Gout experience

[ForresterModern]

Follow your doctor's advice. No one on this forum knows the condition of your overall health, and it is unlikely that a qualified physician will be suggesting treatment on a public forum about kilts. The advice tendered could complicate, not lessen your medical problem.

I AM a qualified physician and I AM going to second Mac's advice to listen to your own physician's plan for caring for your particular case of gout.

Gout is a form of artritis caused by a buildup of uric acid crystals (yes, literally little spike like crystals) in the joint due to excess circulating uric acid in the blood stream. Uric acid is a break down product of DNA (yes the same stuff that our genes are made up of) which is generally present in higher concentrations in rich foods, particularly protein rich foods. There is a whole list, however, of certain things which can set off acute attacks of gout, and some things cause it in some folks while others things do so in others. Most people who get it have a lifelong battle with it, as their particular metabolism just does not seem to be able to keep up with turning it over and getting rid of it through the kidneys (thus its prevalence in folks with longterm kidney disease). Allopurinol blocks your body's ability to manufacture uric acid (during the breakdown of native or ingested DNA) and thereby is good to keep gout in check between events. The little crystals of uric acid, however, once formed in the joint get eaten by the normal white cells which would normally clean up excess waste materials in the joint, and those crystals actually puncture those cells, releasing their digestive enzymes into the joint (along with the crystals) thereby causing an acute inflammatory reaction in the joint (the enzymes actually try to digest your cartilage while the crystals just wait to get eaten by another unwary white cell then rupture out again---a vicious cycle once it starts). Colchicine blocks the white cells ability to absorb the crystals thereby keeping them from being punctured, and ibuprofen (or naprosyn, or aspirin) cut down on the generalized inflammatory response and help with pain as analgesics (tylenol helps with pain but not the inflammation). Eventually, if your blood uric acid goes down the crystals in the joint resorb slowly and your acute episode goes away.

IF you have a tendency to get gout your doctor may recommend allopurinol, along with some dietary restrictions, to keep you from developing the rising uric acid blood levels which bring about active disease. Dietary restrictions alone are usually enough for most people. If you are having gout acutely he/she will likely treat you short term with Colchicine and/or ibuprofen/naprosyn to get you over the acute episode, while simultaneously starting you on allopurinol and dietary restrictions to drop the blood uric acid levels and get you started back toward normal. Untreated gout can totally destroy a joint in fairly short order (usually the base of the great toe is most often involved). More generalized joint involvement is rare but can be particularly devastating if not treated promptly.

Beer, and to a lesser extent, wine, have high concentrations of purines (the part of the DNA molecules that get turned into uric acid) relative to other types of alcohol (hard liquors), particulalry in relationship to the actual amount of alcohol present, and therefore are indeed often associated with initiating or exacerbating episodes of gout. It has to do with the yeast used in fermentation breaking down, releasing purines (from its DNA) into the solution. While the same thing happens in fermentation for hard liquors those are then distilled with the alcohol boiled off then recondensed to form the stronger spirit, leaving most of the purines in the remaining dreggs(which are typically discarded), thereby separating the alcohol from the purines.

So, yes, cut back on the beer, and wine if necessary. But harder liquors, while not completely immune from causing gout, would be a better way to get your fix of alcohol if you are a gout sufferer.

DOCTOR HAT OFF: My personal suggestion---drink good single malt scotch---works for me (and I have never had gout).