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Dave, thank you so much for digging out those test results.
Now, though you say you were first diagnosed with gout 6 weeks ago, uric acid crystals have been building up for years before that. It’s impossible to know exactly when. There are now advanced imaging techniques that paint a better picture of your uric acid burden. But, we can manage without those.
We just need to know what to manage. There are 2 things:
- Uric acid burden
- Gout Pain until uric acid burden has mostly dissolved
Your test results show your uric acid is well under control. You could go lower if you wanted to as a temporary measure for a few months. Most doctors will only agree to this if you have visible signs of tophi. I’m guessing this is not the case for you. So, all that’s left to do is to maintain regular tests. I recommend monthly tests, at first. As your results stabilize, you can extend the interval. Always test at least once per year. Uric acid tests should be accompanied by kidney function and liver function tests. That is usual for most doctors, but always best to check.
You might find fluctuations in uric acid test results. This is normal, especially if your appointments are at different times of day. However, you should soon see a natural average. Ideally, this will fall below 300μmol/L, but 309 is very close. If it does start to rise as you get older, you might have to increase allopurinol dose. This is fine, as you are well within the maximum dose.
For a few months, you are absolutely right when you say “I *think* this is normal and that this is simply the Allopurinol working and dissolving the crystals and whilst this happens, you can have further mini-attacks.”
For this reason, good gout doctors usually prescribe pain control for a few months. There are several different approaches to this. Some doctor prescribe daily colchicine for a few months as a preventative. Personally, I think if you are managing OK without that, then best to stick to naproxen.
All I would say, if you are incapacitated, is to speak to your doctor about paracetamol, or similar compatible painkiller, to take alongside naproxen. I think it’s important to stay mobile when you have a gout attack. That, at least for me, stopped gout attacks sticking around for many days.
All in all, Dave, I’d say you are well on the road to recovery. Your diet seems healthy, which will be good for other potential health problems that often run alongside gout. Of course, if I need to clarify anything, or you get other questions, just ask.
I’m sure your gout attacks will become fewer, and less intense, as you continue to bring uric acid under control. It amazed me how little gout hurt when I knew my uric acid was safe, and occasional flares were just a sign of old crystals dissolving. ๐
There’s no evidence to suggest that purines in spinach, or any other vegetable, convert to uric acid.
The gout will get worse until you get uric acid to safe levels. After spreading to all joints, uric acid crystals start to damage skin, kidneys, heart, and other organs. I’m sure it’s hard to get medical care when you’re on the road. But, it’s very important to tackle gout before it becomes even more dangerous.
Urgent care facilities don’t seem very good for gout, from what I’ve heard. They can help control the pain. But, unless you control uric acid, the attacks will continue, and get worse. It’s pointless hoping that random diet changes will make any difference. You have to measure the effects of diet changes on uric acid levels. There are walk-in labs for blood tests. Is that an option, David?
Review Gout Food Tables
My page Gout Foods Tables Introduction is confusing.
It needs urgent review. So, I believe it’s best to reorganize all purine tables into separate pages for low, medium, high, etc. Then link to other pages that summarize different aspects of nutrition for gout sufferers. These pages should differentiate between proved links and suggestions. Because Gout Dieters need information that they can use to compare to changes in uric acid. Whereas Gout Foodies are more concerned with how they feel about food.
For practical purine control, the pages should start at How Purines Affect Gout. Which needs to introduce various plans for purine intake management. Then, it should refer to related purine facts in Gout Resources section.
Thank you for lots of information. There is one important fact missing: when did you first start with gout symptoms? โ
I’m guessing it was several years ago. So, you have to accept that it will take several months to dissolve old uric acid crystals. Until most of your old crystals dissolve, you are at risk of gout attacks. You need pain control for at least six months.
Also, I strongly recommend increasing your allopurinol dose. Make sure your kidney function is OK. You seem to be OK with 200mg per day allopurinol. Take this, but go to your doctor after 2 weeks to get blood tests. You need uric acid, kidney function, and liver function tests.
You should also consider further increases of allopurinol. This will shorten the period you are at risk from gout attacks. That is because lower uric acid levels cause old crystals to dissolve faster. Be very careful with this, as you have kidney problems. Increase dose gradually, and always get the 3 blood tests I mention – uric acid, kidney function, and liver function.
You will find that gout attacks become less frequent and less painful. In a few months, when most uric acid crystals have dissolved, you will be free from gout pain.
Hi Michael,
8.2mg/dL is definitely too high for uric acid. Because it will cause gout to get worse every day, even if you have no symptoms. Also, 7.2 is too high. So, you must work on your gout diet to get below 5.
Gout diet has to be personal.
I start with what you eat now. Then, I suggest ways you can improve it. So. please start posting about what you eat each day, and we will take it from there.
Also, I highly recommend you ask your doctor for a 24-hour urine test. That measures your uric acid excretion rate. It’s only important in a small percentage of pharmaceutical gout treatments. But, it’s very important for all gout sufferers who want to control gout through diet improvements.
Alkaline diet is generally good for gout. It promotes uric acid excretion. But, how do we know if that is what you need?
Anyone seeking to control gout by diet and lifestyle improvements should get their uric acid excretion rate tested.
Have you ever discussed that with your doctor, David? โ
There are aspects of vegan diet that might be bad for gout. Are you taking any supplements, David, that might mitigate these effects? โ
Why on earth would you give up spinach!??! โ
That’s three questions, but the most important is: What are your recent uric acid test results? โ
I’m glad you’re recovering from heart problems. Now, let’s tackle the gout!
Brilliant, Nick.
I shall have to consider cutting down to 5 pints a day! ๐ ๐
[for the alco-gout police – that was a joke!]
@mike-salls Mike,
You’ve had some great responses, but a bit of a mixed bag. I hope you can see an emerging theme here – listen to your own body, not the common messages about gout triggers.
How about some feedback on the responses so far.
More importantly, what do you want to do next about beating your gout? โ
Like all gout treatment, your exercise has to be personal. So, I should ask what exercise you like to do. Then, I can research the specifics rather than just give general advice. I’ve already written a lot of general advice about gout and exercise. You can easily find this by searching gout exercise in the search box at the top of every page. The key points are:
- Exercise is good for gout.
- Exercise for gout should be gentle and regular.
- Most gout sufferers have damaged joints. Therefore, gout sufferers should avoid exercise that stress ligaments and other parts of joints.
That last part is where we can look at specific exercises. One idea I’ve had for a few years is to checkout different exercises from a gout point of view. I’m fairly certain that swimming is very good. But, I don’t know what the limits are. For instance, I can imagine a few lengths of butterfly puts enormous strain on the shoulders. For most gout sufferers, the shoulders only get affected after several years of uric acid crystal buildup. But, everyone is different.
Once we realize gout exercise has to be personal, it’s easy to create a healthy plan. Safety should recognize which individual joints have been affected by gout. And, which joints are most likely to be affected in the near future. Then, safe gout exercise is a mix of personal favorites and safe ways to do those favorite exercises. I have a reliable source of advice, as my son-in-law is a qualified trainer.
Back to you. What are your favorite exercises?
Does gout make your feet sore like running a marathon?
Easy Life Uric Acid Control Solution is definitely available for Uric Acid Meter test strips. Each time a batch of test strips is manufactured, it is given a code. Solutions are available for at least 6 current batches (8221, 8290, 8334, 8336, 8479, and 8497).
What does your supplier say? Have you told them the code on your uric acid test strips, and asked for the specific control solution for that batch? I warned about the need to be fastidious and meticulous.
I strongly recommend you:
- Forget the home testing routine.
- Arrange a uric acid blood test with your doctor, or other medical facility.
- Get all uric acid test result history from your doctor.
- Post dates and test results here.
That way we can make a definite decision about the scale of your uric acid problem, if any. Then, we can plan a way to control your uric acid, if such control is necessary.
All I have at the moment, is a single result of 6.2 mg/dL around March 2016. A single result has very little value in the Risky Uric Acid Range. We need to know if that is a representative result, or if you are usually higher or lower.
Wow Pat!
Thanks for a great question. But, I feel a bit out of my depth.
I run GoutPal to help gout sufferers communicate better with their doctors. I try to help you know what questions to ask. I try to help you understand what your doctor tells you. So, when I’m faced with a situation of two life-threatening diseases together, my first reaction is: “I’m not a doctor!”
But, I remember discussing Lasix in the old gout forum long ago. It was with a kindly New Yorker with heart and gout problems. He felt let down by his doctor, and did his own research. So he could “train his doctor,” he said!
He taught me that Lasix is great for congestive heart failure. But, there’s a catch. Lasix (furosemide) is a well known gout-causer. I’ll come back to that in a minute.
Pat, I never heard of Ejection Fraction before. I now understand it’s a measure of how well your heart is performing. There are complex considerations regarding diastolic heart failure and systolic heart failure. That is well outside the scope of a gout forum. But common sense tells me that Lasix is probably keeping you alive. Please don’t even think about stopping it now. I’m only just getting to know you, Pat. I don’t want to lose you.
Anyway, let’s get back to Lasix. Lasix, is the most common brand of furosemide. There is a study titled “Effects of the uricosuric action by losartan on the patients taking furosemide”. Cozaar is the most common brand of losartan. There is a very specific treatment plan. It involves taking Lasix, which dumps your excess fluid (but increases uric acid concentration). Then, around 4 hours later, take Cozaar, which encourages uric acid excretion.
Please, Pat, do not take this as your treatment plan. This is a suggestion for you to discuss with your doctor. There are many other medicine combinations that should achieve heart failure treatment with uric acid control.
ACV (Apple Cider Vinegar) has no effect on gout, other than it’s placebo effect. Cherries and cherry juice have some small value in herbal gout treatment, but must be part of a much more comprehensive plan. In your case, I’ll go out on a limb, and say they are a waste of time and money. Unless, Pat, you have some radical herbal gout treatment plan that you are keeping from me. ๐
I hope this helps you, Pat. It’s a complicated subject, so please ask for clarification if I’ve assumed too much.
Thank you for raising this Lasix issue again. Lasix causing gout seems to be too common. I’ve covered it in the past, but I think I need to review and improve my guidelines for Lasix and gout. I’ll add an idea in the suggestion box.
Normal, when applied to blood tests means average. It is a statistic that includes gout sufferers as well as people without gout. Normal has no medical value. I’ve put the important numbers in the colored table in the right-hand sidebar.
You can find a lot more relevant information if you search for normal uric acid levels. Use the search box near the top right of every page. Then, let me know what you think about the results you find.
The big question remains, viji, What is your uric acid number? โ
I think you are very wise, Rhys.
Purines are relevant to gout. But, everything has to be put into context. In your case, it’s your 95% vegetarian eating style. I love that phrase as an alternative to Mediterranean diet. I’m going to use it when I describe a sensible approach to healthy eating.
Purines in the context of healthy eating are never very significant. We can never avoid purines completely until we become skeletons. Human flesh is the biggest source of purines, unless we have a truly unhealthy carnivore diet.
So, as you say, “How bad can tiny amounts if these be?”
The answer is, not very bad at all. Certainly not worth worrying about.
One important consideration is that purine foods rarely trigger a gout attack. Gout attacks come from the millions of crystals that have built up over months and years. Managing that comes down to keeping uric acid at safe levels. That means, getting uric acid blood tests at least once a year.
Until we get rid of most of the old uric acid crystals, we always risk a gout attack. There are lots of things that can trigger a reaction to those old crystals. I don’t think a few seafood purines are going to make much difference. You could negate their effects completely with a glass of milk with your meal.
Gout symptoms are always interesting, Martha. We’ve had quite a few discussions over the years about redness, itching, eczema, and similar symptoms. People don’t realize these are typical of gout. But, they are very common. If you want to know the medical reasons for this, please let me know.
When I did a survey of gout symptoms, redness was the second highest. Over 60% of gout sufferers experience redness, with or without associated pain.
I thought the LO reading meant the droplet size was too low to test ? โ
I could be very wrong with that, so best to check with the manufacturers.
Some people find it useful to get a doctor’s blood test to compare results. I’ve a vague memory of one gout sufferer who persuaded his doctor to test a drop of his venous blood draw on his home uric acid test strip. That might be a false memory, as I’ve tried searching for it to no avail. Maybe it was just too long ago.
