If you are worried about a particular gout symptom or treatment, or if you want to clarify something on the GoutPal website, then simply ask GoutPal. Here is a recent letter about a puzzling gout symptom (moving gout) and diet.

Why is it that if I eat anything with tomato in it I’ll have a severe attack. Also I’ve been having moving gout attacks. It attacks my knee, I’ll take my colchicine till I vomit. The attack will move to my heel, elbow or wrist. These attacks have lasted for weeks at a time.
Gout Sufferer, United States.

Dear Gout Sufferer,

Let me first point out that I am not a doctor – just an ordinary Joe with gout, getting a bit tired of confusing information and also fed up with gout not being taken seriously.

If colchicine is making you vomit, I really think that you should talk to your doctor aybout it. As an anti-inflammatory it is often very effective for gout, but it is not for everyone. Upset stomachs are a common side-effect, and there are alternatives. Incidentally, I use Ibuprofen to help reduce swelling and ease the pain, but again it isn’t for everybody.

What you should realize is that both these drugs are simple anti-inflammatory medicines that help to ease pain through reduced swelling. In the case of Ibuprofen, it can also be taken at the same time as Paracetamol which will further help pain relief. That is as much as I can say – I’m really not qualified to advise on medicines. The best approach is to discuss alternatives with your doctor and find out which suits you.

Anti-inflammatory drugs treat the gout symptom but do nothing to reduce uric acid which is the cause of gout. Uric acid should be excreted through urine, but when the levels are too high it is deposited as crystals in the joints, hence the painful swelling, and eventually as semi-solid lumps under the skin called tophi. I have experienced similar moving gout attacks to yours and you have my sympathy. I have learned that they will continue until you do something to reduce your uric acid levels. What actually happens is that crystals will normally form in the joints that are easiest to start crystallization – usually because blood flow in those joints is lowest. So if you are sat for long periods, it is likely to be the knee or foot area. Asleep it can be the hand, wrist, elbow etc. When these crystals form, and the pain starts, your blood uric acid levels actually fall, which is what your body is seeking. When the crystals breakdown again, they will dissolve back into your blood, raising the level and increasing the risk of another attack.

One option – which you can discuss with your doctor when talking about pain relief – is a drug to encourage excretion of uric acid. This is a personal matter, but I prefer not to take medicines unless I can avoid them. I have found that it is usually possible to manage your own uric acid levels. Unfortunately, there is no simple test, and so this relies on self-management and common sense.

All you really have to figure is reducing uric acid in, and increasing uric acid out. Some substances behave differently depending on how much you take, e.g. aspirin. (A recent study into aspirin and uric acid now suggests that this may not be the case.)

This complicates things, but don’t worry too much about this now – just concentrate on reducing your uric acid levels. My diet tips page is a good starting point.

As for tomatoes, this is another example of why I approach gout by saying, “see what works for you”. The human body is so complicated, and everybody is different, that it is hard to generalize. There is not much research done on gout, though I have heard elsewhere that tomatoes can be a problem, I can find no scientific information about this (yet). My theory, for what it is worth, is that you have a high uric acid level nearly all the time. This doesn’t always lead to gout, but as soon as something triggers it, the crystals start being deposited at the easiest point. Another explanation is that tomatoes might be lowering uric acid, which can also trigger a gout attack. Only a uric acid test will help you determine if, and how, tomatoes are affecting your gout. Contact me if you need more help on uric acid testing – I have some great news on this that I will publish when I have the full details.

Good luck with managing your gout – please get in touch again if anything I’ve suggested isn’t clear.

Keith GoutPal.com

Since replying to this, I have done more research into the effects of acidity and alkalinity in diet. Though diet and gout is very complicated, I have highlighted the key points in my Diet section. There are also some relevant tables in my Food section.

If you have questions about your gout symptom, or any aspect of gout, you can get them answered quickly at the gout forum.

I first published this gout symptom page prior to 2008, and republish here as part of ongoing website maintenance. For up-to-date information, please browse the Gout Symptoms Section.

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