Showing posts with label gout. Show all posts
Showing posts with label gout. Show all posts

Saturday 21 December 2019

It's that Time of the Year!

Another December, another annual check up! Glad to say that I'm still fine - creatinine 129, BP 112/75 and cholesterol down a bit. After taking allopurinol for the last year, my urate level has dropped from 525 last December to 332; I now have just an occasional slight twinge of gout which lasts for a few minutes but am otherwise not affected at all by it.

I'm always delighted by the treatment at the transplant centre; this is the one where my initial tests were done in 2012 but the operation in 2013 was the centre near my brother in London. I arrived 20 minutes early due to buses being on-time and having just sat down was surprised to hear my name called. There were a good dozen other people waiting there and I felt almost guilty at being called before them!

Consequently I had finished with the consultant by my appointment time, and so had time for a chat with the same transplant nurse whilst waiting for bloods to be done. She is the same one who looked after me during the tests and she still remembers me and my recipient brother. I am glad that patients like me help make her job rewarding! She is frankly a real treasure and I would be disappointed if she left.

On the same sort of topic I should mention cutting my head on a Thursday at the end of November: I went to A&E at a smaller local hospital at about 3.30pm and was out (with the wound glued) by 4.40 which is pretty darn good in my book. Why do people criticize the NHS?

BTW, that's not the fastest turnround that I have ever had in an A&E. One Sunday about 20 years ago my back went into spasm and my son drove me in; they treated me and sent me out in just under a hour! I think that speed was explained by the time of day - at 2pm the expected sports injuries had not yet arrived. I do still see a chiropractor about my back when it starts to hurt.


Friday 8 February 2019

Kidneys and Gout

In the last couple of years I have suffered from gout. The very first time it was so excruciating that I failed when I tried to walk from my house to the GP surgery, only 500 yards away!

Since then there have been recurrences which were not so bad, but I felt that they were getting more frequent so I asked my nephrologist about gout when I had my annual check up just before Christmas. This seemed like a reasonable thing to ask, considering that gout is caused by uric acid in the blood, and urate level is one of the many things which I have been tested for ever since I became potential living donor.

The common response when I tell someone that I have gout is "Isn't that to do with drinking too much port?" Instantly, you know that they need education!

Gout was once a problem which only affected the well-off so it was associated with what they ate and drank and, yes, one of those things was port. However, the point is that the average person at that time did not have a good enough diet to raise their urate level to the point at which they could be affected by gout. It was just the high consumption of lots of "good food and drink" which caused the gout in the well-off people (and principally the men, I suspect).

By the late 17th C, gout did start to affect the rest of the population and this has continued, generally thought to be due to the improvement in diet of the so-called working class. Research in the 19th C by the British physician Alfred Garrod identified uric acid as the causative agent into the causes of gout; the idea being that uric acid accumulates in the circulation and crystallizes into needle-sharp urate crystals. These crystals then lodge in the soft tissues and in the joints of the extremities –- classically, the big toe — and cause inflammation, swelling and an excruciating pain that was described memorably by the 18th century bon vivant Sydney Smith as "like walking on one’s eyeballs"! Because uric acid itself is a breakdown product of protein compounds known as purines – the building blocks of amino acids – and because purines are at their highest concentration in meat, it has been assumed for the past 130-odd years that the primary dietary means of elevating uric acid levels in the blood, and so causing first hyperuricemia and then gout, is an excess of meat consumption.

It is still generally thought that consuming foods which are high in purines will make you more likely to suffer from gout, and these high purine foods include lots of things which are otherwise good for you such as "oily fish" (omega oils) and "whole grain"! The list even includes Marmite and beer (both due to yeast). In a series of studies in the 1960s, clinical investigators first linked hyperuricemia to glucose intolerance and high triglycerides, and then later to high insulin levels and insulin resistance. The gout research effectively ended in the 1960s when the drug allopurinol was discovered which is effective at reducing the amount of urate produced. This cessation of research was understandable as gout is not fatal and so when a cure is found, there is no point in spending further research effort on it. However, the effect of ending research is that the commonly-accepted view is not challenged, althugh some scientists have said that "low-purine diets have a negligible effect on uric acid levels". I have been educating people about purines as the cause (as the bottle of port in my drinks cupboard has been there for about five years and is still not empty) but I have just found an alternative culprit.

That new culprit is that the rise in the incidence of gout in the UK might be linked to the massive increase in the sugar trade in the 18th - 19th C. It has been demonstrated that fructose consumption and uric acid levels are linked. The earlier researchers later admitted that they were unaware that sucrose is 50% fructose (and the other 50% is glucose, if you were wondering).

The hypothesis is that sugar (sucrose) and high fructose corn syrup (which is used in many foods) would constitute the worst of all carbohydrates when it comes to uric acid and gout. The fructose would increase uric acid production and decrease uric acid excretion, while the glucose, through its effect on insulin, would also decrease uric acid excretion. Thus, it would be reasonable to assume or at least to speculate that sugar is a likely cause of gout, and that the patterns of sugar consumption explain the appearance and distribution of the disease.

The trouble is that this is still only a unproven hypothesis. However, I offer it as a possibility for anyone who suffers from gout as it might just help them to cure the actual cause rather than simply address the problem with allopurinol for the rest of their lives.

Much of the above comes from the blog of Tim Ferriss (https://tim.blog/2009/10/05/gout/) where he presents it as the missing chapter from Good Calories, Bad Calories by Gary Taubes, a science journalist and author. I don't know if either of them are also medical doctors, but I know I'm not!




Tuesday 27 December 2016

Annual Check Again

Well, yet another year has gone by.   I attended the Churchill on Tuesday before Christmas for my annual "MoT".  I remain very impressed by the reception I get, as just one of many donors who must pass through their door. They always welcome me with a smile and even remember that the recipient was my brother (who they never met) when they ask after his health as well.

I have had one slight worry this year (see below); health-wise, it has been quite a boring year which, after all, is what one would hope for at any age but especially whe you are past 60! That reminds me of what the examiner said once when I had a pilot's licence and was doing a General Skills Test; we had done a couple of touch and goes and I called "Downwind - to roll" expecting to do another circuit; he immediately thumbed the button and called "correction - downwind to land" (i.e. a full stop landing). Then he smiled at me and said "I'm bored!" It's what you want to hear, isn't it?

My figures this year were much the same as before- notably creatinine 132 and cholesterol 6.0 - and everything else was in the right range. However, my blood pressure was even better than last year at 116/71 and the consultant was even more envious of that than he was last year!

In discussion with the consultant I found out that it is normal for creatinine to vary a lot and also that it is less if you have more muscle - this probably explains why Tim's figure is better than mine!

The one slight worry with my health was that, back in July, I suffered from gout - just the second toe of one foot and the middle toe of the other. At one time it was so painful that I was unable to walk more than 20 yards. It seems that gout is caused by something called purines. These are natural compounds found in many foods which, when metabolised, produce uric acid as their end product; gout is essentially a build-up of uric acid crystals in joints. My urate figure has been high since the first blood test in 2012 amd I thought nothing of it; now, studying the diet guide, I find that there are certain foods which are high in purines, which should be eaten in moderation if not avoided entirely. To my surprise one of these was something that I have eaten all my life, namely Marmite, because it contains yeast extract. The list also includes mackerel (and other oily fish) and stock cubes! So, I am now on a low (or lower) purine diet and we'll see what happens; the gout has not recurred anyway.

That's it for another year, unless something dramatic happens.