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Having just found this very useful site I thought I’d share my own experiences. Background: I’m a 56-year-old male, three years (early) retired, 6 foot tall, weighing 75 kilos (not overweight, then). I’ve been experiencing gouty arthritis for the last five to six years; the attacks on my feet and knees, and occasionally elbows and shoulders, more frequent during the winter months than the summer. The pain has been crippling and I now possess a fine collection of lumpy bones and joints. Treatment has thus far been limited to doctor’s pain management prescriptions (Naprosyn and Co-dydromol).
Each winter for the last three years I have been staying in Thailand and touring South East Asia for a couple of months, normally between December and February. During each holiday there has been a significant reduction in gout attacks prompting me to analyze what was different in my lifestyle. It boils down to two things really: climate and diet. The change from the English wet and cold climate to the Thai dry winter sun had an almost immediate effect on any existing condition and promoted a general feeling of wellness: I just knew that I wasn’t in line for another attack. In addition, I could list significant changes to my diet. Gone were the Sunday roasts, the bbq burgers and the 10 oz steaks. There is little or no consumption of beef, lamb or pork over there (what little ‘red meat’ is dished up is in minuscule, thinly sliced amounts in stir-fries accompanied by a larger percentage of vegetables). I ate more coconut milk curries, more seafood such as prawns and squid, and more rice and chicken dishes than I do in England. As a result, I extended that diet when I returned each spring. I cut out beef, lamb, and pork and have been sticking to chicken fish and vegetables, most of it in one form of curry or another. I miss the meat but, luckily, I am quite omnivorous so can eat just about anything and enjoy it. The result? A marked reduction in the number of gout attacks in the summer months.
But . . . and it’s a big but! I’m still getting some bad gout, especially in the autumn and winter months. This has forced me to look at one other factor: alcohol. It’s pretty fair to say that my alcohol consumption didn’t change on holiday (if anything, it was worse) yet the gout disappeared. This would lead a trained mind to suspect that alcohol doesn’t factor in it at all. My doctor vehemently disagrees. I have to admit to being ‘alcohol dependent’ most of my adult life. I enjoy the stronger lagers and, when I was working under some stress, could be drinking five or so pints a day. Since retirement, I’ve cut back to around half that: still far too much according to the medical profession and I’ve no argument with that. However, I’d still like to enjoy what’s left of my life and do not want to turn into a teetotal vegetarian. This site has had some pretty interesting things to say about alcohol. But I do not want to apply an alcohol dependent’s ‘wish fulfillment’ to the available data. As a result of an anecdote (heard in the local pub, I confess) about a friend of a friend who lives in Spain and switched from lager to cider and henceforth never had a gout attack again, I did some research on the net. GoutPal’s purine data makes a very good case for cider in terms of the relative purine content of beers and cider. Beer carries around 20 mg/L of purine; cider just 0.4 mg/L.
The doctor has just put me on Allopurinol (and, yes, it does hurt to start with!) and ordered me to cut out the beer. Does anyone have an informed opinion on switching from lager to a couple of pints of cider a day?
Can I drink Cider with Gout? Yes you can Da5e said:
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The doctor has just put me on Allopurinol (and, yes, it does hurt to start with!) and ordered me to cut out the beer. Anyone have an informed opinion on switching from lager to a couple of pints of cider a day?
Dave, first of all: Welcome to our WORLD (the gouty forum) and second: Thank you for your wonderful English (besides Keith's). You wonder why? Ingrish is not my mother tongue but I have used it twice as long as my German and having paid triple: money, effort, and time to acquire it, I've tried to use it properly. However, having lived for more than 54 years in the States who have “murdered” the English language, especially in our modern, computer dominated age, I have fought a losing battle against morons to preserve at least 1 item one really cannot buy with money and own it and that is a good, intelligent, workable language. Very few pleasures are left for me, and reading a well written comment in English is one of them.
?Now to the core of your comment: ALCOHOL & CIDER
I can consider myself a somewhat self-proclaimed authority on that subject. I was practically raised on cider, and I mean CIDER. ( I know I drank it before I entered school and my IQ wasn't too greatly impaired considering that even at the present, it is still hovering around 145-150.) I am not talking about the sweet sugary kind, but the kind which puckers your mouth more than a kiss ever can. My parents came from the farms and inherited a few acres of land with apple and pear trees. So my father made each year between 200-300 gallons of fermented apple juice=hard cider. Since neither he nor my sisters cared too much about that (other) nectar of the gods, my mother and I got about 95% of it. (She made it to about 92 and I am on my way to it at 80+ now.)
Now, where I come from, Trier, the oldest town in Germany [>2000 years old] is also considered the wine capitol of Germany and the cider capitol. Some drinking establishments (almost) only serve hard cider (at least ?it used to be that way, 50 some years ago.) What I am trying to say is that a lot of people were drinking cider and GOUT was hardly ever the issue. My father had it for more than 40 years but survived it without meds until a couple of heart attacks shortened his life at 64. I, myself, didn't have the pleasure of dealing with it until I was 53 and I have had a lot of “fun” since then.
Now that you mentioned that cider has only .4 mg/ltr of purines vs 20 for beer (which I used to make for almost 30 years before I quit [for now] until Dec 2009) you may have a point that cider may be “healthier” than beer. And the medical industry hasn't yet convinced me of the “deadly” impact of alcohol on gout, considering that literally millions of, particularly,? French and Italians drink wine and/or beer daily, and they are not known to be nations of crippled gouties, maybe of something else, but NOT gouties. Since I can't get a decent mug of hard cider in the Land of Enchantment, I have consoled myself with ACV (Apple Cider Vinegar) instead, since it makes for a good tasting salad dressing.
Apropos CLIMATE: I just don't think, I know that it adds an unbelievable amount of good tasting spice to my life. While I was living in St. Louis, MO from 1981-1996, with temperatures and humidity reaching 100 in the summer and 0 (windchill) and 90, resp. in the winter I slept with a box (of all boxes a Gin box) in my bed because I could not stand the pressure of, even a sheet, let alone a blanket or more on my right, big toe. Since I moved to the
Land of Enchantment with temps in the 90's and humidity in the teens, I haven't had a box in my bed ever. Unfortunately, since I don't like to go to bed with my “grandmother” and my “granddaughters” don't have too much in common with me, I? haven't hardly had a warm body either in my bed any more since my last wife left for higher/hotter/colder altitudes.
And apropos MEATS: I am still enjoying red (beef), rose (pork), yellow (chicken), and white (fish) meat, except New York and Porterhouse steaks and shrimp/crab. Haven't been able to stay away from herring in wine sauce, though and a daily glass of wine, particularly my PP wine (PP=Prickly Pear) . My Uloric has, so far, protected me from attacks from heaven and hell, especially, as people know, god doesn't exist for me, so he can't attack me, and the devil doesn't want to waste his precious time on me, since he has far juicier tidbits in Washington and other parts of this planet to gorge himself on, and since I am a good, little boy who tries to obey Mother Nature, She has been trying to award me for my obedience. However, when ever I forget, She won't hesitate to remind me who is ruling this universe.
Also worth bearing in mind that although cider may be low in terms of purine content, most of the [email protected], mass produced ciders, which are designed for unsophisticated younger palates e.g. strongbow, magners etc are simply fizzy water with added fructose, chemical flavouring and alcohol. Try and stick to the posher, organic ciders that come from a small producer (unfortunately, not many pubs stock them). Personally, I have found wine to be the safest alcohol, but then I don't drink that much anyway and it's usually with food.
Da5e said:
The doctor has just put me on Allopurinol (and, yes, it does hurt to start with!) and ordered me to cut out the beer. Anyone have an informed opinion on switching from lager to a couple of pints of cider a day?
In my very well informed opinion, the response to this type of ill-informed “order” is to politely agree, then ignore it.
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On allopurinol, there is no difference between types of alcohol, though if you can find Stowford Press cider locally, it's worth switching for taste.
Are you saying that once I get my uric acid number down to a normal range, if I stay on ALLO, I can enjoy a glass of wine again?
Donna4878 said:
Are you saying that once I get my uric acid number down to a normal range, if I stay on ALLO, I can enjoy a glass of wine again?
Yes, and a few other/more goodies to boot.
Thanks for all the comments, everyone. (You sure lead an interesting life Hansinnm!) Just to recap on the subject discussed:
Climate: Yes, I agree with you Hansinnm. There appears to be a correlation with well-being under sunny, dry climes when it comes to gout and arthritis and an increase in misery under grey, wet and cold conditions. Probably explains the annual exodus of the English oldies to Spain around the end of October. The link between gout and arthritis is not clear to me from the available scientific data but my own body can attest to it.
Diet: I read Keith?s last post concerning Gout Food Lists and I agree. I can only report on what has worked/not worked for me. At 6 foot and 12 stone I could hardly be described as overweight. So, after I returned from a gout free holiday in Thailand only to celebrate with a rare 10oz rump steak at a local restaurant followed by exploding knees for two weeks, I took the general internet advice about ?red meat?. I cut out all beef and lamb for the rest of the summer and replaced all my favourite recipes with ?white? pork . . . until someone pointed out that pork is also considered ?red? in some dietary circles. So I cut that out as well. So far so good, but the nagging question of what it is particularly about ?red meat? that causes gout led me to more research. I assumed it was fat content but it appears that it is the purine content, something that is all-prevalent in foods and the body, which is the culprit. Fair enough: except when you see that chicken is also fairly high in purines yet much of the internet advice suggests that it isn?t a big factor in acerbating the gout condition. Anybody have experience of gout under a chicken diet?
Alcohol: Similarly, what is it about the medical profession?s obsession about alcohol? I know that my alcohol consumption was greater in sunny Thailand than at home but the gout was non existent. From what little information I can distil from the internet it would appear that the alcohol threat comes under three general headings:
- What little statistical research has been performed suggests that gout is more prevalent in beer-drinking males. This may be so but it hardly takes into account other relative environmental factors such as stress, climate, eating habits, etc.
- As with ?red meat?, beers and lagers do contain purines although measurements are in mg per litre as opposed to mg per 100 g in foods. I admit this could be a factor, hence the reason why I latched onto the relatively low purine concentration of cider. Also interesting is the number of web sites that conclude that wine has no demonstrative influence on gout attacks. Again, does anyone have more data on purines in alcohol, or any other component of alcohol that might present a risk?
- Whilst a high purine diet may increase the quantity of serum uric acid produced by the body, the other side of the coin is the body?s ability to excrete it. Simple balance sheet: if you produce more than you can excrete then the difference builds up as crystals. Excessive alcohol is said to inhibit the body?s ability to excrete the uric acid (presumably, the ?dehydration? effect). That suggests that the answer is to drink moderately and ?take plenty of water with it?! That, by the way, doesn?t mean I would subscribe to the government?s diktat of Four Units A Day (or one unit if you?re over 65)! I reject any One Size Fits All government policy as a matter of course.
Sorry if this is all a bit simplistic. I have no biology education; in fact, all this is an existential attempt to understand what is afflicting me. I would be very happy for someone to put me right here.
One Postscript: My local pub (which is a mere 30 seconds walk from my house) sells Thatchers and Stowford Press, Keith. In the interests of furthering scientific endeavour, I?ve switched allegiance to the latter for the duration (it?s cheaper than lager, too).
Da5e said:
Thanks for all the comments, everyone. (You sure lead an interesting life Hansinnm!) Just to recap on the subject discussed:
Climate: Yes, I agree with you Hansinnm. There appears to be a correlation with well-being under sunny, dry climes when it comes to gout and arthritis and an increase in misery under grey, wet and cold conditions. Probably explains the annual exodus of the English oldies to Spain around the end of October. The link between gout and arthritis is not clear to me from the available scientific data but my own body can attest to it.
Most people with inflamed joints (whatever the cause) will attest to the increased aches in damp weather. However, for gout sufferers, there is also a possible situation where gout increases in hot weather, unless you stay hydrated.
?
Diet: I read Keith?s last post concerning Gout Food Lists and I agree. I can only report on what has worked/not worked for me. At 6 foot and 12 stone I could hardly be described as overweight. So, after I returned from a gout free holiday in Thailand only to celebrate with a rare 10oz rump steak at a local restaurant followed by exploding knees for two weeks, I took the general internet advice about ?red meat?. I cut out all beef and lamb for the rest of the summer and replaced all my favourite recipes with ?white? pork . . . until someone pointed out that pork is also considered ?red? in some dietary circles. So I cut that out as well. So far so good, but the nagging question of what it is particularly about ?red meat? that causes gout led me to more research. I assumed it was fat content but it appears that it is the purine content, something that is all-prevalent in foods and the body, which is the culprit. Fair enough: except when you see that chicken is also fairly high in purines yet much of the internet advice suggests that it isn?t a big factor in acerbating the gout condition. Anybody have experience of gout under a chicken diet?
And if you hadn't had the steak, but still got the gout attack, would the conclusions be the same? Statistically, you need 50 incidents of steak eating followed by gout every time for the connection to be considered safe. You're right about the purines, but don't forget that excess protein can sometimes trigger inflammation. Simple abuse of your body through overeating can trigger metabolic reactions that increase your cell turnover (the major cause of uric acid). It's hard for those with an established meat eating habit, but 10oz of meat in one meal is twice the limit for gouties. Always remember though, that 10oz of meat pales into insignificance compared to your own human meat, and anything that upsets the metabolism will always produce far more uric acid than any meal can.
Alcohol: Similarly, what is it about the medical profession?s obsession about alcohol? I know that my alcohol consumption was greater in sunny Thailand than at home but the gout was non existent. From what little information I can distil from the internet it would appear that the alcohol threat comes under three general headings:
- What little statistical research has been performed suggests that gout is more prevalent in beer-drinking males. This may be so but it hardly takes into account other relative environmental factors such as stress, climate, eating habits, etc.
- As with ?red meat?, beers and lagers do contain purines although measurements are in mg per litre as opposed to mg per 100 g in foods. I admit this could be a factor, hence the reason why I latched onto the relatively low purine concentration of cider. Also interesting is the number of web sites that conclude that wine has no demonstrative influence on gout attacks. Again, does anyone have more data on purines in alcohol, or any other component of alcohol that might present a risk?
- Whilst a high purine diet may increase the quantity of serum uric acid produced by the body, the other side of the coin is the body?s ability to excrete it. Simple balance sheet: if you produce more than you can excrete then the difference builds up as crystals. Excessive alcohol is said to inhibit the body?s ability to excrete the uric acid (presumably, the ?dehydration? effect). That suggests that the answer is to drink moderately and ?take plenty of water with it?! That, by the way, doesn't mean I would subscribe to the government?s diktat of Four Units A Day (or one unit if you?re over 65)! I reject any One Size Fits All government policy as a matter of course.
Sorry if this is all a bit simplistic. I have no biology education; in fact, all this is an existential attempt to understand what is afflicting me. I would be very happy for someone to put me right here.
Most medics, when pushed, will admit that they have no idea where the recommendations on alcohol intake come from. It doesn't stop them from pushing the “cut down on drinking” mantra. My approach, recently adopted is simply lie when they ask how much I drink. They are asking stupid questions as a matter of rote, and deserve stupid answers. On a personal level, all you can do is spend a month or two drinking at different levels, and see if it has any effect. But in my current mood, I'd say that is pointless. Common sense tells me that there has to be more health benefits to enjoying social drinking with friends compared to boring abstinence alone or with tee-totallers. There seems little doubt that excessive drinking raises the risk of liver and kidney damage, but this will vary enormously from person to person. The best advice for general health is to have annual health checks, which should include kidney and liver function tests (mine are fine, and four units a day does not come anywhere near). The best advice for gout health is to take allopurinol, and stop worrying.
One Postscript: My local pub (which is a mere 30 seconds walk from my house) sells Thatchers and Stowford Press, Keith. In the interests of furthering scientific endeavour, I?ve switched allegiance to the latter for the duration (it?s cheaper than lager, too).
That will be a Weatherspoons then. I had a nice inexpensive session on the Thatchers in one of their Leeds branches yesterday. Heaven would be the middle of a triangle of Weatherspoons, Sam Smiths and Joseph Holts pubs, but I'll settle for a train ride, because living there would be just too much temptation.
Keith (Gout Admin) said:
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Most people with inflamed joints (whatever the cause) will attest to the increased aches in damp weather. However, for gout sufferers, there is also a possible situation where gout increases in hot weather, unless you stay hydrated.…Keith, with all due respect, and you do know I do respect you, ?I am not buying the hot weather theory entirely, especially based on just one study. ?
I have a 15 year history of living in the State of Missouri=Misery with recorded 100-105 deg. in the summer and humidities in the 95-100% range. Each day (almost each) 45 minutes sauna (165-185 degrees), 3-4 bottles of home brew, also some Canadian whiskey, or gin, or vodka, and after dinner liqueurs (1 or 2), half the amount of water than today (for the last 15 years in New Mexico) and only ONE=1 attack every 16-18 months, just like clock work. (Also ate 16-22oz steaks or Prime Rib roast.) And I also grew some beautiful, invisible tophi during that time which manifested themselves 15-25 years later, clear up to this day.
Unless we get some accurate records of people living in the Sahara and/or Gobi desert, Australia, or Arizona, Utah, Nevada, and New Mexico (not just from me) with gout and reoccurring attacks and their life style, I don't buy it.
…They are asking stupid questions as a matter of rote, and deserve stupid answers. …
So true, however, not only for doctors with stupid questions but for all descendants/members of the species “Homo Stupiens”.?
That's a tricky one Hans, but it raises issues that strike at the heart of gout management.
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My view is that statistical gout studies can give us pointers that suggest ways that we can understand our own gout better. However, only personal analysis can tell us as individuals what we might get? most benefit from.
Thus, if we live in a hot climate, and dehydration is a risk, it is a fairly easy self-experiment to try drinking 2 to 3 liters of water during the course of the day to see if it helps.
Going a stage further, we know that individuals react to uric acid crystal deposits differently. Some people get the intense, painful swelling at the first hint of a crystal floating around. Others can spend years growing beautiful invisible tophi, and barely notice!
I fall between the two, with (up until recently) frequent swollen joints, but nothing that a few ibuprofen couldn't handle. And going back to day one of my gout journey, I failed my inexperienced doctor's gout test because the swelling was in my ankle, not my big toe.
?
When it comes to gout, it's very much “each to his/her own.”
Keith (Gout Admin) said:
?
That's a tricky one Hans, but it raises issues that strike at the heart of gout management.
?
My view is that statistical gout studies can give us pointers that suggest ways that we can understand our own gout better. However, only personal analysis can tell us as individuals what we might get? most benefit from.
Thus, if we live in a hot climate, and dehydration is a risk, it is a fairly easy self-experiment to try drinking 2 to 3 liters of water during the course of the day to see if it helps.
Going a stage further, we know that individuals react to uric acid crystal deposits differently. Some people get the intense, painful swelling at the first hint of a crystal floating around. Others can spend years growing beautiful invisible tophi, and barely notice!
I fall between the two, with (up until recently) frequent swollen joints, but nothing that a few ibuprofen couldn't handle. And going back to day one of my gout journey, I failed my inexperienced doctor's gout test because the swelling was in my ankle, not my big toe.
?
When it comes to gout, it's very much “each to his/her own.”
As usual, Keith, you almost always hit the nail right on.
While I agree about the values of statistical studies, however, if they are sporadic, and possibly money/profit/recognition motivated (which quite often is not apparent or easily visible) statical studies murky the issue more than they clarify.
Hot climate or not, our bodies “should” be properly hydrated, but our laziness (I am speaking strictly for myself) is the biggest monkey wrench in that process. Besides, we sapiens homos can always find a very reasonable, “intelligent” excuse what/how to substitute, like one six pack of suds (6x12oz= a little more than 1/2 gallon of water) will do the trick.
And, of course, the individuality of gout attacks, tophi and SUA levels responsible for gout.
Yes: ” When it comes to gout, it's very much 'each to his/her own.' ”
hard to wade thru’ the threads, but for starters i’ll start leaning on cider! and like as recommended (sumwear above) i’ll focus on the “craft” (small & local) cideries (well, what do you call it? not “wineries” nor “breweries?) — uh, cider places!
and i also agree with the avoid EXCESS of “red meat” admonitions — we’ll see …
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