Gout

What is it?

Gout - a form of arthritis caused by excess uric acid in the bloodstream. 

Purine is produced naturally in your body and is also found in certain foods. Purines break down into uric acid, enter the bloodstream, travel to the kidneys and is excreted in urine. If it cannot be cleared, the uric acid level rises, which in excess forms crystals that deposit in your joints, particularly in toes, fingers causing pain and inflammation. This joint pain is referred to as gout, or a gout attack.

Eating a lot of purine heavy foods, results in a higher uric acid level in your body. Alcohol, especially beer is a big contributor to uric acid levels.

The most common risk factors for Gout :-

• Dehydration
• A high-purine diet
• A high intake of sugary or alcoholic drinks

Early Identification

Blood test every 6 months. Check for Uric Acid, Calcium, Vitamin D and B12 levels

My story

I had been on a high protein diet for a long time. Almost a decade of oats for breakfast along with raisins, cashew, almonds, flaxseeds, walnuts mixed with milk. I had a soft spot for peanuts and I used to munch on it the whole day. I am a moderate alcohol drinker but I realized that the drinking was not followed up with drinking more than enough water.

8 years back when I did my blood test, I was told my uric acid level was on borderline. That is all what they said. They did not say what would happen if it goes up.

So one fine day when I was drinking with my family, a pain near my right toe flared up. I had experienced similar pain when I had sprained my leg. This time, it was unbearable and I hardly slept during the night. The next day, I went to the Orthopedic. One look at my leg and he proclaimed "Gout!". 

The first time I heard that word in my life.

He gave tablets for 5 days, some guidelines and sent me home. I read up as much as possible on Gout. The pain did come down but my toe was not the same. My leg would not fit in a shoe, I walked with a limp and I could not bend my toe. And when there was a Gout flare up, he prescribed pain killers for 10 days.

That was not the way to go.

I met another Orthopedic and after further tests realized that I had Vitamin D and B12 deficiency that was causing pain in my left knee joint. He also suggested I meet a Dietitian, who prescribed a low purine diet for my Gout. My medication was for 3 months which also had Vitamin D injections every week. For the pain in my left knee joint, I was given a gel, to be applied in the morning and evening, followed by 20 minutes of ice pack. This did not help.

Blood test report - 12/Apr

What I did

My prime aim to was to reduce my uric acid levels. This was also a learning process as I identified foods that caused the pain to increase. 

I am a vegetarian and hence the below does not talk about any non vegetarian food.

Ate/Drank

• Atleast 2 litres of water a day (with lime added to it sometimes) [Tip - Fill 2 liters in bottles and keep it where you can see them]
• First drink in the morning on an empty stomach - 2 tbsp of Apple Cider Vinegar + 2 tbsp of lemon juice + less than a quarter tbsp of turmeric in a glass of warm water (this has to be done using a straw without the liquid touching the teeth as much as possible as per the Dietitian). Ate a Banana after 30 minutes of this
• Last drink before going to bed - a glass of water boiled with shredded ginger and strained [Update 19/5/21 - This has been stopped]
• I read that turmeric and ginger have anti inflammatory properties and help with reducing the pain due to Gout. It did help a lot. Apple Cider Vinegar helps flush out uric acid
• Papaya - Cut pieces were my regular snack
• Cherries - 4 to 5 a day [Update 19/5/21 - Depending on availability. Season has started again]
• Celery - Remove the leaves, cut up the stem and eat 4 to 5 short stems a day (raw). I had to stop after some time as they got stuck between my teeth
• Gooseberry (Amla) - High in Vitamin C
• Glass of milk - For Vitamin D [Update 19/5/21 - This has been stopped]
• Snack items were biscuits with 0% Sugar and 0% Maida (White Flour) [Update 19/5/21 - Replaced this with khakhras]
• 1 spoon of powdered Flaxseeds a day
• 1 Cashew and 1 Walnut each in the morning (I had a lot of leftovers. If you don't have any, that is fine)
• Gluten free Pasta once in a while
• Brown Rice preferable over White Rice. White Rice is also fine
• More Vegetables
• 2-3 teaspoon of Curd
• Chewed my food mindfully. I ended up eating less. Most of the time, my dinner was my lunch leftovers. This also helped me eat an early dinner - before 7 pm
• Ate everything in moderation
• Started including soya chunks / beans in my diet to compensate for the reduction / lack of protein [Update 19/5/21]

Avoided / Reduced

• Continued my no Sugar in my drinks (not even in my Tea / Coffee)
• No foods containing Maida (White Flour) - look at the food labels
• No foods containing Yeast - Bread, Bun, Pastries, Pizza, Cake, Rolls (High Purine)
• No Kabuli Chana (Chickpeas) - I had a Gout flareup because of this
• Reduced Urad Dal (Split Black Gram) - especially in papads
• No Moong Dal (Yellow Split Gram) / Green Moong Dal
• No Raisins (Highest Purine content)
• Reduced Dates (1 or 2 pieces a day is fine)
• No Oats (There are mixed views on this. Some say 2 bowls a week is fine. I avoided it altogether)
• No packaged juices / soft drinks (this has high Fructose)
• No Alcohol (increases the levels of uric acid in the body and inhibits the body's ability to excrete uric acid) [Update 19/5/21 - Having in moderation. 1 to 2 (30ml) drinks a month with water. Absolutely no Beer]
• No Peanuts
• No packaged Sauces, Mayo, Ghee, Vanaspathi, Dalda [Update 19/5/21 - Started including 1 spoon of Ghee in my diet every day]
• Drastically reduced fried snacks
• No Spinach, Asparagus, Peas, Cabbage and Mushroom
• No non rice Noodles
• Avoided Urad Dal papads. Opted for Potato, Rice, Garlic ones
• No ice cream (studies are mixed about whether to eat them or not) [Update 19/5/21 - Having in moderation. 1 to 2 scoops a month]
• Avoided outside food

There were occasional cheat days, may be once in every 2 weeks - limited quantities of fried snacks, cake, chocolate - 1 piece / handful.

My blood test results from 5th Vital after 3 months of medication and diet:-

• Creatinine : 0.9 mg/dl [Range - 0.66 - 1.25]
• Uric Acid : 6.3 mg/dl [3.5 - 8.5] Down from 7.5 mg/dl. 5.5 is ideal I feel
• Calcium Total : 11.0 mg/d [8.5 - 10.1]
• VITAMIN B-12 : 637 pg/mL [Normal : 239 - 931 pg/mL]
• Vitamin D Total-25 Hydroxy : >150 ng/mL [Toxicity Level. Sufficiency is : 30 - 100]
• Vitamin D was high as I had just got off the medication. Another Vitamin test is due in 3 months

Update

The uric acid levels are coming down :-

Reference Interval - 3.5 - 8.5 mg/dl

12/Apr/20 - 7.5 mg/dl

16/Jun/20 - 6.3 mg/dl

30/Oct/20 - 6.2 mg/dl

30/Apr/21 - 5.7 mg/dl

To summarize

Anything to avoid that pain in your toe joints that keeps you awake in the night!

Pain Pleasure principle

Picture Courtesy - corporatecoachgroup.com

Gout side effects

Picture Courtesy - creakyjoints.org

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