The Hypocritic Oath

Gout

Posted in Uncategorized by trinkwasser on November 8, 2009

This is yet another condition “associated” with diabetes, principally Type 2, and insulin resistance in general.

Curiously if you look at almost any website on the subject you will find little controversy. Most doctors will agree on treatment and will NOT be telling you to “eat more liver and kidneys to stabilise your purine level”, they will almost certainly tell you to avoid food containing high levels of purines. Strange that the same logic does not apply to diabetes.

A useful resource I was pointed to by Quentin, writer of a most entertaining book (and currently in hospital undergoing radiation therapy, having survived not only diabetes but leukemia and another form of cancer for far longer than anyone expected): apparently Dalmations have a genetic inability to process purines, and it would appear from this most comprehensive list that they also suffer from owners who feed them things like Endive.

Seriously though, this is one of the best available sources for purine content.

Excess dietary purines are only one factor though: other things can affect purine metabolism and increase uric acid, one such being fructose. Some people demonstrate chronically high uric acid levels without ever developing gout. Medications such as diuretics may also affect purine metabolism or uric acid clearance.

Update on mother: it turned out NOT to be gout after all but an infection in her toe, as we first suspected. Fortunately we can generally get a GP out quickly when required: she is now on antibiotics and recovering well (and has had her steroids increased again) so kidney is back on the menu! Curiously the last times she had gout attacks it was after eating rhubarb: probably some combination of the fructose and oxalic acid set it off, and she was put on allopurinol which along with the food avoidance had served to keep her gout-free for a long time.

One potential way of identifying gout in its initial stages is that one or more joints become red and swollen and hot to the touch. Unfortunately as we have discovered this may also be a symptom of a bacterial infection! The later stages where more joints are affected and crystals of urate emerge through the skin are more easily identified, by which time the pain is appalling.

IMO it’s important to get this diagnosed as soon as possible as it may come on very quickly and it needs to be differentiated from similar arthritic conditions including pseudogout, and as we now know from infections which in old folks and others with reduced circulation can rapidly turn to cellulitis.

If in any doubt get a second opinion: I now realise I had two attacks in the past, both only in one thumb joint, which my doctor failed to identify even when the tophi (a mix of pus and crsytallised uric acid) burst through the skin. He assured me it was a “trivial skin infection”. Fortunately our local crew are far more competent.

Yet another condition whose incidence can be reduced by tight BG control and especially reducing insulin resistance.

 

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One Response

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  1. Behandlung Von Gicht said, on June 16, 2010 at 12:36 am

    Gout surely must be seen as a horrifying condition, my own grand daddy is suffering from the illness for some years now. It is awful, finding a loved family member and friend suffer from severe joint pain many times. Sticking to an appropriate diet program for prevention and making use of adequate medication and therapy is something I believe to be critical. I would personally would suggest anyone who is currently noticing primary indications of inflammatory arthritis to by any means take this absolutely serious. You should see a physician as soon as you can and adapt your nutrition to prevent the outbreak of the disease. It is definitely no fun, really. Try to look for healthy therapies and stay clear of foods with high amounts of purine, alcoholic beverages and so forth to take prophylactic measure!


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