Confusing Uric Acid Levels

[Matthew]

Hi, I’m a first time gout sufferer and as of right now am totally confused by my Uric Acid results. I had a physical last Aug and normal results (5.8) and that was the day after a VERY heavy drinking weekend. Below is what has me confused.

Aug 28: 5.8
(Physical done the day after the Mayweather fight and I literally had 1/2 bottle of whiskey and 1/2 bottle of vodka and god knows how many wings)

June 18: 6.1
(This was DURING my first Gout Attack and had to get a shot in my toe. Hadn’t drank for 2 weeks prior and was working out every day)

June 28: 5.4
(This was my GP double checking levels after the clinic had done my shot)

July 23: 7.2 !!
(This was taken yesterday. I had a normal weekend where I did eat meat and drank MILDLY but nothing out of the normal. I was on a plane for a couple hrs though)

I have appointments for rheumatologists but that’s a month away. My GP wants me to start on allopurinol already. Any idea why the whipsaw UA levels which still seem low compared to others I’ve seen on this site?? Thank you for the advice!!

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What causes changes in Uric Acid?

[nobody]

The “whipsaw” isn’t so surprising.
The conditions of each test aren’t clear but even if each test was done in the same conditions by the same people (the technology used can make a difference), there still are random-looking variations.

What is more surprising is that none of your results are high.
Do you have a reason to think your uric acid used to be higher (possibly you used to be fat or you used to take a drug known to raise uric acid)?
Another explanation is that you might have misread the test (that’s not uncommon apparently). There are three different units in active use. 720 or 0,72 is quite high for instance whereas 7,2 is merely borderline.
What is the basis for your gout diagnosis? Merely the appearance of your foot or did a test actually prove you have gout?

[Matthew]

Hi, sorry if this response is long. Just want to give you all the information. Yes, I use to be heavier. I’m 6’3” and last Sept I was put on an anti anxiety medication that took my weight from 209 lbs to 245 lbs in six months. After stopping the medication I started working out heavily and got back down to 220 lbs in two months, that is when the attack happened. But prior to that I’ve been in a 210 lbs range (again I’m 6’3”) for the last six year. Prior to 2012 I was heavier (back at the 235 range for a while).

Admittedly I do binge drink on weekends, but only vodka.

The 7.2 mg/dl is what they’re using. The podiatrist diagnosed gout from the symptoms and look / heat of my toe. But he didn’t actually draw fluid from it.

Lastly the only drug I take on a weekly basis is prescribed testosterone shots. Thank you again for all your advice!

[nobody]

That was some rapid weight loss. That’s known to be dangerous if you are prone to gout. Since you exercised heavily, you probably built muscle mass and so lost even more fat… unless you lost water, which is also dangerous. Heavy exercise itself can raise uric acid. And then there’s the diet you were on when you were losing weight… it can’t have been gout friendly. There have been reports of people developing gout after going on a low-carb diet for instance.
For all I know the anxiety drug did raise your uric acid. Certainly the food you must have eaten to put on 35 pounds over 6 months must have increased your uric acid. Simply being fat has an effect as well.
And then there’s the binge drinking which can cause dehydration (a gout trigger). Alcohol is known to increase uric acid anyway. It doesn’t matter if it’s vodka or whiskey.
In case you didn’t know, having had higher uric acid in the past can cause gout now. At that point, it’s best to drive uric acid way down to clean up the mess. Else uric acid crystals can persist even though the amount in your blood wouldn’t be high enough to form new crystals from scratch.
All in all I’d say the gout diagnosis isn’t implausible. It was kind of quick though. Especially when your uric acid isn’t all that high, doctors will often want to see repeated gout-like attacks before jumping to conclusions.

Even if you do have gout, I’m not sure you need allopurinol to get rid of it.
Then again if you don’t have East Asian ancestry, start with very low doses of allopurinol (you can cut pills) and get frequent blood tests during the first months of treatment, allopurinol isn’t very risky. So if you’re comfortable taking a daily pill, starting allpurinol now isn’t such a bad idea. It could be you don’t even have gout (which would make allopurinol pointless) but if you do have gout, there are risks involved in not taking allopurinol as well…
An alternative to allopurinol would be to quit alcohol and change your diet. That’s nowhere as effective as allopurinol but with your test results, it probably wouldn’t take much to get your uric acid test results into the safe zone. Since alcohol and junk food are generally unhealthy, my recommendation would be to try lowering your uric acid without allopurinol. That’s probably your best option in the long run, though taking allopurinol on a temporary basis while your are changing your habits might be helpful.
You could also do nothing besides getting more blood tests for a while. If you get more gout-like attacks or if you see your uric acid test results creeping higher, you’ll know the time to act has definitely come. But at that point, you may regret not having acted earlier.
I don’t think there’s a very strong case to be made for either of these three options in your situation. It’s more a matter of personal preference.

[Matthew]

Sorry for the delayed response, I was traveling for work.

Thank you very much for all the information!! I definitely think I’m going to try the allopurinol. (I’m Irish and Italian) so will do the 50 or 100 to start. I know these questions are almost impossible to answer because everyone’s body is different, especially with gout. But 1) in your experience should allopurinol allow me to live my life as normal? ie. eat meat regulatory and consume alcohol. 2) (again I know this is just a guess/opinion) but given my levels are low, if I’m on allopurinol for 2 – 3 years and my body is able to dissolve the current crystals, would I be able to come off the medication and basically starting over from ground zero?

In regards to my diet when this happened (losing the 25 lbs in two months). I was doing the intermittent fasting (wouldn’t eat after 6pm) and would box for an hour the next morning on an empty stomach. I also switched to eating salmon every day for lunch for the two months. Basically I did everything wrong!

[nobody]

You did lose weight so you got one thing right at least. But yeah, you could have done it more gently.

I’ve seen people on allopurinol eating meat and drinking alcohol, sure. Your body needs to tolerate the drug and you need to be regular with the pills. It’s as simple as that. Well, first you need to get the dose right.
People have been able to take extended breaks from allopurinol after taking it for long enough to clean up their system but I don’t think that’s like starting over with a clean slate. Once your immune system has learned to target uric acid, you’ll form crystals quicker than people who never had gout. It’s kind of like getting a vaccine. If you are able to keep your uric acid down by working on your lifestyle though, you could in theory quit allpurinol for many years, until aging causes your uric acid to creep back up. Some people have so much uric acid that they’ll need to be taking allopurinol (or something similar) for life. But that’s not your situation.

[Matthew]

Thank you for all the help! And i didn’t realize age also made uric acid levels go up. At some point I know I need to focus on lifestyle changes, I’m just hoping the allopurinol will push that off for a while.

[Keith Taylor]

Why does my uric acid fluctuate?
I’ve had an idea to summarize selected posts in future. So that visitors can quickly see what a topic is about, and find relevant facts.

Obviously, as a first attempt, there will be several things I can improve upon. But for now, I’m just putting it out there as a talking point.

When (if?) I introduce this properly, the summary will sit above the topic after the title. Also, I’ll probably include some explanatory text. But for now, I’d like as much feedback as possible.

By the way, if your comments relate to summaries in general, rather than dealing with fluctuating uric acid levels, then it’s best to reply to Gout Forum Topic Summaries. Or start a new topic.

[Author]

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