The Gout Conundrum -- There Must Be An Answer

So follow this logic:

1. A person suffers from gout ...

2. Gout is caused by eating a staple of foods high in purines and protein ...

3. A person is scheduled to have WLS ...

4. WLS requires a high protein diet in order to get the greatest benefit in the first 12 - 18 months ...

I'm confused about how to manage this moving forward.

Here's my plan:

1. Cherry Juice concentrate smoothies in the blender daily ... CJ is a proven treatment for gout
2. Continue to take colchicine and allopurinol along with the Cherry Juice concentrate ...
3. Stay very, very well hydrated ... dehydration spurs an attack
4. Expect a series of attacks ... rapid weight loss will likely spur an attack ...
5. Pray that significant weight loss will bring down uric acid levels and rid me of gout forever ...

OK -- What do you think?

Hey there...I have the same problem.  I have high uric acid...never had Gout (but both of my brothers have).  I had a kidney stone from the high uric acid and still take Allopurinol daily.  I know what you're saying...almost a Catch-22 situation.  I too heard about cherries and eat the fresh ones in season...even out of season I will buy a few for the higher price (above $3.00 a pound).  I also will eat the dried cherries that look like raisins (out of season).
I asked my surgon about this issue (rapid weighloss+high uric acid).  He said the weighloss is more important than the Gout...Most bariatric surgeons agree.  Being obese creates problems with the heart and kidneys.  The high cholesterol levels clog the arteries and you will have a shorter life span.  During the rapid weighloss you may have to put up with gout...but it should relieve itself after awhile...You'll be able to move better and be able to go back to a more "ash free" diet later on.  Personally (just me) I went with more cooked green vegetables along with my high protein.  If you don't get in your protein you can lose muscle mass.  Cooked spinach and brussel sprouts helped me through those early months.  Brian  

Never had Gout ever before til i lost all the weight....Allepurenol was my saviour! Hope to avoid it again but doubt it during weight loss. SO SO painful especially in the feet. 

 My uric acid had always been high, but dropped a couple of points post RNY as has remained normal for 4 years. I thought maybe this was typical, but peraps not. 

my question is, i am on allopurinal and indomethicine for gout, i get rny aug.24 will i not be able to take indomethicine for an attack since it is a NSAID?

 Not sure what they'll do for you a month or so post-op, but I imagine you'll be able to take that or other NSAIDs if you take some kind of acid-inhibiting stomach med. That's what the docs generally do for people who have to take NSAIDS.

rich:

That is correct.  NSAIDs should not be used after most WLS surgeries.

If you still get gout attacks, you will need to take either daily colchicine or prednisone to keep the attacks away. 

For the gout attacks themselves, extra colchicine, prednisone, and cortisone injections can be used.

I have not had a gout flareup since the WLS.

I will say that for me at least, the issue was most likely due to VOLUME of protein I would eat pre-surgery. Multiple burgers, massive steaks, etc.

Now, I believe, I CANNOT physically eat the amount of protein needed to get a flareup. :)

That's my personal opinion. I am not doctor, but, seems logical to me.

Cheers!

CidGrad:

You will actually probably do much better than you think.

- it is the amount of purines you take in your body quantitatively speaking which is the important thing to consider (as Lonestar said). Although your diet will be higher proportionately in purines with high protein diet, the total amount will be substantially less even with this high protein diet compared to your preop eat all you can eat diet as most of us were able to eat a lot more meat before the surgery than after it.

- the cherry juice really has little medical evidence regarding how well it works in gout. However, there are quite a few studies using vitamin C that show it helps to decrease uric acid levels. The more you take in a day, the better. (Vitamin C causes the kidneys to excrete more uric acid). So, I'd recommend taking Vitamin C 1000 - 2000 mg a day. Get a huge, cheap jar from Walmart for this.

- you are spot on that it is more likely the volume depletion (dehydration) that can occur with a low purine diet and decreased oral intake after surgery that is truly the biggest potential cause of gout flares. So getting in that 64 ounces a day of water is absolutely essential.

-also... find out what your last uric acid level is. Too many docs don't realize that it must be treated to get the uric acid level below 6.0 constantly. If it is not below that number, then the allopurinol dose should be increased (we use it up to 800 mg a day for gout).

Good luck!

I believe you guys are right on, because the last bad flare up was when I was on the atkins diet and I ate nothing but meat all the time.
thanks guys