Nutritionist please, gout & whey protein

On a recent post, I asked if gout is more common in GB patients. I was suprised that the response was probably not. I found this article on www.arthritis.org excerpted form Arthritis Today, linking & posing questions about gout & whey protein supplements. Further consideration on a connection? http://www.arthritis.org/gout-questions.php#3 Also, the section on "Psuedogout" talks of a problem with metabolism of ,for example, Ca & Iron, (as opposed to an immune problem with "gout").  I am not getting satisfactory answers from my PCP or my surgeon. My PCP said she did not think the severe pain, swelling & redness in my foot ( between my big toe and my ankle)  was gout because it was not in JUST my big toe, but just above it. You know... that joint that looks like a bump on the top of our foot. She took an X-ray (looked fine), told me to take tylenol and go home. On the other hand my bariatric surgeon, without seeing me, over the phone, perscribed Indomethacin and said IF it is gout you should feel better in 24 hours.  My predicament: I don't want to take the medication ( which has gastric side effects) if it is NOT gout. So I have been suffering. I thought gout only lasted 3-4 days...anyone know how long a typical attack is? It has been 1 1/2 weeks now. Yesterday, I felt better, ate normally but, I had 1/2 of a New Whey bullet last evening ( which I haven't had for a while), went to bed and woke up in excrutiating pain. Does gout behave this way? better one day, worse the next? seems odd! I am frustrated, can barely walk and don't know how to proceed, any help, experience or advice would be appreciated.  Thanks, Jo

The fact is, gout is usually diagnosed by "ruling out" other problems, not by "ruling In' your metabolism of purines and uric acid production.  This is a standard way of achieving a diagnosis in medicine - and why your doc says, 'take the medicine, if it gets better, then you have gout'. The additional information that you provided is compelling, but I don't think it's really applicable to a WLS patient.  The whey that they are discussing is protein taken as a supplement to a regular diet - whi*****reases your protein load above your needs.  This description is gout caused by excessive protein intake - irregardless of the source being whey or casein or gelatin.  It is describing a flare up of gout as a symptom of excess.  In WLS, the protein you are getting is meeting your base needs and does not often get to the point of excess. I think more accurately you could apply the idea that fasting is making the gout - or pseudogout - flare up.  The process of weight loss with WLS definitely puts your body in a fasting state and results in the circulation of increased waste products thereby putting a limit on the amount of uric acid you can remove and so it may deposit in joints causing pain. The metabolism problems of Ca and Fe (if you had them) would have likely resulted in symptoms prior to this.  I would offer the idea that waking up in excruciating pain may also be compounded by muscle cramps - often in the feet and often related to calcium deficiency, dehydration, or potassium deficiency.  All of these factors are required for proper muscle function and although potassium is often blamed for muscle cramps, calcium is more often the culprit.  Night time, rest (naps) or early morning are often the time when these painful cramps occur. Yes, gout can be worse on day and better the next - it all depends on the circulating uric acid and that changes from day to day and whether or not it is irritating a sensitive area.  Gout is an awful, debilitating condition that usually comes in waves and often with long periods of time passing between flare-ups.  Medcations have been a godsend to those who have severe cases.  In previous generations, this was a reason for a person to be in a wheelchair or bedbound - and often doped up on pain killers. (historical novels always have a bad case of gout and of tuberculosis in them - they were pretty common and very incurable).  Most people opt to use the medications.  They are effective and have relatively few side effects.  The indocin (indomethacin) is a NSAID and has the GI side effects associated with Aleve and Advil. There are other meds such as allopurinol & colchicine which may be effective with fewer side effects, that you may wish to discuss with your physician. So what can you do?  The choice is yours. You can try the herbal medications that you mentioned in an earlier post. You can increase your fluid intake to help with the "flushing" of waste from your body. You can try the medications. I hope this at least offers you some ideas to explore. Happy New Year!

Danielle, thank you for such a thorough & thoughtful answer. You gave me much to consider. Happy New Year to you too!