Questions about Gout

Hi all!  I'm 6 months post-RNY and I've been awakened at 3am the last three nights in a row with sharp waves of pain in my big toe.  It lasts for several hours.  I know that gout often affects the big toe first and I've been worried about it.  Although there is no swelling or redness and it doesn't really hurt to touch it, the pain is enough to keep me awake at night, but not enough to contact my doc over it just yet. 

So, I researched it online today and found some interesting information as to how it may relate to my WLS.  I read that gout is a build up of uric acid in your system and that uric acid is a crystalline product your body produces naturally from the use of protein.  (That raised a red flag for me.)

I also learned that if you have gout, fast weight loss can cause further attacks.  (Another red flag).

I read that foods to avoid when having an attack are:  meats, poultry, fish, seafood, beans, etc.  All protein rich foods.  (Red flag.)

So my question is this:  Is gout known to be a common side effect of WLS or rapid weight loss?  Or even of protein rich diets?

Anyone here suffer from this ugly disease - if so... what does an attack feel/look like?

Thanks in advance for any information you might have about this.  

I was diagnosed last Oct. with gout. I had actually been having minor flares in the big toe of my right foot for years such as what you described, but I never mentioned it to my doc because I thought it was pain from ingrown toenails, and it would come and go. Then last Oct. I woke up one morning with my foot swollen, red, and screaming in pain. It was some of the worst pain I've ever experienced! I had stubbed my big toe a few days prior to that so I thought maybe something was broken or I had blood poisoning. Called my doc and she said go to the emergency room, and after 6 hours there just waiting to be seen, (did I mention how I hate emergency rooms and avoid them like the plague?!?) was diagnosed with gout. I was given some medication and told to follow up with my PCP. It would calm down for a few days and then flare up again, over and over. I've been on anti-inflammatory meds ever since my diagnoses, and they have some very serious potential side effects. I hate taking them but it's the only thing that controls the flares. I've been told that once I have my RNY I cannot take the anti inflammatory meds any longer. I was told, and found out through my own research, that gout is often times related to obesity and losing weight can help clear it up, BUT at the same time, rapid weight loss can actually bring on flares. I am hoping with weight loss the gout will clear up and I won't be one of the unfortunate ones to experience flares because of the rapid loss.

I tried taking Allopurinol, which is a common treatment for gout and one that can be used after RNY surgery, but it pushed me into a flare so painful I couldn't stand it and had to stop taking it. Allopurinol will help control gout but when you first start taking it it can push you into flares as it cleanses the body of all the uric acid trapped in your joints. It takes awhile to get all the build up out - if you can stand the pain while that is happening it is a good thing to stay on the allopurinol, but I just couldn't take the pain.

What does a flare feel like?? For me, my foot swelled up, turned red, stung like hundreds of wasps were stinging me, and felt like it was on fire. It also felt like there were razor blades trying to break through the skin from the inside - I've been told that is the uric acid in the joints breaking up, which is sharp like little shards of broken glass!! It also hurts for anything, even a sheet, to touch the foot or other area that is flaring. It is actually pretty hard to describe the pain. I've had four 9 and 10 pound babies, 3 naturally, and while that was pretty painful, at least it only lasted a few hours and there is a baby as a reward for all that pain - gout can last for days, weeks, or even months, the pain can be excruciating and there is no reward at the end!! It is easy to diagnose with a simple blood test. If I were you I would see my doc now and get a diagnosis and if it's gout, begin treatment - you don't want to wait until you have a full blown flare, believe me if that happens you will be sorry!! 

Wow... really great information here, Catsi.  Thanks so much for taking the time to type that all out.  Good luck - I hope the surgery cures you of this.  

Oh! Also - it's not aggravated by foods high in protein, but rather foods high in purines, and also fatty foods, and acidic foods. There is a specific diet to follow that includes staying away from meats that are high in fats and purines such as organ meats. Certain kinds of fish are also no-no's, and turkey is bad too. They used to say stay away from beans and legumes but the most current research now says it's OK to eat those. Full fat dairy can be another trigger - so if you consume dairy products, make sure they are low or no fat. It's best to follow an alkaline diet. Tart cherry supplements can be helpful, but it must be TART cherry, not black or regular cherries. That can be taken in tablet form or juice - but if you choose to use juice, make sure it is 100% juice and sugar free. You cannot get the amount you need simply by eating tart cherries, you'd have to eat hundreds every day. The juice or pills are the way to go if you choose to try that.

More great info - thanks.  I wonder if anyone knows if it's safe to take the tart cherry supplements at 6 months post-RNY.  (They sell them right across the street at the NutriMart store, I could pick some up today.)

I suppose you should ask your surgeon or PCP about that, but I will say that both my surgeon and PCP know I take them, and when going over medications with me that I will or won't be able to take after surgery, neither one mentioned that I would not be able to take those. I was using the juice but it is very high in carbs and I have to watch my carb intake now in order to lose the required weight before surgery - so I switched to the pills. If you do ask your doc, let me know what he/she says. I can't imagine why it would be an issue since all it is is concentrated tart cherry. I have also heard that the Mount Morancie supplements are the best - personally I don't use them as they are a bit too expensive for me, and I seem to be doing well with the ones I get from Rolling Rock for 7 bucks a bottle.

Okay, so I called my NUT and asked her about the Tart Cherry Supps, and about my most recent lab tests.  She said my uric acid was well within normal range on my pre-surgery labs, and that since I'm concerned about it, she'll make sure they test for that again in my next labs.  She said the Tart Cherry Supplements may be an irritant to my new pouch and not to take them until I get my next lab tests and they can check my levels.  She said normal range is between 2.7 - 6.6 (mine were 5.4 in Oct.) but that they don't treat for gout unless your levels are above 10.  She said if the pain continues more than 5 days to call my PCP to get a lab test right away, which I will definitely do.

So, thanks to you, Catsi - I'm now more informed and have a plan.

I just love this website.  Thanks for all the help!  

Wow, that's interesting that they don't treat unless your levels are above 10! Never heard of that before. The highest mine got were 7.5 and they put me on Prednisone right away to get my levels down and then started me on other meds. That's good to know about the tart cherry supplements! I see the nutrition doc the end of this month and I'll be sure to run that by her. If I were you, knowing what I now know about gout, I think I'd be requesting a blood test right away. If you haven't been tested since last Oct. your levels could have certainly increased since then. Gout left untreated can cause kidney damage and damage to the afflicted joints. It really is, or can be, a serious issue. Also, since it is known that WLS can bring on gout, the fact that your labs were within normal range BEFORE surgery doesn't really mean a whole lot. I mean I'm not a doctor, but that only makes sense to me! Anyway, yep, you have a plan and I have some questions to ask my nutrition doc when I see her next. I hope you're feeling better soon :-)

My husband suffers from gout. Food he has to stay away from are citrus, peas and peanuts, peanuts trigger it every time. In the meat dept. stay away from organs such as liver. 

I had two attacks of gout 1.5 mo and 3.5 mo post op. PCP gave prednesone which eased the worst of the attacks.

Also, Dr. put me on Uloric 40mg (supposed to be better than alopurinal)

I do daily epsom salt foot soaks during and for a week after an attack. (reduces uric acid.)

I also take magnesium supplements (for dietary reasons) but also helps reduce uric acid.

I did NOT stop eating meat! What else is there?