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Hi Irma,
Please don’t worry about the blood tests photo you sent. That’s exactly the right thing to do. It’s very useful to see the actual result. It means I can see exactly what you see.
You’re right about the numbers. You are just below 6.5 mg/dL. I’m guessing the H means High. This is significant. Many doctors will not treat below 7mg/dL (0.40 mmol/L). I find that very odd. The correct target for treatment in most patients is below 5mg/dL (below 0.30mmo/L).
Returning to your meds:
– Premarin (conjugated oestrogen) is associated with reduced uric acid in women.
– Coxflam/Mobic (meloxicam) is associated with slightly reduced uric acid in rats.
– Piascledine – no information relating to uric acid found.
– Paracetamol/acetaminophen – the jury is out! Unlikely to have any effect at normal dose.
– Omega 3 – new research suggests this is excellent for reducing frequency of gout attacks. I’m investigating further.
– Turmeric Curcumin – Again, I’m investigating some new research which adds more evidence to show how curcumin from turmeric helps reduce uric acid.
– Vitamin D – recent research suggests a genetic influence and a link that is “clinically very small”. To be honest, “Potential causal associations between vitamin D and uric acid: Bidirectional mediation analysis” is very difficult for me to understand. I don’t think it’s significant: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586492/
– Probiotic – too little evidence. 1 study shows insignificant increase in uric acid. Another shows insignificant decrease.
– Vitamin C – Vitamin C lowers uric acid. But note that other studies have failed to find significant benefits in gout patients.
– Co-Enzyme Q10 – little evidence. I only found one study, and that found no link between Co-Enzyme Q10 and uric acid.
Nothing on the other 2.I’ll talk about meds in your new thread.
Supplements are a very personal topic. As far as uric acid is concerned, many effects depend on the individual. I think the best approach is to have a healthy diet, then use supplements for specific vitamins and minerals where necessary.
I’m particularly forthright on that topic when it comes to alkalizing. It goes against everything I believe healthy to take alkalizing supplements. pH balance should come from natural food and drink. But, that’s just my opinion of course! Alkaline diet is good for gout.
@chris-starkey Hey Chris,
What do you think about my views on gout doctors? Is there somewhere I should start looking for your gouty doctor? Or, do you agree with me that it doesn’t really matter?
I’m still waiting for some information from the Urit-10 company. To be fair, I’ve never dealt with them before, so I’m not sure if I’ve contacted the right person. I’ll give it a few days, and remind them. Can you help me do that, Chris? I’m very forgetful. If I don’t post an update here, please post another reply, to wake me up. I tried to-do lists, but had to stop when I had a list of 10 to-do lists. ๐
Anyway, please can you thank your neighbour. He’s the inspiration for Is Gout Like Rising Damp?
I can absolutely promise you Betsy. There is no deliberate gender discrimination on my websites.
Mostly, it’s a non-issue. Well, it is for me. But, I want to make sure that I understand exactly what you want. I don’t wish to sound critical, but your complaint is mostly quite vague. Please don’t take that the wrong way. I’ll examine your diet question in a moment. But when you say “all the studies…” I’m not sure what you are referring to.
Officially, this forum exists to improve my guidelines on GoutPal.com, and to provide personal help interpreting those guidelines. The first word of that sentence really deserves some “quote marks”. This is a forum that does things friendly, not official. I’m just here to help.
I think you are complaining about the rest of the Internet. In case I’m wrong, have I unconsciously introduced gender bias on GoutPal.com? If I have, I really didn’t mean to. Give me the specifics, and I’ll change them.
Let me, for now, assume you are talking about the Internet, in general. I started GoutPal a few years after I was diagnosed with gout. I was incensed by the poor quality of information. There is a lot of misleading information by doctors and other professionals, who should know better. There are many, many more exploitative lies from people with hidden agendas. It’s a jungle out there.
I like to think of my little gout project, first and foremost, as a safe haven from exploitation. I really have never thought “Who gets exploited most in the world of gout, men or women?” If that’s your point – that I’ve disregarded women – then I ask you to help me get it right.
Anyway, Betsy, you specifically mention studies and diets, so I’ll examine those.
Gout Studies Gender Bias
I don’t know where you go for your gout studies. For me, the absolute best source is PubMed. I don’t even have it bookmarked, because it’s permanently open in my browser. I’ve drifted a little way towards ResearchGate. But, old habits die hard.Here are some PubMed Numbers, search term followed by count of studies:
- gout + women – 493
- gout + men – 605
- gout + men + women – 341
- (gout and women) not men – 152
- (gout and men) not women – 264
So, Betsy, if I were still a marketing manager, I’d campaign about the outrage on behalf of women gout sufferers. 605 studies about men. But, only a quarter of that, 152, exclusively about women.
Spot that little marketing trick? But, even like-for-like comparisons show significant bias in favor of men. Total is 493:605, and exclusive is 152:264.
Can I pretend to be a man for a moment, and push the male argument?
According to the American CDC (Centers for Disease Control and Prevention), incidence of gout among US adults in 2007-2008 was:
- women – 2.2 million
- men – 6.1 million
WTF! Women are way overrepresented in those gout studies. It’s not fair. I want my mom!
[Pause for the voice of reason to return.]
As far as those studies are concerned, I still believe gender is a non-issue. There are a total of 15,133 studies about gout. Gender is a tiny aspect of gout.
That population analysis also gives percentages. 5.9% men, and 2% women. Just like “normal uric acid”, statistics like that cause my hackles to rise. There are medical reasons for the differences in gout rates between genders. Why produce meaningless statistics that mask the facts?
It’s interesting, for some people, to discuss gender and gout. My view is simpler – you’ve either got gout or you haven’t.
Gout Diet Gender Bias
Now, I’m moving into an area where I need your help, Betsy.Immediately prior to reading your message, I was thinking if I should provide a general purpose diet plan for gout sufferers. I do not want to do that, because I believe that gout diet should be part of an individual treatment plan. Diet should be based on individual needs and tastes. I don’t even like the word “diet”. I prefer to think of healthy eating styles.
But, if I do provide a “standard diet” this is the first time I’ve ever considered gender.
To me, a good diet must be based on healthy food balance and on eating the right amount. I’ve never understood statements like “2500 calories for men, and 2000 for women”. Surely my stepdaughter, who is 2″ taller and considerably more active, needs more calories than me?
Anyway, I’ll leave that discussion now, to see what you think about it. I’ll finish with your skim milk question.
The amount of skim milk you need per day has nothing to do with gender. Skim milk is what I think of as a gout diet “tweaker”. On an individual basis, you can assess if a person’s diet matches their uric acid control plan. Then, you can look at a range of dietary adjustments that might make the plan work better. Skim milk is a good potential adjustment, but pointless if the basics are wrong.
Now, I’m going to jump right out of my comfort zone for an analogy. Laugh at me if you wish. If you could see my search history you’d be wetting yourself! ๐
Let’s view skim milk as the accessories that complete the outfit. The best gloves in the world won’t fix a size 14 dress on a size 18 body.
Sorry, Betsy.
Seriously, tell me practical ways I can help you better. If I’ve misunderstood what you are asking of me, tell me. I would seriously appreciate your help in making sure I am not getting GoutPal wrong for women.
Thanks for those, Dave.
Urate is uric acid. Strictly speaking, it’s a salt of uric acid. I nearly always use uric acid instead of urate. I feel that it is more widely used in our world. Urate seems more common in the medical world, but uric acid is still most common, in my experience.
Urea is completely different. The urea test is part of a standard kidney function test. In my opinion, kidney function (and liver function) should always be run alongside uric acid tests. Uric acid is a specific test that is vital to gout diagnosis and treatment. These other tests are good indicators of general health. The results need to be interpreted by someone with far more medical knowledge than I’ve got. In the context of gout management, these tests help:
- At the diagnosis stage, as a general purpose tool for ruling different diseases in, out, or maybe.
- At the treatment stage, as a check for adverse reactions to treatment.
I’m not qualified to talk about your urea test result. I believe that these results are most valuable when compared to earlier patterns.
I could talk for a year about uric acid test results. But, I’ll try to rein it in. As I said before, 309 is pretty good.
I have to warn against anyone taking those normal ranges seriously. They should be banned! People think “normal” means “usual” or “acceptable”. Lab results do not use the word “normal” in this way. It is a statistical term that defines a specific type of averaging – The Normal Distribution.
Another way to consider it is this. Take a room of healthy adults mixed 50% men and women. The normal range for breasts and testicles is both around 1! Do you want that as a basis for medical treatment?
Normal ranges are ignored by anyone with more than half a brain. If any doctor tries to pass off 430μmol/L as acceptable they need to be retired. Or, buried, as they do with their other mistakes.
You’ve done it Dave! All day, I’ll be ranting to myself about Normal Uric Acid!
Quick somebody – warn the neighbors! ๐ ๐
P.S. Thanks for another interesting post, Dave. Keep ’em coming.
And, thanks for reminding me that I used to wonder about the difference between gout and gouty arthritis. It prompted me to include an explanation in Gouty Arthritis Sufferer Or Not?
In fact, that could be written for you Irma, as it deals with the common situation of the uncertain gout sufferer. That article is the starting point in this situation. I’m wondering if I’ve included all the different types, though. As an uncertain gout sufferer, do you identify yourself as
one of the following three types:
1. You have a doctorโs diagnosis of gout, but you doubt it is true.
2. You think you have gout, but your doctor doesnโt agree.
3. You think you have gout, but you will not consult a doctor.Is there a fourth type – “doctor not sure?”
As a starting point, I’m only interested in people identifying themselves as members of GoutPal’s Arthritis Sufferers Group. One of my important pieces of advice, depending on the answers to my 2 questions, is “consult a rheumatologist”.
I’m pleased to see you are doing that, Irma. Would you indulge me, and give me your opinions on my article?
I’m minutes away from releasing a guide to the first steps for Arthritis Sufferers. It’s called Gouty Arthritis Sufferer Or Not?
I’m hoping that once I’ve got the first Gout Group started, I can quickly work through the others.
Part of the new guide deals with the issue where people do not want to discuss health problems in public. I’m determined to keep my advice public so that everyone can benefit. But, it is perfectly reasonable to follow a trail of relevant website pages privately. Instead of getting personal help in my forum, private people can keep their own notes.
So, I will start producing reading list guides, and research recommendations, for each group. These will help people who want to remain private. They will also help people who are getting structured help here in the forums.
I’ve added this note here as a reminder to myself, more than a useful contribution to this thread.
But, as ever, I appreciate any thoughts you have on improving the quality of support.
What would you like to see in a reading and research guide? โ
Fascinating information, Chris!
I’m expecting information back on uric acid test strip availability after the weekend, but not sure exactly when.
I’ve got lots to say about your latest information. But, I don’t have time to write it all now. I hope to be back tomorrow with some answers and opinions.
Speaking of opinions, I’m not convinced we want a doctor who is a gout sufferer. We want one who understands patients – specifically, who understands you!
I’m going to help you ask the right questions so that your doctor has no choice. He’ll have to treat you properly.
In the meantime, if you want to continue your quest, it might help if you let people know which part of the world you want to find your gouty doctor.
Thank you for your fascinating response.
I just spotted you said “gout or gouty arthritis”, Irma.
They are the same thing. Gout is a form of arthritis. Gouty Arthritis is the long name for gout, often used by the medical profession.
“slightly elevated Uric acid levels” doesn’t give me enough information to help. I need the exact number. I’ve heard doctors call 8mg/dL “slightly elevated”. It makes me mad. Anything above 7 is dangerous, and needs urgent treatment.
I hate the idea of withholding treatment because you’re overweight. That’s just nonsense. I’m still overweight. But I found it much harder to lose weight before I got my gout under control. Some doctors don’t understand.
I understand your situation completely. I can help you through this. But I need very specific information.
As well as your exact uric acid numbers, I need to know exactly what meds you are taking with their daily doses.
Help me to help you, Irma. Gimme the numbers! I’m a data geek โ ๐
Great question Chris!
I’m on it right now. I hope to be back with some more information soon.
Out of interest, where did you buy your Urit-10?
More importantly Chris, how are you progressing with controlling your uric acid? โ
I always shudder a little when I get asked about kidneys. Because personally, if I had any persistent kidney pain, I’d go straight to my doctor.
Anyway, in my gout studies, I’ve learned a little bit about drinking water and kidneys.
First, it’s a mistake to think that only plain drinking water is important. There is water in everything we eat and drink. It’s used up all over the body. The kidneys try to regulate supply so there’s always enough for everything we need. But, that changes all the time. Temperature and activity change the amount of fluid we need. So, there’s never a fixed amount daily.
We should drink regularly throughout the day. Then, check urine color. It should be pale straw colored. Not completely clear, or too dark. If it’s too pale, it’s an indication that you are drinking too much. That can overstrain the kidneys.
The other important thing I’ve learned about kidneys is blood tests. Everyone should have kidney function tests at least once a year. That lets your doctor see what is usual for you. Then, if significant changes happen, your doctor can investigate. Tests are more important when you are lowering uric acid. It doesn’t matter which method you use. Allopurinol is most common. But all uric acid lowering treatment needs regular monitoring. That applies to herbal medicines and diet, just as much as drugs such as allopurinol, Uloric, or any others. Though I say at least once a year, at the start of treatment it should be once a month. Then, as uric acid stabilizes, you can extend the time between tests. Always insist on liver function and kidney function tests when you get uric acid tests.
Finally, coffee and milk are better than water at encouraging uric acid excretion. From a calorie point of view, skim milk is best. Plain water is still good. But, variety is much nicer.
The obsession with relating food (including alcohol) to gout is partly an inbuilt human desire to form connections. The Internet proliferation of unsubstantiated nonsense is more sinister. It’s used as fuel to sell unworthy information or treatments.
Misinformation is a well known tactic of fraudsters. Make a false claim, then defy anyone to disprove it. In my opinion, it’s best ignored. Gout information should be referenced to peer-reviewed science. It’s not perfect, but anything else is merely opinion.
Now that I understand purine metabolism better, I’m shocked that anyone should be obsessed with the effect of beer on uric acid. It’s mostly hyperbole, because the only valid test is the one I outlined above. It’s a test that is very rarely done. When crossover trials with alcohol are performed on gout sufferers, they always show mixed results.
Gout treatment must be personal. And that is what professional rheumatologists recommend. Sometimes I can’t help ranting about misinformation. But the truth is, most gout sufferers can be helped. It’s just a matter of focusing on personal gout facts and attitudes. Then we can find personal gout control that works.
By the way, uric acid levels are extremely important to gout management. But, there is no correlation between an isolated uric acid blood test result, and gout symptoms. Just as there is no correlation between the amount of rainfall on your roof, and the pressure of water through your faucet.
Last year you grew lots of uric acid crystals. This year you’re paying the price. Was beer to blame? I don’t know. But, I’d want to review your calorie intake and weight before I formed a working hypothesis.
Hey, don’t get me started on the beer and gout issue!
Oh, alright then…
I do not believe that beer has a strong influence on gout. People have strong views on it, but there is no strong science. I feel you have to listen to your body, not the rhetoric. A recent contributor claimed falling uric acid when drinking 5 pints of British ale each day.
If drinking beer gives you gout attacks, then stop drinking beer. If it doesn’t, then enjoy it. But be careful of false associations. It is very easy to blame beer when something else caused the gout attack. And, as you’ve experienced, lowering uric acid can cause attacks. So, to test properly, you have to measure uric acid each month. Between uric acid tests, you must record daily gout symptoms. Take alternate months with IPA (or whatever) and without IPA. Repeat until you can see clear results.
Of course, if you are on allopurinol, this experiment won’t work. Once allopurinol has dissolved most of your old crystals, you can eat and drink whatever you like. However, moderation is best. You don’t want to control your gout, then go on binges that promote heart disease, diabetes, or other diseases associated with bad diet.
You can definitely look forward to the occasional IPA in the near future! ๐
It sounds exactly like my gout in the first few years. So much so, that the first doctor I consulted didn’t believe I had gout. He referred me to hospital, where a rheumatologist confirmed my gout with a painless joint fluid test.
Personally, I found that gout attacks subsided quicker if I kept moving. My best trick was to drink water as often as I remembered. I even set a reminder on my PC until I got into the habit. It has the double benefit of having to walk to the toilet more often.
I’m convinced that this will pass once most of your old uric acid crystals have dissolved. You should find that the pain is less frequent and less intense over the next few weeks.
Sorry for the delay in responding, Bob. Sometimes I miss things.
Is anyone else thinking I’ve forgotten to respond to a post? The best thing to do is to add another reply here in the forum. That way, I’ll see it during my daily review of new topics and replies. It is best to add some more useful information about you and your gout. The more information I have, the better I can respond.
In your case, Bob, I can’t really answer you, as I have virtually no information. The advice I gave to Rhys was very specific to him, based on the information he gave me about his current healthy diet, and his uric acid levels.
If you’re living on burgers, then you will never control your gout.
I suggest you start a new topic, Bob. Include information about your gout symptoms, and your uric acid levels. If you want advice about diet, I need a lot more information about what you currently eat. Also tell me about things you want to eat, but feel that you cannot.
And for a shorter answer:
No! A glass of milk will not neutralize the purines in a ground chuck burger. It is possible to make burgers that will fit into a gout diet as a monthly treat. We’re a long way from that. And turkey burgers, unless they are part of a well-balanced gout diet, are almost as bad as beef.I appreciate your views David.
Food as medicine is very important to me. Or, I should say that healthy eating should mean less medicine. For me, less medicine means that I still rely on certain pharmaceuticals. But less medicine can also mean no medicine at all. It’s a personal view.
I’ve been a firm believer in the value of alkaline diet for many years. I have not felt the need to test the effects of this, though I might start doing so soon. I believe, if I test my urine, I can probably give better quality advice about the value of alkaline diet for gout. It’s less important to me personally, because I’m happy to control my uric acid with allopurinol. But, for other gout sufferers, who want to rely on diet, alkalizing food, in a calorie controlled diet, is the best start.
I know that baking soda has some advantages in this regard. But, I cannot accept that it is a food. It is a chemical that is needed for some baking processes. But, it’s been shown that baking soda can be dangerous for gout sufferers. The main problem seems to be that baking soda is sodium bicarbonate. Excess sodium is a well known problem for heart and related problems. If you are going to use chemicals, then potassium salts might be safer. But, that needs to be checked by your heart specialist. Personally, I prefer to use food sources.
Protein is always acid producing in the body. But we need it, and protein is good for gout. So protein has to be balanced. A healthy diet must include sufficient potassium, magnesium, and calcium. Those 3 minerals are best for alkalizing the body. I think they should come from food rather than chemical additives. So, on my healthy eating website, I published these lists:
As you can see, spinach is top of the first two lists, and third in the other. It’s also a good protein source, as are asparagus and broccoli.
Rapid weight loss can trigger gout attacks. That might be gout attacks from raised uric acid from your flesh loss. Or, it might be gout attacks from old crystals dissolving because your uric acid is lower. You can only judge why if you know your uric acid levels before, during, and after the rapid weight loss period.
Less weight always means a reduced risk of future gout attacks. But, specific personal numbers are important. The only general fact is that lower weight is good, so long as you are not medically underweight. Underweight might be good for gout, but bad for other health problems. It is usually best to lose weight gradually. But, if you have had rapid weight loss that has contributed to gout, it’s in the past now. So, no point in worrying about it.
Any gout problems from fructose are those from food additives. If you’re following Forks over Knives, your whole food diet should not contain such additives. If you personally feel you are consuming too much fruit, then replace some of it with lower fructose fruit or veg. NutritionData has a useful list of high fructose foods. If you want me to provide a better list, just ask.
Yes Dave.
I know you’ve written your responses as questions, but they can also be read as statements. You’re doing everything right. So, if you are happy with progress, then it’s good to continue as you are.
There’s not much point in speculating about your next test results. But it’s great to see you’re getting those all-important tests to monitor your progress.