Confused, scared, and in pain

**Georgiana** · April 8, 2009, 03:15 AM

Re: Confused, scared, and in pain

Hey there.

Atkins can be done by people suffering from gout, but it must be done under medical supervision. There is some info about this in DANDR and I'm pretty sure I once read something about it online as well (maybe on atkins.com?), although I can't find it right now.

If you suffer from gout, you should talk to your doctor about allopurinol and slow down your weight loss. There are also foods that may trigger gout symptoms, like mushrooms, asparagus... some of them on the list of foods acceptable during Induction.

And talking about Induction, it is maybe better for you to move to OWL and consume more fruits and vegetables. One cup of strawberries is usually a quick remedy for pain and it only has about 9 net carbs. A few fresh cherries eaten daily are also said to help, and they are relatively low in carbs (about 1 net carb per cherry).

These foods are not allowed during Induction, but you could eat them in OWL. Furthermore, since your weight loss rate is quite fast, your CCLL is probably high enough to fit more vegetables and fruits while still losing weight. So better move to OWL and also talk to your doctor about possible medication.

**EverLosing** · April 8, 2009, 03:35 AM

Re: Confused, scared, and in pain

I think Georgiana is right! Move to OWL, get some more carbs in with veggies and fruits. That's a fair compromise AND it's the only thing you can really do to know whether or not you can stay with this WOE. If you just drop Atkins, you'll never really know if you could've made it work. I know all about chronic pain, believe me. Car accident while pregnant, back injury, then gave birth to a nearly 14 lb baby with the back injury untreated (accident while pregnant) and two back surgeries. Can't tell you how many times I've "learned to walk again."

I'm willing to bet you'd be more miserable in the long run if you try to go back to "eating healthy carbs." I know whenever I've tried that, it just turns my body into an insulin machine. Some people can't handle that. Those people should be low carbing. It's what agrees with their body type. I'm sorry you're struggling. I remember many sleepless nights in complete agony! Wish I had been awake when you posted. Know it's going to be ok. Ask your doc for some prescription pain relievers while you're trying to adjust your carbs. Your doc should be willing to help you find a way.

**momtomany1** · April 8, 2009, 06:42 AM

Re: Confused, scared, and in pain

I commented briefly on the other gout post, but I want to make my plug for strawberries. No liver, more strawberries, and plenty of vitamin C has made all the difference for me. Cherries have a great rep for helping with gout too but I haven't tried them.

Best wishes to relief for you!

**Chicklady** · April 8, 2009, 07:04 AM

Re: Confused, scared, and in pain

(((((tutti))))) I'm so sorry that you're in pain! You must do what's right for you, but how about changing your ratios first? Something like 70/10/20 fat, carb and protein?
Even 65/15/20 if you keep your carbs high fiber.

I know that you are just starting out and this suggestion is NOT doing the ladder in order, but how about increasing the quantity of lower carb veggies and trying the Dreamfield pastas to stretch out your meals. Yes, I am suggesting a deviation, and if you can afford it, the House Foods Shiratake noodles would be a lower carb and equally filling choice....around here, however, they run 2 bucks for 8 COOKED ounces in water.

BTW, is gout a pain on the end of your toe?

**Desertthorn** · April 8, 2009, 08:37 AM

Re: Confused, scared, and in pain

Hope you feel better. Keep a detailed food journal and see if you can't see any patterns. Sometimes it might be just one food.

**ipedregon** · April 8, 2009, 08:37 AM

Re: Confused, scared, and in pain

Hi Tutti

I've had gout and kidney stones in the past and atkins did not seem to make it any worse. I think that you may want to pay close attention to your ratios as Chicklady has said here those adjustments can make the diffrence. And consider OWL because "we" tend to get so focused on what Induction does that we kind of get greedy and think we can stay on induction until we are at our goal. This is not healthy and not at all what the way of life is supposed to be about. You need all the nutrients, antioxidants, vitamins etc that come with veggies and fruit to keep your body balanced.

I know how bad it hurts, if you have gout it's also possible to get kidney stones, and then gout doesnt seem to hurt so bad anymore once you feel that!

Keep the water intake high, also I think if I remember right lemon juice in your water can help, just squeeze a wedge into the water as you should be drinking tons of water anyway. Get some GEL ice packs and apply them for 15 minutes at a time to help with the pain and swelling and keep drinking tons of water.

I have not had a gout attack in a little over a year, and my last kidney stone was over 2 years ago. I have been on/off atkins these past two years.

I think if you manage your ratios good and drink LOTS and LOTS of water it will help.

Gout is caused by an abnormally high level of uric acid in the blood due either to increased production of uric acid or decreased elimination of uric acid by the kidneys

So water, water, water will really help your kidneys flush the uric acid

I really hope this helps hang in there !

**SunnySmile501** · April 8, 2009, 09:03 AM

Re: Confused, scared, and in pain

This suggestion has nothing to do with the diet, but it will probably give you some pain relief until we can find some better information for you.

Get some Epsom salts, not the kind in the drug store department, but the kind from a garden center--it's twice as strong. Wal-Mart carries it in the garden center. Dissolve a one cup per gallon of the hottest water you can stand. Soak your foot until the water cools completely.

The hyperosmolar magnesium sulfate in the Epsom salts actually enters through the skin and relieves pain by acting as a calcium channel blocker, reduces swelling and inflammation (which gout is). Epsom salts also acts as an osmotic agent, extracting toxins and irritative chemicals through the skin.

**Kathi22** · April 8, 2009, 09:19 AM

Re: Confused, scared, and in pain

Aw I am so sorry. I don't have any advice in this area. Let us know what your Dr. says. I hope you find relief soon!

**SunnySmile501** · April 8, 2009, 09:26 AM

Re: Confused, scared, and in pain

I'm going to be googling as much information as I can, so hang on.

Atkins suggests that his plan may aggravate gout, but not because of it being low carb ... he attributes the problem to rapid weight loss. His suggestion is to slow the weight loss by adding a few more carbs and also to take prescription medication for gout.

From the Protein Power FAQ's the Drs. Eades have this to say: I have heard that eating higher amounts of meat can cause elevated uric acid levels. Is this true?

Increased levels of uric acid are associated with insulin resistance, which results from high intake of sugars and starchy foods. Most people who have gout have a problem with under excretion of the uric acid from the kidneys. There isn’t a problem with the production of uric acid but there is with the excretion of it. Although it is not fully understood, there seems to be some enzyme defect that causes this to happen. The uric acid gets stored in the tissues and once insulin levels start to drop, from decreased carbohydrate intake, the uric acid becomes mobilized and there can be crystallization within the joints, therefore a gout episode.

It is important to drink plenty of fluids, supplement with magnesium, and do not go on and off the plan. People with a known history of gout problems should discuss with their physician, the possibility of using medications to prevent attacks when first starting the plan. Once they have their insulin and uric acid levels under control with the diet, the medication could be discontinued.Some nutritional references suggest supplementing folate (folic acid) up to 50 mg a day, and essential fatty acids ... flax and/or fish oils may be helpful for reducing inflammation.

Previously, patients were put on a strict, low-purine diet, which was basically vegetarian, and very low protein. However, dietary purine only accounts for 50% of uric acid production and .. studies since the 1990's show the link between gout and increased insulin and insulin resistance, and several small studies show improvement of gout symptoms with a higher protein, low carb diet.

**tuttifrutti** · April 8, 2009, 10:03 AM

Re: Confused, scared, and in pain

Originally posted by Georgiana View Post

Hey there.

Atkins can be done by people suffering from gout, but it must be done under medical supervision. There is some info about this in DANDR and I'm pretty sure I once read something about it online as well (maybe on atkins.com?), although I can't find it right now.

If you suffer from gout, you should talk to your doctor about allopurinol and slow down your weight loss. There are also foods that may trigger gout symptoms, like mushrooms, asparagus... some of them on the list of foods acceptable during Induction.

And talking about Induction, it is maybe better for you to move to OWL and consume more fruits and vegetables. One cup of strawberries is usually a quick remedy for pain and it only has about 9 net carbs. A few fresh cherries eaten daily are also said to help, and they are relatively low in carbs (about 1 net carb per cherry).

These foods are not allowed during Induction, but you could eat them in OWL. Furthermore, since your weight loss rate is quite fast, your CCLL is probably high enough to fit more vegetables and fruits while still losing weight. So better move to OWL and also talk to your doctor about possible medication.

Thank you everyone this morning from the bottom of my heart!

Georgiana~*I actually tried allopurinol, but my Dr. took me off because I am one of those lucky people (NOT) who had a bad allerigic reactions too it. Enlarged liver for one and intense skin rash blah! So I get high doses of perscribed Napoxen (Aleve) when I get an attack

I do keep a daily journal of all foods I eat over at fitday.com and I have been reveiwing it this morning. I did have mushroooms in a salad I made before this attack came on. And I have been eating alot of ground beef. I think I will follow everyones advice and go ahead and say goodbye to extended induction and move up to OWL. When I use to feel an attack coming on I would eat a whole bag of cherries. Can't even imagine how many carbs that contained lol. I have decided to lower my intake of red meats. I can still eat some and will stick to mainly chicken now. I can get plenty of fat in still by eating the dark meat and continue cooking my chicken breast in olive oil or coconut oil. I will be reducing my ration as well. They recommend gout suffers to not eat more then 100 grams of protein a day. I have been averaging 120-150, so I shouldn't have any trouble lowering that. And it is really hard to sink into my brain that I need to slow down on my weightloss. I know a rapid weightloss helps trigger gout too. BUt with so much weight to lose, its hard to think about that but I know its what is best. I will take a folic acid supplement and I am already taking soem really good essentail fatty acids. I am also taking a good cal/mag/potassium pill so I am good at that end too.

SunnySmile501~*thanks for that info. It makes sense what it says over on Protein Power FAQ's. I stopped posting on the cheat free challenge cuz I had a few slips. I never really counted or acknowledged them as cheating to anyone because then mentally in my head I would talk myself out of this way of eating. So yes physically I had a few higher carb days. My carb intake going up and then back down again can't be helpful at all for the gout! I am also insulin resistant/borderline type 2 diabetic. I will see if I can get ahold of someone to get that salt for me. There is no way I can walk to the store and get it.

Chicklady~* my gout pain is not usually at the end of my toe. For most people it usually starts at the joint of your big toe. And then it flares up into the main part of your foot as well.

As for water, I am definetly not having problems getting that in. Was in last months water challenge and got in 100 oz. a day and April I am getting a minimum of 120 oz. You guys are definetly the greatest! I am not going to give up on Atkins. All but for the gout I have never felt better in my life since starting this way of eating. I think I am going to start reveiwing some new food and menu options and figure out my plan of attack. So I am now officially no longer in induction and moving up to OWL

**SunnySmile501** · April 8, 2009, 10:10 AM

Re: Confused, scared, and in pain

Here's a very good medical study promoting low carb, high protein diet.

Gout, Diet, and the Insulin Resistance Syndrome

ADEL G. FAM, MD, FRCPC,
Professor of Medicine,
Sunnybrook and Women's Health Sciences Centre,
University of Toronto,

-snip-

DIETARY FACTORS IN THE PATHOGENESIS OF HYPERURICEMIA AND GOUT Being a metabolic disorder, gout is significantly influenced by dietary factors that include overeating, obesity, alcohol abuse, dyslipidemia, and insulin resistance syndrome1,5-8.

-snip-
(I found this information interesting. Obesity CAUSED by increased production of uric acid and decreased kidney excretion of the uric acid)
Several epidemiological studies have demonstrated a strong correlation between obesity and hyperuricemia1,5-7,10-12. Thus, 3.4% of subjects with a relative weight below the 20th percentile are hyperuricemic, compared with 11.4% of those above the 80th percentile6,11. Obesity is associated with both increased production and decreased renal excretion of urate13.

-snip-

Habitual intake of a purine-rich diet may also uncover an underlying renal genetic defect that can lead to hyperuricemia. Mean serum urate levels are higher and the incidence of gout is greater among Filipinos living in the USA compared to individuals of identical racial background living in the Philippines. This is explained by the limited ability by some of these people to increase their renal excretion of urate when exposed to the high purine North American diet15.

-snip-

The presence in gout sufferers of an associated metabolic disorder, such as dyslipidemia and insulin resistance syndrome (IRS), may warrant treatment of its own accord, and often some modification of gout management. Nowhere has this been more true than in patients with both gout and IRS, since treatment of gout with a purine restricted diet that is usually rich in both carbohydrate and saturated fat may negatively influence the management of IRS.

-snip-

Recent data indicate that hypertriglyceridemia in patients with primary gout is often due to an underlying IRS, or metabolic syndrome X6-8,34-37. This is characterized by overall and abdominal obesity with visceral adiposity (a waist/hip ratio > 0.85, with a waist circumference > 100 cm)38; impaired glucose tolerance with resistance to the effects of insulin and compensatory hyperinsulinemia; and the dyslipidemic combination of hypertriglyceridemia, an increase in levels of apolipoprotein B, low density lipoprotein cholesterol (LDL-C), and atherogenic small dense LDL-C particles, and a decrease in high density lipoprotein cholesterol (HDL-C) levels. IRS is often associated with hyperuricemia, hypertension, and coronary artery disease (CAD). The basic defect in this metabolic syndrome is insulin resistance, which can be detected years before the onset of type 2 diabetes mellitus. Although the exact pathogenesis of IRS is not fully understood, certain dietary factors, particularly fat and total calorie intake, in combination with decreased physical activity, lead to overall obesity with centripetal deposition of fat38. Centripetal obesity, in turn, is a powerful stimulus to increased insulin plasma levels38.

-snip-

Since patients with IRS may initially present with hyperuricemia and/or gouty arthritis, it is important to screen these individuals for concomitant impaired glucose intolerance, dyslipidemia, hypertension, obesity, or other cardiovascular risk factors6-8,47,48. Hyperinsulinemia and IRS have been estimated to occur in 95% and 76% of gout sufferers, respectively39.

-snip-

Weight-reducing, calorie restricted diet, with moderate carbohydrate restriction and increased proportional intake of protein and unsaturated fats. Given the strong association between the IRS, hyperuricemia, and gout, a weight-reducing calorie restricted diet with moderate carbohydrate restriction and increased proportional intake of protein and unsaturated fat has recently been advocated in patients with primary gout39. Low purine foods are often rich in both carbohydrate and saturated fat. These tend to further decrease insulin sensitivity, leading to higher plasma levels of insulin, glucose, triglycerides, and small, dense LDL-C particles and decreased HDL-C levels, thereby increasing the risk of CAD in these patients39,57. By contrast, a low energy, calorie restricted, high protein, high unsaturated fat, low carbohydrate diet improves insulin sensitivity and decreases plasma glucose, insulin, and triglyceride levels, with a reduction in the incidence and mortality of CAD39,57,58.

-snip-
CONCLUSION

While dietary restriction of purines has long been superseded by more effective urate-lowering drugs, recent data suggest that dietary measures may play a much greater role in the treatment of metabolic disorders commonly associated with gout: obesity, IRS, and dyslipidemia. Before commencing lifelong urate-lowering drug therapy, it is important to identify and treat any of these underlying disorders that may be contributing to the hyperuricemia. In light of its clinical and therapeutic implications, it is important to recognize the strong association of IRS (abdominal obesity, dyslipidemia, raised serum insulin levels, and glucose intolerance) with hyperuricemia and gout.

There is growing evidence that a low energy, calorie restricted, low carbohydrate (40% of energy), high protein (120 g/day, or 30% of energy) diet, with unsaturated fat (30% of energy) and high dietary fiber, is more beneficial in terms of lowering serum urate, insulin, LDL-C, and triglyceride levels, and hence reducing CAD risk, than the conventional low purine diet, with its unlimited intake of carbohydrates and saturated fat8,13,39,57,58. Restriction of alcoholic beverages is key in the management of gout; a continued high intake of alcohol can result in refractoriness to urate-lowering effects of both allopurinol and uricosurics31.
http://www.jrheum.com/subscribers/02/07/1350.html

**SunnySmile501** · April 8, 2009, 10:19 AM

Re: Confused, scared, and in pain

SunnySmile501~*
thanks for that info. I will see if I can get ahold of someone to get that salt for me. There is no way I can walk to the store and get it.

Get a friend or family member to get it for you. I can tell you first hand how much better your pain will be right away. You get a great big bag for about $2. It's worth it.

**tuttifrutti** · April 8, 2009, 10:41 AM

Re: Confused, scared, and in pain

Originally posted by SunnySmile501 View Post

Habitual intake of a purine-rich diet may also uncover an underlying renal genetic defect that can lead to hyperuricemia. Mean serum urate levels are higher and the incidence of gout is greater among Filipinos living in the USA compared to individuals of identical racial background living in the Philippines. This is explained by the limited ability by some of these people to increase their renal excretion of urate when exposed to the high purine North American diet15.

Very very interesting info you found. I am Filipino

**SunnySmile501** · April 8, 2009, 11:56 AM

Re: Confused, scared, and in pain

Originally posted by tuttifrutti View Post

Very very interesting info you found. I am Filipino

I had read on an earlier post that you are Filipino--that's why this paragraph jumped out at me.

I have been doing research along these lines and have come across many reasons why a diet that is very healthy for Asians (as an example) is not healthy for Europeans. When Asians were shown to be very healthy after centuries of eating low protein, but very high carbohydrate in the form of rice and noodles, everybody jumped on the band wagon to mimic that diet. Suddenly, rice and pasta is THE health food for the world at large. Not so. Asians have evolved over eons to have a much bigger pancreas to be able to handle the insulin needs to metabolize a diet high in carbohydrates. A European that evolved as a hunter-gatherer did not need to develop a large pancreas because they only ate vegetation during the summer months and little during the winter months. Any grain stored over the winter would have been unprocessed, whole grains.

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