The Best Diet For Gout Page Just Got Better

I was self-critical in my recent article about a low purine diet for gout.

I have fixed that now, but I need to ask you a favor.

Before the favor, let me do a quick review of where I stand on the diet for gout issue

I know there are some excellent gout recipe books around. I say excellent, because I have a weakness for recipe books. To be honest, I have a weakness for food, so drooling over recipe books is my low-calorie alternative to filling my face.

Unfortunately, the book browsing soon turns to cupboard browsing, but that is not the issue here.

Diet for gout recipe books are a distraction.

They stop you from understanding the real issues. They stop you from realizing that the best diet for gout is what you eat now – tweaked a little to replace some of the bad foods with good ones. It is pointless for me, as an outsider, to list good and bad foods. Food can only be good or bad in the context of your entire diet, and in the context of the current phase of your gout treatment plan.

What is bad for one gout sufferer, is OK for another. What is undesirable during the uric acid removal phase of your gout treatment, may be OK during the maintenance phase.

There is no script. If someone tells you you can fix your gout by following a set diet, they are wrong. The only way forward is to assess your own current diet for weaknesses, then correct those weaknesses. Weaknesses are excesses or shortages that do not help your gout treatment. They are personal to you.

The bad side is, you have to do some work to see where you can improve your diet for gout. The good side is, you have the free support of GoutPal, which starts with my new, improved, Diet For Gout page.

Best Diet For Gout: Next Steps

This is the point where I usually advise what to do next, but I’m going to take a liberty, and ask a favor.

During my review of the diet for gout pages, I noticed that a recent software update had ruined the layout of one of my pages. It was still readable, but only just. I hope it was a one-off, and I will continue to review the gout information here, and improve it when I can.

You can help with this, and it will only take a few seconds. If you spot something wrong on a page, please click the “Tell Me” button which is at the top and bottom of each page. This will open a new topic in the gout forum, and you can type the details of the problem, or your improvement suggestion, in the details box.

You will be helping me, which is good. Even better, you will be helping the thousands of gout sufferers who visit the page after you.

Together we can make gout better.

Leave Best Diet For Gout To see other Diet For Gout pages…

You have gout, and that is serious. You might feel at the end of your rope, but I am here to help you, and together we can beat your gout.

But this guy has something far worse – terminal ignorance.

If you don’t know what I’m talking about, watch the following news clip:

That’s right! He actually said:

“The very poor in this country do have a lot of programs, a lot of benefits. People aren’t dying in America. You know, in fact, the very poor suffer from gout. In the 1920 and 30s, that was called the rich man’s disease.”

Ignorant, ignorant ignorant.

We have moved forward in the intervening century. We know that gout is largely genetic. So could it not exist amongst the poor people a century ago? Of course it could. It must have done, unless our parents came from space. But who would diagnose it? Who would recognize it?

Fortunately, we have progressed since the early 20th century, or at least some of us have. But it is not too difficult to imagine what health care must have been like for poor people during the Depression. I can’t imagine many sitting in the rheumatologist’s consulting room. I can’t imagine them getting the explanation: “You have an inherited defect in uric acid metabolism so stop worrying you unwittingly ate too much filet mignon!”

I do not understand how anyone who claims a poor background can be so careless and ignorant about welfare issues, but this guy’s moral compass is so skewed, he probably can’t understand it either. Let’s hear a bit more from him (do not click play if you are offended by swearing)

No self control. No appreciation of the value of a varied society. No hope.

It is depressing, but look on the bright side.

You and I can work together to fix your gout pain. This idiot can never stop being the waste of space that is Charles Payne.…

I am not surprised by their concern, because the Internet is full of nonsense about purines and gout. What surprises me is the source of their worries.

When I ask why they are so concerned about purines, usually to the exclusion of everything else, they reply that their doctor gave them some lists of foods that they should avoid, and others that they should limit. I try to ask them what other advice they received, but they cannot remember.

“Something about acid, maybe, and I might need tablets for life,” or “I have to cut out alcohol,” or “There are some colchy-something-or-other pills I can take, but they will give me awful diarrhea.” Whatever else the doctor might have said, it is all forgotten, and the years of pointless obsession about purines begins. Sixteen years ago, I went through a similar experience, and it is also pretty much all I can remember from the consultations of the time.

I know a lot more now, but I feel I have let you down.

Some time ago, I started the section of my gout diet department that deals with medical issues of diet. Although diet is often overrated as a cause of gout, it can certainly be a factor in the treatment plan. There is a crossover between diet and treatment, so I have some medical pages in the diet department, and food pages in the treatment department. This makes good sense, as gout sufferers have different concerns when they arrive here.

Gout patients with concerns about their treatment, are most likely to start in the treatment department, and then want to know how diet might affect their gout treatment plan. This is my preferred way, but on a website, I cannot dictate where people will start and finish, so the diettreatment relationship has to be a two-way street.

Gout patients with concerns about their diet, are most likely to start in the gout diet department. It is my duty to explain that they should consider a treatment plan first, and explain how treatment and diet fit together. This is where I have let you down.

The section of my gout diet department that deals with the medical aspects of diet for gout sufferers is pitiful. As usual, I got sidetracked once I had started it, and only realized it when I tried to give good advice to visitors looking for a low purine diet for gout.

I am sorry. It will be fixed within a week. I have improved it.

To be certain you do not miss updates, please subscribe to my free update notification service.

Leave Low Purine Diet For Gout to read other Diet For Gout pages…

At least one patient, or rather his wife, has reported good initial results in the gout forum, and has promised to keep us updated with progress. Any new treatment is always interesting, and people want to know more about it.

The scientists get to have their say in the professional publications, but much more important, is the way treatments affect gout sufferers. Now, gout patients have a chance to tell their story.

A leading health magazine is looking for Krystexxa patients to interview. Please see the details at that link, and share your story.

Of course, I would be delighted if you could also share your experiences about Krystexxa, or any other gout treatment in the gout treatment forum.

Leave this Krystxxa article to browse more Gout Medications To Lower Uric Acid…

Potential Renal Acid Load (PRAL) is a calculated value that estimates how foods might change acidity or alkalinity of the body.

PRAL is a precise calculation from 5 nutrient values in food, but it is not an exact measure. It is a shortcut measure to assess the affect of foods on the pH of the body.

PRAL For Gout Sufferers

PRAL is a widely used tool for estimating the acid load on your kidneys. This is the general pH level derived from many different compounds, not uric acid.

PRAL is not a measure of uric acid, but a higher pH makes uric acid more soluble. This means that crystals are less likely to form.

It is important to realize that pH of blood is tightly regulated by our body, and so following an alkalizing diet is not likely to have a dramatic effect on gout. However, an alkalizing diet is widely recognized as promoting good general health. For gout sufferers at risk of kidney stones, an alkalizing diet is very effective in preventing or dissolving uric acid kidney stones.

What Is Potential Renal Acid Load?

Potential renal acid load experiments show that PRAL is a reliable approximation of the pH effect of foods. It is calculated from:

PRAL =

0.49 Protein + 0.037 Phosphorus - 0.021 Potassium – 0.026 Magnesium – 0.013 Calcium

Acid forming foods have a positive range, alkaline forming foods have a negative range. For adequate nutrition it is important to chose a combination of foods with positive and negative PRAL values. You need some acid forming foods, but you must balance these with sufficient alkaline forming foods to give an overall negative total. As far as I know, there is no target value to aim at.

Your target is really to increase the pH of urine, so frequent testing will show if you need to improve your PRAL score.

As PRAL is more about nutrition than gout, I have moved my tables of individual food items to my Food Diary website. There you can analyze your total diet, and then see which food items you should change to improve your gout diet.

Leave the Potential Renal Acid Load page to read other aspects of an Alkalizing Gout Diet Menu…

A recent discussion about uric acid and heart disease prompted me to take a look at current research. This also tied in with a little bit of reorganizing I am doing. An old post about lowering uric acid levels did not appear to have any relevance to heart disease, but one link led to another, and before I knew it, a whole host of other diseases seemed to connect with gout.

Interestingly, the link between many of these diseases is via new research into allopurinol. I will come back to that at a later date, but for a hint of what is involved, please see Do you have gout with another disease?

Lower Uric Acid

In an earlier post, I mentioned that Hershfield believed that lowering uric acid below 2mg/dL (0.12 mmol/L) would probably be safe ^[1]. On reviewing that report in more detail, I noticed that much of his evidence was based on other diseases. There are conditions where people have the opposite conditions to gout sufferers. I.e., they either cannot produce uric acid or they over-excrete it. The first case is because they do not produce xanthine oxidase, the second because they have genetic kidney defects that stop the kidney from reclaiming uric acid. In both these conditions, people have no known ill-effects with uric acid levels below 1mg/dL (0.6mmol/L)

When I followed this through to other investigations of lowering uric acid, I hit on a report that also looked at other benefits of lowering uric acid outside the world of gout.

Allopurinol For Other Diseases

Wei and colleagues investigation, Impact of allopurinol use on urate concentration and cardiovascular outcome ^[2], attracted me for several reasons. The investigation highlights the poor level of treatment generally, with only a small percentage of gout patients achieving safe uric acid levels. This is one of my pet topics that I will keep returning to, but the investigation also ties together the issue of lowering uric acid for gout sufferers with the advantages of such a regime for patients with other health problems.

This has set me on a path to investigate and summarize several other diseases. Mainly, I am hoping that the outcomes from helping other diseases through lowering uric acid, will bring a better understanding of how uric acid affects us beyond the obvious gout problems. But, that is for another day. For today, let me leave you with the conclusion:

In conclusion, more than half of the patients taking allopurinol did not reach the recommended target urate levels. High-dose allopurinol use was associated with a lower risk of cardiovascular events and all-cause mortality than low-dose allopurinol use, suggesting that higher doses of allopurinol may be of benefit by reducing cardiovascular disease or death.

If you are interested in the links between gout and other diseases, please join the gout forum discussion I mentioned above.

Leave Gout And Heart Disease to browse the gout disease pages

Gout And Heart Disease References

1. Title: Reassessing serum urate targets in the management of refractory gout: can you go too low? Author: Hershfield MS. Published: Curr Opin Rheumatol. 2009 Mar;21(2):138-42. Can Uric Acid Go Too Low?
2. Title: Impact of allopurinol use on urate concentration and cardiovascular outcome. Authors: Wei L, Mackenzie IS, Chen Y, Struthers AD, MacDonald TM. Published: Br J Clin Pharmacol. 2011 Apr;71(4):600-7. doi: 10.1111/j.1365-2125.2010.03887.x. Allopurinol Uric Acid And Cardiovascular Health
…

Gout is often associated with other disease, though often the links are unclear. We have situations where gout causes another disease, another disease causes gout, or there appears to be a statistical link, but nobody understands how the health problems affect each other. We know that excess uric acid causes gout, but other properties of uric acid are less certain.

There are many investigations that show statistical links, but these often raise more questions than answers. In many cases, a statistical association leads to specific investigations, but it can take several years of detailed research before scientists understand these complex relationships.

I have covered many diseases associated with gout, but if you think I have missed one, please share your views and experiences in the gout disease forum. I would also appreciate your comments there if you want me to give priority into researching or summarizing a particular disease and it’s association with gout.

There are lots of discussions in the gout forum about different disease associations. Use the search box near the top of every page to find current discussions. This will also include relevant articles from the gout disease blog.

Gout And Heart Disease

Heart disease, or cardiovascular disease, which includes related conditions such as stroke and angina, is currently being investigated widely. Various associations are being considered, in particular the role of uric acid. Some recent investigations into allopurinol in heart patients reveals strong links between uric acid and heart disease, though the relationship is not yet fully understood.

Search for heart or cardiovascular for articles and discussions related to heart and gout disease.

Gout And Kidney Disease

As uric acid is excreted or reclaimed through the kidneys, there are many associations between gout and kidney disease. Kidney stones are a common risk for gout sufferers.

Search for kidney or renal for articles and discussions related to kidney and gout disease.

Gout And Liver Disease

As the liver plays a big part in producing uric acid, there are many associations between gout and liver disease. Some gout treatments create concerns about liver damage, but this requires individual case investigation and analysis, because gout patients can also get liver improvements.

Search for liver or hepatic for articles and discussions related to liver and gout disease.

Gout And Osteoarthritis

As uric acid is deposited around joints as crystals, there are many associations between gout and osteoarthritis. Joint damage is a common risk for gout sufferers.

Search for osteoarthritis, bone erosion, or joint damage for related articles and discussions.

Gout Disease: Next Steps

In the Gout Disease Blog, I often report associations between gout or uric acid and other diseases. As these associations become better understood, I review and summarize the relationship here. You can keep up-to-date with developments in the field of gout associated with other diseases by subscribing to my free update service:

Leave this Gout Disease page to browse other gout-related topics.…

This page will explain how an alkalizing menu can help gout sufferers.

The most important thing to realize is that this has nothing to do with neutralizing uric acid, a common misunderstanding. Adopting an alkalizing diet creates an environment in your body where uric acid is more soluble. This has a noticeable effect on urate kidney stones.

The second-most important thing is to realize that you must analyze the whole of your menu to estimate the acidic load of your total diet. Individual foods are meaningless in isolation, though once you have a view on your entire menu, you can look at individual foods to see where you must make changes.

Pending the summary information, you should read the following articles for more information:

Alkaline Foods: More Myths Exposed

Avoid the myths about alkaline foods for gout and see what benefits the gout sufferer can expect.

Alkaline foods are said to give massive health benefits. But what are the hidden dangers for gout sufferers?

Diet For Gout Sufferers: Food Tables

Introduction to the food tables that help plan a diet for gout sufferers.

You cannot plan a diet for gout sufferers without food tables. These gout diet tables are the best, and will get even better.

Alkaline Foods For Gout

Using PRAL to plan your gout diet menu to avoid gout kidney stones.

Alkaline foods for gout are hard to understand. This explanation makes sure you avoid the pitfalls of bad gout diet planning

Is Alkaline Diet uricosuric?

Will this gout PDF file help lower uric acid using an alkaline gout diet menu?

Planning a gout diet menu often includes an alkaline diet. Tasty, healthy, but can it really lower uric acid as a uricosuric?

Leave Alkalizing Gout Diet Menu to browse the Gout Diet section…

Why limited appeal? As I noted in the original article, baking soda tends to raise blood pressure. There is a high occurrence of high blood pressure amongst gout sufferers, so many simply cannot contemplate it.

Baking soda for gout sufferers is most useful as a method for dissolving or preventing kidney stones, but you must consult your doctor about this.

To understand why this works you need to consider the causes of gout.
In the first place, uric acid levels build up to a level that cannot be held in the blood.
Crystallization occurs and uric acid salts are deposited in the joints.
There is no specific level when this happens and some people can have high levels of uric acid (hyperuricemia) without developing gout.
Therefore, you should not simply focus on uric acid levels, but also on other factors.

Body fluids are a combination of many different compounds. Some are acidic and some alkaline.
Acidity or alkalinity is generally measured using a pH scale with values between 0 and 14.
On this scale 7 is neutral, anything below 7 is acidic and anything above 7 is alkaline.
As the overall pH of body fluids fall, uric acid becomes less soluble, increasing the risk of gout attacks.
Conversely, increasing alkalinity lowers the risk of uric acid crystallizing and helps dissolve existing crystals.

Due to the effects of acidity, many people find that treating gout with baking soda dramatically improves their condition. The maximum dose, unless advised otherwise by your doctor, is 4 teaspoons per day. This can be either one teaspoon dissolved in water taken 4 times a day, or 1/2 teaspoon more frequently.

Do not exceed this maximum, and always dissolve it in water – undissolved baking soda can rupture the stomach.
Disadvantages
Although I do not class baking soda as a drug, it can have side effects and interactions with drugs you may be taking. You must not start taking baking soda without consulting your doctor. Significantly, as a salt of sodium (baking soda is also called bicarbonate of soda or sodium bicarbonate) it can raise blood pressure. Possible side effects include:

• Appetite loss
• Breathing slow
• Continuing headache
• Feet or lower legs swollen
• Mood changes
• Restlessness or nervousness
• Twitching or painful muscles
• Unpleasant taste
• Urge to urinate frequently
• Vomiting or nausea
• Weakness or tiredness

If you have tried this, or have any questions or opinions on it, please discuss baking soda in the gout cures forum.

Alternatives To Baking Soda For Gout

There are alternative ways of increasing alkalinity of body fluids as a gout treatment. The main alternative is food. The standard text for checking pH values is the US FDA’s “Approximate pH of Foods and Food products” list.

I have reformatted this list elsewhere, but since doing this I have realized that the pH value of food is not especially important. The significant effect of food is how it affects the alkalinity of the body after it has been digested. To learn more about how food affects body pH, see treating gout with an alkalizing diet. …

With a growing amount of information about gout and uric acid, indexing becomes more important to help you find the information that is most relevant to you.

Gout And Uric Acid Indexing

There are several indexes available now, and I am building more through 2012.

Subject Section Gout And Uric Acid Indexing

The main index pages are divided by subject, and are accessed via the Gout Index in the main menu.
Other categories are listed on the following pages:

Alphabetic Gout And Uric Acid Indexing

I am working on alphabetic indexing now.

Personal Relevance Gout And Uric Acid Indexing

This is the main indexing project for 2012.

I am looking at why people visit GoutPal with a view to standardizing the various aspirations of my visitors. This allows pages to be flagged with their suitability for a particular aspiration. For example, if you are looking to lower uric acid, then previous visitors who have the same aspiration can recommend the most suitable information that has helped them.

Progress of this indexing project now rests with you. I have recently introduced the Gout And Uric Acid Status project. Please vote for the statements about gout and uric acid that most match your aspirations. If you have other gout-related aspirations, please add them as answers. and if you can think of better wording for any of the statements, please add your comments. Also, remember to vote up the question if you think this project is a good idea.

Other Gout And Uric Acid Navigation Tools

In addition to the indexes, there are several existing ways to find information, with more planned for 2012.

Gout And Uric Acid Menus

The box menu near the top of most pages gives lists of Top Level Sections, Best Gout And Uric Acid Pages, Similar/Related Topics, and pages within the Same Section.

During 2012, these will move to a menubar that will stay at the top of the screen. This is an extended version of the menubar at GoutPal Interactive. I will also add menus for Favorite pages and Recommended pages.

Searching Gout And Uric Acid Information

I have saved the best (in my opinion) until last. The final way to find information is to use the search box at the top of every screen.

You can also use it here:

Please note that, whilst this search box is specifically to search GoutPal pages, you can use the Full Search to find any pages on the Internet. Please bookmark that link and use it to replace your current search tool.

Gout And Uric Acid Navigation: Next Steps

I am always interested in improving the methods for finding gout and uric acid. If you have a favorite way, please vote for it on the gout and uric acid navigation poll. If you know of better ways, please add your suggestions as answers to that poll. If you have suggestions for improving current indexes or other navigation methods, please add your comments to the appropriate answers.

Leave this Gout And Uric Acid Navigation page to browse other gouty arthritis related pages.…