[Keith Taylor]

Thanks for posting this, Ashley.

If you have more information about it, I will also post on my main gout website, which is much busier.

You can send information to my HelpDesk.

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[Keith Taylor]

I look forward to seeing your vegetarian videos and reading your blog, Rhys. I’m watching for announcements on your Twitter feed 🙂

[Keith Taylor]

My approach is to balance your diet for health first. Then tweak your healthy diet to make it more gout-friendly inline with a comprehensive gout management plan. So, there is no quick way to make a Vegan diet gout friendly.

Having said that, I’m acutely aware of the need to present easy-to-follow gout-friendly eating plans. Hence my project to develop good gout foundation diets. But, as yet, I have not included veganism in that list.

My main reason is that I am completely uninspired by vegan diets. Everyone talks about cutting out all animal products. But nobody seems to be interested in how you replace the essential nutrients lost by those food choices. I find that frustrating, as I’m genuinely interested. However, no vegan so far has ever explained the benefits in a way that excites me. So, I’ll probably do more in future. But I’m currently focused on Mediterranean eating styles.

Interestingly, I’ve just read 9 points to a Mediterranean vegan diet. At first glance, those points seem relevant to gout health. But, I’ll have to study them in more detail.

Can Vegan Mediterranean Diet work for gout?

So my question to Karen is: Can you inspire me to find a vegan diet exciting? ❓ Because Mediterranean eating has huge science-based health benefits. But mainly, it provides recipes that I’d love to eat. Maybe you could share some inspiring vegan recipes. Then I can say if they are gout-friendly. Or, how they can be made more gout friendly. Hopefully, you can explain why you find veganism so attractive.

As far as nutrition-so-called-facts is concerned, I find it a celebration of style over substance. There might be something useful in there somewhere. But I won’t waste my time looking. The first gout video I watched is appalling! I was tempted to do a point-by-point review. But, I don’t think it deserves any energy spent on it. Having said that, if anyone finds anything of value on there which isn’t on my website, please let me know.

By the way, Rhys, how can you be “mostly vegan?” Surely, you are either vegan, vegetarian, or omnivore?

[Keith Taylor]

Hi Nadia,

Unfortunately, I can’t see the real connections between your uric acid test results, your symptoms, and your longterm plans to stop gout returning.

For example, you ask: “My concern taking Allopurinol is what would I take if I had a gout flareup?”

But does that mean you are worried about uric acid treatment triggering a gout attack? If so, I hope you can understand the principles in: Allopurinol Medication: Why It Hurts To Get Rid Of Gout. Because the important thing to realize is:
Untreated uric acid will cause gout pain that gets increasingly worse. Until it kills you. But uric acid treatment might cause gout pain that gets increasingly less. Until it disappears forever.

As you are being treated for another medical condition, it is inappropriate to suggest what temporary pain relief is best for you. But the medical profession has a vast array of pain relief choices. So, ask your doctor about temporary pain relief that you might need for a few months until allopurinol has removed your risk of gout attacks. At the same time, you should ask about your concerns regarding allopurinol with alectinib. Because, though there is no reported risk in generally available literature, your doctor should have access to professional drug interaction databases.

[Keith Taylor]

Hi Bob,

I hope you can see from my reply to Phillip that there are different phases during gout recovery. Because, until you reach the maintenance phase, you need to manage gout differently.

So, your rheumy is right to recommend you avoid inflammation triggers. Because you are at risk of gout flares until most old uric acid crystals have dissolved. Also, science now tells us that the complex processes that trigger gout flares are often related to inflammatory foods. But this often has a genetic component. So the trigger could be sugar for one person, fatty acid imbalance for another, or both to varying degrees.

Once you reach the gout maintenance phase, you can often relax diet restrictions. But always try to keep diet generally healthy – or else you just replace one disease with another.

[Keith Taylor]

Hi Phillip,

You need to take febuxostat according to your prescription. Because a good doctor will prescribe febuxostat to match your target uric acid in 3 phases:
1) Starting phase – start with lowest practical dose and test kidney function and liver function after 2 weeks. If all OK, increase dose until uric acid is at best target for debulking (dissolving old uric acid crystals).

2) Debulking phase – maintain highest practical dose until you’ve gone 6 months without a gout flare and without uric acid rising above 6 mg/dL (5 is better and even lower uric acid will speed gout recovery).

3) Maintenance phase – usually for life, maintain the dose that gives uric acid below 6mg/dL (below 5 is better). Get liver function and kidney function tests with each uric acid test. Test uric acid at least once per year. Liver function test is especially important with febuxostat.

Febuxostat and diet
Febuxostat makes all foods low-purine. So no need to worry about that. Except too much animal protein is bad for general health. So I recommend Mediterranean style eating. However, if that diet does not provide enough meat for your personal taste, the DASH diet is also relatively healthy. I recommend these diets for the sake of your general health. Because febuxostat will control your uric acid effectively. But, it seems pointless to stop your gout only to fall ill to heart disease or another metabolic syndrome disease.

Normally, I would advise gout sufferers to avoid ketogenic diets because they raise uric acid. However, febuxostat removes that risk. However, I’m not convinced that keto diets are particularly healthy. But, I’m prepared to be convinced if evidence is available.

Coincidentally, I’m preparing a report comparing Mediterranean Diet with a ketogenic diet[*]. So, I’ll be sure to consider the health benefits of both diets beyond uric acid control.

* Castaldo, Giuseppe, Luigi Monaco, Laura Castaldo, Giovanna Galdo, and Emanuele Cereda. “An observational study of sequential protein-sparing, very low-calorie ketogenic diet (Oloproteic diet) and hypocaloric Mediterranean-like diet for the treatment of obesity.” International journal of food sciences and nutrition 67, no. 6 (2016): 696-706.
Subscribe to my Gout Facts update to see when I publish the report

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[Keith Taylor]

I’ve just seen an interesting study about gout and women. So, I used a chart from it to illustrate this topic above. Also, I added the study to the Gout and Uric Acid PDF files here. But, I haven’t done a review of this study.

If you want me to add a review of this gout and women study, please let me know.

Gout and Women Reference
Bhole, Vidula, Mary de Vera, M. Mushfiqur Rahman, Eswar Krishnan, and Hyon Choi. “Epidemiology of gout in women: Fifty‐two–year followup of a prospective cohort.” Arthritis & Rheumatology 62, no. 4 (2010): 1069-1076. Gout In Women PDF.

[Keith Taylor]

You get a uric acid test. Then arrange with your doctor how to make that safe. But it takes 6 months or more to get uric acid safe. So also arrange preventative and reactive pain relief for that time.

I can help you every step of the way. So let’s get started. Tell me what your doctor says.

[Keith Taylor]

Ron,

Allopurinol can be prescribed as an annual course for a few weeks instead of every day. But you’ll be lucky to find a doctor with enough gout experience to manage that properly.

Extreme lifestyle changes might get your uric acid into the safe zone. But I don’t know enough about you to guess the likelihood of success. If you want to consider lifestyle changes the starting point is a lifestyle analysis that includes height, weight, exercise levels and a 3 day food intake diary.

[Keith Taylor]

Gout is caused by excess uric acid. So it’s very easy to stop it by getting rid of by controlling your uric acid. But if you confuse the situation by over stressing alcohol or by not instructing your doctor properly then you make gout control more difficult than it needs to be.

[Keith Taylor]

Thanks @d_q

I’ve summarised my thoughts in Seasonal Gout. But one statistic I forgot to mention is the split between highest and lowest seasons was something like 27% & 23%. So given that and the fact that there is statistical differences between which season has most gout, I’d say this is a non-issue.

[Keith Taylor]

Hi Rebecca,

Working backward through your points:

Colchicine For Gout

I’ve added a few notes to Colchicine For Gout about stopping and restarting preventative colchicine.

Fundamentally, it’s all about your perception of risk. Also, highly dependent on when was your last gout attack, and when did you last have uric acid above 5mg/dL. Because the longer those two periods are, the less chance you have of getting a gout attack. So, if you are worried, and had no problems with colchicine in the past then you should be OK. But, as with most aspects of practical gout management – the devil is in the detail.

As regards your other points:
Exercise and Gout
I don’t know what ‘water walking’ is. But did you read our recent discussion about exercise and gout? Because, as you can see, opinions differ.

Calcium
I’m not aware of any gout issues regarding calcium (except for pseudo gout, of course). But, this high calcium foods list might be useful to you. It is presented starting with foods in order of highest calcium per 100 calories. But, you can sort and search however you like.

Vegan Gout Diet
As for vegan diets for gout, that’s a huge topic, unless I’m over-complicating it. Because we don’t actually know why common vegan diets are bad for gout. So, all I can assume is, it’s due to one or more of the common vegan diet deficiencies:

• Polyunsaturated Fats, especially EPA, DHA, and ALA. I think this is very relevant to gout. But, I haven’t got my research to a point where I can suggest any practical advice.
• Vitamin D – not likely to be a problem on a beach vacation!
• Iron – lower than usual iron could be good for gout sufferers. But requires a competent doctor to assess all the issues associated with low iron.
• Vitamin B-12 – I’ve not started investigating the relationship to gout yet.
• Zinc – also not started investigating. But, it’s been mentioned in the forums, without any real analysis with respect to gout.

So, I’d say, whatever you are doing in the UK to avoid these common vegan diet issues should be transferable to Turkey. But, check customs regulations first regarding importing supplements, if you take any. As for potential gout affects, it’s probably not an issue if your allopurinol is still keeping your uric acid safe.

[Keith Taylor]

Gout, or as I prefer, Urate Crystal Arthritis, is a uric acid metabolism problem, not an eating disorder. So, a healthy, nutritionally-balanced, vegan diet should not make that metabolism worse. I.e. a correctly planned vegan diet will not hurt gout.

Unfortunately, we can see that most vegan diets do hurt gout. Presumably, because our bodies try to offset poor nutrition with extra uric acid. Who knows?! Because that study is based on statistics and has not yet been followed up with specific research showing why vegans are at highest risk of gout.

Most importantly, we have to put statistics to one side. Then, focus specifically on Martin’s vegan diet.

1. Is your vegan diet balanced? I don’t know, so we’d need to analyze it properly.

2. Is your vegan diet good for EDS? I don’t know, so you need to educate me about EDS.

3. Is your vegan diet helping your gout? I don’t know enough about your gout to answer that. But, I’m confident with more information I could make it so.

However, I do not believe it is possible for any diet to get uric acid safe when the baseline is 10.5 mg/dL. So, we’re going to have to find combinations of diet and medicine that tick all the boxes. Which depends entirely on keeping the open mind – but start planning and investigating – not searching.

[Keith Taylor]

Thanks for the update, Colin. You’ve added some interesting discussion points.

Blood draw
There’s strong evidence to suggest that drawing off blood helps gout by reducing iron.

Allopurinol and gout pain
Allopurinol removes the cause of gout pain (excess uric acid) but this takes a long time. Also, it only works when uric acid is below 6mg/dL. So, you might be right to suggest an increase in allopurinol dose. But that has to be guided by blood test results. Never by gout symptoms. Because partially dissolved uric acid crystals can cause gout flares.

Note that gout flares that happen when uric acid falls towards 6 tend to be less intense and shorter period than gout flares from growing crystals. Also, the further you get below 6, the sooner this burden of old uric acid crystals that Patrick refers to will dissolve.

[Keith Taylor]

For the avoidance of doubt, Stephen, I should reiterate that you will be best served by working directly with a professional nutritionist to ensure your vegan diet is suitable for you. Then, if you like, I can share the research links with your nutritionist about the metabolism of different types of purines.

Also, a professional nutritionist will assess your fluid intake requirements as part of their diet review. Significantly, some people find blood pressure is lowered by insufficient fluid intake. Although this is not simple because it requires simultaneous assessment of sodium intake and other minerals.

But, if you can’t find a suitable nutritionist, we can review all the relevant research together. However, we will need to start with a 3-day diet review, which I can arrange with you. Usually, I consider 2 week days and 1 weekend day, depending on your lifestyle. Please note that diet, in nutritional terms covers all intake of food and drink, including supplements, as well as exercise.

[Keith Taylor]

GC Gout Care Ingredients from http://www.goutcare.com

Yucca Schidegera
Turmeric (Curcumin)
Certified Silymarin Extract
Artichoke Powder (Cynara Scolymus)
Aged Garlic (Allium Sativum)

What have these ingredients got to do with gout?

[Keith Taylor]

Stephen, this vegan diet idea worries me. Because we know the average vegan diet is among the worst for gout. But, we also know that a well-balanced, plant-rich diet is generally very healthy. So, what’s going wrong?

I think the answer lies in “well-balanced”. Because in my experience vegans tend towards the exclusion of animal products without planning nutritional intake properly.

Unfortunately, I have no nutrition qualifications. But, I consider myself a diligent researcher. Also, I work with 2 groups of nutritionists in my Foodary project. So, my first look at how I might help reveals:

Compared with other vegetarian diets, vegan diets tend to contain less saturated fat and cholesterol and more dietary fiber. Vegans tend to be thinner, have lower serum cholesterol, and lower blood pressure, reducing their risk of heart disease. However, eliminating all animal products from the diet increases the risk of certain nutritional deficiencies. Micronutrients of special concern for the vegan include vitamins B-12 and D, calcium, and long-chain n–3 (omega-3) fatty acids. Unless vegans regularly consume foods that are fortified with these nutrients, appropriate supplements should be consumed. In some cases, iron and zinc status of vegans may also be of concern because of the limited bioavailability of these minerals.

In other words, vegetarian diets are basically gout-friendly. But cutting out all dairy means you have to source essential nutrients by other means. So, it begs the question: are you prepared to commit to proper nutritional planning?

If so, I guess it’s best to start with current diet analysis. So, do you want to consult a qualified nutritionist to do this, or do you want me to get involved? Whatever you do, you have to ignore unresearched statements about vegetable purines. Because they are an insignificant distraction for you.

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