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Gout


Busboy
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As a tall, poorly coordinated individual with a liking for strong drink and bare feet, I am not altogether unfamiliar with the way a toe or two feels the morning after having been smashed against something the night before, a door-jamb while on the way to the cellar for another bottle, perhaps, or a bit of baseboard while journeying to the kitchen for something cold from the fridge: that sear when you role over and smush the toe(s) against the mattress, the colorful bruises encircling a joint or two, the pointless trip to the doctor where he says "yup, it's broke," tapes the toes together and advises you to wear hard-soled shoes for a while. But I was mystified by this one. I'd been on a belated "get-in-shape-for-summer" program and living entirely on food and water for days at a time, so it seemed odd that I couldn't remember the cause of the searing pain at the base of my big toe.

Whatever it was, walking around on it -- limping, actually -- didn't seem to make it any better and so, at the pleading of my wife I wandered into the emergency room about 7 AM last Saturday morning (a surefire way to beat the usual mobs of bleeding and/or unconscious emergency room victims to whom triageurs might assign a higher priority than your toe) and hobbled out with a diagnosis of gout.

This shit hurts. More than that it's inconvenient -- it makes everything from cooking dinner to walking to the bus stop a pain in the ass foot. It also sounds stupid --it's not like I'm some French lord living on foie gras and caviar. Try saying "I can't, I have gout" to someone with a straight face.

And worse, it's messing with my dinner -- no meat, fish, poultry, tofu [!] or booze, at least for as long as the outbreak lasts. Gout is indeed caused by one's diet, and it's not only sweetbreads and rognons du veau which are to blame. Apparently all meats, but especially red meat, and even that demon spinach are high in the feared purines, which elevate the level of uric acid (ick) in the bloodstream which then cause little deposits to form on your toe joints after which, depending on the direction you're counting, that last little piggie does indeed cry "wee wee wee" all the way home.

So, my question: anybody out there ever had this? Any tips for speeding the healing process? Do Quercetin and B-5 work? Is there a "safe" level for meat? How does one diminish the odds of a recurrence without living like a vegan?

Any tips or amusing stories appreciated.

I'm on the pavement

Thinking about the government.

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I feel your pain. Literally. Only I get it in my ankles and once had it in my knee. They swell up, turn purple, and I'm not walking for a while. I get it about once a year. Lasts anywhere from 2 -6 weeks, with the first week being the most painful. I'm alergic to alopurinal (sp) so I can't take that. I've been watching my diet and the last few rounds have been very short, just about a week. But I hear ya and can definitely empathise. Doc says I'm just prone to it.

That's the thing about opposum inerds, they's just as tasty the next day.

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welcome to the club, wish you didnt belong...

ive found that tons of water helps clear it up faster. my doctor prescribed both colchicine and indocid (active ingredient indomethacine) which are the only drugs that i know of which dissolve the nasty nitrogen crystals. with the treatment the attacks start fading after three days or so. they cause a little stomach discomfort and can cause ulcers if taken on an empty stomach but are far preferable to gout pain.

if you get more than one attack you probably need to be on allopurinol daily to keep the uric acid uncer control. thats what i do, but i still cant have asparagus, spinach, any offal, and most shellfish.

i find that the occasional steak doesnt bother me much and regular fish and poultry are ok too.

hope this is helpful, and good luck, this thing is a pain in more ways than one.

btw in case it helps, i tell people that i have elevated levels of uric acid, it gets you out of the gout discussion at least half the time.

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Most beans not just soy are on the no no list also..so you basically cant have anything but iceberg lettuce...sorry...

My B-I-Ls both get this really bad - one of them swears by Organic Cherry Juice

He even gave everyone a bottle at Christmas

The other one just drinks more beer to feel better

Like mentioned above Water Water and more Water...and it seems to run in families too

tracey

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My first and only attack happened about 20 years ago in the big toe in my right foot. I couldn't walk and was told to stay off of it (but not advised about diet or anything else). I do remember drinking a lot of water and it cleared up within a week.

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Tracey, I hope your brother-in-law understands that beer is a particularly high-risk beverage (!!).

Anyway, in relation to diet specifically, this particular study may be a nice read (it has some interesting conclusion regarding purine-rich vegetables like spinach, peas, beans, lentils, mushrooms, cauliflower, and oatmeal and dairy products).

Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. 2004. Purine-rich foods, daily and protein intake, and the risk of gout in men. N Engl J Med 350:1093–1103. (links to a PDF file)

With regards to pharmacologic (and non-...) therapy, this summary may be a useful read.

Zhang et al. 2006. EULAR evidence based recommendations for gout. Part II: Management. Ann Rheum Dis 65:1312-1324.

For some reason the website requires subscription, but with some creative Googling I was able to get around that and download a copy. It doesn't really put out anything new, but it does say that there need to be more studies regarding the optimal dose of drugs for both acute attacks and prophylaxis so we can minimize the toxic effects.

Mark

The Gastronomer's Bookshelf - Collaborative book reviews about food and food culture. Submit a review today! :)

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Most beans not just soy are on the no no list also..so you basically cant have anything but iceberg lettuce...sorry...

My B-I-Ls both get this really bad - one of them swears by Organic Cherry Juice

He even gave everyone a bottle at Christmas

The other one just drinks more beer to feel better

Like mentioned above Water Water and more Water...and it seems to run in families too

tracey

feel better

Fortunately, we are in the midst of cherry season right now, so I'm able to bypass the juice and go straight to the source. Otherwise, I was pleased to determine that pizza is approved, as well as cheese and broccoli, so I'm able to buckle down to a weird but tasty diet.

Thanks everyone for all the tips, I'm hoping to get through this without having to hit the doctor for drugs or abandon sweet breads for life and will report back, in case I learn anything of use.

I'm on the pavement

Thinking about the government.

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Staying hydrated - yup.

Cherry juice - well, doesn't seem to hurt.

Was getting it all the time about a year ago. Had started making my own granola. So, looked up on the web, and sure enough, oatmeal is a big no-no. In fact, a surprising number of "healthy" foods - lentils, asparagus and spinach, whole wheat bread, are not good for gout sufferers (in addition to the above-mentioned alcohol, offal, red meat, shellfish, etc.)

The good news? Allopurinal seems to work for a lot of people. I've been taking it for about a year. But for the first six months at least, my gout seemed worse. I'm still taking it though.

The bad news? If you do suffer from it, in most cases the severity and frequency of attacks usually increases over time.

Also, if you have a mild case and want to take over the counter meds, be aware that both aspirin and tylenol can both aggravate it. So advil (or equivalent) is what you will want. I actually find that Advil works better for me than colchicine. I found indomethicin a bit like taking psilocybin or something - it made me feel really, really weird. Kind of out of body feeling, and with the added bonus of something akin to wolverines rampaging through my intestinal tract. Not a pretty picture for you, I'd imagine, and not a pleasant experience for me. Can't do it, even though it did seem to work for the swelling.

Onto the eating and drinking. I've found that organically raised red meat almost always triggers an attack. The factory farmed stuff? Not with any predictability. Anybody else find this? Shellfish? Well, if I drink a bunch of red wine with it - I'll expect to pay, but don't always. Overindulge in alcohol - doesn't seem to have any direct cause and effect. But, overindulge and then abstain for several days and refrain from eating supposed gout inducing foods pretty much the entire time? I always have an attack.

So, my experience is that attacks aren't completely random - there's a few things that do seem to have a fair predictive value of an attack, but often when I'll do all the stuff that should provoke an episode I get nothing. And vice-versa.

I'd recommend, if this does turn out to be more than an infrequent occurrence, that you take notes of what you ate in the day(s) before the attack to see if you can discern a pattern.

I've also found that the attacks can vary greatly in severity (from mildly annoying to wishing for death) and that where you get them greatly affects your mobility or lack thereof. I get them across the top of my foot a lot. Sore, but I can get around. Ankle of knee? Less good. I've had attacks lasting from a few hours to days. I just about never get the big toe anymore.

Good luck with it. I'd talk to your doctor about something like allopurinal - especially if altering your diet to avoid all high-purine foods ain't in the cards. My sense is this can help moderate (but not eliminate) episodes in the majority of sufferers without requiring major lifestyle (ie diet) changes. Worth looking into, imo. YMMV.

cheers,

Geoff

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Most beans not just soy are on the no no list also..so you basically cant have anything but iceberg lettuce...sorry...

My B-I-Ls both get this really bad - one of them swears by Organic Cherry Juice

He even gave everyone a bottle at Christmas

The other one just drinks more beer to feel better

Like mentioned above Water Water and more Water...and it seems to run in families too

tracey

feel better

Fortunately, we are in the midst of cherry season right now, so I'm able to bypass the juice and go straight to the source. Otherwise, I was pleased to determine that pizza is approved, as well as cheese and broccoli, so I'm able to buckle down to a weird but tasty diet.

Thanks everyone for all the tips, I'm hoping to get through this without having to hit the doctor for drugs or abandon sweet breads for life and will report back, in case I learn anything of use.

Warning: This is a long post. And if you have gout symptoms, talk to your doctor.

Thank your ancestors for gout, the gift that keeps on giving. (Insert sarcasm smiley here)

I had my first attack of gout about 18 years ago, after consuming a two pound lobster, some shrimp and quite a large quantity of wine. I didn't realize that it was a gout attack though. I thought that it was a spider bite as we were staying at a friends beach house. My big toe was swollen, red and extremely painful, as if someone had struck it repeatedly with a cast iron skillet, slammed it in a car door and then for good measure stomped on it. After several days, my toe went back to normal and I was fine. I never went to my doctor. Just thought it was a spider bite.

About eighteen months later I suddenly developed pain in my heels. I went to the doctor this time and he told me to stop wearing flat, unpadded shoes. "When we reach this age, we need to change shoes. Get something like Earth Shoes or Ecco's," he told me. I did and the pain went away. I continued to drink beer, eat offal, drink wine and not worry about my diet.

Over the years I had a few more instances of extremely painful joints - knees, toes, fingers, elbows, heels and ankles - but chalked it up to increasing age, possible hereditary arthritis and being on my feet a lot. About two years ago I woke up in the middle of the night after consuming a lot of beer with the sharp shooting pain that gout sufferers know and fear but that I had not associated with gout. I thought I had sprained my ankle. The next day I went to a party for a friend of mine and was describing the symptoms and how quickly they appeared. He looked at me and said, "You've got the gout. I know because I have the same symptoms sometimes."

I did some investigating, made an appointment with my doctor and sure enough, I was diagnosed with gout. "Change your diet," she said. I did and for awhile didn't have any trouble. Drank lots of water, ate pounds of cherries, drank cherry juice, drank pineapple juice and stayed away (mostly) from offal. I even stopped eating as much meat as I was.

Then around March of last year I had a flare up that kept me at home, with my feet up, for 10 days. I drank lots of water, ate ibuprofen like they were M&M's and swore a lot. Finally my doctor gave me steroids for a week, but that didn't help. At last she gave me Indomethacin and I was able to walk again. This relieved the symptoms but did nothing to the underlying cause: The way my body deals with purines and uric acid.

Even though I knew several people who have gout I wasn't on Allopurinol or Colchicine, though several of them told me to get my doctor to me put on them. I was going to change my diet, drink more water and beat this thing "naturally"! Was I ever wrong. At Christmas last year I had the worst flare ever. I was on crutches because my foot and ankle were swollen so badly. I wanted to either self amputate or score some heroin, the pain was so terrible. When the pain finally went away I called my doctor and got a prescription for Allopurinol. It has helped, a lot.

Caveat: It took several months to really start working.

That's not to say that I haven't had some minor flares of gout, because I have. But they certainly have been less painful than before. I'm told that once you start Allopurinol, you are obliged to keep taking it. If you stop, back comes the gout. Also it isn't effective unless you drink lots of water, at least three or four pints a day(And yes drinking that much water will definitely cause you to get up at night). You also need to keep an eye on your kidney function.

As to diet: There is lot of information out here on the "Intrenets"(sic) but you will find that many "Gout Sites" contradict each other about what you can and cannot eat: No meat, meat, mushrooms, no mushrooms, spinach, no spinach, etc. There seems to be a lot of guesswork out there. The best that I can suggest is that you talk to your doctor, do some research on your own and drink lots of water. The one thing that seems to be consistent among the "Gout Sites" is that you should keep your diet at around 55% carbs, so losing weight with an Atkins type diet is out. I still eat everything you're not supposed to eat, but only in moderation. And if I've overindulged I will split one of my Allopurinol tabs and take a little extra(I don't tell my doctor). I still have a big bottle of Indomethacin which I use occasionally as well.

Good luck.

Philly Francophiles

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Charles,

Welcome to the club.

My rheumatologist (go see one of you're just going to your primary care doc) says diet does not trigger attacks, but purine rich foods may (and may is the operative word) make one last a little longer.

I was told more than 25 years ago during a routine physical that my uric acid count was on the high side of normal, and that I may be prone to gout later on. Sure enough, but my initial attacks were fairly mild, and my regular doc doubted it was gout since it wasn't extremely painful.

The specialist eventually tried allopurinol and tweaked the dose after several blood tests so my uric acid level was in the safe range. I take 300 mg/day (one pill) and no gout since. I eat whatever the hell I want, including red meat, many of the so-called purine-rich vegetables and grains, and enjoy alcohol daily.

Jim

olive oil + salt

Real Good Food

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Both my father (so if it's hereditary, I may, too) and my boss have had this problem, and my father was told to avoid chocolate. But my mother is a nurse who dislikes chocolate, and she thinks avoiding chocolate is a cure for just about everything. Just thought I'd throw that in, since those who suffer may want to talk to their physicians about it.

My boss swears by cherries. And since I'm a big fan of cherries, it sounds to me like a good excuse to eat nearly unlimited quantities of them.

I skimmed the posts, so may have missed this, but it's my understanding that gout can also wreck your kidneys. So again, if you're having a less-than-excruciating attack and are thinking of just suffering through it instead of figuring out what's triggering it, you may want to ask your doctor if that's true, and how significant he/she thinks the risk is.

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Both my father (so if it's hereditary, I may, too) and my boss have had this problem, and my father was told to avoid chocolate.  But my mother is a nurse who dislikes chocolate, and she thinks avoiding chocolate is a cure for just about everything.  Just thought I'd throw that in, since those who suffer may want to talk to their physicians about it.

My boss swears by cherries.  And since I'm a big fan of cherries, it sounds to me like a good excuse to eat nearly unlimited quantities of them.

I skimmed the posts, so may have missed this, but it's my understanding that gout can also wreck your kidneys.  So again, if you're having a less-than-excruciating attack and are thinking of just suffering through it instead of figuring out what's triggering it, you may want to ask your doctor if that's true, and how significant he/she thinks the risk is.

Charles, so sorry to hear this news. Hope you're feeling better soon as I've witnessed how painful it can be. I'm so glad I've seen a few mentions here of watching out for kidney damage. My MIL was diagnosed last year, along with Type 2 diabetes. Not a great combo, and in our research we did find mention of the effect of high purine levels on the kidneys. I'll check my files for any saved info to send you.

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Oh yeah. The wonderful world of gout. I know it well.

All my life I'd been an extreme carnivore; then, a few years back, I made a half-hearted attempt at weight loss via Adkins. Succeeded in provoking the king-hell gout attack of the universe, in the classic location, my big toe (why the disease likes the lower extremities: the precipitating uric acid crystals tend to follow the bloodstream and gravity to one of the lowest points of the body, till they wind up in capillaries too narrow to let them pass; they then collect there, the needle-sharp crystals start poking into things, and there you are with a throbbing toe).

My doc slapped me onto a script for colchicine to knock down the acute attack, and then phased me onto allopurinol to keep the gout under control long term. I've been on the stuff ever since.

I have discovered that, for me, the allopurinol works pretty well but is not an iron-clad protection. I can have about 10 ounces of animal protein daily without penalty. Pushing it much above that, though, or pouring too much alcohol on top, or overindulging in certain other foods from the purine-rich lists, starts this tell-tale warning tingle in my toes that, if I were to keep on indulging, could probably turn into a "breakthrough" acute gout attack. I've had no motivation to test that theory--ow. :laugh: So I just back off and take evasive measures whenever the tingle starts.

It was my pharmacist, when I handed him the script for allopurinol, who enthusiastically recommended cherry juice to me. I found that, for me, the stuff really does help head off an attack, and have used it from time to time when I start having one of those incipient breakthrough attacks. I also find putting my feet up helps (gets all those little crystals to quit jamming up in the toes). And yeah, drinking lots of water/fluids (which I'm still notoriously bad at making myself do).

Like many of these things, everyone's metabolism is a little different, so some high-purine foods that are triggers for some people might not set off others, and some folks might be able to tolerate a greater quantity of purine-rich foods than others. Myself, I've noticed I'm especially sensitive to turkey, though organ meats also push my limit. On the other hand, I've consumed numerous meals of sauted liver and mushrooms with no noticeable ill effect--as long as I keep my portion moderate.

I too had read somewhere in the literature that there is a hereditary component, a heritable predisposition to the condition. My dad had had gout--duh! But another more insidious thing I found out is that some people with elevated uric acid blood levels can experience low-level aching joint pain for a long time before the get an acute attack. Duh again--I'd been suffering from that kind of chronic ache for literally years! I'd at first thought it was some form of arthritis; or maybe a fibromyalgia condition; and then came my first acute gout attack and at last I knew what it was. And I'm still teed off at the several doctors I'd had over the years to whom I'd told my chronic pain problem, but not a one of them appeared to think of testing my blood for uric acid levels. Grrr.

Anyway, yeah, it was a sad day when I finally realized that I could no longer get away with tanking on meat the way I used to--but frankly, with my (much healthier) approach to weight management these days, I had kissed my extreme meataholic ways goodbye anyway. There are no foods I avoid now, but I do practice moderation--in other words, as someone once said, "Yes, you can have it all--you just can't have it all RIGHT NOW." :biggrin:

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For what it's worth, I picked up some quercetin and bromelain at the health food store and they seemed to have an immediate and beneficial effect on the inflammation. I'm not positive that they did the trick -- I take all internet-based advice with a grain of salt -- but the swelling was down within hours of my first dose. I'm also consuming massive doses of fresh cherries and blueberries, surely the most pleasant prescription I've ever had filled. Am looking forward to my first bit of red meat in over a week tonight -- we'll see how the toe reacts to organic goat and free-range pig.

I'm on the pavement

Thinking about the government.

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You have my sympathy. I have a good friend who has had gout for many years. He is not on any preventive medicine, but takes some prescriptive med when he has an outbreak. A while ago he backed off red meat, but didn't go cold turkey. He still eats shellfish as well, also in moderation. The only thing he completely stopped eating was smoked meats and head-cheese. For some reason that escapes me he ate a lot of head-cheese. He and his wife have upped their consumption of beans and it has not been a problem. Nor is oatmeal; he eats it every day for breakfast. He drinks red wine, also in moderation. He doesn't think cherry juice does anything for him, but does eat large quantities of raspberries and blueberries. He hasn't had an outbreak in over a year, and he had many of them before that. He believes it's the smoked meats and the head-cheese that are the worst offenders.

Almost every disease has dietary prohibitions and prescriptions that work for some people. Trial and error. Good luck!

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For those who have been helped by drinking cherry juice, is there a minimum daily consumption amount?

I think the effective amount varies with the individual. My practice has been to buy good quality 100% pure cherry juice (as opposed to one of those juice-drink/blend things) from a natural foods store and have myself a couple of big glasses worth.

Dried cherries have worked for me too. Again, I have no precise amounts to offer. There's nothing for it but to experiment and see what, if any, amount works for you.

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This reminds me of my first attack. I was at work on a conference call in the VP's office with the Pres and Sales Manager (small company, I wasn't that important). We were going over the spec of our software. It had been sore for a day or two and I was limping around. But it started to hit hard during the meeting. They got me to take my shoe and sock off, and we watched it swell and turn purple during the call.

I went to my doc after the meeting. He suspected a clot. He hooked two giant (almost as big as meat injectors) needles up to blood pressure gauges. He said, "You're not going to like this, but I'm going to take blood pressure readings from different areas of your legs. If they're not equal, you have a clot." Well after 3 or 4 really painful sticks, he told me not to move. If I did I could die. He called an ambulance to take me to the ER.

The doc there wasn't nearly as freaked out as I was. She hooked up a series of blood pressure cuffs from my groin to my toes, both legs completely mummified by these things. Then she pressurized them all the way down. Weird feeling. She said, "Its gout, that guy's a moron." Take these.

Whew.

Edited by chileheadmike (log)

That's the thing about opposum inerds, they's just as tasty the next day.

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It's much more common than one would think. My dad's had it for years, and at least half a dozen people I know have it too. Dad gets a flare up every now and then, especially if he's had too much red wine and other rich foods over a few days. Anyway, he swears by apple cider vinegar & honey, says it lessens the frequency and intensity of flare ups. Every single morning, he takes one tablespoon each of the vinegar and honey, stirs it into a cup of hot water, and drinks it all down. Dad's gotten a couple of his gouty buddies on this treatment and they say that it's doing wonders for them too. :smile:

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This "Perverse, ungrateful, maleficent malady,"* your body's last-ditch recourse for stashing excess nitrogen, prompted interesting and technically informed threads a few years ago on another forum, popular with wine-interested physicians and at least one widely-respected biochemistry professor, here and here.

I'll add that I checked later a detail surfacing, but unanswered, there. Acc. to the standard general medical text on the subject, allopurinol (as a medication) actually does not clash harmfully with xanthines (caffeine and its relatives), so that factor at least doesn't preclude patients from using coffee, tea, cocoa, yerba maté, etc. etc. if taking that medication. (This being no substitute for individual professional advice, obviously.)

* Title of Roueché's very popular essay on the disease and its history, mentioned in the linked threads.

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Ouch, Busboy :shock:

You'll find recipes for ground-elder and vanilla muffins and ground-elder pie on my blog. They're delicious AND good for you, trust me (I've written more about ground-elder here).

PS Ground-elder is also known as goutweed in English - and that's for a reason :rolleyes:

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Diabetics (I'm one) are prone to gout, but unfortunately cherry juice is sky high in sugars and carbohydrates. There are only so many cherries one can eat, but I read somewhere that strawberries were almost as good as cherries, so ate a lot of strawberries when I had my last attack.

I don't drink and don't eat red meat to excess nor any of the other foods which are blacklisted. One source says that a "diet of rich foods" no matter what kind, is the culprit. Guess they got me there. My left big toe always has a bit of pain to remind me not to get too carried away.

Ruth Dondanville aka "ruthcooks"

“Are you making a statement, or are you making dinner?” Mario Batali

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Allopurinol is probably the best treatment to reduce the incidence of gout for those who are prone to it. Another unpleasant corollary is that those who are prone to gout are also prone to uric acid kidney stones. Talk about adding insult to injury! I take allopurinol because I have had the stones, though not gout so far.

John Sconzo, M.D. aka "docsconz"

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- Ferran Adria on eGullet 12/16/2004.

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