Is rapid weight loss bad for gout?

[eric]

I have had 4 attacks of gout, this is the worst by far. It led me to research it and realized that this was the 4th attack. I see cautions about rapid weight loss, is rapid weight loss more than 3 pounds a week? Has anyone ever seen a number or percent?

I want to try to do things right, and  need to work on the weight, but sure as heck don’t want to intentionally bring an attack on.

This attack hit both feet, ankles big toe, and one foot the base of the toe next to big toe, been on and off crutches for 2 weeks, but today I can nearly walk normally without them

Male, 54, 50 pounds overweight, winter attacks

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Secondary Gout Plan

Weight Loss and Gout

This is a discussion about weight loss and gout. Especially, the common concern – can rapid weight loss cause gout?

Losing lots of weight suggests that you should be on a Secondary Gout Plan. But every case is different. Most importantly, if your uric acid is high, you need to discuss a treatment plan with your doctor. Otherwise, you risk becoming a Gout Victim.

[Keith Taylor (GoutPal Admin)]

Thank you for this interesting post, Eric. It raises many relevant issues.

1. Your main question is difficult to answer. I do not know enough about human biology and nutrition to give an exact answer, but the principles lie in the fact that extremes are bad for gout. Extreme weight gain is bad because there is simply too much cell tissue around. The benchmark for gout weight is BMI, but this is only a guide, as everyone is different. Basically more body mass means more cell regeneration (metabolism) thus more uric acid from the cells that are being replaced. But rapid cell death can also occur when the body is under-nourished. 3 pounds a week doesn't sound too much, but if it is a result of gaining a pound a day for 6 days, then losing 9 pounds in one day for the next weighing day, then this extreme can produce a uric acid overload as your body struggles to get rid of the body tissue contained in that 9 pound weight loss. The best thing to do is monitor uric acid levels, but treat results with caution because results can fluctuate as uric acid crystals form or dissolve. Let's assume that your weight loss is reasonable at 3 pounds per week, and your uric acid is falling, which leads to a seconf important point…
2. Though you have recognised 4 specific gout attacks, you can be sure that there have been many smaller gout attacks in between. These may have been minor, and merely resulted in a little stiffness, numbness or tingling (pins and needles). During this time, uric acid crystals have been slowly building up in your joints. When your blood uric acid falls, through diet or uric acid lowering medications, these uric acid crystals start to dissolve. As they do, they become exposed to the immune system again, and sufficient numbers of dissolving uric acid crystals can trigger another gout attack. This is very difficult to distinguish from a gout attack caused by excess uric acid. Uric acid monitoring and advice from a rheumatologist might help. One aspect that is more common in a “good” gout attack (blood uric acid levels falling) is that it tends to attack many joints at the same time. This is not conclusive, as “bad” gout attacks can also do this, so it is really a question of seeing the big picture, guided by frequent uric acid tests.
3. You mention that you can now almost walk normally. This is typical of gout attacks – they tend to go away in a few days. If you are on a trend of falling uric acid levels, then the attacks will become less frequent, and less intense, as more existing uric acid crystals resolve. Again, the key is uric acid monitoring,  to reassure yourself that you are following the right course of action, and the end is in sight.
4. Finally, you mention winter attacks. Most gout sufferers, myself included, see attacks worsen in cold weather. This is simply due to reduced circulation – as the weather gets cold, blood vessels constrict and blood flow becomes slower in the extremities. In these circumstances, it is much easier for crystals to form and trigger a gout attack. The best course of action is to keep joints wrapped in layers of loose clothing.

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