The Challenges Of Living With Gout
In a recent survey, we asked gout patients what their biggest challenges when dealing with their gout symptoms were. They certainly did not disappoint as many of them were more than happy to share their experience.
The gout survey results were organized to help shine a light on what living with gout was like.
Out of a total of 386 respondents, 319 were men and 67 were women. The 3 biggest issues were:
- Physical Pain
The survey is useful because it provides insight into how gout affects ordinary citizens. Gout affects men the most. Furthermore, men over the age of 50 had more difficulty managing their gout symptoms.
Let’s take a look at how these three main challenges affect the lives of gout victims.
The Physical Pain Is The Biggest Challenge Of Living With Gout
Few things are more painful than a gout flare. So, if you’re awakened in the middle of the night by a tender, swollen, red, and radiating heat joint, you’ll want to act quickly.
While the big toe is the most usually affected joint, gout may affect other joints in the foot, ankle, and knee as well. In people with gout, flare-ups, or attacks of symptoms, are common, followed by periods of no symptoms.
Typically, the episodes last three to ten days. Some people go months or even years without having another gout attack after having one. Attacks on some people may become more common over time.
Check out some of our respondents’ comments to get an idea of how painful and debilitating these attacks may be:
- “Too much pain in my leg. I cannot sleep well at night. can’t walk well. Every time feeling pain. Sometimes feel that maybe one day I will be in bed and can’t move.”
- “I try to keep moving as much as possible, but the truth is it hurts so much that I have to rest with ice packs over my foot.”
- “I have chronic tophi gout, so my biggest challenge is just trying to live.”
- “The pain in both of my feet, When I walk for the next day, I am very sore… If I injure it somehow even a tiny little bit by playing sports or anything I get a bad flare-up. I hate it!”
Gout is a difficult disease to diagnose. Once diagnosed, it may be managed with medication and lifestyle adjustments.
Acute Gout or a Gout Attack Symptoms
Here are some warning signs that you may be having a gout attack:
- Crushing or throbbing pain in one or more joints (typically the big toe, knee, or ankle) that may last for several days.
- An acute attack of gouty arthritis may occur at any time of day or night. The big toe joint pain may be so severe that even the weight of the bedsheets causes discomfort.
- Joints that are swollen and inflamed, with reddish-purple skin that may be warm.
Signs of Chronic Gout Symptoms
- Chronic gout pain is more of an ache or soreness than the dramatic nature of acute gout pain.
- Pain is characterized by a persistent dull ache or joint soreness.
- Tophi are hard white deposits or lumps beneath the skin that may appear on the elbows, ears, or fingers.
The Risk Of Untreated Gout Symptoms
Patients with gout may develop more serious conditions, such as:
- Gout attacks regularly: Some people may never experience gout symptoms again. Others may get gout several times throughout the year. Medication may help prevent recurrent bouts of gout in people who have it. If untreated, gout may cause joint erosion and damage.
- Advanced stages of gout: If gout is not treated, tophi (urate crystal deposits under the skin) may develop. Tophi may appear on your fingers, hands, feet, elbows, and the backs of your ankles’ Achilles tendons. Tophi are typically painless, but during gout bouts, they may swell and become sensitive.
- Kidney Stones: Gout patients’ urinary tracts may get clogged with urea crystals, resulting in kidney stones. Kidney stones may be prevented with the use of certain medications.
Do This When You’re Getting A Gout Flare-up
Here’s what you can do if your gout flares up to relieve the pain and reduce the risk to others.
- Take any medications you have on hand: Start with over-the-counter ibuprofen (Motrin, Advil) or naproxen (Aleve), but avoid aspirin, which may exacerbate a flare.
If you’ve previously experienced a flare and your doctor has advised you to take an anti-inflammatory medication in case you experience another, do so. To reduce the risk of flares, continue to take uric acid-lowering medication if you are already taking it.
- Apply an ice pack: Applying an ice pack to the inflamed joint may help to reduce pain and inflammation. Wrap a pack in a dishcloth (a bag of crushed ice or frozen peas will do) and apply to the affected area for 20 to 30 minutes at a time, multiple times each day.
- Get in touch with your doctor: Tell your doctor as quickly as possible what’s going on. They may prescribe a new medication or request that you undergo a joint fluid test (to confirm the gout diagnosis) or a corticosteroid injection (to relieve inflammation immediately). Treatment within the first 24 hours of a flare’s development may help shorten the flare’s duration and severity.
- Consume plenty of nonalcoholic fluids: Staying hydrated aids in the elimination of uric acid (the source of your joint pain) as well as the prevention of kidney stones, which is another issue associated with high uric acid levels. Drink eight to sixteen cups of fluids per day, at least half of which should be water.
- Avoid alcohol: Although it may be tempting to have a drink to relieve pain, it is critical to avoid alcohol, particularly beer. When the body metabolizes purines, it produces uric acid. Furthermore, alcohol prevents your body from excreting uric acid.
For Gout Sufferers, Diet Is A Major Worry And Challenge
Dieting was recognized as the second most important issue and challenge for gout sufferers in our survey. Some respondents experienced a significant impact in several areas of their overall diet routines:
“Right now figuring out what I can eat! I am lacto veg now and sometimes do have a little chicken and salmon. Gave up sugar, eat low sodium, and low fat and just miss enjoying food. Lost my desire to go out to go where people are drinking and struggled emotionally with going anywhere where people are celebrating with champagne etc…lol. I am a Louisiana girl…what can I say. No more crawfish…seafood…poboys…ya get the idea! Lost lots of weight which is good and getting healthier so glad. But eating out ducks and I find it a challenge. Miss..tomatoes…mushrooms…spinach, etc…very confused about what else besides the usual suspects (protein, etc..) so I cut it all..including oatmeal. Read somewhere people have HD issues so…Physically, after the gout attack my feet got weak…not sure why. I am coming back k slowly but it was a bad year. I have had early-stage cancer twice…uterine and breast…mastectomy and the whole thing and gout is my worst challenge. .trying to use this experience to make positive change and see it as a positive. Hard when my family is enjoying the food I lived with. Also sharing dinner out with my husband a d being able to taste wine or have a food memory is different. It is a new normal.“
Diet Management and Gout
According to studies, gout affects 8.3 million adults in the United States alone. Men’s rates are over three times greater than women’s. Dietary choices may play an important role in symptom management for those with the disease.
However, people must understand that gout may either be a genetic disease or a dietary disease.
Gout is caused by uric acid crystals forming in the joints. People who have gout have a genetic predisposition to have a high uric acid level in their bodies. That means that even if their diet is “excellent” from a gout standpoint, they may still develop gout.
Therefore, if a person has gout, they will almost always need to take medicine in addition to keeping a close eye on their diet.
Having said that, gout may be exacerbated by a poor diet and eating the wrong foods. Gout may even begin at a younger age than would otherwise be the case. The difference is that those who do not have a genetic predisposition to high uric acid may consume the same foods without developing gout.
Gout And Diet Have A Strong Relationship
There is a substantial link between gout and food, according to research. As gout research advances, more information regarding the relevance of diet and nutrition, as well as the link between blood uric acid levels and gout flares, becomes available.
More patients are inquiring about the role of diet in their disease, which provides an excellent opportunity for discussion. Here are some of the most significant challenges they face as gout sufferers:
- “The diet. I have been eating high protein for years and now with less protein and more carbs I am hungry and putting on weight.’
- “I stop eating all fishes, no liver, no lamb, no pork.”
- “Being restricted with food choices. Especially TOMATO and being nervous to try certain foods in case they trigger attacks.”
- “Diet is my biggest challenge. I’m so busy and don’t always have time to cook and sit and eat a good proper meal.”
There has always been a focus on avoiding alcohol and reducing purine-rich meat and seafood sources. Doctors, on the other hand, frequently emphasize that one of the most essential goals is to live a healthy lifestyle in general, which will aid a patient’s gout treatment. It will affect the patient’s other comorbidities as well.
Can A Diet Cause Gout?
Gout once thought to be an ailment of the wealthy and gluttonous, is making a comeback. Is this due to the popularity of high-protein, low-carbohydrate diets such as the Atkins diet? Yes and no, according to experts.
According to studies, gout rates reduce during times of struggle, such as World War II, and rise during times of prosperity and excess. As a result, many people should not be surprised that gout rates are expected to rise in the United States as the country battles an obesity epidemic.
Gout is associated with obesity and high blood pressure. These are two major public health issues in the United States, with obesity on the rise.
Losing weight too quickly, on the other hand, may raise the risk of gout. As you lose weight, your body begins to metabolize body tissues, resulting in an increased flux of purines for the body to deal with, raising uric acid levels. Gout is increased by crash diets, in which patients lose a lot of weight soon.
The Truth About Purines
Purines can be found in a range of nutritious meals. As a result, it’s crucial to remember that purine restriction isn’t necessary. Dietary guidelines for gout management are generally the same as those for the general public: consume a healthy, well-balanced diet.
Limit your intake of processed foods as much as possible and concentrate on whole foods. These include fruits, vegetables, whole grains, beans, legumes, healthy fats such as olive oil, and low-fat dairy products.
Most organ meats, such as liver, kidney, heart, and sweetbreads, should be avoided in general. Beef, lamb, and pork, as well as shellfish such as mussels, scallops, shrimp, and clams, are other meats to avoid.
White bread, cakes, confectionery, ordinary soda, juices, energy drinks, flavored yogurts, meal replacement bars, and breakfast cereals should all be avoided, as should anything prepared with high fructose corn syrup.
The Correct Approach To Take With Dieting And Gout Management
Several genes have been uncovered that enhance the likelihood of acquiring gout. A healthy lifestyle consisting of regular exercise, moderate alcohol consumption, quitting smoking, and eating well, according to a study published in BMC Medicine in 2022, was sufficient to cut inherited risk by at least one-third.
Nearly half a million people from the UK BioBank were monitored in the study. This is a big database of health and genetic data about people in the United Kingdom. The least likely to get gout were those with low genetic risk and a healthy lifestyle. On the other hand, those who were more likely to have it had a high inherited risk combined with a less-than-healthy lifestyle.
Even people who are at high risk may reduce their risk by adopting healthier habits. This includes eating anti-inflammatory foods instead of gout triggers like red meat, beer, and sugary drinks.
For some people, sticking to a gout-friendly diet is a matter of staying disciplined. There’s no negotiating with gout. If you want to avoid it, watch your diet. As this respondent demonstrated, limiting your diet may help reduce gout while still allowing you to eat many of your favorite foods:
“You just have to stay away from the foods that cause gout. It is just up to the person if they won’t work at it. I am 72 years old now and I eat chicken, bacon, and other pork and haven’t had (gout) in about 4 years. If I don’t eat red meat (steak) or shrimp I don’t have gout anymore. Beans I love and eat every day. All the other food that causes gout I stay away from.”
Alcohol and Gout
For centuries, people have known that drinking alcohol can cause gout attacks. Scientific research now strongly supports this link. In healthy men, two 12 oz beers raise uric acid levels by about 10%, while drinking to intoxication doubles uric acid levels in alcoholics.
However, most alcoholic beverages contain no purines, so how does alcohol raise uric acid levels?
- While drinking alcohol, the kidneys’ ability to remove excess purines from the blood is diminished by at least 50%.
- When the liver processes alcohol, it expends a lot of ATP (an energy molecule); ATP contains purines, which are broken down into uric acid.
- Beer is especially harmful since it contains both alcohol and purines (which are created by brewer’s yeast).
One drink of alcohol per day is generally safe for women, while two drinks per day are generally safe for males, according to often stated health advice. If you have gout or are at risk of getting gout, however, you should limit your alcohol intake.
If you have gout or have been diagnosed with gout, your doctor may advise you to limit certain foods that may aggravate gout symptoms. They are specifically referring to foods high in purines, which break down into uric acid during digestion. The list includes alcoholic beverages such as wine, beer, and spirits.
Many respondents identified alcohol reduction as a significant issue affecting their quality of life. When faced with having to reduce their intake of alcoholic beverages, the following are some common challenges:
- “Staying away from a good beer.”
- “My social life as I drink frequently with friends.”
- “I enjoy casual and social drinking. Although I am very careful most of the time, it is hard to cut it out completely.”
- “No drinking and can’t walk without extreme pain.”
- “Not drinking alcohol…wine & spirits, beer.”
Is it necessary to avoid or eliminate alcohol if you have gout? To begin, you should always consult with your doctor about alcohol consumption and your specific health conditions, medical history, and medication use.
Let’s learn more about the link between alcohol and gout, as well as health considerations to keep in mind.
How Does Alcohol Affect Gout?
Consumption of alcohol raises the risk of gout in two ways:
- Some alcoholic beverages, particularly beer, contain a high concentration of purines, which are broken down into uric acid.
- All forms of alcohol, including beer, wine, and hard spirits, have an impact on kidney functions. This may alter how uric acid is excreted in the urine.
Because alcohol causes uric acid to be reabsorbed into the body, less is expelled in the urine. As a result, uric acid levels in the blood rise. When uric acid isn’t eliminated in the urine, it causes crystals to develop in the joints, causing significant pain and inflammation.
An analysis of nearly 43,000 people’s data from multiple studies on alcohol consumption and gout discovered a dose-response of gout risk to alcohol consumption. That is, the more alcohol people consume, the more likely they are to develop gout.
What Is the Worst Kind of Alcohol for Gout?
All types of alcohol have an impact on gout flares and symptoms, albeit the impact varies depending on which study you look at. Beer is particularly detrimental to gout sufferers, according to some research. That’s because it contains higher levels of purines, which break down straight into uric acid.
According to research, the risks differed depending on the type of alcoholic beverage consumed:
- Two or more beers per day doubled the risk of gout compared to non-beer drinkers.
- Two shots of spirits per day increased gout risk by 1.6 times over non-drinkers.
- Two four-ounce glasses of wine per day did not increase the risk of gout.
Other studies, on the other hand, have discovered a relationship between gout and wine. Wine appears to be the least offensive of the three types of alcohol, according to the consensus. Nonetheless, it has the potential to cause a problem.
Is it Possible to Reverse Gout by Avoiding Alcohol?
Regrettably, the short answer is no. Eliminating or limiting alcohol consumption is unlikely to reduce uric acid levels sufficiently to cure gout. Many gout patients have a target uric acid level of less than 6 mg/dL.
People who have high uric acid levels can go on a diet, lose weight, avoid high-purine foods like shellfish, and stop drinking beer. At best, they may reduce their uric acid from 10 to 9, but not much lower.
Dietary changes are insufficient at this point; the patient must be on uric acid-lowering medication.
Is There A Safe Amount Of Alcohol To Drink If You Have Gout?
Doctors advise gout patients to limit their alcohol consumption. Especially in the first six months after using a uric acid-lowering drug like allopurinol to control it. After six months on allopurinol and no gout flares, a person may usually increase their alcohol intake, at least slightly, without having flares.
This appears to be due to allopurinol’s ability to remove uric acid from the joints. As a result, there is no “overflow” situation when uric acid levels rise rapidly due to alcohol.
If you have gout and are taking medication to control it, you may eat high-purine foods like red meat and shellfish on occasion and drink a small amount of alcohol.
Treating Gout With Medication
There is no permanent cure for gout. Fortunately, there are a variety of effective treatments available for this condition. Medicines are the most effective treatment at the moment.
Medicines may help in two ways: they may ease pain during an attack, and they may lower uric acid levels, which are the cause of the condition.
NSAIDs are used to treat gout by alleviating joint pain and swelling. Ibuprofen and naproxen are the two most common types. NSAIDs may help shorten the attack if used within the first 24 hours. Ice, rest, and elevating the joint are other methods for pain relief.
Your doctor may suggest you use one of the prescription medications listed below, which are not available over the counter: Allopurinol, Colchicine, and Febuxostat among others.
Even With Medications, Challenges Remain
Many respondents shared that they still face significant issues while on gout medication:
- “My 400 mg of Allopurinol and vegetarian and alcohol-free diet is not working even after two years.”
- “Getting Doctors to recognize and prescribe appropriate pain meds. Tylenol/ extra strength just does not cut it.”
- “Allergic to Puricos, so can’t manage effectively. and there is no other substitute that can help control it. Can have an eating plan however can’t implement it as we still eat as a family.”
- “Have been taking colchicine and diclofenac for over years unfortunately I can’t take allopurinol because it just worsens the situation.”
It’s important to keep in mind that starting a uric acid-lowering medicine has the risk of causing a gout flare. If this occurs, there should be a management strategy in place. Preventive medications (steroids, colchicine, and NSAIDs) combined with uric acid-lowering therapy may typically prevent this.
Consult your doctor for the best drug options for you. Your kidney function, as well as any potential side effects and other health problems, will determine the type.
Preventing Gout Complications With Medications
Your doctor may recommend that you take medicine to reduce your risk of gout-related problems if you have numerous gout attacks per year or if your gout attacks are less frequent but more painful.
Uric acid-lowering medicines may be administered if joint X-rays show signs of gout damage, or if you have tophi, chronic renal illness, or kidney stones.
Home Remedies And A Healthy Lifestyle
Taking medications is the most effective way to treat gout attacks and prevent recurrent symptom flares. However, lifestyle choices are important, and you may want to:
- Make healthier beverage choices: Limit your intake of alcoholic beverages and drinks sweetened with fruit sugar (fructose). Instead, consume plenty of nonalcoholic beverages, particularly water.
- Avoid purine-rich foods: Purines are found in abundance in red meat as well as organ meats like liver. Purine-rich seafood includes anchovies, sardines, mussels, scallops, trout, and tuna. For gout sufferers, low-fat dairy products may be a preferable source of protein.
- Regular exercise will help you lose weight: Maintaining a healthy weight reduces your chances of developing gout. Walking, bicycling, and swimming are low-impact activities that are better for your joints.
Don’t Let Gout Control Your Life
If you are experiencing gout symptoms, make an appointment with your doctor. Following an initial examination, your doctor may refer you to a specialist for the diagnosis and treatment of arthritis and other inflammatory joint conditions (rheumatologist).
There are numerous medications on the market today that may help relieve gout symptoms. More treatments, as well as a potential cure, are being investigated. For more information on gout treatment, speak with your doctor.
Posted by Spiro Koulouris