Gout attack after diving

[Butchbs1985]

Hello,
I did four dives in Honolulu last week and woke Friday (nearly 48 hours after last dive) with pain in my right Great toe that got progressively worse over the next couple days. Saw an urgent care doc Sunday who thought it was a sprain and got Vicodin. Pain continued to worsen so I saw my family doc yesterday who did an X-ray and bloodwork to determine what it was. Turns out that I have elevated Uric Acid levels so probably Gout which I've not experienced before. My doctor theorized that the gout could have been brought on by being in the cool water (possible based on what I've read) but also suggested that it could be caused by the changing pressure due to diving. Granted he acknowledges that he knows nothing about diving or dive medicine so I figured I'd aske the community.

Is there anything aside from the cool temps that would make a diver more likely to develop a gout attack?
Is there relation known between change in pressure vs. uric acid levels?

I did also of course contact DAN before my appt yesterday just to inquire about possible DCS. Per the DAN medic, DCS is unlikely because pain didn't present unitl nearly 48 hours after the last dive.

BTW, for anyone who hasn't had gout before, it is the WORST pain I've ever felt. Even worse than a broken finger.

Thanks for your thoughts,

---------- Post added January 15th, 2013 at 11:22 AM ----------

Found some answers here: http://www.scubaboard.com/forums/diving-medicine/3668-gout-medication-diving-2.html

Still interested in the thoughts on temperature. Looks like there's no evident relation to change in pressures and uric acid levels based on that thread though.

 

[danvolker]

Hello,
I did four dives in Honolulu last week and woke Friday (nearly 48 hours after last dive) with pain in my right Great toe that got progressively worse over the next couple days. Saw an urgent care doc Sunday who thought it was a sprain and got Vicodin. Pain continued to worsen so I saw my family doc yesterday who did an X-ray and bloodwork to determine what it was. Turns out that I have elevated Uric Acid levels so probably Gout which I've not experienced before. My doctor theorized that the gout could have been brought on by being in the cool water (possible based on what I've read) but also suggested that it could be caused by the changing pressure due to diving. Granted he acknowledges that he knows nothing about diving or dive medicine so I figured I'd aske the community.

Is there anything aside from the cool temps that would make a diver more likely to develop a gout attack?
Is there relation known between change in pressure vs. uric acid levels?

I did also of course contact DAN before my appt yesterday just to inquire about possible DCS. Per the DAN medic, DCS is unlikely because pain didn't present unitl nearly 48 hours after the last dive.

BTW, for anyone who hasn't had gout before, it is the WORST pain I've ever felt. Even worse than a broken finger.

Thanks for your thoughts,

---------- Post added January 15th, 2013 at 11:22 AM ----------

Found some answers here: http://www.scubaboard.com/forums/diving-medicine/3668-gout-medication-diving-2.html

Still interested in the thoughts on temperature. Looks like there's no evident relation to change in pressures and uric acid levels based on that thread though.

According to the guy I believe is the BEST resource on the Internet for Nutrition and Health Advice, Dr Mercola....With Gout..."...the REAL underlying problem causing the inflammation, and subsequent damage, is likely due to having chronically elevated blood sugar. (The sugar molecule causes far more damage than any other molecule.) And, your number one way of normalizing your blood sugar and insulin levels is through your diet."

Dive boats tend to have THE WORST food and drinks on board possilbe, things that cause and promote Diabetes and Gout.....Coke...Oreo Cookies, pretty much everything is sugar. Even if you go with diet sodas, this typicaly means Aspartame, which is horrifically inflamatory in people that are sensitive to sugar or to Aspartame( lots of people )

So I am suggesting you look at your diet around the dive trip, as well as during the trip.

Try visiting How to Eliminate Gout Without Dangerous Drugs

 

[Sevenrider860]

How about the temperature in general?

Many people travel to Hawaii or the tropics during Winter and end up becoming dehydrated because of the warmer temperature and humidity. Did you stay well hydrated?

Just thoughts....

 

[tridacna]

According to the guy I believe is the BEST resource on the Internet for Nutrition and Health Advice, Dr Mercola....With Gout..."...the REAL underlying problem causing the inflammation, and subsequent damage, is likely due to having chronically elevated blood sugar. (The sugar molecule causes far more damage than any other molecule.) And, your number one way of normalizing your blood sugar and insulin levels is through your diet."

Dive boats tend to have THE WORST food and drinks on board possilbe, things that cause and promote Diabetes and Gout.....Coke...Oreo Cookies, pretty much everything is sugar. Even if you go with diet sodas, this typicaly means Aspartame, which is horrifically inflamatory in people that are sensitive to sugar or to Aspartame( lots of people )

So I am suggesting you look at your diet around the dive trip, as well as during the trip.

Try visiting How to Eliminate Gout Without Dangerous Drugs

1. Mercola is a quack. No question. A very rich quack. An excellent marketing quack too.
2. Aspartame has been shown to have anti-inflammatory properties. Exactly the opposite of what you (or Mercola?) claim. Aspartame: Sweetener with anti-inflammatory potential?
3. Not ALL dive boat food is bad. I've been on many that served fresh fruit. Perhaps you feel that also raises sugar levels and may be a causal agent for gout?
4. Which sugar molecule are you referring to? Glucose, fructose, lactose?

 

[uncfnp]

Trauma and irritation can also lead to a flare up of gout. I would think that repetitive diving would itself qualify, then add in cold water...

Here is a good general reference

http://www.mayoclinic.com/health/gout/DS00090

A slightly more technical article

http://www.ccjm.org/content/75/Suppl_5/S2.full.pdf

And a good source of diet and gout as we currently understand it

Gout diet: What's allowed, what's not - MayoClinic.com

 

[graham_s]

I am prone to gout.
I've never had an attack after diving though.
The main things that I find bring it on are dehydration and oily fish.
Avoid food with high uric acid content.
As soon as I feel the attack coming on, I take Diclophenac (anti-inflammatory med) and that usually sorts it out.

 

[Butchbs1985]

According to the guy I believe is the BEST resource on the Internet for Nutrition and Health Advice, Dr Mercola....With Gout..."...the REAL underlying problem causing the inflammation, and subsequent damage, is likely due to having chronically elevated blood sugar. (The sugar molecule causes far more damage than any other molecule.) And, your number one way of normalizing your blood sugar and insulin levels is through your diet."

Dive boats tend to have THE WORST food and drinks on board possilbe, things that cause and promote Diabetes and Gout.....Coke...Oreo Cookies, pretty much everything is sugar. Even if you go with diet sodas, this typicaly means Aspartame, which is horrifically inflamatory in people that are sensitive to sugar or to Aspartame( lots of people )

So I am suggesting you look at your diet around the dive trip, as well as during the trip.

Try visiting How to Eliminate Gout Without Dangerous Drugs

Thanks. Diabeties runs in the family but I've never had high blood sugar. Did have a minor kidney disorder a few years ago but it's well under controll but most likely suspect according to that site. I don't give a whole lot of credit to medical websites other than published studies though. Food on board wasn't bad at all. Water and fresh Pineapple (it is Hawaii).

How about the temperature in general?

Many people travel to Hawaii or the tropics during Winter and end up becoming dehydrated because of the warmer temperature and humidity. Did you stay well hydrated?

Just thoughts....

Wife Definately got dehydrated. Climbed Diamond Head but she didn't drink any water. Nasty headache later of course. I try to stay well hydrated but it is a possibility. Thanks!

---------- Post added January 15th, 2013 at 12:40 PM ----------

Trauma and irritation can also lead to a flare up of gout. I would think that repetitive diving would itself qualify, then add in cold water...

Here is a good general reference

Gout - MayoClinic.com

A slightly more technical article

http://www.ccjm.org/content/75/Suppl_5/S2.full.pdf

And a good source of diet and gout as we currently understand it

Gout diet: What's allowed, what's not - MayoClinic.com

Love the articles. Thanks.

I am prone to gout.
I've never had an attack after diving though.
The main things that I find bring it on are dehydration and oily fish.
Avoid food with high uric acid content.
As soon as I feel the attack coming on, I take Diclophenac (anti-inflammatory med) and that usually sorts it out.

I think the food is going to be key with me. As someone who is prone to gout, do you drink beer or red wine? Biggest issue for me will be limiting red meat and beer. Don't drink in excess but love a craft beer or two in the evening so just wondering if moderation is key or if I need to cut it out entirely. Love a glass of red wine with pasta dishes too but both are high in purines

Have you ever just used ibuprofen? I wonder if it would be as effective since I have it on hand all the time for migranes. Thanks,

 

[danvolker]

1. Mercola is a quack. No question. A very rich quack. An excellent marketing quack too.
2. Aspartame has been shown to have anti-inflammatory properties. Exactly the opposite of what you (or Mercola?) claim. Aspartame: Sweetener with anti-inflammatory potential?
3. Not ALL dive boat food is bad. I've been on many that served fresh fruit. Perhaps you feel that also raises sugar levels and may be a causal agent for gout?
4. Which sugar molecule are you referring to? Glucose, fructose, lactose?

Absolutely wrong..
I would put Mercola's ideas on nutrition over the last 15 years up against any "traditional Pharmaceutical Symptom treating MD", and I would win
I have used Mercola's ideas for over 20 years now, to maintain a competitive advantage over cyclists half my age..... I never need to use drugs or the symptom treating non-sense the REAL Money Makers of Medicine have brainwashed you with....( that would be the pharmaceutical industry, and the MD's that were brainwashed to believe in treating symtoms over trying to cure....)
I have many friends that are MD's, and the ones I respect the highest are the ER Docs, and the Research MD's.
The worst tend to be GP's and Orthopedic Docs, for the damage their mindsets can cause, if they are the type that just let the drug companies and insurance companies dictate the form of care they focus on providing.

Fructose is the worst, Glucose not as problematic, but it is still going to cause a blood sugar spike if you consume to much of it.....Which is typical.....Not typical is for blood sugar to spike from consuming protein or very complex carbs.

I avoid fruit for the fructose, and no longer eat bread or pasta, due to the high Glycemic Response.
Divers would be much better served by a Sports Drink after diving like Hydrate, with no sugar and the right mix of nutrients.
See H2O Overdrive Hydrate - 16oz - Jostaberry Grape Explosion - Case of 12 for ingredients. All fruit juices are going to cause major sugar spiking and blood sugar elevation.....and most fruits are going to have to much glycemic response in the quantities they are consumed in...
Fructose shows relatively low glycemic indexing, but the response is what is important, and Glycemic index is not worth even looking up.

Are you familiar with A.G.E. ? Advanced Glycation End Products?
This was not a topic Mercola entered into first...there were many researchers that found their way to this first, but it ties in beautifully to everything Mercola discusses relating to nutrition.... When you understand how frequently AGE is involved in the high sugar diets of most Americans, and the effects of the chronic inflamations it will cause....this leading to everything from Arthritis, to heart disease, cancer and a huge assortment of the popular illnesses of today...when you read up on A.G.E., the likelihood is that you will see Sugar as the threat that it really is...and how right Mercola has been for so long on how we can prevent diseases.

 

[cutlass]

Because no bodily gas spaces are involved, I don't see how depth pressure by itself has a direct effect on gout attack; excluding other causes of circulation inhibition such as suit or equipment strap squeeze. However, scuba diving typically involves breathing extremely dry gas and exposure to cool water. The former promotes dehydration which can increase uric blood concentration and also reduce kidney efficiency in removing uric acid. Cold can promote crystallization of uric acid and also induce vasoconstriction which can both reduce flushing efficiency and mechanically concentrate uric crystals. But I'd expect an acute attack to occur in the presence of or soon after these conditions. The 2-day delay is a little puzzling; diving might be unrelated unless it can be linked to triggering uric acid buildup. I do see some history and diet watch items in the above posts; viz., familial diabetes, "minor kidney disorder a few years ago", proteins (meat), beer, wine.

 

[Butchbs1985]

Because no bodily gas spaces are involved, I don't see how depth pressure by itself has a direct effect on gout attack. However, scuba diving typically involves breathing extremely dry gas and exposure to cool water. The former promotes dehydration which can increase uric blood concentration and also reduce kidney efficiency in removing uric acid. Cold can promote crystallization of uric acid and also induce vasoconstriction which can both reduce flushing efficiency and mechanically concentrate uric crystals. But I'd expect an acute attack to occur in the presence of or soon after these conditions. The 2-day delay is a little puzzling; diving might be unrelated unless it can be linked to triggering uric acid buildup. I do see some history and diet watch items in the above posts; viz., familial diabetes, "minor kidney disorder a few years ago", proteins (meat), beer, wine.

Agree. This may be what it takes to get me on a better diet. Ironically, the doc had previously suggested a low carb diet which is opposite of what I'll be going for now due to purines. Controlling uric acid seems like a catch 22 situation though because you are to limit meats and carbs. That doesn't leave too much other than vegetables, fruits, and a small amount of whole grain. I've tried to 'learn to love' salad but that's not worked out so we'll see what I can come up with.

Suggestions?