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Dietary conflicts

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pippin

Well-Known Member
I am really feeling upset about this as there seems to be a struggle with my dad following a strict diabetes recommended diet with all the whole grains and oats in breads and cereals. I have been following all the rules and now he has a severe attack of gout (the pain is dreadful and he can only walk a very short distance using crutches) feeling so stressed myself :(

He has had to take medication for the gout (oats, soya (in one make of bread) and whole grains are high in purines which have built up to cause gout) Porridge for breakfast and oatabix very good for BG levels but now we have purines to cope with. I have only been buying wholegrain/granary bread which possibly hasn't helped either yet how does he eat as advised for his diabetes?

I don't even think the nutritionist we saw could equate what we meant although now we have evidence of how the purines have affected him. He will hopefully see the Dr tomorrow about the gout plus we both think our case for a BG monitor is now a necessity as we don't know at all what his levels are especially now he is taking other medication and is afraid to eat any oats or whole grains. Nightmare as I don't know which cereal or bread I can buy to keep to his diabetes regime.

Felt guilty this morning by adding some rice crispies to his shredded wheat to try and balance his breakfast.
Everything was going well with the proper diet (well until we know his HbA1c result next month!) now we have this I am totally confused and down.

Well he can eats nuts as they come into both diets!
 
Very sorry to hear all this Pippin :( I'm afraid I don't know a great deal about the correct diet for gout sufferers, but would be interested to know what aspects of that diet are incompatible with the diabetes-friendly diet. What we can eat as diabetics covers quite a broad area, and it may be that, for those recommendations that are causing other problems because of the gout, they can be left out of the diet and alternatives given instead.

Perhaps if you could give some examples of what is best for your father's gout problem and the members here could say whether they would be OK or suggest alternatives that would suit both conditions.

Try not to get too down about it. I know it must be distressing to see your father suffer when you have been trying so hard, but you will get there, and we will do our best to help you both 🙂
 
Hi Northener (oops this is long don't worry about reading all of it)

The very strict gout diet is restrictive to be followed when under a severe attack - Cauliflower and all green leafy veg plus oily fish are totally out of bounds (rich in iron & purines)

Ripe bananas - good for gout - we have been advise bananas are best to be eaten when not so ripe for diabetes.

Eggs are fine although on the strict diet they exclude the yolks

Bread and breakfast cereal but NOT whole grain or oats (most have whole grain etc and only the sugary or refined cereals are allowed for gout but we don't include them because of diabetes) Strictly speaking shredded wheat has whole grain but it's the only thing we have atm which doesn't have oats.
I stopped buying white bread and also wholemeal yet if I use bread with oats or whole grains I add to the purines.

They suggest yoghurt and fruit or fruit smoothies plus honey for breakfast!
Dad prefers toast although this morning he ate very little of it & he had started to enjoy cereal more regularly. I don't think he would have yoghurt for his breakfast.

Gout allows chocolate, ice cream and biscuits which we don't include any way so this is ok for the diabetes side. Pure butter no low fat spreads for gout

Brown rice is the one which the gout diet recommends especially if combined with almonds and sweetcorn - basmati for diabetes diet.......and how much sweetcorn is he allowed for diabetes (again we would need to test)

High purine list is all the oily fish
medium Chicken/Beef Pulses (all the ones which are excellent for controlling BG levels) including peas, lentils and soya Wheat germ and bran!

Cherries are excellent for gout which is why dad pre-diabetes drank cherry active which helped lessen any gout tendencies :(

The diet is very restrictive yet they warn to eat enough as loosing weight can make gout worse.

Just another point to add his statin was put up to 40mg as a general thing in September (previously on 20mg) I found the letter which showed on of the side effects can be muscular pain (we can't decide between the gout and muscle pain) it was also in DUK's Balance magazine so we have asked the Dr would this be adding to the pain and they may look to reducing his statin.

His Frusomide doesn't help gout but helps his heart and now his statin is supposed to be at a 'one fits all dose' and it may be affecting his muscles! Gout and diabetes are all circling around meds used to solve one problem but cause others :( I know some must be in his genes but the whole situation is a vicious circle.

It wasn't too long ago when they could hardly find his medical records as he was never at the Dr and now I am sure it is a tome! medication and food at war

Many thanks for your support. I hope we can get a bit further with the pain when the Dr sees him tomorrow and then maybe a dietician who can work both problems out as I feel as if I am doing a degree 😉 looking after knees and feet and diet now.

wee guess they may put him on meds for his diabetes (which is what I was trying to avoid) but it may be the only way to work this out as his good diet has now become :(

I know this is probably impossible for anyone to understand. I will report back when he sees the Dr although I don't think any of them really know how hard it is to cope with.

Thank you for listening to me as it helps my mind which was struggling to cope with all of this
 
Oh dear, I can see your difficulties now Pippin - quite a few clashes there :( It may be that, if he isn't able to keep to the best diet for his diabetes then he may need help from medications, but with such a complex combination neither you nor he should see it as any kind of failure. Quality of life is very important too, so if the medications allow him to be more flexible in his diet then they are worth having.

Regarding statins - 40mg is the normal dose that they gradually get people on. If there isa possibility of your dad suffering side effects - like the muscle pain you mention - then there are other versions available which may suit him better. Unfortunately, he can't take the alternative route of trying to keep his cholesterol in check by eating oily fish, or even the dairy products containing plant sterols, because of the gout.

I hope that the dietician, when you see her/him, is able to rise to the challenge and devise an eating plan that keep both problems in check and also is something that your father is able to enjoy! Do keep us updated, and remember we are always here if you want to let off steam or just talk things through 🙂
 
Sounds like you need to see a good dietician who can help you work out a suitable diet for your Dad. Hope your Dr is able to help.
 
Hi Pippin.

Have you looked at pasta, or is that bad for gout ?

ALso, if weight and cholestorol aren't an issue, adding some fat to any meal will delay digestion and reduce any spikes.

If it were me, I would be tempted to extend the diabetes diet list to medium GI foods and look at ways of combining or modifying meals to lower the GI without including wholegrains, etc.

Rob
 
Pippen - who was the nutritionist you saw? Were they a registered dietician? You really need proper advice for solving your Dad's conflicting dietary needs. Hope you get some help soon.
 
Many thanks for all your replies! Just on my phone ATM but will read everything in detail tomorrow. Hopefully I can remember most of it in this reply

The dietician comes to our surgery to see diabetics each month although I really don't think she was experienced enough to cope with this situation. We have another appointment next month & I intend to take the gout sheets I have with me. Going to get dad to ask if we could see someone more specialised to work out a plan as it is a nightmare for me to get both right.
I didn't realise a little extra fat will slow down a spike thank you for this tip.

If the gout was under control I will have to balance the amount if purines with the healthier eating for diabetes. At the moment oats are out even dad who never refuses food is afraid to eat them! All the meds are making him less hungry which is an added worry as both conditions need to maintain weight.
Hard to believe if he hadn't gout he never stops although with each attack his joints are more damaged :(

I am exhausted as I'm coping on my own my sister will take him to the Drs but this time he knows for sure what he needs to ask and I will add more expert advice on the diet. If only there was a balance he didn't mind the diabetes one as he was fortunate he enjoyed healthy food the gout one is more restrictive. Pasta is fine which is a good thing although white pasta for gout and I had changed to wholewheat!

Thank you very much I will report back hoping they don't send him to hospital tomorrow :( I will do all I can plus even in the hospital who works take time to cater for both diets! Really appreciate all support as I have been really down for the last few days when the gout really took a hold. Hard to watch the s-l-o-w movements only when absoutely necessary. My file is building up with food lists!
 
Even in my iPhone I type too much!! Nervous energy 😉
 
Your Dad's complex needs certainly require an appropriately experienced dietician - please ask your GP to refer you to a hospital clinic.
 
Update after Dr saw dad this morning although unfortunately the aspects of diabetes v gout were of less concern to the Dr than treating a combination of Gout and arthritis. Dr knows we follow dietary advice to the letter but even when dad mentioned a more senior dietician it wasn't followed with 'definitely looking into this' he responded but nothing which indicated a *noted* to do list...

There is a bit of a dilemma as gout only started with the other meeds dad takes - bit like diabetes which is mainly shown to happen in people who are over weight - eat lots of sugary foods etc (none of these apply to dad) gout is rich food and drink (dad has never sipped an alcoholic drink in his life!) I always feel embarrassed mentioning gout in case people think it is his lifestyle.

The severity of this attack relates to a previous on on his other knee about a year ago. We bought the Cherry drink as cherries are the only documented fruit known to lower uric acid levels in the blood. Stopped this when he was diagnosed with gout which may be why this is so vicious plus the extra oats etc I have Cherry Active capsules which look to be lower in carbs so I will investigate this option.

Part of the knee has the gout crystals and another part shows arthritis plus the tendons at the back of his knee are swollen (I was really worried about the lump there) Although I was relieved to see dad coming home (I was terrified about the hospital) & we have more gout tablets plus advice we still don't have the dietary advice. I think the other Dr would have taken more of this on board.

Our options atm are to speak to the nurse when she sees dad and tell her that we feel we need a specialist dietician plus I will investigate a private option if they don't see there are complex issues. The DSN is next month and so is the other dietician. I will be taking the pages of gout info which may mean she will *have* to pass the case on to someone who is more specialised.

On a better note although we still need to ask about the strips one of the companies I applied for the BG monitor rang this morning to let me know we are getting one. The first company hasn't contacted at all although they said 28 days.

I am totally exhausted dealing with this but will keep on going until we resolve the issues. We never had any problems with our surgery and they know we don't pester etc but now we have added diabetes to the care we really need to find out what the limits are especially when they know we don't abuse the system.

Think when dad feels better pain wise he will be more vocal as he knows the affect on both of us. I am really feeling the stress of watching all of this :( Just feel so tired today as I don't think I have stopped doing things and I don't have the best energy in the world either!

I have taken the GI advice Robster65 and will work with this hoping to get the gout under control without affecting his BG. Going to check out how many ways I can cook sweet potatoes! Cheese and pasta are allowed on both within the limits. Thank you for the lower GI tips

Thank you to everyone - when I feel more awake I will be checking more of our options and I will update this post when things start to come together (hopefully) Dr was good for the current problem but seemed lost for both??.
 
Thanks for the update Pippin. Even though we are not qualified to help you find a solution to the conumdrum of your Dad's diet, we are here to support you as much as we can. Try to make sure you find sometime for yourself. I know it is easy to say and difficult to do, but from what you have told me you have already had an exhausting time helping to care for your Mum, and you need to make sure you keep your own strength up. I have been reading a very good book lately about caring (I read a LOT of books! 🙂) and if you can find time to read it I would recommend it. It is called The Selfish Pig's Guide to Caring by Hugh Marriott. Don't be misled by the title - it's not implying that you are in any way selfish! It's one of those books that helps make what you do easier to cope with by talking about things you may not have considered, and is very light-hearted too! 🙂

Best wishes to you and your Dad. I hope your Doctor confounds expectations and goes ahead and arranges for you to see an appropriately qualified dietician, and that you don't need to wait too long.
 
Thank you Northener
I really appreciate support and understanding. It is easy to feel really guilty taking 'me time' Love the title of the book and I will have a look as I read a lot of books too 🙂 both of us read a lot although as you can guess my latest reading list has been diabetes and now it's gout!

Both of us cared for mum but now it's just me to care for dad which can feel a little more strain although now I understand why dad kept the severity of MND from us as long as he could. The strain of this is what caused his raised blood pressure going unchecked which in return started all of the heart problems. Vicious circle with tablets and caring....hopefully I will sleep better and be more refreshed to get going again. It's in my nature to keep on going despite the fact I have a few health issues myself.

Many, many thanks going to sort out a few things and then it's early to bed for me. Dad does shout about me doing too much but it's hard not too when your me 😉 this forum has been the best bookmark I have made this year 🙂
 
Update to situation after spending all the time I could looking after dad with special attention to both diets. I am excited today as this is the first day I have noticed the most improvement 🙂 his knee isn't as much like a football now plus he has a lot more movement. Still depending on the crutches but now can put his foot down which he couldn't do without pain.

I studied both diets although I had to look at the oat aspect and limit bread as most have oats as part of their 'high in oats' healthy label! No red meat at all and the first meat he had was a small portion of chicken last night. I made a 'concoction' of sweet potato & squash with the spices which are good for Gout (turmeric, cinnamon etc) haven't a clue what it tasted like but dad ate it. (like a soup but much more filling) the rest of the time I tried to serve as much as possible raw thinking of the lower GI plus trying to loose as little of the important vitamins/minerals as possible.

There are a few friendly type dips which I made to serve with raw veg.
Gout diet suggests egg to be eater with fruit juice although we didn't go this route but did maintain his allowed portions of fruit in the combo to work with both plus nuts in moderation.
He still had a shredded wheat but no porridge or any oatcakes (Nairns) just to get the healing process going.

Somedays I really got down as there seemed to be no change although I am annoyed that dad's HbA1c in April will not be as good as I hoped given we have had to restrict oats and whole grain which help with BG levels. We had stayed so much to the advised diet I was really hoping to see an improvement but now don't know what the result will be although we haven't stepped outside the basis of the diabetes diet (just had to lessen the foods which give it a boost)

I have been doing dad's knee and feet each day, did them today and didn't realise I was working with the bad foot and knee 🙂 SO pleased as it felt different to all the other days when I had to lift it so carefully! Knee still odd shape but foot a better colour.

One of the BG monitors I applied for arrived yesterday 🙂 although we still have to ask about using this (hopefully they will see why we really do need to use one) I tired for the Abbots one last month but it didn't arrive although the say 28 days.
This is a Glucomen one with 10 strips in the set haven't used any sort of thinking maybe we need to wait to be 'allowed' The dietician will have her work cut out when we bring the facts of both problems.

Thank you for all your support there has been ups and downs (mainly with me) but today has been a lot brighter. Hoping progress continues even if it is slow?. trying not to get too excited just yet.
 
Very glad to hear about the improvments Pippin 🙂 And thank you also for all the useful information you are bringing to the forum about the difficulties of combining both diets - I suspect you are starting to become more expert than the dieticians you are likely to encounter, as there is nothing like personal, day-to-day experience to sharpen and inform the mind. Keep up the good work! Hopefully, you will be able to get some strips provided for the Glucomen meter so you can get more useful information from observing and recording the effects of your 'concoctions'! 🙂
 
Thank you Northerner

I have just registered the monitor, somehow I don't think he would appreciate me ordering a pink cover for it 😉
Definitely need to test my 'concoction' if we need to continue or introduce it from time to time.

I am going to try and get info on suitable bread. The Gout site may reply although they just send an out of office stat reply. I have another contact which I will look up and see if they can suggest anything given both diets.

A lot to learn although I am finding it interesting just have to learn when to stop for a wee rest 😉
 
Whilst its great you are taking such care in looking after your Dad - make sure you don't forget yourself. You need to take care of you too and make sure you get enough rest so you are able to take care. (Your last line made me think you might be in danger of over doing things)
 
Hi Margie you really have summed me up I tend to use all my energy to care always have done but it is to the detriment of my health. I spent more time looking things up today then doing the things I thought needed done now when I've stopped I realise I am going to have to take it easier as I am really tired. Will need to build up some energy as we wouldnt have any food to cook!
Not like me to leave the ironing & admit it's too much for me to do today!

Thank you for caring I appreciate this as sometimes I make myself earn time to rest when even dad tells me to relax. I'm wound up like a spring at times.
Everyone needs to take care including all of you as your support is excellent 🙂
 
Thought I would update although we still don't have any official advice April is getting closer when dad gets his HbA1c test plus we see the dietician.
I've just been coping with both diets although he still needs crutches the swelling and pain are a lot less 🙂 we have been very strict keeling watch in food ph values along with everything else. Really had to increase portion size and variety as I felt so sorry for him but still watching the type of food.

The second monitor arrived 🙂 although we haven't used either of them until we see if there is one which we can get extra strips for. Tempted to try but with only 10 strips I might worry too much until he sees the nurse.
I haven't been back to update as I really am exhausted went out on Friday to wait at Apple & haven't recovered my energy since then!

I'm happy things haven't got worse just hoping the next week will see dad less dependent on his crutches. Podiatrist on Wednesday with the critical reports in April. Bit worried as we had to mix & match the diets. If we get back to normal I think he can introduce the other good foods but have to watch the amounts he can tolerate.

I've compiled my lists for the dietician 😉
 
Hi Pippin, glad to hear that Dad is feeling a bit better, hope things continue to improve 🙂 Regarding the meters/strips - your doctor can prescribe strips for practically every meter, so if yours are common meters don't worry about not being able to get the strips. I get two different types of strip as I have a main meter and a back up meter.

Hope YOU can get some rest to recharge your batteries, and that Dad is feeling well enough to tolerate a bit more flexibility in his diet 🙂 Take care.
 
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