Rheumatoid arthritis and gout are unlikely to be at the top of an active person’s wishlist, if they’re even on your radar at all. Provided you’re doing sport and eating well, shouldn’t that be enough? Unfortunately not, as staff writer Patrick has experienced. Facing a double diagnosis, he explains how he’s now able to ride pain-free again, and why his mealtime portion sizes have shot up.

DISCLAIMER: We’re neither medical professionals, nor miracle healers, but we love riding our bikes and doing other sports. We’re not as young as we once were and injuries and ailments—as you may know—are becoming increasingly frequent. It’s for this reason that we’re creating a series of articles to share our experiences with people like you, who may well be going through something similar. Expect to read what we are experiencing, how’s it being treated, what’s working for us and what’s not.

Don’t read this expecting a Sermon on the Mount from the Apostle Nutritional to cure all your ailments… Although I can promise that mountains will feature – both for your eMTB and on your plate. But all in good time, friends. First, let’s go back to 2014 when I (Patrick) was 38 years old, and struck by a nagging pain in my right shoulder. It came on without warning and, as far as I could tell, without any real reason. As a sporty individual, I presumed that if something came from nowhere, that’s also where it would end up disappearing off to when it was ready. Alas, no. It continued to plague me. On and off, sometimes the right shoulder, sometimes the left, then joined by the elbows and the odd finger. It was indiscriminate. The intensity of the pain varied and so did the number of body parts involved. The only thing that was constant was that I was always suffering from ‘something’. I had to give up playing badminton and squash – two of my favourite pastimes – at the end of 2014, and riding a bike (obviously without a motor back then) got harder and harder. I realised I needed to see a specialist.

Nothing appeared on the x-ray, but my blood tests showed my uric acid level was too high. “It’s gout,” I’m told, which goes by the equally uncool medical term hyperuricemia. I scratched my head: Isn’t gout for old people and alcoholics? The doctor sent me home with a prescription for Allopurinol, general advice to lower my alcohol intake, eat less red meat, take some anti-inflammatories, and to return in two weeks for a check-up.

More specifically, I’m told to eat a low-purine diet. Purines are a natural substance found in basically everything we consume, but in varying levels. The more you consume, the more likely you are to get gout. And losing weight would be a good idea too, I learned. Great, thanks. Just when I was learning to embrace my middle-aged spread…

On medication for the rest of my life? No way!

The pain subsided after a few days and my urine values were back in the acceptable zone at the two-week check-up. Here’s where the story could have ended if you were happy to spend the rest of your lifetime dependent on tablets, or at least that’s how the orthopaedic specialist ushered me out of the office. His words echoed in my head: ‘Keep an eye on your food, stay active and take Allopurinol on the daily.’ For the doctor, I was now a neatly closed case. But not for me. The more I thought about it, the more unsettling it all felt. Don’t people say there’s no effect without side effects? Allopurinol’s packaging told me everything, spelling out such aspirational side effects as stomach trouble, diarrhoea, vomiting and nausea. In some cases, it could lead to blood count changes, like leukopenia, leukocytopenia, agranulocytosis, and eosinophilia. Skin reactions sounded like they were all part of the parcel.

I wasn’t mentally prepared to rely on medication for the rest of my life. So, I tried to do it another way: No more alcohol, a lot less meat, and a keen eye on the evil purine intake. Within a few weeks, there were slight improvements, but still some episodes of pain, particularly in my elbows which, as you can imagine, isn’t especially conducive to working at a desk. I got my uric acid levels checked fairly often, and while they were always a little elevated above the norm, they were not crazy.

Increased joint pain… but no gout this time?

While the uric acid situation was sorted, things continued to get more dramatic elsewhere. The pains I’d been feeling continued to get worse, despite my textbook low-purine diet. My shoulders were a constant source of burning discomfort, joined at times by increasingly grumpy finger and toe joints. Even my ankles wanted to join the pain party, either with drastic swelling or unprompted stiffness. By the middle of 2016, the idea of regularly partaking in sport felt like a far-off dream. Luckily I could dabble in riding my bike, but not too often. I noticed that the pains got worse as soon as the temperature dropped, so it was especially bad in winter and worsened each time I went wild swimming in summer. One positive discovery: going to a sauna was like a godsend.

Do like Patrick and get some temporary relief from joint issues by becoming a regular sauna-goer.

At the close of 2020, after four years of ups and downs – and ups aren’t always positive if you’re looking down at the scales – I decided to consult another expert: a doctor in internal medicine with a sports specialism. I crossed my fingers and regaled them with my entire medical history. Based on the original diagnosis of gout, they wanted to take my bloods again. Their findings: Absolutely nothing out of the normal with my uric acid levels, and no sign of gout. However, as my finger joints were visibly swollen at this point, there was a murmur of rheumatoid arthritis, and the call to do an MRI on my hand. When that came back, it was confirmed that I was now arthritic. Right, but what does that mean, I wondered. The NHS website explains it like this: “Rheumatoid arthritis is a long-term condition that causes pain, swelling and stiffness in the joints. Your immune system (which usually fights infection) attacks the cells that line your joints by mistake, making the joints swollen, stiff and painful. Over time, this can damage the joints, cartilage and nearby bone. Possible complications include inflammation in other areas of the body (such as the lungs, heart and eyes).” It didn’t sound like much fun.

Even less fun was the proposed treatment: Cortisone injections, repeated when necessary. Plus an immunosuppressant, like methotrexate (MTX). When I googled the medication, I felt concerned, which was then multiplied tenfold by speaking to members of my family – yep, MTX was a no-go for me! It all made the physiotherapy side of the treatment sound more and more like a spa day. (Note: I’m aware that immunosuppressants serve a very good purpose against many serious illnesses, just not in my case).

No effects without side effects – Is there another way?

Desperate to understand more of what my body was going through, I took time to do some in-depth research. Basic topics like gut health and nutrition kept cropping up over and over again, especially related to auto-immune diseases. I’ll be honest, my aim to lose weight hadn’t been a huge success, but this time I was committed. In fact, I’d do anything to prevent more inflammation. The research was pretty straightforward: Eat mainly plant-based food, avoid white flour and don’t eat things from NOVA’s group 4 category of ultra-processed food. A lot of food we eat contains arachidonic acid, which is really important for humans but only to a certain amount, so you really want to avoid a high intake of these. The biggest culprit that I discovered: Croissants. I was shaken to the core.

Let’s keep it short: Avoid animal proteins and add as much colour to your plate as possible.

My diet got more colourful, with countless types of fruit and vegetables, plus wholemeal flour for everything, as well as fish, nuts and seeds. My protein and fibre intake rocketed (hurray for my digestive tract!), and I was confident that the nuts and seeds had to be giving me all these invaluable secondary plant metabolites that I read about. I also made sure I was getting enough healthy oils, full of omega 3 fatty acids, like linseed, fish and algae oil. More conscious eating to improve your gut health can be hugely helpful for many chronic, autoimmune diseases, like psoriasis and neurodermitis, as well as bowel diseases like ulcerative colitis. I was feeling pretty smug at this point, but was still oblivious to the fact that a big nemesis in terms of health was still standing proud in my food plan: milk.

Back on the bike – and feasting!

Within a few days of this strict diet, I felt that things were starting to work better, and there was a lot less pain in my shoulders and elbows. So little pain in fact, that I decided to get back into sport, although weighing an extra 20 kg wasn’t going to make things easy for me. At around the same time, I took a holiday to Austria where there were eMTB guided rides and rental bikes advertised everywhere. I signed up unwillingly – still stubbornly in the ‘I’m-too-young-for-an-ebike’ camp – but came back from the ride having fully drained the battery, probably due to being overweight. Go figure. This experience made a big impact on me, so as soon as I got back from the holiday, I walked into my local bike shop and rode away with a Specialized Turbo Levo Comp. I also got a walking pad to put under my desk. Seriously, I bet you didn’t know you can complete a 30km walk, while working at your desk. Win-win.

After hopping back on his eMTB, Patrick is feeling fresher and truly reinvigorated.

After a few months, I was a bit worried that I’d ended up in some sort of stagnant state. The initial upward trajectory with less pain, weight loss and a sense of feeling good had slowed. In fact, progress was literally crawling now, and some pains were knocking loudly at the door to come back. The solution came while listening to a podcast about nutrition, with the hosts discussing a sensation that felt oddly familiar. Each time I ate a substantial amount of cheese or milk, I’d get horrible pains in my fingers and elbows. I nodded along with what they were saying – animal proteins, I learned, are a trigger for inflammation, which can be disastrous for those with autoimmune trouble. That was it: no more dairy milk. From now on, I was an oat milk only kinda guy. Or soy, if that’s all the café has. This decision was life-changing. Another epiphany in the podcast related to portion size, which I’d been carefully controlling in my bid to lose weight. There had been several times where I’d cracked under pressure and binged, but the general tone from the experts was to eat until you feel satisfyingly full. And when they say eat a lot, they mean eat a lot of the good stuff: at least 500 grams of vegetables each day, plus masses of fibre from nuts and seeds. Berries have a really great anti-inflammatory effect, so these are a must for everyone, and as much ginger and turmeric as you can handle – turmeric’s anti-inflammatory superpowers could put some real medication to shame. And don’t rely on the big brown things on your plate, like potatoes, pasta or rice to make you full – think more about protein sources instead

There are so many things I do now that I wouldn’t have done before – like eMTBing – but another big one is that I now eat a fully plant-based diet, and take supplements (it turns out vitamin B12 is really hard to find in a vegan diet). At BBQs, I’ll hover next to the grill feeling sorry for myself.

No medication, no pain

After ten years of joint pain that kept me away from doing the things I love, I feel like I’ve turned a corner, with only small relapses of pain – and I’ve done it all without medication. There are times when I knowingly ‘self-harm’ and end up dealing with stiff fingers, elbows and toes for days, simply because I couldn’t resist a frozen pizza, a big hunk of processed cheese, or a glass of red wine. I’m now 32 kg lighter than when I was at my biggest, and so happy each time I’m outside mountain biking – with or without a motor.

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Words: Patrick Gruber Photos: Julian Lemme