Boyfriend having bad gout attack...
April 20, 2014 1:20 PM   Subscribe

My boyfriend is having a very bad gout attack, hasn't slept in a couple of days and is now refusing to eat anything at all because he thinks it will exacerbate the gout.

My question isn't about general treatment advice for gout, or general diet, but specifically whether not eating anything at all when having a gout attack is healthy.

My instincts say he should eat something because not eating places additional stress on the body. I want to fix him some low-purine foods but he won't eat anything or drink anything except water and cherry juice.

I haven't been able to find anything online about whether not eating during a gout attack would help, hurt, or not matter.
posted by mysterious_stranger to Health & Fitness (18 answers total)
FWIW, I've had gout attacks and eaten during them, just not the things like organ meats and beer that exacerbate the malady. Didn't seem to hurt. Didn't seem to help either. Damn, gout hurts. Best luck to him. (There are pain meds for it, and other meds to help prevent attacks if he turns out susceptible.)
posted by fivesavagepalms at 1:41 PM on April 20, 2014

My husband had gout, and found that drinking vast quantities of water helped keep the attacks at bay. Hope it passes quickly. I wouldn't wish it on my worst enemy.
posted by kate4914 at 2:07 PM on April 20, 2014 [2 favorites]

Fasting can actually bring on a gout attack. I don't know that it would make it worse once you're in the midst of a flare-up, but it doesn't seem like a great idea. I agree that it sounds like, at minimum, he would simply end up being cranky and hungry while enduring the pain.

Does your boyfriend have access to medical care? I know you aren't looking for general advice, but there are drugs that are prescribed specifically for the treatment of flare-ups. It is a horribly painful condition and I would want to encourage someone to seek treatment ASAP so they can get relief and prevent kidney damage.
posted by annaramma at 2:10 PM on April 20, 2014

Did he eat a lot of fruit before the attack? Apparently, pomegranate is the most common cause of gout due to its fructose content. He should try to flush the sugars from his system and try to cut out fruit, fruit juices and fruitbased sugary products.
posted by parmanparman at 2:49 PM on April 20, 2014 [1 favorite]

FYI, it's not just purines that are an issue: sugar and fructose consumption also seem to be drivers. Just so you know.
posted by rr at 2:49 PM on April 20, 2014

Some people get quick relief from gout by drinking cherry juice or eating fresh cherries. It is easy and quick to search and inexpensive to try.
posted by jet_silver at 3:35 PM on April 20, 2014 [1 favorite]

Fasting can cause a gout flare if fasting causes you to become dehydrated, which raises the level of uric acid in your blood. If he is determined to fast, he needs to be sure to stay well hydrated to flush the uric acid.

With that said, I'm not sure why he is not willing to eat some of the types of foods that actually may help protect you against gout, like low-fat dairy foods, and complex carbohydrates (whole grains).

He can drink unsweetened coffee and tea (i.e. with low fat milk but not sugar). Also, Two separate studies showed drinking four or more cups of coffee a day dramatically reduced the risk of gout for men, and that levels of uric acid in the blood (high levels are associated with gout) significantly decreased with increasing coffee intake for men and women.
posted by gudrun at 3:41 PM on April 20, 2014

I don't think it would really hurt him not to eat, but it certainly isn't going to help very much. The pain can definitely kill your appetite, though.

I would also worry about the extra stress not eating might cause him, especially if he can't sleep. I've had good luck eating low-fat dairy and generally quite bland foods during an attack.

I would second annaramma's advice—you aren't looking for general medical advice, but anti-inflammatory meds like Indomethacin can really shorten the duration of an attack, and they're prescription-only. I've found that other NSAIDs, such as naproxen don't touch the pain at all.
posted by jamietie at 3:51 PM on April 20, 2014

Has your boyfriend asked his doctor about this?
posted by Justinian at 3:51 PM on April 20, 2014

Agreeing that tart, unsweetened cherry juice can help a lot. If you have access to medical care, cholchicine medications will relieve the swelling in short order. Not inexpensive, though. Apparently it had been available generically but they somehow managed to re-patent.
posted by uncaken at 4:02 PM on April 20, 2014

Thanks all for the responses thus far.

Annaramma: He makes too much to qualify for Obamacare, but too little to afford health insurance (it would be $300/month). Even a single doctor's visit would probably be financially problematic right now.

parmanparman & rr: No fruit or fructose seems to contradict the suggestion to eat/drink tart cherries/juice and dark berries. ?? :-(

gudrun: interesting, I hadn't seen that coffee info before. 4 per day is a tall order, though. I have tried telling him about fasting. He didn't eat for most of the day before this flare-up, but he doesn't seem to categorize even not eating for a few days as "fasting" (shrug). I'll try to nag on this point.

Justinian: He has seen a doctor previously for this, and was told he over-produces uric acid.

uncaken: he has tried colchicine before and it made him quite sick. I don't know if he would be up for it at this time, but the point is moot for now since he's in no shape to go to a doctor to get a prescription.

He's doing the tart cherry juice and lots of water. I've just gotten him to agree to some rice and vegetables.
posted by mysterious_stranger at 4:17 PM on April 20, 2014

As a gout sufferer, I get the fastest relief from Ibuprofen in 800 mg doses and drink the black cherry juice. I do this once every twelve hours or so and drink plenty of ice water in between. Colchicine is Satan. I avoid bacon and pepperoni and skip butter for a while.
posted by halfbuckaroo at 4:45 PM on April 20, 2014

Hi, guy-with-gout here: I don't know all the snowflake factors that your boyfriend is basing his decision on but when I've had a flare up, the last thing I've needed is additional stress and misery from something like fasting.

If he insists on sticking to liquids, you might encourage him to try a tablespoon of baking soda or apple cider vinegar in his water - something to neutralize all that extra acid in his blood. I've tried the just wait it out strategy and I get his reluctance to introduce anything else into his system, but it tends to be a looonnngg wait. You gotta go after it and eating a diet of anti inflammatory foods is part of that.
posted by EatTheWeak at 5:57 PM on April 20, 2014

I asked a friend who started suffering with it last year and is now managing it with medication, he raises one point not covered here:

Looks as though they have all the right answers already. Not eating could be problematic as it's *fluctuations* in uric acid levels that cause or exacerbate gout attacks, not just high levels. This is why you don't take increased levels of uric acid controlling drugs in an attack - they don't help. You want to be eating your normal diet provided it's low in purines. Cherries do help some people and the high water intake (provided still at generally safe levels) does seem good advice too.
posted by epo at 2:54 AM on April 21, 2014

I wonder if he could go to an urgent care center? That should be fairly inexpensively priced and he could get a script for Indomethacin, which is generally been the most helpful NSAID-type pain reliever for gout flares.

In the longer term, there are several newer (non Colchicine) drugs for gout control, and since he's uninsured he would probably qualify for free meds from the manufacturer - they all have patient assistance programs. (These generally apply only to Brand-name meds) However, this approach would require him to establish a relationship with a physician, as all patient assistance programs require input from the prescriber. The specialist he'd need to home in on his specific situation is probably a rheumatologist. I find that they are among the brightest and most curious of the medical professionals, and they are generally sympathetic to their patients' pain and financial needs. After all, most awful rheumatologic diseases are life-long and can be very debilitating, and it takes a empathetic person to make such patients his or her life's work. You might try contacting a local academic medical clinic. The best rheumatologists are often associated with academic practices, in part because rheumatology is one of the lowest-paying specialties - this is directly related to the smaller number of complicated patients they see. Complicated patients take time. Academic physicians are paid a salary, so they are much better placed to take the time they need to appropriately diagnose and counsel patients. There will also be an infrastructure to deal with such things as patient assistance programs, becuase many of their patients need it.
posted by citygirl at 7:18 AM on April 21, 2014

A short course of prednisolone should knock it right out -- cheap and effective, and works within 24 hours for me. If either of you has a relationship with a doctor or a nurse practitioner they might be willing to just call in a prescription for you. Gout is uniquely horrible, and most doctors are very sympathetic about the need to make it go away quickly.
posted by plantbot at 1:34 PM on April 21, 2014

tablespoon of baking soda or apple cider vinegar in his water - something to neutralize all that extra acid in his blood

this is not how it works and is silly bad advice. also, apple cider vinegar is an acid (significantly below blood ph level).
posted by rr at 3:00 PM on April 21, 2014

I have gout, a father with gout, and friends that are doing clinical research in the field. The issue about diet seems to being toned down by physicians as a direct reason for the flairs. He has right now literally sharp crystals in his joint that generate a crazy inflammation. What he needs to do is to get rid to the crystals and the inflammation at the same time. That means significant amounts of water and a powerful NSAID. The strongest ones are prescriptions only but 2 Aleve (naproxen chloride) 220mg tablets twice a day is enough for met. Taking too much can generate ulcers and I have at some point been recommend combine with nexium. What food he is eating doesn't matter right now, just hydration. Alcohol is an absolute no no. He uric acid levels are actually probably much lower right no than normal since it's all crystalized...
posted by brorfred at 3:50 PM on April 21, 2014

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