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To Your Good Health: There Is Prevention for Gout Attacks

Dear Dr. Roach: It seems that this is a bad year for gout. I haven’t had it for several years, but this time I have it in my big toe and the toe next to it. It is very difficult to go through a day with such extreme pain. Many of my friends either have gout or know someone who does. The attacks usually last for two to three weeks. I know to watch what I eat and drink, especially malted beverages and rich foods (heart meats, shrimp, etc.). I have heard that prednisone will reduce the swelling and pain, but also has extreme side effects. I have also heard that black cherry extract is beneficial. My uric acid levels are at the high end of normal. What is the best way to handle a gout attack? — H.P.

Answer: Gout is a condition where crystals of uric acid cause pain and inflammation. The most usual spot is the big toe, but it can happen in other joints, especially the hand. Gout also can cause kidney stones. As everyone who has suffered through one knows, the best way to handle a gout attack is to not get one in the first place.

Some of the treatments we have for gout are designed to prevent gout attacks, others to relieve them when they occur. You mentioned prednisone, which is given for acute gout attack, and can be given by mouth or injected directly into the joint. Prednisone, indeed, has many side effects, especially when taken chronically, and I would never recommend chronic prednisone for gout.

Cherry juice concentrate, when taken regularly to prevent attacks, was shown in one trial to reduce the number of gout attacks. That does not necessarily mean that cherry juice concentrate, cherries or cherry juice will be effective in an acute attack.

Anti-inflammatory medicines, such as ibuprofen, are given for acute attacks, as is colchicine, originally extracted from autumn crocus. Allopurinol is appropriate for some but not all people with gout, and although it can prevent attacks, starting it during an acute attack actually can make it worse. Talk to your doctor about treatment for acute attacks and whether you should be on treatment to prevent them.

Dear Dr. Roach: I have been using tart cherry juice to help me sleep for about three months now, and it is working wonderfully. It is an organic tart cherry juice from concentrate and is unsweetened. My concern is that it has 24 grams of sugar in an 8-ounce serving, which is what is recommended for sleep. Should I be concerned with the sugar content? It is the only natural thing I have tried that has helped me sleep. Thanks. — A.C.

Answer: Today seems to be the day for cherry juice. I found a study that showed improved sleep with tart cherry juice, and you already have found that it worked for you. It may work via the natural melatonin found in the cherry juice. Twenty-four grams of sugar is a lot — about the same found in half a can of a typical soft drink.

— but if you are careful the rest of the day, I wouldn’t worry too much, unless you are diabetic or at risk.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.