Managing Gout Without Medication
I’ve written a couple of posts about gout before. The “mega attack” I had in December 2023 while in Hong Kong (ate all the bad purine rich tasties) and then a more optimistic post this February about getting a handle on my gout woes.
A quick gout refresher from Wikepdia:
Gout (/ɡaʊt/ GOWT) is a form of inflammatory arthritis characterised by recurrent attacks of a red, tender, hot and swollen joint,caused by the deposition of needle-like crystals of uric acid known as monosodium urate crystals. Pain typically comes on rapidly, reaching maximal intensity in less than 12 hours. The joint at the base of the big toe is affected (Podagra) in about half of cases.
It’s painful. Very painful.
Elevated uric acid (hyperuricemia) is caused by purines from foods like offal, red meat, and shellfish — meat and fish are generally high in purines. Sugar and alcohol especially are very bad as they can not only be a source of purines (beer) but can also cause your body to produce more purines.
I went vegetarian and stopped drinking. It’s been about four months now, how did I get on?
Mostly good and then not so good. A few twinges and minor flare ups occasionally and then two major attacks in the last month. The most recent one is currently underway. Those were due to lapses in diet.
I can easily link the two major attacks directly to choices shortly before. About a month ago in Istanbul I tried to test some boundaries. A kebab (lamb), chicken, a fish wrap, and a soup likely made with offal (one of the worst things for gout). So no surprises that a few days later I had an attack. Big left toe was inflamed, leaving me hobbling around for six days — even with the prescription strength naproxen anti-inflammatory I had on hand.
The current attack is linked to fish and chips (chips aren’t really a problem but fried foods should be avoided), a chicken burger, a cider (first drink in months) and a big bag of Twiglets (Marmite is high in purines, yeast extract — I didn’t realise). All in the space of ten days.
So why have I slipped up here? Eaten and drunk things I shouldn’t have? Because it was too hard to maintain the strict vegetarian diet. Not drinking on the other hand has been easy, I wasn’t a big drinker to begin with. But missing out on foods, particularly comfort foods, has been hard on my mental health. Especially with a minor quad strain which prevented me from running while in Istanbul. Then being back in my childhood bedroom for the first time in years. It’s hard to stick to good habits when you’re not doing great mentally.
For this current attack I went to a hospital walk-in centre (GP was too far to hobble) and after three hours of waiting was prescribed colchicine and prednisolone. Both are used to deal with acute attacks. I’d been prescribed those in Taiwan after the mega attack which started in Hong Kong. They deal with the symptoms, managing the pain and inflammation, but not the cause — the high uric acid levels.
After a little more research it turns out uric acid levels take MONTHS to decrease rather than mere weeks. So here I was being good for a few weeks and then trying “sneak a cheeky treat” in. That was wrong. My uric acid levels as of February were 423 μmol or 7.11 mg/dL. For men a maximum of 7 mg/dL is considered healthy. Higher and the acid crystals don’t have enough space to dissolve and stack on top of each other, forming those needle like crystals. I haven’t given myself enough time for the levels to go down. I can visualise all the meals and drinks last year while travelling, with a meter filling up, not giving it a chance to go down. Especially since my car accident last July. It reached breaking point.
Time to get another blood test and keep getting them monthly to give me much needed data and feedback. Given that I’ve only triggered two major attacks and both were linked to “things I was trying to get away with” I am now armed with the knowledge to manage this better. There are no cheats or shortcuts here.
There is another way. Allopurinol is a prophylactic which lowers uric acid. It’s taken daily and in the earlier stages may cause more flare ups due to disrupting the existing uric acid crystals. It’s a long-term medication and I was prescribed it in February. I asked my GP if it was possible to manage gout with lifestyle and diet changes alone. He shrugged and said “see how you get on.” So I did. I got on… okay. If I hadn’t indulged over the last month I suspect those two major attacks wouldn’t have happened. But I can’t know for sure.
I’ve also had a doctor friend following my Instagram who keeps nudging me to start taking allopurinol. I’m on the verge of just doing that. My initial reluctance was anxiety around getting repeat prescriptions if I kept travelling, but this is likely not going to be the case any longer. I need to settle for a bit and tackle this and other issues.
I will listen to the experts but I’m giving myself a last 1–2 month window to see how I get on. I am taking this seriously since sustained high uric acid can also lead to kidney stones, kidney disease and worse problems. If a last push to manage this myself doesn’t seem to be moving the needle in the right direction I’ll start on the allopurinol. The other factor is my mental health and how it’s affected by continuing to deprive myself of things I enjoy, even occasionally. Ultimately that may be the deciding factor. Not being able to enjoy life and risking flare ups or attacks which prevent me running would be a downward spiral. That’s to be avoided at all costs. Repeated attacks can also lead to permanent joint damage, so there’s that too. I’ve had an x-ray on the right big toe post-mega attack and so far it’s looking fine.
I lead a generally healthy and active lifestyle so this is just further incentive to lean more into that. I am taking this as a challenge and a goal. I’m focused and determined.
I’ll re-evaluate in a month or two. Allopurinol or my own good habits, eventually it would be nice to have a cocktail or even oysters and mussels again. Even if only once or twice a year. Without fear or regret. That time is still far off. In the meantime there’s still plenty I can safely enjoy. I’m looking on the positive side of this and taking opportunities to explore tasty vegetarian options. And dairy isn’t an issue at all. Cheese!
I would love to hear experiences from others who’ve tried to manage gout without medication and if they’ve avoided flare ups altogether or just how they’ve got on.
