Gout: A Painful Big Toe?

by Gabe Mirkin, M.D.

If you have recurrent pain and swelling behind your big toe or in your ear, you may have gout.

Gout occurs when uric acid crystals precipitate out from your joint fluid to cause pain, swelling and heat. The only way to prove that a hot painful joint is caused by gout is for the doctor to remove joint fluid and to see crystals in it under the microscope. Attacks of gout can be precipitated by being overweight, having a tumor, exercising for a long period of time, taking in large amounts of fructose in special fruit drinks, drinking alcohol, particularly beer, eating large amounts of purine-containing foods or taking aspirin, diuretics or large doses of the vitamin, niacin.

Doctors usually treat painful attacks of gout with aspirin or non steroidal pain medications, such as

indomethacin. After the pain is gone, doctors usually prescribe allopurinol to reduce the amount of uric acid manufactured by cells, and probenecid or sulfinpyrazone to draw uric acid out through the kidneys. Probenecid should not be prescribed to people whose livers make too much uric acid because it will cause kidney stones. Your doctor should ask you to provide a 24-hour urine specimen and check it for total uric acid. If levels are high, you should take only allopurinol and not probenecid.

Doctors usually do not recommend low purine diets to lower uric acid because drugs are so much more effective. High-purine foods include meats, particularly organ meats and seafood, meat extracts and gravies, yeast, beer and other alcoholic drinks, beans, peas, lentils, oatmeal, spinach,

asparagus, cauliflower and mushrooms. A low-purine diet includes refined cereals and white flower, milk and diary products, butter, margarine and other fats, fruits, nuts and peanut butter, lettuce, tomatoes and green vegetables, cream soups made without meat and low-purine vegetables, water, fruit juices and carbonated drinks

Dr. Gabe Mirkin has been a radio talk show host for 25 years and practicing physician for more than 40 years; he is board certified in four specialties, including sports medicine. Read or listen to hundreds of his fitness and health reports at http://www.DrMirkin.com

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