This sounds crazy but my family doc thinks I may have gout. I am a very active person gearing up for a buzy tri season and Friday night my right knee became red and hot. This was After my usual Friday brick workout. She thinks it may be due to my high protein diet (about 100gr/day).
2 questions: has anyone ever heard of gout in triathletes ( I thought my fat uncle was the only one to get this)
How much is too much protein?
This sounds crazy but my family doc thinks I may have gout. I am a very active person gearing up for a buzy tri season and Friday night my right knee became red and hot. This was After my usual Friday brick workout. She thinks it may be due to my high protein diet (about 100gr/day).
2 questions: has anyone ever heard of gout in triathletes ( I thought my fat uncle was the only one to get this)
How much is too much protein?
Why does it sound crazy? Gout has a large genetic component. My dad and brother both suffer from it as do I. Diet contributes but without taking allupurinol I’ll have flare ups. Getting dehydrated will trigger a flare, you essentially increase the effective concentration of uric acid by being dehydrated. The crystals then precipitate out of the blood and you get that very nice pain.
I have not noticed any ill effects from allupurinol so I take it daily. Colchicine was the poster child for drug companies screwing the world. It was put through the approval process after around 2000 years of use. The cost for my prescription went from $4 to $205. Luckily I only need that when I have a flare up and I have not had that for a couple years. Also colchicine can really give you som ecreative digestive track issues.
100g does not seem like a lot of protein.
I was initially diagnosed with gout, but actually turned out to have something called “Reactive Arthritis” which was joint swelling and pain triggered by a viral reaction. If testing for gout proves inconclusive, it might be worth seeking out a rheumatologist to rule it out.
M
I concur with JPO’s points. The colchicine thing in particular is an absolute atrocity of corpo-profit-whoring but that is a separate bottomless thread.
Couple of additional things:
-you may need to rule out pseudogout, which is calcium-based. Pseudogout likes the knees, gout (especially first attack) likes toes. I believe the only way to really differentiate is joint aspiration (OUCH)
-are you taking in that much protein based on a g/bodyweight calculus, a la bodybuilding regimens? any reason for this? what is the timing of this intake - small amounts 6x/day or 3 big hits? what is the rest of your diet like?
-alcohol intake?
-what are your protein sources? Gout correlates with high protein but it is more specifically tied to purine metabolism rate. Certain protein sources are worse than others for this.
-Acid/alkaline balance is hugely important for those predilected to this. Test your urine - if you are well below 7.0 in the morning you are running very acidic. This is also really bad for recovery, inflammation, etc. Easiest fixes for this - hydration and plenty of greens!
frrtlek’s post is very good. Gout is not that common in the knee (although not unheard of). Pseudogout (CPPD) far more common to cause an acute, inflammatory reaction in the knee (assuming no trauma of course).
Can assume you had blood work done, but serum (or urine) uric acid isn’t always elevated in gout (but a very high reading, say 10 mg/dL is likely a more “slam dunk” diagnosis with your clinical picture).
As mentioned, a joint aspirate to look for rhomboid vs. negatively bi-refringement crystals under polarized microscopy is the only sure diagnostic test.
Gout is not the disease of the idle rich as historically portrayed. It seems to be genetic, and the triggers vary greatly so yes trigeeks are as susceptible as the general population.
Knees are not a common place to have a flare, but gout can attack any joint. I had an unusual swelling in my hand after a HIM, even got X-rays for a fracture. There was no conclusion, the only thing we could think of was some type of hyperextension from the swim. Fast forward 3 months to my first gout attack (in my foot, the most common site) and it seems clear the first problem was likely gout.
I always travel with colchicine as this drug seems to work well for me and I take it when I feel a flare up coming on.
Get a uric acid test when you have a flare up to confirm if this is gout. Your doc should be able to give you a lab requisition for the test to have handy so you can rush in and have blood taken the moment you feel an attack coming on. It is important you do this before you take anti-inflamatories or any other meds (these will interfere with the uric acid test).
A gout attack was my greatest fear when training for my first IM. Dozens of times I was sure it was going to flare up and derail things, but luckily I had 10 gout free months leading to my race.
BTW, no gout history in my family that we know of, so it was big surprise.
Edit: DD made several good points. We used a combination of serum uric acid PLUS successful use of colchecine to confirm gout (and a red swollen foot helps).
I got gout again about a month ago while on a VEGAN diet so don’t buy the protein nonsense. While I was Vegan, I was also drinking beer and I am about 20 pounds heavier thanks to an accident I had last year and the resulting injuries from flying across a car off my bicycle.
Cherry juice helps. Naproxen really helps.
After the gout I immediately went back to eating chicken, egg whites, lowfat dairy.
Ken and others, try and stay away from alot of alcohol, avoid stress (not an easy task), I am also on allopurinol, it keeps the gout in check.
and never, ever, ever, ever, ever, ever … (at least for me):
I can’ remember the last time I had an organ … that aint it.
But Red Wine seems to be fine as long as I don’t over do it. Also, if I run on the gouty toe it seems to extend the problem.
I’m also a gout p/t. Living a healthy life–running, biking, swimming, no beer (only about 1 mix drink a month, at most). I still got gout… I think family history has a lot to play in the part. Anyone with some expert opinion can chim in here?? I’m frustrated!! I have to take a pill a day to keep the uric acid down, but I still feel some crystal or hint of pain in my toe and area where the last flare up was. ANY SUGGESTIONS???
If you are currently on allopurinol (100-300mg/day I’ll assume) and you are still getting flare-ups, a repeat serum acid is in order with your goal less then 6 mg/dL. If not, switching to one of the newer uricosuric drugs or another xanthine oxidase inhibitor (i.s. uloric) is the way to go. Something you should discuss with your physician.
Yes, largely genetic for sure! Obviously, eating right and avoiding dehydration are important in a type-A triathlete/endurance athlete as well.
As someone who suffers from gout flares more than I would like, here is my 2 cents in. Although I am not as active as I have been in the past and do not eat as healthy as I should, I have eaten many items that are supposed to cause gout flare ups such as high purine meats, or have drank alcohol and have not had a flare up. When I typically get flare ups it is when I drink soda, energy drinks, or sports drinks (such as Gatorade or Powerade) . I believe these flare ups have been caused by the intake of too much sugar or high fructose cornsyrup. That has been my experience and I know the cause of a flare up for gout suffers is different for each individual but I hadn’t seen this one mentioned so I figured I would share.
After two excruciating flare-ups, I’ve been drinking a lot more water, like three times the amount I was before. I do believe I’ve been dehydrated much of my athletic life until now. I’ve had very minor flare-ups since, can just barely feel them. No other huge changes to diet. Just drinking more water has worked for me.