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OK, Colin, I can understand that you would not go to your doctor about gout. Because you do not want to treat it as a medical matter. So, I can agree with you up to a point, as I identify 3 potential types of treatment.
In Questions for Gout Sufferers I consider medical, lifestyle, and herbal treatments for gout. Or, you can combine these for different parts of your treatment. In fact, I can see that you are doing this when you combine ibuprofen for gout pain, with diet changes.
But, you don’t have a safe plan. Because, as nobody pointed out, you seem to be ignoring the cardiovascular risks of long-term NSAIDs. So, please start by reading your ibuprofen label. Then, tell me what you think about those risks. After all, I’m here to help you decide what’s best for you, not dictate what you should do.
Most importantly, I want you to understand that gout control depends on uric acid control. As I said, there are 3 types of uric acid control. But, we can’t even begin to control uric acid until we measure it.
So, it might be that your medical records contain some historic uric acid test results. If they are fairly recent, that could be our starting point for permanently stopping your gout. But, if you do not have a recent uric acid test result, then you need a blood test.
Again, you have 3 options:
– A doctor or similar medical facility.
– Walk-in lab test.
– Home uric acid test kit.So, I won’t waste time just yet explaining the pros and cons of those choices. Because I’d like you to rank them in order of your preference first.
Colin, I hope to learn more about your gout history and preferences soon.
Thanks, d_q, for mentioning Ouch! Why does Gout Recovery hurt?
I’ve added some extra notes about getting uric acid levels safe. So, hopefully, it is more relevant to Bob.
Bob, I feel you have been let down by not getting the correct uric acid lowering treatment to get your uric acid safe. Also, in the light of that negligence, I worry that you might not have the right safety monitoring of your treatment. Because when you get tested for uric acid, you should also get blood tests for kidney function, and for liver function.
That way, you can be certain that allopurinol is working for you safely. So, if it is, the obvious solution is to increase your allopurinol dose to get uric acid levels safe. Usually, that would mean increasing by 100 mg and retesting until you achieve a low enough level. Alternatively, your doctor might advise supplementing allopurinol with additional uric acid meds.
Finally, Bob, I realize this might be shocking after you’ve done all you can to “do the right thing”. So, please feel free to discuss any doubts and uncertainties you might have.
Yes, I was surprised and confused by 2.7mg/dL. But, I think most doctors and patients would be pleased with 0.27 mmol/L. Personally, I wanted a lower uric acid level to speed dissolving tophi. Because I had untreated excess uric acid for many years before I came to my senses and started allopurinol.
Like every aspect of gout management, uric acid targets have to be set according to individual needs. So, Rebecca, I’m surprised that your doctor didn’t explain why she thought a lower target suited your case.
It’s obvious at 0.27 that you are on your way to gout recovery. That’s excellent news. But I still don’t understand what the issues are? Do you want to speed up your recovery? Then, increase your dose. If you’re happy as things are, then stay on 100mg. If you have doubts, please tell me what they are, and I’ll try to explain better.
Hi Colin ( @colin-purves )
My first question is: “What does your doctor say about your gout?”
1. Looking forward to it.
3. Yes, but personally I stop any gout pain relief the moment the pain becomes tolerable. I include colchicine in that. Because it contributes to the gout relief package without actually relieving pain.Now the biggie.
2. I’ve never been aware that one NSAID is stronger than another. I naively assumed that a dose dependent amount of gout pain relief was available from any NSAID. Also that the choice was down to personal tolerability and preference.
I’ve never had any problems at all with ibuprofen. So, I’ve never felt the need to risk anything else. But, for completeness of my knowledge, I’d love to see some references to pain relief comparatives between different NSAIDs. Please share some links.
Speaking of link sharing, I hope they are better than the Arthritis Research UK link. Because they spend over £4m annually on “Information and Awareness” (2015/16 accounts). So, you’d think they could do a better job.
To clarify:
– Uric acid lowering section gives no explanation of debulking. Also, it is confused by a pointless reference to high purine foods that makes no distinction between food from plant and animal.
– Ice pack suggested with no reference to warming joints after ice pack application. Or, just using a warm compress.More importantly, we are talking about colchicine:
So, where the F has “You shouldn’t take colchicine at the same time as NSAIDs” come from?
– The big seller, Colcry$ (due to Americans loving their insurers spending too much money) has no mention of NSAIDs.
– What should be the biggest seller, Mitigare (due to it being a very affordable alternative to Colcry$) has no mention of NSAIDs. Both Mitigare and Colcry$ warn against use in conjunction with drugs that inhibit both P-gp and CYP3A4.
– A UK colchicine provider, Wockhardt/CP Pharmaceuticals Ltd (who provided the colchicine that my doctor prescribed alongside ibuprofen) has no mention of NSAIDs. But, it does have a completely different list of other medicines, compared to Mitigare and its expensive cousin.
And, finally…
Australian Rheumatology Association provides a free fact sheet on colchicine (brands Colgout & Lengout) which includes:Colchicine may be taken if needed in combination with other arthritis medicines, including […] anti-inflammatory medicines (NSAIDs) such as naproxen (Naprosyn) or ibuprofen (Brufen/Nurofen)
Interestingly, the Colgout label does warn against combining NSAIDs and colchicine in patients with stomach problems. So, it might be better to try them individually at first. Then, combine if no stomach problems. Personally, I’ve been medically described as having a “cast iron stomach”. Because I’ve never had any ibuprofen problems, even at the maximum prescribed dose.
The Lengout label looks very similar to Colgout. But, I haven’t done a complete comparison. Notably, both these Australian colchicine brands have a comprehensive list of other medicines to avoid at the same time as colchicine. Also, they indicate that colchicine should only be taken if NSAIDs can’t be tolerated or don’t work. So, this suggests an “either/or” approach instead of my beloved combination. Which kind of supports my other main tenet:
Gout pain relief combinations must be developed by doctor and patient working together for the patient’s best interest at the time of treatment
Hi David,
It’s probably nothing, but you ought to point it out to your doctor. Because at this stage in your allopurinol treatment, you should be getting a follow-up check. So, that means testing uric acid, kidney function, and liver function. Then those function test results will tell your doctor if you need to worry about the rash. Also, the uric acid result suggests you should have a higher dose of allopurinol for a few months to speed your recovery.
As for food, all you need to concern yourself with is general healthy eating. The most freedom is found in the DASH diet. But, Mediterranean style eating plans are even better. Mostly, you need to get sufficient exercise and maintain a healthy weight. Then eating is simply EFSEP – Eat Food, Sufficient, Especially Plants.
EFSEP means eating real food, not manufactured food-like products. Sufficient means enough calories to fuel your daily activities. Also, most of your calorie intake should be plant based. Occasional meat or fish is good. But if you reject all flesh, you should consult a nutritionist to ensure you get essential vitamin and mineral supplements.
Slight allopurinol rash?
PS David, I used an old photo as an example of a rash. If you have a photo of your allopurinol rash, please can you send it on the feedback form below.
I’ve checked PubMed for saw palmetto. Because I’ve never heard of it before. Which would surprise me, if it had any connection to gout treatment. But there is nothing.
I found 20 studies on saw palmetto or Serenoa repens. But they were mostly related to prostate or urinary tract problems. Then I found another 515 studies that mentioned saw palmetto or Serenoa repens. But definitely no mention of gout or uric acid.
So, Ednan, I think you have 2 options:
Either 1) Seek a better doctor.
Or 2) Go back for a blood test after 2 weeks and see if your uric acid has reduced.
Saw Palmetto (Serenoa Repens)
Hey, Urankjj, don’t worry about taking a break. Because we all need one from time to time. So, it’s good to see you back.
Good luck with your guinea pig experiments. I hope you can find a way forward. But, if you need any help assessing symptoms etc, just ask.
I look forward to reading your blood test results. Because, without those, all I can do is generalize. But, you need specific treatments to make your uric acid safe. Also, don’t forget that each day uric acid is much over 6mg/dL, you will get more uric acid crystals forming. And that happens even on days where you have no symptoms.
By the way, your topic about malic acid generates a lot of interest. There are hundreds of people reading this each month. Though, none have joined in yet, which is not unusual. So, no pressure, but there are probably thousands of people by now who are waiting for you to prove, one way or the other if malic acid helps gout. How do you like them apples! 😉
Well, Tony, there are things you can do to relieve gout pain. But, it will resolve naturally anyway, as I think you are experiencing now.
The biggest problem is that it will keep coming back until you can control uric acid down to a safe level. Also, it gets worse each time. Because uric acid crystals are forming even on days that you feel no pain. So, we really need uric acid test results to start. Are walk-in labs a possibility? Sorry, but you’ll have to explain the cost implications to me, as I’m UK-based.
If your only pain is inflammation from gout, then it will resolve quicker with gentle exercise.
As far as your main topic goes, I can’t help much without knowing your uric acid level. Do you have any recent blood test results?
Let’s learn about your gout together. Then I can help you control it.
Uric acid level 2.7? Really?
Now, I’m totally confused. Is it possible to get the result emailed from your doctor, and paste it here? Ideally, you can get a list of results with dates, numbers, and measurement scale. If you have your blood test results in printed form, please let me know. Then I’ll give you instructions for sending me a scan or photograph of them.
Yes, d_q, I hope more people ask more questions here (the gout forums generally rather than this topic). But, searching before you ask the question increases your chances of a good answer.
Ideally, you formulate the question focussing on the topic you are thinking of. Let’s say
How can Google help me understand my gout betteror more simplyGoogle Gout. Then, search for that in the box at the top of the GoutPal page. Either, the results might help you, or not. Or partially. So, your next step depends on those outcomes:GoutPal Google Helped Totally
Non-members should leave feedback on the result that helped them. Because that positive feedback reinforces the value of the article.Members should post an equally encouraging message in these forums. For the same reasons, and because I like to be stroked, pampered and petted. 🙄
GoutPal Google Helped Partially
Non-members should ask for clarification in the feedback form on the result that nearly helped them. Because that prompts me to improve the text for future gout sufferers.Members should post in these gout forums with:
Title = your search phrase.
Description =
1. Why you searched for that phrase.
2. Which result almost helped (link to actual page).
3. Why it didn’t quite help.
4. Everything else you have tried.
Because that puts your question into context, giving the best chance of a relevant answer to you. Also, it prompts me in the same way as page feedback.GoutPal Google Didn’t Help
Your response is almost the same as for nearly helping. Except you cannot link to a specific page. But, you can refer to the phrase you searched for.Unfortunately, non-members cannot leave feedback on the current version of GoutPal Search Results page. However, if that is a service you want, you can suggest it in the usual places.
Other gout information sources
Please note that the above also works for all information sources. If you’ve read something that helped you share it with others in the Gout Resources forum. But make sure you summarize key points and say why they helped you.Similarly, ask about other gout information that you disagree with or otherwise find unhelpful. Also, if other information confuses you, give a specific link to it. Because that is much easier to respond to than vague “Why are there horror story accounts of people who gain 50 pounds …”
I know what you mean about ice, Rebecca! But, it does work for some gout sufferers. Because gout pain management is very personal when you account for different reactions to, and different tolerances of, pain.
To those gout sufferers who prefer ice, I recommend applying a warm compress after the ice. Because that should bring the temperature back up to avoid encouraging more uric acid crystals to form. For me, I prefer to lose the ice and go straight for gentle warmth.
1. Sorry d_q, that’s all a bit too general. I need a timeline of walking and pain meds to understand your symptoms in relation to pain meds. Can you give me an hour-by-hour list of symptoms, meds, and exercise?
2. I keep getting 2 maximum a day wrong. Because it’s actually max of 3 colchicine tabs per day unless they are 1mg tablets. Even then, individual cases might warrant more. But personally, I’ve never taken more than 2 per day (0.5mg). Or, had the need to.
I’m putting the discrepancies down to lack of distinguishing between preventative colchicine and “as required”. In future, I’ll try to take more care. But, in my defense, most of my lack of focus is down to analyzing what-if scenarios. I’m usually better when I’m discussing this in an actual one-on-one situation.3. Until you feel the need to stop.
I feel like I’m getting an education here on taking more time to vet questions before I make assumptions and spout advice that might be too general. So, I need to emphasize there is no right way to take colchicine. There are certainly wrong ways because too much of this poison is fatal. But the right way is more about understanding what is going on in your body, from day-to-day and during the day.
Personally, I try to be acutely aware of symptoms and how they are progressing. Because it’s better to adjust gout pain medicine on an hour-by-hour assessment rather than blindly rely on x number of pills per day.
Finally, if you are concerned about taking colchicine, I would always advise not taking it. Why burden yourself with the anxiety of drugs you don’t want to take when there are alternatives for gout pain control?
To explain, we are discussing the 1st stage of a 3 stage gout pain prevention plan. Which means stopping, or limiting, inflammation from getting worse. So, the choice is colchicine, steroids, or nothing. Personally, I will only take steroids if a doctor forces them on me when I’m unconscious. But, other people love them. Again, personally, I went many many years with adequate pain control from ibuprofen and paracetamol. I just found colchicine added speed and convenience to the mix. Also, I’m concerned about the long-term effects of high dose NSAIDs. But, I’m perfectly happy with low dose colchicine.
Anyway, that’s enough of my rambling for now. But, I’ll probably add lots more once you reply about Q1.
I don’t think Google is the issue. Because I’ve learned many useful gout facts from Google Scholar. Also, that has guided me to search for meaningful topics on the main Google site, and on Google Plus. So, let’s just forget the Internet for a moment, and think about real life.
When you have a health problem, do you nip down the pub or cafe to discuss it with interesting people you never met before? Or do you stand on murky streets and consult the drug users and their dealers? Up here in Leeds, the police and local government have collaborated to try and create a tolerated zone for street sex workers. I’m sure they’ll have lots of interesting health issues to discuss. 😳
Seriously, Rebecca, I’m not trying to be offensive. But why would you discuss your health with thieves and vagabonds? They’ll either rob you blind or lead your health astray. Beware, strangers!
Google Gout Search
Use the Google box at the top of each page here. Unfortunately, it isn’t perfect. Because any search engine is only truly useful when you know what to ask. But 9 times out of 10, you’ll get an answer from my Google Gout Search. Or, results that help you frame your next search better. For instance, search for nocebo.
As a fellow chickpea lover, I’m going to try your aquafaba, Rebecca. As it happens, I always include the entire contents of the can when I’m making a chickpea dish. But, I’ve never tried making an egg white substitute in this way.
Is it as simple as it sounds, or do you add other ingredients?
Anyway, I can find no purine analysis for aquafaba. So, I’ll try and guess it. Let’s take 500g of the chick peas listed in my purine chart. So, we start with 5 x 109 = 545 mg.
Then, we rinse those chickpeas for 2 minutes, guessing that washes out around 10%. So, let’s say we have 500 mg left, and we boil and simmer 40% of purines into the water. Again, I’ll guess we have 1-liter water left, with 200mg purines in it.
So, if you are on a normal purine restricted diet, you should restrict yourself to 2 liters chickpea water per day. If you are on a very strict purine diet, then half a liter per day will be enough. That ought to satisfy the appetite of the most ardent gouty aquafaba lover. But, it’s not very realistic.
Adding Realism To Aquafaba for Gout Sufferers
Apart from the fact that you’d be eating by the bucketload after whipping the chickpea water into the right consistency, there are upsides to consider in terms of uric acid control:1. Most evidence points to vegetable purines being gout-safe. That’s not absolutely conclusive, so you’d need to run your own experiments.
2. Aquafaba is a good protein source, which encourages kidneys to excrete more uric acid.
3. It is also a good source of fiber, which encourages the gut to absorb more uric acid.So, Rebecca, it seems you might have stumbled on a gout superfood. Where’s me whisk!
Other Gout Foodies who are obsessing about foods in this way should consider taking allopurinol. Because allopurinol puts everything you eat into the very low to zero purine range.
Is Aquafaba a Gout Superfood?
Hey Rebecca, I totally understand how overwhelming things can be when you first learn you have gout. In my case, I wasted a lot of time reading stuff on the Internet. Then, I eventually learned that 95% is self-serving garbage. Now, with the growth of the Internet, the situation is even worse. But, I try to maintain GoutPal with a logical approach backed by real science.
Now, if you restrict yourself to studying British Rheumatology Guidelines and NHS information, you should soon realise that our health service is better than most. So, you now have a great allopurinol plan with your doctor. Or, at least the basics sound correct.
If I were in your shoes, I’d forget about everything else and focus on getting your uric acid controlled. Then, you will not be troubled by gout, and your life will take on a new happier meaning in a few months.
All the recent posts coupled with some personal problems are delaying my progress on new styles of structured plans. But, it’s only a slightly different format from what we are doing here.
So, let’s get all your allopurinol issues resolved here. Then, tell me which of your other topics you want to resolve next.
