A Follow up to 'The Gout Attack'

I received a good question from a reader and when I began writing a lengthy reply, I realized this would be  good for others well. Thanks Elizabeth! ( The Gout Attack )

Hey Lily! Love your site. I just found this morning looking for a remedy to clean my husband's swimming goggles. I'm wondering what you found out and ultimately did about the gout and restrictive diet? I'm a registered dietitian and HATE having to put people on the diet. I am a runner too and seem to have gout in my big toe (other family members have gout, too).

Thanks!

Elizabeth, RD, LDN Jax Beach, FL

Hi Elizabeth!

Thanks for reading my little blog. I'm really glad it helped.

I actually haven't had a 'gout' attack since writing this post and forgot I even had a 'gout' issue.

I did a restrictive diet for the duration of about 2-3 months, I took cherry supplements, drank 3-4 Liters of water and everything the books told me to do. However, I really didn't find relief or a difference in pain on my wrist or toe.

I had a blood test analysis done at my yearly physical by my physician and what I found out was I actually didn't have gout, even though I experienced ‘gout-like’ symptoms. So all this time I thought I had gout, but it wasn't. It was actually a funny conversation.

me: "Dr. Lee, I wanted to ask you what I can do about my gout"
Dr. Lee: "Gout??!? what are you talking about!! you don't have gout! I would've told you if you had gout"
I naturally have a slightly higher uric acid level, but for my body it operates at that level, which the orthopedic surgeon misread and automatically assumed it was gout (if the uric acid range was 4-8, I'm at 8.5), but gout itself wasn't my culprit which is why I didn't find any relief from the restrictive diet.

With that, I began to use other remedies to treat inflammation and not gout

My 'go-to' remedy to relieve inflammation is Ginger! I used to hate ginger, but now I LOVE it. I take ginger capsules and drink ginger tea  (julienne ginger root and add hot water) after any 'questionable' meal (a 48oz Rib eye steak, or an all you can eat seafood buffet - yes I consume those things haha) and I haven't had any pain or flare ups since. 

As for running and having big toe pain, the anatomy of the foot or the shape of shoe may be the cause of the inflammation. I started using custom orthotics made from the podiatrist and along with the ginger I haven’t had any issues with the toe. (FYI- check your insurance carrier it might cover orthotics, which my insurance thankfully covered my $250 custom orthotics)

I hope this helps and that maybe you’re like me, we have gout-like symptoms but not gout itself, and managing inflammation may by the remedy for you and for some of your patients as well.

Happy eating! J

Lily

The Gout Attack

I'm not a newbie to gout, I've had it ever since I was in my teens.. the pain in your big toe.. it would come for a day or so, and then go.

So for the past few months, I've been having a sharp stabbing pain on the top of my right wrist.

I know its a ganglion cyst,  (which I named "my lumpy")  forming because I have one on my left wrist and went through about 2-3 years of pain. For my left wrist, I removed the cyst several times, but "My Lumpy" would always come back, and hurt more.. However, I started to realize when the lump was there, the pain was gone, and when the lump was gone, pain would return. So I learned to live with the lump if it would mean I would have no pain.

My doc said that because of the lump, the extra fluid has an area to escape, and not press on the nerve = no pain.

Now the same thing is happening to my right wrist. However, I can't ignore it. Being right handed, I can't go 2-3 years with pain. I am unable to carry things, and do certain movements. I can't flex or extend my hand in a 90 degree angle. (My workouts are suffering because I can't do burpees or pushups). If I fell on the ground, I can't even push myself up. Stupid right hand..

So I finally went to see an orthopedic surgeon, hoping that he could just do some magic surgery to make everything all better.

But his diagnosis was something much worse.. He said.. GOUT..
and what makes gout even worse, the remedy..... RESTRICTIVE DIET!

He said the build up of fluid, is getting trapped on the top of my wrist, and pressing on the nerves = pain.
So... reduce fluid = reduce pain..

I love meats, and seafood (purine heavy foods). To greatly reduce it, really sucks. :(

I've started to do some research, and a new theory, is that gout, isn't caused by the purines in food we eat, but instead by glucose and insulin = sugar and carbs.. AHH my other 2 favorite things..

I actually do believe the sugar and carbs would have a greater effect than just purine only in meats and seafood.. I'm still researching, but somehow it just seems to makes more sense than just purines alone. But I'll let you know what I find out, and what I end up doing.

So.. what will I eat now? :(
The doc said a restrictive diet for 2-3 months to reduce the pain.

I'm a sad panda..

Weight Loss 101: How to Calculate a Calorie Deficit

Great Article By Matt Fitzgerald 
For Active.com
http://www.active.com/fitness/Articles/How-to-Calculate-a-Calorie-Deficit.htm?cmp=17-3-668

Do the Math

Your ultimate goal is to figure out exactly how many calories to eat daily to lose weight without being hungry and lethargic and without sabotaging your training. To do that you need to figure out how many calories you burn each day and then subtract your target deficit of 300 to 500 calories from that number.

There are two components to your total calories burned daily: calories burned at rest and calories burned in workouts.

To begin, add up the total number of hours you train in a typical week and divide that number by seven to yield the average number of hours you train daily. For example, suppose you train seven hours per week on average. This works out to one hour per day. Next, multiply this number by your body weight in pounds and the average number of calories you burn per pound of body weight per hour of training. The average number of calories you burn per hour of training is influenced by your speed. Use this table to get the appropriate multiplier.

Training Speed	Calories per pound per hour
Slower (run 11:00/mile)	4
Average (9:30/mile)	5
Faster (7:00/mile)	6

The result of this calculation is the average number of calories you burn through exercise daily. For example, suppose you run one hour per day on average, you weigh 150 pounds, and your speed is slower. In this case, 1 hour x 150 pounds x 4 calories per hour = 600 calories per day on average through exercise.

Your next step is to calculate your calories burned at rest (i.e. outside of workouts) during the day. To do this, first visit the caloric needs calculator and enter the information requested. In the "Activity Level" field enter "Sedentary" if you are mostly inactive outside of your workouts (that’s most of us) or "Lightly Active" if you have a physical job. Do not select "Active", as this option is intended to account for your workouts, which you’ve already accounted for separately for greater accuracy.

The result is an estimate of the number of calories you burn in 24 hours outside of exercise. But since you spend part of those 24 hours working out, we need to remove that part from the estimate.

To do this, take your estimate of calories burned at rest and divide it by 24, then multiply the result by the number of hours per day that you donot spend working out. For example, suppose your calculated calorie usage outside of exercise is 2,000 calories per day. If you work out 1 hour per day on average, then there are 23 hours of the day when you’re not working out. In this case, your daily calories burned at rest is (2,000 calories per day ÷ 24 hours per day x 23 hours a day you do not work out = 1,916 daily calories burned.

To determine the total number of calories you burn daily, add together your average daily exercise calories burned and your calories burned at rest. So, if you burn 1,916 calories per day at rest and 600 calories per day through exercise, then the total number of calories your body burns per day on average is 2,516.

This number also represents the total number of calories you would need to consume daily to maintain your current weight.

The total number of calories you should aim to consume is equal to the number of calories you would need to eat daily to maintain your current weight minus your chosen calorie deficit. Remember, the appropriate deficit range is 300 to 500 calories. Let’s say you choose 400. Then you should aim to eat 2,116 calories per day (2,516 total calories burned per day – 400 calorie deficit) during your weight-loss initiative.

Kashi U Cereal

Really tasty and healthy. Some high fiber cereals kinda taste like wood, but this one is really tasty. Gets a little soggy in the milk, but overall holds its crunch well.
There's tasty black currents, walnuts and oat clusters.
Best part it has 7 grams of fiber, (2gs soluable, 5 gs insoluable)

Some fiber Facts via http://www.healthcastle.com/fiber-solubleinsoluble.shtml



Insoluble Fiber

Functions of Insoluble Fiber

-move bulk through the intestines
-control and balance the pH (acidity) in the intestines

Benefits of Insoluble Fiber

-promote regular bowel movement and prevent constipation
-keep you feeling fuller longer
-remove toxic waste through colon in less time
-help prevent colon cancer by keeping an optimal pH in intestines to prevent microbes from producing cancerous substances

Soluble Fiber

Functions of Soluble Fiber

-bind with fatty acids
-prolong stomach emptying time so that sugar is released and absorbed more slowly

Benefits of Soluble Fiber

-lower total cholesterol and LDL cholesterol (the Bad cholesterol) therefore reducing the risk of heart disease
-regulate blood sugar for people with diabetes

Sneak in more Protein

Here is an a Super Easy and Healthy way to sneak in some more protein into your diet.

Its important to get adequate amount of protein in your diet to build Lean Muscle Mass. Your muscles need protein to maintain itself and to get stronger. If you start cutting calories, and especially the protein, your muscles will wither away, leaving you lighter in weight, but flabby.

You want to get tone, not flabby.

How many grams protein to do you need per day?

A good gauge is to take your weight. 
-divide by 2 (if you want to build more muscle)
-divide by 3 (if you want to get lean but not bulk up too much)
anywhere inbetween 2 & 3 is a good number to be at.

If you want to build lots of muscles, go 1 for 1, 1lb / 1 gram of protein. Some guys actually do more than that..

example
weight 125
divide by 2 : 62.5 grams of protein
divide by 3: 41.6 grams of protein.

I cant' take all the credit for this, my b/f showed me this.

• Oatmeal 8g
• Egg white (or with yolk your pref) 4g
• Soy milk 7g
• Protein powder (as much as you like)
• mix it all together, microwave. 
• Done. 

You get 19g alone, without the powder, if you add in 10-15 grams of powder, you're already at close to 30-35 grams in just 1 meal.

Its much easier, and less fattening than eating a ton of chicken or steak.

Oatmeal (Kashi has 8 grams of protein)

Egg whites about 4g

Add as much protein powder - I do a spoonful about 10-15g

Soy Milk, about 7g

Add it all together, microwave for 2 minutes