at its worst, gout can cause pain that self-reports at a 9 to 10 level for many hours or days running. Even individuals that have established an extraordinarily high tolerance for pain can be brought to the point of continuous weeping and loud vocalization (i.e. screaming), until the strong, quick acting opioids can be administered.
Again, my sympathies!
It must be even more painful to discover that the moral superiority that most vegans take such pleasure in claiming as their reward, provides no protection of any kind.
Basic truth: food is not medicine. It's nutrition, something entirely different.
12
Podiatrist for gout? Seriously?
8
Uloric works like a charm
2
I suffer from gout and then lived in China for a decade. The doctors in central China did things to me that sounded like middle age medicine to a doctor I met back in the states. He told me I could have lost my leg. (They also wanted to try to scrape the dirt of my eye with a blade.. I almost said when in Rome, but then decided otherwise and with some solution squirted into my eye it came out.)
For the gout in my knee, the doctors withdrew - through a small pipe that they knocked into my knee - the fluid from my knee. They then injected saline solution into my knee and let me bend my knee to create a kind of washing machine to clean my knee. The pain was staggering.
China, great place to eat, great kind and friendly people, not a great place for medicine. For those who think Chinese medicine is all the rage, all the power to you, but I wouldn't want to take it to fight cancer.
Good luck to gout sufferers everywhere.
14
I am surprised at this list of foods the author writes that he must avoid: "black beans, spinach, asparagus, raisins, chickpeas and hummus, all heart-healthy stuff I’d been eating for years, had to go.” Generally, plant foods are low in purines, and chickpeas, which are also the basis of hummus, are near the bottom of the list of purine content. -- Diets rich in plant foods are not associated with increased risk of gout, even when higher purine plant foods are consumed….Garbanzo beans, cooked ½ cup (82 g) 19g purines. -- [for comparison, fresh anchovies , 100 g, 3.5 oz, contain 411 mg purines.] http://www.brendadavisrd.com/plant-based-diets-and-gout/
And more: — the impact of purine from plant sources on the risk of gout attacks was substantially smaller than that from animal purine sources.
The study authors also referred to additional research which discovered that over the long-term, habitual consumption of purine-rich vegetables was not associated with an increased risk of gout. In fact, that study found subjects who ate the most vegetable proteins experienced a 27% reduced risk of gout compared with subjects who ate the least vegetable proteins. It’s possible that other healthy ingredients in vegetables, such as fibre, antioxidants and healthy fats, contributed to these benefits. — https://www.blackmores.com.au/arthritis-joint-bone-and-muscle/can-vegeta...
12
Many plant foods are high in purines - but the bigger issue is high levels of protein. Purines increase the tendency to gout, but the primary mechanism is excessive or preferential metabolis of protein to form uric acid.
4
Thanks for sharing your story! There are so many health benefits to eating a vegan diet. Best of luck and here’s more info on gout and diet: https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_...
6
My old GP helped me the most: during flare ups Diclofenac(NSAID) Tylenol, otherwise a daily 50mg maintenance dose of Desuric(Benzbromarone)
I’ve had no problems since I started the Desuric. Prednisone caused my more problems than it solved and was only mildly effective. Stay away from opioid pain relief!!!
You can purchase both
of them in Europe for next to nothing. Diet has little to do with it.
The puncture test is barbaric. The only thing more painful is a gout attack.
You don’t have to live with it. Find a good reumatologist
1
Thank you for sharing.
1
I feel your pain. this happened to me several years ago. It was a horrible experience, and eye opening as a fellow active person. If you've never been physically limited in your mobility due to pain, you realize just how horrible this is. Good luck to you in your battle with this annoying, painful full condition.
2
Well here's the rub.
You think you are doing things well.
You are doing yoga, pilates, walking, biking.
refraining from vices,eating healthily, even vegan,
and still pains starts.
For me, bi-lateral arthritis that has me hobbled - from either "manageable" pain through which i can walk, to
incapacitating pain which has me sedentary and trying
to mentally jostle my way through woe.
Bless you for getting rid of gout.
If I could do the same for this achey-jointy body,
I'm be as happy as Punch
7
Coffee and water.
It appears you make an effort to hydrate after you have a gout attack. Try ensuring you hydrate each and every day! That is probably the single best thing you can do.
One doctor told me that while the causation is not understood, coffee has a positive affect on gout. It made me restart daily coffee.
Some say dark red cherries help too.
You appear to have had/have serious gout. But it also appears you may not be taking easily incorporated steps that at the very least would be complementary to your medication and whatever else you are doing. What you have cut out of your diet, seems to follow what I was told is dated medical "wisdom." But since every medical issue seems to face reversals of recommendations/prohibitions every few years, who knows!
6
There are two classes of cherries - sweet and tart (tart are not necessarily unsweet.) Only the tart cherries apparently work for gout. You need to check varieties.
5
Gout has convinced me that we all are simply roaming bags of chemicals covering the Earth until we become a part of it. However given we are all different bags of chemicals I launched into the whole gut/macrobiotic search when my impromptu diagnosis hit after a fish taco lunch. Not one to ever endorse a pill solution for anything (I'd take a needle first)... I have now developed a profound respect for Vitamin D3 in my body (which lives in a building-coded-approved-cave in a dark forest on most days).
9
Gout is brutally painful, I agree. The section of Mr Max's article that hit home for me has to do with coping with the loss of mobility. After several bouts with cancer, I have almost lost the ability to walk and use a wheelchair when out. It can be so difficult to be in a crowded place. For instance, many, many times at the grocery store people have reached over me "just to grab something," pushing me and even hitting me on the head. Elevators can be very difficult as well. It's almost as if people have no conception that I am not sitting for leisure, or that jostling me or my chair is the same as pushing a standing person.
20
Always seek a natural cure first, either as an alternative to or in conjunction with whatever your doctor and Big Pharma are providing.
As stated by a couple of posters, the elixir for gout is tart (and only tart) cherry juice. Just Google it.
And unlike many other "cures" which are pedaled as a supplement because the FDA will not allow it, the tart cherry juice sellers can loudly and proudly claim that it can alleviate the pain from gout (and arthritis).
Why not give it a try?
11
Beautiful piece, Mr. Max. Write more. On anything.
13
An MRI to diagnose the first presentation of a hot swollen ankle in the absence of a history of trauma? .... only in America. Health care costs will keep rising as long as technology substitutes for clinical judgement.
33
While I do agree, Americans are so litigious - especially when it comes to the medical sector - that doctors likely cover themselves by ordering any tests they have access too. Otherwise, if you miss something important, you'll be sued, and there goes your career.
13
Crazy. MRI not necessary here. Blood test to determine uric acid levels ... that’s all that’s needed to dx gout.
11
I can certainly relate to your pain, although mine was limited to the joint on my big toe. the cause? different for everyone, for me it was eating to much broccoli of all things and not drinking enough water. easy fix and have not had a re-occurrence since (14 years). cheers
7
I had been diagnosed with gout--a terribly painful case--about 30 years ago, and have been taking low-dose Allopurinol every day since then to control my uric acid. Since that diagnosis, I occasionally experience a rare bout of gout pain a couple of times a year, and I am completely convinced that it is a result of stress. It inevitably occurs within a few hours (a day, at the most) of an extremely stressful experience. It may sound crazy, but I eat all the red meats and other foods that I am not supposed to touch, and yet I remain relatively gout pain-free. Try to recall if your gout attacks have occurred shortly after stressful events. I've also found that, at the slightest hint of oncoming pain, 1 or 2 capsules of Indomethacin seem to take care of it well.
So, the secret is to live without stress. LOL.
9
I believe everyone is a little different....everyone has to find out what food works in her/his body....maybe has to do with the microbiome.
If my foot had blown up, I would have water/vegetable juice fasted for a few days to see if a food(s) was the culprit. If so, try one food at a time to find/eliminate it.
I have been vegan for 38 years. I have found that spinach, asparagus, and lentils do not work in my body.
7
A friend and nurse suggests cherries to control gout .
It worked for her friend .while on a retreat his knee became badly inflamed . The only cherries available were canned , he ate a large amount , what ever that was and was able to stay at the retreat .
4
I've had gout in both ankles, big toes and the joint just below the big toe. I describe it as someone holding a lighter to your toe non-stop.
My discovery for a cure via the internet is all natural apple cider vinegar, lemon juice and baking soda all mixed in water. I get results within 4 hours of a dose and also take ibuprofen for added pain relief. I agree everyone is different and find what works.
8
I'm happy for you, Mr. Max, that you've been able to resume you life. I hope it continues. What healthy, non-medically qualified people don't understand is how any disease or injury process is different for every patient.
I have some medical training. I understood, I thought. Then I had an aneurysm in my ankle burst. Of course, at the time, nobody suspected that. It was twice diagnosed as a bad sprain, after 6 weeks 3 different doctors diagnosed it as 'drug-seeking patient'. I couldn't get a referral to orthopedist because of those diagnoses. I saved up enough money to finally make the appointment myself where the doc told me that my talon was mostly dead and what wasn't dead would die - that is why it hurt. That I could look forward to not being able to stand or walk at all on it in 6-7 years and my only choices were amputation and or wheelchair. Just over 6 years later, I had a surgery to fuse it with a replacement ceramic part. The surgeon told me the recovery would take 2-3 years. Another surgery same prognosis. I couldn't walk more than a few feet or stand on that leg more than 20 minutes for 8 years. Crutches gave me a bit more time but not enough to brag about. Recently, 2 years ago, the pain just stopped. I tried everything except pain pills. Everyone had a solution for me and none of them worked. The only that I don't do now, out of everything I tried and what I did before the surgery, is I no longer wear makeup. I really don't think that has any bearing at all.
7
Please, all one needs is just a good, balanced diet, including meats, fish and plants. Moderation in alcoholic beverages, a good night’s sleep and a kind and humble personality. You’ll live to be a hundred.
5
.......and it is obvious that you have yet to experience any real health problems.
23
I'm very surprised how many comments complain that this article unfairly seems to paint veganism as a cause of gout. It doesnt. It merely points out that a vegan diet is not a protection from gout. I appreciated the article, because before I had no idea that a person could get gout regardless of diet or state of fitness.
70
My husband had persistent gout for a few years but was not interested in taking medicines. Now he hasn’t had a serious attack in about a decade. What changed? His diet is now mostly anti-inflammatory (ie vegetables, including beans and greens) but more importantly he exercises and drinks at least a couple of liters of water every day.
Pills are not the only option.
16
Sorry, I agree that many can and should manage gout by hydration, avoiding purines and high-protein diets (plus even tart cherry) but for some there is no solution but pills, like allopurinol.
It is better to try to manage gout without pills, but the damage to your renal system and joints that can build up is much worse than the pills.
5
This seems more like a prelude to a more complete article that would contain actual scientific and medical information that would be helpful in understanding the writer’s condition.
33
Yes, this makes me want to learn more about why vegetarians get gout also. My sister-in-law had it on and off for a few years, and she was a vegan, meditator and yoga exerciser.
10
Please, what did you do to improve?? My thin, fit, otherwise healthy husband is one month into this problem which has had a huge negative impact on his life. Please advise! All tips welcomed!
10
12 cherries a day. Dried from Trader Joe's or fresh. Works brilliantly. And eat a low purine diet. Fixed.
5
In addition to the other tips here, you might try medical marijuana, especially rubbed into the joint, Willard Water, both by mouth and rubbed in undiluted, and DMSO (an old runners' remedy) rubbed in only. Try elevating the feet above the head when lying down, or gentle massage for lymph drainage.
My husband also has terrible flare ups. Most recently it was after losing a bunch of weight and being in ketosis for a few weeks. He tried EVERYTHING (cherry extract, tart cherry pills, bromelain... if it appeared on the internet we tried it). Finally I think that high PH water & electrolytes were what helped him. His doctor told him that ketosis creates an acidic environment in his body and makes his body more prone to the uric acid creating crystals. That made sense to me as we also have acidic well water. I started buying high PH, alkaline water in the grocery store and gave him electrolyte tablets and it's when things started getting better. Maybe it ran it's course or maybe it helped but if he has another attack it's what we we will try immediately. In the meantime I think he's accepted that he might need the allopurinol daily. Good luck.
2
After experiencing the pain of gout ten years now, I can attest that allopurinol might be effective for preventing gout, once you get a flare up allopurinol is useless. When I first went to doctors about it, they guessed I had anything from Lyme disease to rheumatoid arthritis. I wasn't until a young P.A. orescribed a coticosteroid pak which I took over several days that provided relief. I keep Prednisone handy whenever Gout threatens to rear its ugly painful head. ,BTW, the author is right about hummus. I ate some the other day and walking with pain in my ankle the next day.
4
Good grief! I will stick to being a person who still eats poultry and fish, while still searching for a halal, or kosher, butcher, who will treat the creatures humanely. NO mammals, however. They are us.
8
I had my first gout attack about 50 years ago. After 3 more very painful episodes, within the next few years, I was put on 300mg Allopurinal once a day. I also took Colchacine for a week when initially put on Allopurinol. I continue taking Allopurinol daily and have never had another attack. I eat and drink anything I want. My uric acid is tested during my yearly physical exam, and results have always been within normal limits.
11
$9.00 for 3 months supply of Allopurinol 300 mg daily and I have the same dietary restrictions as Jerry... NONE
1
Make your doctor give you DAILY colchicine (and not allopurinol) and all will be well. It took me several years of gout attacks to find out about this easy solution; I don't know why they keep it a secret.
6
Thanks for this. I am dealing with gallbladder issues at the moment and one aspect of that is, when an attack happens, I know that I have to live through hours of excruciating pain and there is nothing I can do to stop it (save getting my gallbladder out, which is scheduled in the next few weeks). It is humbling, after a life of health, to suddenly find my body turning on me and to experience pain as something to be borne. I wish you the best and hope that indeed, this condition has receded for good.
One of the ways I pass the time when an attack happens is to find ways to describe my sensations - I gather you do the same. Your traffic jam of enraged crystals, the sunburn plus banged shin: I imagine when you came up with the metaphors it gave you a moment of relief, even if only intellectual, from a supremely unpleasant experience.
16
A couple misconceptions could arise from this, admittedly, personal account of gout. First, most gout is due to a genetic abnormality, an inability to normally break down the purine bases that are part of our DNA. Second, allopurinol is not a "crystal-busting" drug. On the contrary, if you have uric acid crystals in your joints, starting allopurinol may, paradoxically, make it worse. Allopurinol works by preventing the build up of uric acid that can cause crystals. Once the crystals are formed, anti-inflammatories (as given Mr. Max), are the treatment.
31
They thought I had gout. I could eat piles of shrimp and sardines and nothing happened...
After a year or so they decided that I have some arthritis in my big toe and that coupled with tennis shoes and flat feet was causing the problem.
During the time I thought I had gout, I started reading everything I could fine on the subject. I ran across a British research study. They took a bunch of people and put them on a fairly high dose of vitamin C. It lowered their uric acid. They don't know why.
Since taking 500MG a day of vitamin c is no big deal, I tried it. My Uric Acid level went from about 8.0 mg/dl to 7.0 mg/dl. My drop was right on the mark for the median in the study.
Given that the normal range is 2.0 to 8.5 that is quite a percentage change.
I still take the 500MB of C even though I now know I do not have gout. The lower uric acid level is better overall in any event.
Obscure study, interesting results, worked with me. FYI
26
JD--Very interesting. Thanks for the info.
4
As a rheumatologist, I find this article both startling and sad. There is no reason why most patients should have uncontrolled gout unless they are heavy drinkers or are in certain particular circumstances such as hemodialysis or organ transplants. The author's first mistake was going to a podiatrist who failed to take fluid from the ankle to look for uric acid crystals before injecting it with steroids. If it had been septic arthritis, steroids would have been the wrong treatment. A blood test does NOT confirm the diagnosis of gout; only examination of joint fluid for crystals can do that. And the medical mistakes and misconceptions only begin there. Diet is only one of many risk factors for gout. I advise the author to see a rheumatologist and get adequate treatment for his gout so that he never has to endure another attack.
138
Completely agree with Deborah- I hope readers do not follow the writer's example. My uncle, who's a physician, has gout, as do many of the men on that genetically predisposed side of the family. They've taken Probenecid for years- without any side effects- and never get attacks. If you have gout, visit a doctor for treatment!
14
Love rheumatologists! They are few and far between however, at least 'round this metro area, and thus very hard to get into to see on a timely basis.
Podiatrists, OTOH, proliferate. And often, very little help from them ...
2
Is it really all about the food?
4
My issues with it seemed to be related to sugar intake. I don't eat a lot of red meat or organ meats or shell fish.
Alcohol is very problematic, but that's mainly because it's just like drinking soda for sugar content.
No amount of water you drink will help if you're getting this.
Allopurinol is really effective and will let you eat/drink whatever you want without addressing the actual cause but the best thing you can do is just make sure that you're eating as little sugar as possible.
5
Soy and other beans are well known to contribute to gout attacks. This need not be any sort of attack on vegans, but certain beans certainly do certainly have an impact on gout attacks. However I do agree that there is usually some sort of genetic disposition to gout....
3
The Mayo Clinic's guide maybe helpful. It states that asparagus and spinach are fine. As expected, lots of veggies and fruit, whole foods, avoid red meats and certain seafood. Josh Max's story (fun to read) may distort the relation of vegan diet and gout. In his case, unless he's leaving something out, it maybe a mystery as to why he got it.
11
@wilcoworld
I disagree with the Mayo clinic's guide. Asparagus and spinach trigger gout attacks for me, so I avoid them. I also avoid cauliflower and mushrooms because they, too, trigger gout attacks.
2
Dude! You got the high uric acid by genetics! That is most of why folks get the malady. Less salt, more fluids, maybe a medication to lower your uric acid on an ongoing basis. Jeez, even vegans can get diseases!
Cheers!
85
Right on!
6
Josh, You have a sever case of Gout but it is not the end of the world. Coclchine and Al Purinol control it very well. All the stuff they toldyou to give up is just pure bunk. It won't help you a bit. I trie giving up practically every thing after reading every thing about Gout just like you. DON'T. ENJY YOUR FOODS. I have Gout for over twenty years now and when it flares, my toe and ankle look like what you showed in the article. AND, I EAT EVERY THING INCLUDING RED MEATS AND SHELL FISH IN MODERATION. I EAT EVERY THING. The things they told you to give up do not amount to a hill of beans ....pun intended. GOOD LUCK.
15
The reality is that a diet needs to be balanced and the intake of excessively processed foods eliminated. Gout has been labeled as the disease that is associated with meats because of the purine rich content. That is a fallacy as more modern research will attest to. In actuality, fructose has a higher association with gout development.
11
Those foods have to go because of calcium? So people who say that one needs dairy products for calcium are fools?
2
Not calcium.
The problem is purines which are found in many many foods.
11
1776 reference was an unexpected touch.....
15
Josh Max is a talented writer. I just checked the Mayo Clinic's take on the matter. Looks like asparagus is fine. Diet does matter and is listed in detail. Red meat and other normal American diet elements seem to be the culprit.
Not sure why he was so unfortunate, but please, don't blame a vegan or vegetarian diet.
Please get the facts straight.
10
It's not diet for most folks, it's genetics. See the comments above from doctors. Controlling gout with diet alone is almost impossible for a large slice of people.
10
Ali, thanks for this information. The title and subtitle of this feature implies his vegan diet is to blame. A correction is in order. The Mayo Clinic's guidelines maybe helpful, too. Hopefully specialists can diagnose the correct cause and Josh and others afflicted can continue with heart healthy, earth healthy diets.
@wilcoworld
Actually, some vegetables will trigger gout attacks in me. Cauliflower, asparagus, spinach and mushrooms are all triggers for me. I eliminated these foods from my diet, added ten frozen cherries a day and haven't had a gout attack in over five years.
1
I developed gout from the chlorthalidone I took for my blood pressure. When it was diagnosed, I was given Indomethecin tablets which cleared it up in a day or so. Of course, I stopped taking the medication, but I keep Indomethecin around just in case. I thought every bone in my left foot was broken!
3
Would like to see a medical follow up. The writer needed to have explained this:
“But black beans, spinach, asparagus, raisins, chickpeas and hummus, all heart-healthy stuff I’d been eating for years, had to go, too.”
Why?!
Never heard that those were associated with gout!
27
Disappointing that the author doesn't discuss how he experimented with diet to figure out what helped him get better. I bet that the link between diet and gout is the microbiome in the gut. That just like with oxalic acid there are microbials in the gut that can metabolize uric acid and that people with gout are missing that microorganism from their gut. Just like people with high oxalic acid are missing the microorganism that metabolizes oxalic acid...So it's really about how changing your diet or taking a targeted supplement may change the balance of organisms in the microbiome.
11
What a silly premise for a column for this condition. Vegetarianism is a not surprising cause of hypouricemia due to the low purine content of most vegetarian diets. I view the medical care as moronic. Immediate colchicine accompanied by Allopurinol and our patient would be fine. If not that combination, then an alternative, newer drug such as Febuxostat or a variant.
This is not a stunning issue, I have had the condition for 40 years after running marathons without rehydrating. Allopurinol has kept my uric acid level in the acceptable range for that many years with no detectable side effects. Yawn.
13
Every gout sufferer reacts differently to different foods. There are some I can eat and others I cannot. Some I can eat in small quantities and suffer no reaction, others, not so. I am not willing to take any medication that I can do without by adjusting my diet. This piece is interesting and the author's discovery of good in the bad is uplifting. I'm glad your gout is under control, may it never become a condition that overwhelms you.
15
Good for you that your condition was recognized and that it is under control. Mine took FIVE YEARS to be diagnosed because it presented at first like broken bones. Once I had appropriate medication and modified my diet (a bit) I was able to resume activities like bicycling that had become impossible (after years of 500-mile tours). No need to be judgmental. The writer encountered the ignorance about the condition and its causes as he tried to sort this all out. I don’t advertise a bout of gout (hey! a poem!), but if I’m limping and someone asks, I’m honest. The “knowing” nod and the observation, “Ah! The ‘rich man’s disease’ “ earns an educational lecture from me. Diet is trigger, not the cause, of gout, which for most people is an inherited condition.
17
I love your home health aide partner!
37
Thank you, Kally. "And if you saw my love/you'd love her, too."
17
And love your writing too!
There’s no reason that steroid shot had to be delivered that way and cause you that agony. When I needed a shot in my heel, the first one was done the way yours was and it was agony. The next time a podiatrist’s assistant sprayed the heel with some kind of freeze-y spray during the injection and I felt nothing.
5
And then there is "pseudo gout" canuaed by calcium crystals instead of uric acid crystals. Just as debilitating and painful but there is no known cause or cure for pseudo gout. Sheesh, who knew?
8
Oatmeal has more purines than most breakfast foods.
5
@BigGuy
I can eat oatmeal without any problems. I can't however eat cauliflower, asparagus, spinach and mushrooms.
2
Whenever I think I know what is causing a particular ailment, further experiments cause doubt on my theories.
7
My father suffered tremendously from Gout and found relief for 20 years by drinking Dandelion tea on a daily basis.
14
Just to inform your readers: veganism isn't a diet. It's a philosophy of living that involves living and eating without harming or the use of any animal. It's based on animal rights and anti speciesm. A plant based diet is for those who shun animal products in their diet, but wear fur or leather or ride on animals on their holidays.
Vegan diets range in healthiness to completely healthy to less so due to high quantities of processed food and the salt and sugar they contain. But even so most doctors, health organization and environmental organizations agree it's the world's healthiest and most environmentally sustainable diet. It requires some extra vitamins such as a B12, Vitamin D supplement but beyond that, it makes being and staying healthy easy.
I personally believe most water irregularities in the body are due to salt consumption. I have eaten a salt free vegan diet for 10 years, and at 52 have no health problems, and my yearly check ups are so problem free they surprise even my doctors.
18
Any diet that requires vitamin supplements has a fundamental flaw. We did not evolve as vegans. It's an artificial way of living.
23
massive amounts of supplements and protein powders are consumed by meat eaters--must not be getting enough from their diets...
cattle are fed b-12 and other supplements during their growth cycle. Iodine is in milk only because it is used to clean the cows utters...
2
I’m vegetarian. I don’t take vitamins. Get it all from food.
A study showed that high uric acid levels are caused by sleep apnea. A group of men with high levels were given sleep studies. Nearly all had apnea. Upon using CPAP, the treatment for sleep apnea, uric acid levels returned to normal.
This was the case for me. I sympathize with the description of the pain. But I would get a sleep study done, perhaps treat that and eat what I want.
25
Wow! A holistic approach. I love it.
5
I had not heard of the link between sleep apnea and gout. I was diagnosed with sleep apnea about the same time I had my first gout attack. The Machine and the gout drugs have kept me pain-free for 20 years. Thank you for sharing that.
2
The author's description (and photo) of his first and subsequent attacks of "the gout" are classic. (It would have been even more "classic" if the affected joint had been the one between his great toe and the first foot bone, instead of on the top of his foot.)
Unfortunately, also "classic" was his description of diagnostic overutilization -- x-ray, blood tests, MRI -- to diagnose what, absent any history of trauma or particular susceptibility to acute joint infection or destruction, should have been a "slam-dunk" diagnosis on sight. Any primary care physician with even a modicum of experience could have made this diagnosis "on sight."
The blood test, to determine uric acid levels, was justified, but the imaging was unnecessary, at least at first blush. Had his clinical course not unfolded as would be expected for acute gout, then -- and only then -- other diagnostic tests could have been done. (And people wonder why our medical care costs are so high... )
117
DMCMD2:
Based on physical appearance alone, with a patient presenting to the ER, you cannot be sure of the diagnosis on sight. I agree about the over-utilization of tests, but sight would not exclude other forms of acute arthritis, including pseudogout.
The medical history is crucial. This can occasionally get tricky, and with the recurrent attacks described in this essay, referral to a rheumatologist would be appropriate.
10
Spoken like a true rheumatologist, JSK?!
My hypothetical primary care physician would be well aware of "other forms of acute arthritis, including pseudogout," and the initial therapy of the acute inflammatory attack would be the same. In the same vein, should the clinical course not follow as expected (for the initial episode of gout or pseudogout), then, and only then, need one engage in further evaluation.
Learning such clinical reasoning is why medical education takes so long, and an important part of that education must be learning wise use of resources.
ER physicians may protest that they only get "one crack at it" -- which is a further argument for continuing primary care NOT in the ER -- but all too often, one sees them "running up the bill."
2
Oh, geez, I could feel your pain!
Did you doctor not prescribe a round of colchicine during your acute attack? I can't imagine letting anyone inject my gout flare with cortisone (or anything) during an attack.
The second time I had a gout flare (in the big toe joints on both feet!), what worked to get the pain under control was prednisone -- it was a miracle. Didn't take long, and I only had to take it for a couple of days. Afterwards, my doctor put me on allopurinol twice daily, along with drinking lots of water. It's worked very well -- only two mild flares during the past three years that were nipped in the bud with colchicine (which gout sufferers should probably have on hand).
The dietary advice for gout is bunk. People get it whether they eat high purine foods or no purine foods. It can run in families (my dad and my sister also had/have gout). It can happen once, or a few times, then never flare again or it can be a chronic problem no matter what you do or eat. People get it whether they are fat or thin or average. Eating or not eating sugar doesn't seem to have anything to do with it (I hadn't had sugar for more than a year prior to my first gout flare). Tart cherry juice is expensive and doesn't alleviate flares (and is not good for you if diabetic).
I think you're better off seeing a nephrologist, a rheumatologist, or your internal medicine doctor for treatment for gout -- a podiatrist, not so much.
78
Too many pieces of information are missing in this dramatic essay.
Diet alone is not usually recommended for recurrent gout: https://www.hopkinsarthritis.org/arthritis-info/gout/gout-treatment/ . Alterations can help a little, but are almost never primary management. A medicine to lower urate levels (like allopurinol) usually is, but during early treatment phases attacks can get worse--hence some sort of prophylaxis (type can vary depending on coexistent medical issues) for acute attacks will be necessary for some months, if not longer.
The dosing of medication to lower urate levels can require adjustments for a number of reasons, and the serum urate levels need to be dropped below a certain level to ensure long-term effectiveness. A number of issues (including medication reactions) can arise as optimal dosing is sought. Medication may need to be continued for life.
There are other types of crystal-induced arthritis that can appear just like gout, hence joint fluid crystal analysis is the most accurate diagnostic test, but it is not always necessary--again depending on other lab tests and medical circumstances.
So the management of gout can be tricky: https://www.sciencedirect.com/science/article/pii/S0149291816309249 ("Limitations of the Current Standards of Care for Treating Gout and Crystal Deposition in the Primary Care Setting: A Review").
18
It addition to the prevention mentioned above, there are also relatively effective treatments available for acute gout flares. Prompt dosing of high dose NSAIDs, colchicine, and prednisone can all lessen the severity and duration of a gout flare.
The physicians with the most expertise in gout management are rheumatologists - the website for the American College of Rheumatology has a list of these physicians near you!
17
DrBags:
That is certainly the case. I was focused on long-term (given limited space). Many of those agents used for acute gout can be used at lower doses for prophylaxis during the inception of urate lowering medicines. People do need to understand that these are different types of medications.
I suffered a few gout attacks in my big toe joint. The first came while I was using a creatine supplement as part of my fitness regime. I noticed the others were triggered after eating items with frosting (once at a cupcake store opening and once after a funeral). The only thing I found that stopped it was lemon juice/baking soda combination. 1 tsp of baking soda with 2 tbsp of lemon juice. Once it stops fizzing, add water and drink. Works best right before bedtime.
5
In my experience, gout attacks do not immediately follow eating an offending food, but take two to three days to develop. Your frosting was probably not the problem. No idea about the creatine, but dehydration can increase the level of uric acid in your blood so there might be a correlation there. Take a look at a list of purine rich foods and see if you eat any of them regularly. There is also a chain effect...a trigger food followed by a series of gout sustaining foods is a surefire problem for me, while those some gout sustaining foods might be no problem at all without the trigger food.
2
Did you try giving up all forms of sugar? Metabolic syndrome includes gout, and it's tied to sugar consumption.
7
Just looking at that picture gave me pain. I'm afraid I'm more confused now than before reading this. I have to wonder what the author was eating regularly. And, it doesn't say much about the state of medicine when the doctor and an obedient patient can't contain this condition for years on end. Looks like it just went away on its own- for now.
21
“Years on end” is not an anomaly. Prednisone treatments have been mentioned in this comment thread already; they’re the most dramatic (and most risky) way to relieve an acute attack. But gout is a chronic condition, and I can attest that once an acute episode begins, it takes several days to clear it up. Colchicine (which is derived from strawberries) is a good thing to have on hand. My dad’s worst episode took prednisone to clear, and after that he had a dose pack on hand “just in case.” Thankfully, it never flared up that dramatically again, because he had gotten the message about the importance of daily medication and fluid intake.
4
Oops. Colchicine is derived not from strawberries but from colchicum, a different genus. It's almost surely also synthesized today.
Another theory is that the crystals may always be present, though benign, but become agitated through an event or series of events. In my case, a specific trauma (e.g., stubbing a toe), has precipitated symptoms, though I believe that diet and hydration are complicating factors when this occurs. Colchicine works, but is rough on the digestive track. Warm epsom salt baths are soothing, perhaps somewhat curative, with no apparent downside. Perhaps more art than science, but I encourage a multi-faceted strategy.
17
I had gout bouts a couple of times a year 20 years ago. I couldn't touch my big toe, stayed home because I couldn't put on socks and shoes. The prescription drugs worked but also had diuretic side effects. I hated the prescribed diet that basically eliminated almost everything including vegetables and alcohol, After some research, I tried grape seed extract tablets. Voila, virtually gout free for the last 20 years. I can eat everything forbidden (yes, meat) within reason. I have three blood tests a year and the uric acid level is well within limits. Grape seed extract tablets worked for me and a couple of friends. But everybody is different.
30
My Husband had a gout attack on his big toe, too.
I am glad grape see extract tablets helped you.
What dosage? and do you take them for attack or all the time?
I struggled with gout for years, and deeply sympathize with others who suffer from it. For years, I tried everything -- high alkalinity water, cherries, quitting alcohol, quitting red meat, quitting dairy, going vegetarian, exercising, losing weight, sleeping more, lowering stress levels, you name it! I discovered only one remedy which has truly worked. It is a drug called Uloric (febuxostat). It lowers uric acid levels. Within one month my uric acid dropped to healthy levels. I have not had a gout attack since then. Everyone who has gout should ask their doctor about Uloric. It has truly changed my life.
23
I’m not a fan of the vegan diet. All in moderation. I know vegans who eat lots of sugar and processed foods and junk instead of meat. Humans are not meant to be vegans. I guess it’s easy if u don’t have the intelligence to know what a healthy diet should be.
I’m 68 and tried it all. I grow my own food, plant based diet, no processed food, pasture eggs, limited free range meats.
And I’m in excellent health. Read Plant Paradox.
25
Unlike you Mary, I am a great fan of a vegan whole food, plant-based diet; this way of eating does not include junk food. It is a very healthy way to eat and live. I am 66 and in wonderful health. I was a vegetarian for 36 years or so and a vegan for the last 6. There are lots of great reasons why humans are herbivores. Perhaps you'd like to check out this lecture by Dr. Milton Mills, who is a plant-based doctor and advocates this way of eating to many. In this lecture he shares several reasons why we are not biologically meant to be carnivores. https://www.youtube.com/watch?v=sXj76A9hI-o
46
Humans need vitamin b12 and cannot produce it like horses do for example. This tells me humans are meant to ingest some animal proteins, albeit in moderation.
3
This seems like a poor reason to eat meat, because we were "meant to". Did a message come down from the heavens or something to say this?
20
Doctors can tell you what gout happens to be and they have some good treatments that sometimes work quickly and sometimes not so much. Unfortunately, nobody can tell you what with certainty causes it to develop. That is still unknown.
I've had it flair up when over eating protein foods and when eating too little protein foods and after dieting for a couple of months. I've escaped it despite eating high purine foods and red meat, and I've had it rage from chicken. Home remedies like milk and cherries sometimes seemed to help and other times not. May be staying hydrated works, I cannot be sure. Sometimes water alone may not be enough to properly hydrate I have heard.
6
Alfred Baring Garrod, an English physician first detected uric acid in the urine of gout patients in 1848. Hollander is credited with identifying uric acid crystals in the joint fluid white blood cells .of gout patients in 1960. While some questions remain (e.g. what role to antibodies play in the interaction of white blood cells and urate crystals? and why don't patients with high levels of uric acid deposits in their tissues have gout attacks almost continuously?) the fact is that gout patients are either genetically programmed to make way too much uric acid (irrespective of diet), or they make a normal amount but have abnormal kidney function that prevents them from excreting what they do make. It remains important to separate the less-than-perfect response to medical therapy from the notion that gout is not understood. No medical therapy is perfect, but our understanding of this disease is remarkably complete. Most patients who fail medical therapy fail to understand that gout is a chronic disease and requires chronic therapy for control. This lack of understanding leads to short-term treatment programs, disappointment, and the flawed opinion that their problem is beyond medical control and leads to the dramatic lifestyle changes described by this patient.
As a fellow guitarist, I am hoping he (and any other readers) will opt for a consultation with an appropriate specialist. Of all the misery that befalls humans, there is no need to suffer with this particular type.
10
My Japanese husband started to get indicators of gout when he started eating more deep fried foods, meat, beer, etc but we tried Chinese herbal medicine first. He could always go back to Western medicine if the herbal medicine didn't work. The doctor was surprised to see a year later that the indicators were all in the normal range. Purines are the problems and in Japan gout is increasing among men who eat a diet heavy in meat, deep fried foods, beer, etc all very popular items. Despite the pain going away and indicators low, he did focus his diet on more fish and vegetables. Chinese herbal medicine in the hands of a licensed professional can work but the trick is to catch the symptoms early.
13
I was a former typical flesh-eating, dairy-ingesting guy who lived at the drive-thru and ordered his steaks extra rare. When cI saw the plight of pigs and cows in "If Slaughterhouses Had Glass Walls," I knew I had to at least try to go vegetarian. I was 39, a bit overweight, and nagging arthritic pain, and early COPD. Flash forward 10 years later as a vegan, I have discovered the joy of cooking (there's that joy of cooking "real" food!), and, of course, loving the plethora of plant-based "meats" from companies that have exploded over the last decade. My arthritis and COPD vanished, I became conscious of getting off Big Pharma meds, and became organic and happy (and 30 lb. lighter). I seem to have a youthfulness in body and spirit my meat/dairy-eating peers don't share at my age. And, I have the gift of a clear conscience. Now, when I turn on the TV, which is rare, the onslaught of government-subsidized meat and cheese ads seem jarring ("stuffed crust with extra cheese," and "extra bacon on top of a triple-decker" etc.). You really feel as if you're living in another culture. One by one people seem to be waking up to the truth that so many diseases are not only preventable but reversible with a vegan lifestyle (meat and dairy inflame every organ they touch, including the brain; so many things from Alzheimer's to colitis to diabetes can have a link in meat and dairy). I never feel I'm missing out! I've gained so much in countless tangible and intangible ways. Much love to all!
140
Congrats, Todd, on your changes. I would like make this transition, but my hurdles have included motivation, but most definitely the planning and support needed to do this. Do you have suggestions? How did you get organized?
2
Except, obviously, gout.
5
You were 30lb overweight and eating a typical rubbish diet.
Good for you but I would argue that it is possible to feel alive and well on a balanced diet including milk and meat. However beef, pork, chicken and milk should not be eaten if it comes from factory farms that US has foisted on their citizens. These feed lots and giant chicken sheds produce cheap but less nutritious food and are bad for the soul!
10
Vegetarians are at less risk for gout, due to lower serum uric acid concentrations, than either meat eaters or vegans. So the best dietary approach may be a vegetarian diet that includes humanely-produced dairy and eggs, if those can be sourced.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572016/
25
Science has shown that eggs aren’t vegetables.
11
English speakers know that vegetarians don't eat meat, but aren't restricted to eating vegetables.
1
Not vegetarian tho many all organic, no red meat though, insanely lactose-tolerant due to total N.Europe heritage. Most of my family has had gout, evidence and my experience suggests correlation with red meat (high in purines). Seems like beer too.
The cause of gout has little to do with diet. It is how the body processes uric acid. If you can flush it from your system, you can pretty much eat anything you want without worrying about gout. If you can't, the uric acid builds up and deposits in the joints. Purines in the diet are converted to uric acid and it does not matter whether the source is animal or vegetable. And the body produces uric acid naturally as well so a low purine diet isn't necessarily going to prevent flare ups. If you are overweight and being overweight is major risk factor for gout, weight loss can be very helpful. Allopurinol works extremely well for me although a few people don't tolerate it well. I have also found that tart cherry extract helps and it allowed me to avoid medication for a number of years. There are other herbal treatments supposedly helpful and might be worth a try but I haven't tried them and can't vouch for their effectiveness. I find flare ups resolve quickly with colchicine and prednisone.
39
My husband had one attack of gout after eating a lot of asparagus. His uric acid levels have always been above normal. Following his doctor's advice, he regularly drinks tart cherry extract, which has worked well so far. There seems to be scientific evidence that something in cherries prevent gout.
13
Yes, tart cherry extract!
1
To balance this negative, almost alarming, account of the harm a vegan diet can cause, the health section of The Times could offer accounts from those who have been on a vegan diet for years and achieved noticeable health benefits. It would be to The Times' credit if, on contentious issues such as vegan diets, it offered voices from both sides of the fence.
20
I don't think anyone was denigrating a vegan diet. There has been a false belief amongst many people that gout was due to excessive consumption of red meat and alcoholic beverages, so when non drinkers who seldom or never eat red meat develop gout like this person describes it seems bizarre. But he's right, gout can develop regardless of diet, the cause is still a mystery.
75
What caused gout? I am vegetarian for over 20 years .... am I exempt or are there genetic causes too?
2
A curious article for the NYT Health Section-- long on anecdote but short on facts. Will the author tell the Mayo Clinic that its advice on diet for gout sufferers is wrong? The Mayo clinic advice includes this:
" High-purine vegetables. Studies have shown that vegetables high in purines, such as asparagus and spinach, don't increase the risk of gout or recurring gout attacks."
33
Peter, this is the Voices section, which is based on health-related anecdotes. In this case, the author is telling us his personal story--it is not meant to be a scientific report.
56
As a retired Rheumatologist, I am not at all surprised by the many misunderstandings expressed in both this article and the comments regarding the origin of gout. In fact, this well-defined clinical disorder is one of the best-understood human biochemical problems known to medicine. Oddly, there is a widely held sense that gout treatment is simple and uniform, probably suggested by the short-term success of just about any effective anti-inflammatory treatment to curb the agonizing acute attacks.
Gout is a crystal-deposition disease that can be caused by a genetic disorder of metabolism and various types of kidney dysfunction that result in abnormal body storage of monosodium urate crystals. The factors that can precipitate an acute attack are many, including trauma, alcohol consumption, inappropriate timing of allopurinol therapy, and consumption of high-purine content foods.
The important message here is that acute treatment is vastly different from chronic management, and that most medical providers are good at the former and less adept at the latter. I hope this sheds a bit of light and offers some hope to those with recurrent gout attacks.
188
You know gout but what causes the process to become possible prior to triggering that results in the condition may be less certain than you think. My experience conforms to some of your explanations but sometimes it does not. There seems to be other underlying factors that prevent the process from occurring despite high risks and at other times when the risks seem low for the condition to develop. There may be unknown connections with other health conditions and treatments that play an unrecognized part.
7
Paul Hudson, a rheumatologist: "The important message here is that acute treatment is vastly different from chronic management, and that most medical providers are good at the former and less adept at the latter. I hope this sheds a bit of light and offers some hope to those with recurrent gout attacks.".
As a nephrologist (kidney specialist), whose patients have high incidence of gout, I agree 100% re. acute vs. chronic management skills. See a rheumatologist if the gout is more than occasional!
8
Thank you, Dr. Hudson for your comment.
I was astounded there was no mention of kidney function in this article which was published by the "New York Times."
I wonder if the diagnosis and treatment would have been the same had the patient seen an internist with an M.D. or D.O. degree, and not a podiatrist who is not a licensed physician.
I am sure the pain the joints from the gout was excruciating. However, I'd want a referral to the nearest nephrologist to see if my kidneys were messed up.
2
I'm a woman now in my 70's and about 10 years ago, I also had one round of gout, in the big toe of my right foot. I had no risk factors, either. In my case, it turned out to be a rare reaction to Crestor. As soon as I stopped taking it, the gout went away and it's never returned.
Just a thought for others suffering from gout--check your meds and their rare side effects.
98
This is really good advice. My doctor prescribed some blood pressure meds (Lisinopril and Toprol) and I went almost immediately from one or two gout attacks a year to one every two weeks.
21
While quietly weeping this morning, to see the woman protesting essentially the torture of children by our government being removed our Statue of Liberty - I stumbled onto this this article,
and it made me laugh out loud - especially the part about letting out a scream like Robert Plant.
Josh, thank you for your brilliant and sensitive comedic writing!
In laughing I was reunited with my heart that really does believe we Americans will make it through these times and find a way to reclaim the soul of our democracy.
68
Your treatment regimen (steroid injection and and popping an allopurinol at the time of a flare) is most surprising to me.
I had a confirmed diagnosis of gout 25 years ago. I had many flares at first but now and for many years have none, or at worst perhaps one per year. They last only a a couple of days and are far, far less intense than in the beginning because I take colchicine upon occurrence of a flare.
Has colchicine not been recommended to you?
And in regard to the allopurinol, I believe it is best used prohylactically, not at the time of the flare to "bust crystals." (yes, there can be rare side effects to allopurinol, but I would prefer that risk than the risk of uric acid crystals building up in my kidneys or other organs as can happen with untreated gout)
I take 100mg allopurinol twice a day and watch my diet. Garbanzo beans happen to be particularly dangerous for me. One must experiment to determine which foods are not tolerated.
Perhaps I am mistaken, but I thought this treatment regimen was pretty much the standard.
I've never heard of anyone getting a steroid injection into the joint during a flare and then not being put on regular doses of allopurinol.
13
His experience with initial symptoms is pretty typical, though. Every time I presented a swollen toe or foot to my PCP, he saw trauma rather than suspecting gout. It took a podiatric surgeon three visits to finally make a connection and set up a standing order so I could get a specific blood test during a flareup. It was only after I’d finally been diagnosed that my father and my brother both thought to mention to me that they had suffered from gout flareups for years.
3
1) Organic cherry juice for flares. Not too much. Maybe half a cup a day for several days.
2) Vitamin B12 can trigger a gout flare!!!! This is really important for vegans and vegetarians to know because they are constantly told that they need to supplement with B12. They may need to, to prevent anemia. But it can trigger a gout flare. I have found that taking a multi-vitamin that contains B12 is best, perhaps because it contains other B vitamins to balance the B12. Worst is a methyl vitamin B12 supplement. This is highly assimilable but also most likely to cause a flare.
11
A lack of B12 in your diet can cause permanent nerve damage, not anemia. I agree that taking a multivitamin is the most practical way of insuring as a vegan you get all your necessary doses. B12 is not found in any plant based food so a supplement is necessary.
6
Low B12 - Pernicious anemia, nerve damage and dementia.
Allopurinol indicated for prevention. not acute flare treatment.
Current guidelines suggest steroids and pain meds for flare-ups.
Besides drinking a lot of water regularly and of course the diet, some suggest to regularly massage (deep tissue kind) and anything that can improve the blood circulation of the offending area during the time when they are not inflamed can help avoid the accumulation of the crystal substance. Best of luck!
5
I've been experiencing a long knee injury which has put me on a cane in my early 30s. I appreciate the notion that slowing down has given the author a new perspective on life, something I identify with but struggle to find on any given day. I applaud him for his ability to see positivity in a negative health situation as that's a difficult feat.
50
This article doesn't answer its title in explaining
why those particular foods could cause gout. I
would say that it is simply a description of the
pain of gout in many aspects of the author's
life.
11
Those foods are high in purines, naturally occurring and necessary components of DNA, RNA, and ATP as well as in caffeine and theobromine and many other cellular metabolites.
7
Both the author and his podiatrist should question the assumption that they know which foods do or do not cause gout.
34
This has been well-understood for hundreds of years.
It would have been helpful if they looked at a list, in lieu of understanding chemistry and physiology.
But dietary triggers can be elusive, so more investigation would be useful.