I was shocked/horrified/perplexed/mortified (choose the one you want) when my left foot started hurting on Monday and by Tuesday felt like it was on fire. My initial suspicion was gout, and this was borne-out by my subsequent research and later doctor’s diagnosis on Wednesday.
I’ve never knowingly had gout before, but to be honest I think I’ve been lucky. Gout is basically acute arthritis brought on by the accumulation of uric acid crystals, most commonly in the sinovial fluid around joints and in 50% of these cases in the metatarsal-phalangeal joint at the base of the big toe; exactly my problem. Self-diagnoses was pretty easy given the typical symptoms and I was quite certain I hadn’t injured myself recently (although I had been sprinting & doing body-weight exercises), but perhaps mostly because of my long history of high blood levels of uric acid.
To be honest, I think I’ve just been lucky not to get this before given that my fasting blood level of uric acid has consistently been measure above 7mg/dcl and in my last test it was 9.6 – so not so much a surprise that I got gout, but more a surprise as to why I didn’t get it previously. Ask pretty much anyone what causes gout and they’ll say red meat. There’s a certain element of truth in this, but as usual it’s not so black and white. Actually meat in itself has moderate level of purine, organ meats such as liver contain higher values. In any case, although purine metabolism produces uric acid as a by-product, it’s also a catalyser for excretion of purine, so perhaps the two cancel each other out.
My previous doctor always used to send my blood test results by mail and she’d make notes on the page “good”, “needs to improve” etc. and she’d always circle the uric acid with the comment “Alcohol!”. Now I don’t really dispute this as I’ve been quite a heavy beer drinker since I’ve lived in Belgium (it’s so damn good here), but given that I’d been off the booze since the beginning of January I was a bit miffed to see it higher.
So what brought this on? Well, OK, I have to admit that the Thursday before I did have some beer – I wanted to see how my body would react after being off it for a month, so I decided to drink a couple with my work colleagues. Of course a couple of beers with me often turns into to more and so it was in this case. Then the Saturday before I had half a bottle of tequila – hmmm. Then I have read that the following can increase uric acid: weight loss: check, fasting: check, vitamin C deficiency: probably, low carb intake: check, eating high purine foods (ok, debatable, but I did eat liver over the weekend which is high in purines compared to other foods): check. I also heard from and excellent podcast by Paul Jaminet talking to ‘The Fat Burning Man’, Abel James’, that stated sweet potatoes are high in oxalates, which promoted uric acid. Well guess what I ate at the weekend too…
So I think it’s several of axes playing together that have all converged at the same time. Bad luck for me, but a wake-up call to watch out for this in the future.
So Wednesday I saw the doc – bless her, I has the consultation 15 minutes after calling her. She gave me some diclofenac NSAID for the inflammation, Colchicine to break up those pesky crystals and some Allopurinol to get the uric acid levels under control in the coming months. I can’t say I’m happy to take the drugs, but I really was in some pain and could hardly walk. Today, Saturday, there’s still a dull ache, but no real pain – only issue is the side effect of the Colchicine, which is an upset stomach, so a case of the shits basically and I feel a bit nauseous a lot of the time.