We all are familiar with gout attack if you have ever suffered. The first sight is that your big toe joint feels extremely swelling and painful for no reason. It lasts about 2 weeks. You can’t walk or stand even touch your toe. Then, you go to see a doctor for help. The doctor will prescribe as Colchicine and Indomethacin. In addition, your doctor will ask you to get a test of eGFR (Estimated Glomerular Filtration Rate), creatinine and uric acid. You take the medicines right away. Then you feel relieved. Your doctor might tell you to avoid high purine foods, such as beer, red meats, liver, seafood, beans etc. In the end, you are back to your life and you wonder what was happening to your body and why you got it not others. How do you avoid it?
Are the high purine-rich foods the problem causing gout attack?
High purine-rich foods, such as meat and seafood, contain proteins. Your body begins to digest protein in the stomach with the use of enzymes called proteases (mostly pepsin) which break the chemical bonds that hold proteins structures together.
From here, food travels to the top of the small intestine where the pancreas releases more proteases (trypsin and chymotrypsin) to continue the digestive process. Once the remaining chemical bonds are broken down, the food travels down the intestine. If conditions are right, these amino acids should be absorbed into the bloodstream before the time they exit the body as waste.
These amino acids are carried through the bloodstream to the various cells of the body. Once within the cells, they are used by cell organelles called Ribosomes to create whatever protein that cell needs, like antibodies, muscle, collagen, hormones and enzymes. This is done with RNA, a copy of the DNA in the cell’s nucleus. Amino acids that are not used by the cells of the body are broken down by the liver in a process known as deamination. This removes the nitrogenous amine group, digesting the remainder as carbohydrate. The waste amine groups are converted into uric acid and passed to the blood where they are filtered by the kidneys.
Higher levels of meat and seafood consumption are associated with higher serum levels of uric acid. Dairy consumption was inversely associated with the serum uric acid level. 
Avoiding high purine-rich meat and seafood consumption can reduce the level of uric acid generated in the body. However, the waste of uric acid produced from cell metabolism is higher than the waste of uric acid from high purine-rich foods produced. Our body keeps the level of uric acid (a natural antioxidant) in a balance state. Suddenly bursting of excess the level of uric acid will lead to gout. If it gets too little, it may be associated with a molybdenum deficiency, copper toxicity and a worsening of multiple sclerosis.
Many important functions of Purines in the cell 
- The formation of the monomeric precursors of nucleic acids DNA, Deoxyribonucleic Acid, and RNA, ribonucleic acid,.
- It modulate energy metabolism and signal transduction.
- It is structural components of some coenzymes and it plays important roles in the physiology of platelets, muscles and neurotransmission.
- All cells require a balanced quantity of purines for growth, proliferation and survival.
- The enzymes involved in the purine metabolism maintain in the cell a balanced ratio between their synthesis and degradation.
- The final compound of purines catabolism is uric acid.
What does my body differ from others in term of gout attack?
Uric acid is a waste of cell metabolism from protein consumed. Higher concentration of serum level of uric acid not excreted by kidney causes crystal precipitation any where in the body especially at joint. It causes kidney failure if it precipitate in kidney. That’s why a doctor will check your kidney to make sure it function well. Kidney is the only organ to get rid of such waste. It also regulate the serum level of uric acid in a balanced range. If you drink enough water, your concentration of serum level of uric acid will drop. You will not be likely to get gout attack. High strenuous exercise in a short time also will increase waste from the muscle and lead higher serum level of uric acid and lead to gout attack if you don’t drink water after exercise. Therefore, drink enough water daily or after exercise, you will not be likely to get gout attack.
Nature Remedy of Gout attack
- Taking 1 teaspoon of apple vinegar in a cup of water twice a day will dissolve the crystal of precipitate at the joint. However, do not take the apple vinegar drink with empty stomach. Always have apple vinegar drink after your meals.
- Walk slowly and massage pain nearby area to make blood circulate well in the period.
- Take some anti-oxidant vitamin and grape extract C to help to reduce inflammation at the joint.
- Drink more water always in the period. It helps to reduce concentration of serum level of uric acid.
- Stop eating high purine-rich food in the period
Side effect of medicine to treat gout attack
Colchicine: diarrhea, nausea, cramping, abdominal pain, and vomiting may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Indomethacin: vomiting, upset stomach, heartburn, diarrhea, a feeling of bowel fullness, constipation, bloating, gas, rectal irritation, dizziness, nervousness, headache, skin rash, itching, blurred vision, or ringing in your ears.
Stop taking the medicine if the symptom goes away. try not to take medicine if you can due to impairing your immune system.
Balanced purine-rich foods are essential to avoid spiking of serum level of uric acid. Avoiding strenuous exercise can reduce additional uric acid in the blood. Drinking more water daily may reduce serum level of uric acid and help kidney remove uric acid from your body. Drinking less water causes gout attack unless you have issues that add uric acid in the bloodstream.
Adding a little of vinegar in your diet may help to avoid from gout attack.
Most of uric acid is excreted (removed from your body) in your urine, or passes through your intestines to regulate “normal” levels. Normal Uric acid levels are 2.4-6.0 mg/dL(female) and 3.4-7.0 mg/dL (male).
Creatinine is a chemical waste molecule that is generated from muscle metabolism. The kidneys filter out most of the creatinine and dispose of it in the urine. The kidneys maintain the blood creatinine in a normal range. Creatinine has been found to be a fairly reliable indicator of kidney function. Elevated creatinine level signifies impaired kidney function or kidney disease. The normal serum creatinine value are 0.5 to 1.0 mg/dL (about 45-90 μmol/L) for women and 0.7 to 1.2 mg/dL (60-110 μmol/L) for men.
Reference Choi HK1, Liu S, Curhan G. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey. Arthritis Rheum. 2005 Jan;52(1):283-9.  Jessica Maiuolo, Francesca Oppedisano, Santo Gratteri, Carolina Muscoli, Vincenzo Mollace. Regulation of uric acid metabolism and excretion. Institute of Research for Food Safety & Health (IRC-FSH), University “Magna Graecia” of Catanzaro, Italy Received 10 August 2015, Accepted 10 August 2015, Available online 14 August 2015.