[Keith Taylor]

For most people, the way to get rid of this is simply to take a pill every day.

That’s very true. Also, consider that diet changes are likely to take a long time to be effective, if ever. So it makes sense to get uric acid treatment now. Such as allopurinol, Uloric, or whatever suits your individual condition. For example, uricosuric treatment might be appropriate if you are a uric acid under-excreter.

That way, you get uric acid safe to stop further damage to joints and tissues. Which gives you time to adopt better eating habits. So future uric acid blood tests might indicate to your doctor that you can lower treatment dose – down to zero if you’re lucky.

In any case, you need that 24-hour urine test to determine your uric acid excretion rate. Otherwise, how can you know which diet changes to try?

[Keith Taylor]

Strawberries, Gout, and Histamines

I read a gout study today that reminded me of the mentions of histamines in this discussion.

Johnson, S. “Effect of gradual accumulation of iron, molybdenum and sulfur, slow depletion of zinc and copper, ethanol or fructose ingestion and phlebotomy in gout.” Medical hypotheses 53, no. 5 (1999): 407-412.

There are other aspects of gout diet. But this was the first time I spotted mention of histamines in a gout study…

Red wine and beer, two notorious culprits, contain all the ingredients required to bring about a gout attack: iron, alcohol, histamine and purines […] histamine helps
to arouse the immune system for inflammation […] The histamine produced by some bacteria during the fermentation of some alcoholic beverages (wine, beer, etc.) can trigger the inflammatory response […] histamine in beer, wine, sauerkraut and other foods promotes inflammation.

Figure 1: Multiple Interactions in Gout

Now, there’s a lot more than histamine in this study. As evidenced by Figure 1. But I’ll leave that for another day. Because I was intrigued to see if the “other foods” referred to includes strawberries. Then further intrigued to see there’s a lot more to this than first meets the eye.

Before I look at the histamine content of strawberries I should mention my previously known facts about strawberries and gout. Because strawberries have long been considered as one of many fruits that are good for uric acid and gout. But here we are looking at the other side of gout management – inflammation and pain control.

It turns out that histamine is a complex subject. So I’m not going to try to explain it here. Because anyone with histamine intolerance is going to know far more than me. But while we wait for that person to come along, I’ll attempt to get the ball rolling from a gout point of view.

There are foods that contain high levels of histamine. Many of these are listed in …
Maintz, Laura, and Natalija Novak. “Histamine and histamine intolerance.” The American journal of clinical nutrition 85, no. 5 (2007): 1185-1196.

But Strawberries are not included in the high-histamine foods list. Instead, they’re included in “Foods with suggested histamine-releasing capacities”. Also known as “histamine liberators”.

Finally, there are other complications of histamine:

• People have different tolerances.
• Some foods block histamine effects – Diamine Oxidase (DAO) blockers.
• Cooking and fermentation affect histamine availability.

As yet, I can’t find any specific advice regarding strawberries, histamine intolerance, and gout. But logic tells me that strawberries might help uric acid control if you are histamine tolerant. Though that needs to be part of a comprehensive uric acid control plan.

If you are histamine intolerant then you should avoid strawberries. But this should not be a major problem for gout sufferers. Because there are plenty of other ways to control uric acid, inflammation, and gout pain.

[Keith Taylor]

Hi Dee,

That pain in your feet sounds familiar to me. Because gout is a progressive disease. Which usually starts in one or two joints. Then uric acid crystals spread to all joints. Where they cause increasing physical bone, cartilage, and tendon damage. Before finally spreading to your skin and other organs with unsightly, painful results.

But the only way to be certain is through blood tests and a physical examination by your doctor or a rheumatologist. Then you can get the uric acid treatment you need to prevent further damage.

[Keith Taylor]

As this question was sent to my helpdesk, I would normally answer it in Gout Q&A. But it’s a poor question to start that new service for addressing gout concerns. So I replied personally with a correspondingly curt and useless “yes or no” before adding it to this thread.

In fact, “yes or no” is the correct answer. Because if you drink non-alcoholic beer in normal quantities as part of a healthy diet then it is safe for gout. But if you only consume non-alcoholic beer (or any other single food item) each day, all day. Then it is not safe for gout.

The irony of this question is that it was sent from my page: Best Alcohol For Gout – What’s Yours? Where I specifically state:

You cannot assess if a single food item or beverage is good or bad for gout. You must assess total diet with regard to 5 bad gout food groups

Having said all that – this is a public discussion service. Where my opinion is just one among many. So what’s your opinion on “Is non-alcoholic beer safe for gout”?

More importantly, have you ever discussed this with your doctor? If so, what did they say?

[Keith Taylor]

Not sure, Wesley.

Why not call round with a couple of each, and we’ll test them together? 🙂

Anyway, I doubt you’ll get a purine-free brew in the UK. Because we’re not as gullible as certain other countries. After all, what’s the point of worrying about a few purines in your diet? It’s the way to madness, not Gout Freedom.

[Keith Taylor]

Though I don’t have personal experience, we’ve discussed surgery and gout before. Particularly in the gallbladder thread. But there was no real conclusion.

However, there are some significant factors that we need to know about:

• What is your uric acid level?
• What treatment(s), if any, are you taking for gout?
• What have your doctors said about your gout and surgery concerns?

So please, Anthony, can you let us have this information? There’s no need to join the forum. Unless you want to. Because you can just reply to the forum update list, as you did earlier. Then, I’ll add your replies here.

Also, I’ll take another look at that gallbladder topic. So I can see if there are any more recent reports. Then I will summarize the key points here.

[Keith Taylor]

Thank you very much for your kind words, Carol.

I’m really pleased that you no longer suffer from gout. It sounds that, like me, you are enjoying the benefits of daily allopurinol. But I hope you still get uric acid blood tests to make sure you stay gout-free.

Personally, I think once a year is a good interval. Which I organize around my annual check-up for cholesterol, blood pressure, etc. In fact, I thank you once again. Because you’ve reminded me to put a note on my calendar to arrange my annual health check.

I’m really pleased that my GoutPal information has helped you. And I hope you’ll enjoy the benefits for many years to come.

[Keith Taylor]

Thanks Jerry,

I’m sad that your relationship with your doctor isn’t great. But hopefully that will change when you get better advice from your rheumatologist. Most importantly, your rheumatologist will test your blood for uric acid. So you can finally start to manage your gout properly.

This is the first flare that lasted over a week, and first that moved from one leg to the other.

This is typical of the progressive nature of gout. Because crystals build up in your joints over the years. So what starts out as an occasional attack in one or two joints eventually spreads throughout your body. But I’m sure your rheumatologist can put an end to that.

Always remember that you can ask here about anything you are unsure of. Also, it will be nice to get an update after your appointment so we can share in your recovery 🙂

[Keith Taylor]

Hi Girish and welcome to the forum. I hope Jerry ( @jerry-mills ) finds your comments useful. More importantly, I hope he returns to thank you in person and tell you how your contribution has helped him.

Anyway, why don’t you start a new topic to tell us about yourself? Because it’s unusual for people to join the forum just to reply to others. So I’m intrigued, as I love to learn about other people’s gout stories.

[Keith Taylor]

Aw Jerry! You have my sympathies mate. Cos I remember what it was like in my early years with gout…
– No clue about my uric acid levels.
– No understanding of how it’s impossible to manage gout without knowing my uric acid number.
– Confused about how food affects gout.
– Confused about how water affects gout.

Eventually, I got a plan with my doctor to control my uric acid. Then with a few ups and downs, I got myself completely free from gout pain. But I’ve still got the scars. So I wish I’d started uric acid treatment sooner (that’s real measured treatment.)

But my best advice right now is to get together with your doctor/pharmacist for proper pain control.

Depending on the severity of your attack, you need up to 3 treatments in combination:
1. Colchicine to stop inflammation getting worse. But it has no immediate pain relief. So…
2. NSAIDs such as ibuprofen. But talk to your doc about a prescription for gout strength doses of anti-inflammatories. Because gout laughs in the face of anything less than maximum strength. And in the worst cases, the inflammation is too bad to resolve in a short time. So…
3. Compatible pain-killer such as acetaminophen (paracetamol).

Jerry, please take some time to talk about the right pain relief package with your doctor and/or pharmacist. Because you need to be confident that what you are taking is safe and effective. “Chugging ACV and lots of ibuprofen” is not safe in my opinion. So you must get professional advice. As well as regular posting here to learn what to ask and what the doctors advice means in real life.

Then, once you are confident about gout pain control you can start to tackle the dangerous beast that is excess uric acid. Hopefully, before it cripples you permanently. Or worse!

[Keith Taylor]

What I’ve experienced is seemingly random changes in uric acid test results.

That’s also my experience. And has been noted repeatedly over the years by many recovering gout sufferers. Mainly because you often get a “clump” of old crystals hidden by our immune system shield. Suddenly, that shield buckles as some old crystals dissolve. Then that cache of crystals is more open to dissolving in the bloodstream. Leading to a spike in uric acid blood levels.

But there are lots of other factors. Including weather, hydration levels, food intake, exercise levels, etc. So I guess we might add viral and infection reactions to that list. Which only add to the randomness.

My solution is simply to look at averages. […] after the therapy, spikes shouldn’t be a problem anymore.

That is a great takehome message to all gout patients. Because they can realize that despite pitfalls, their determined effort to control uric acid will definitely lead to long-term freedom from gout.

Finally…

And hello Keith! Long time no see.

Thank you nobody! It’s been a very strange year for me since Gout or broken bones for maximum pain. But thankfully almost over since I realized I needed a little help with the mental scars.

[Keith Taylor]

So this is quite interesting.

Well Jack, I’d say it’s very interesting. Because it’s the first time I’ve heard this. So it’s something for me to look into.
Am I right in assuming you are referring to this?
Papi, Alberto, Marco Contoli, Pierluigi Gasparini, Laura Bristot, Michael R. Edwards, Milvia Chicca, Marilena Leis et al. “Role of xanthine oxidase activation and reduced glutathione depletion in rhinovirus induction of inflammation in respiratory epithelial cells.” Journal of Biological Chemistry 283, no. 42 (2008): 28595-28606. Free from publisher at http://www.jbc.org/content/283/42/28595.full.pdf

In any case, I’m always interested in references to articles about uric acid and gout. So I’ll read that properly soon, and also look at more recent articles that have cited it (only 51 to go! 😉 )

I like your approach to uric acid treatment:

With 200mg daily, my levels dropped from peaks of around 600 to sub 300. My plan is to maintain this level for six months, in order to dissolve any deposits, then attempt to titrate back to 100mg daily to maintain a safe level. We shall see.

And I believe lot’s of gout sufferers can learn a lot from your approach.

For people who don’t recognize the scale, it’s μmol/L where 300 is equivalent to 5mg/dL. So take a lead from Jack. Get uric acid low to encourage old crystals to dissolve. Then you can consider reducing allopurinol dose to maintain a healthy 6mg/dL for the rest of your long, happy life. Of course, I should add that you must discuss those targets with your doctor. Because other factors in your medical history might imply different targets.

[Keith Taylor]

Hi Rebecca,
0.30 is a great target level for uric acid. So congratulations!
I hope you can give me some feedback on my explanation of your current issue – Uric Acid Level Charts . Especially, the feature image for that page which shows my interpretation of the 3 common scales at 4 different ranges.

I see your issue as being similar to currency conversion. As most GoutPal readers are American, I mainly use the uric acid equivalent of the $ – mg/dL. Where I always keep in mind that 5 is safest, 6 is usually acceptable, and anything higher is increasingly dangerous. As a fellow Brit, I switch my thinking to the uric acid equivalent of the £ – mmol/L. Where the similar values are 0.30 and 0.36. Though I have an old habit of rounding that maximum level to 0.35.

I expect you have experience of currency confusion when you first arrive in a foreign country. Then you adapt as you use different numbers each day. So it’s similar with uric acid measurement scales. The more you use them, the easier it gets.

It would be good for you to practice by reviewing the page I mentioned above. Then look at other uric acid pages each week and tell me what you think about them. 🙂

[Keith Taylor]

Welcome back, Dave

First, a question. Because I notice on both your posts that you describe uric acid test results from a home meter. So I’m wondering if you’ve had any blood tests run by your doctor?

If so, it would be useful to compare lab test results with your home uric acid meter. Because I’ve seen significant differences in the past. But also some good correlations. Especially when gout sufferers have adopted a meticulous unvarying test routine.

As for PVNS, I’ve seen many cases where suspected synovitis has eventually been diagnosed as gouty tophi. Also, I’m reviewing cases to see if there are examples of the opposite situation. However, the general view is that gout symptoms often mimic other rheumatic diseases. So it’s important to consult an experienced rheumatologist. Because such gout specialists can test joint tissue to get a better diagnosis. Then that leads to the best treatment.

[Keith Taylor]

Firstly Jason ( @jason-ayers ), I’ve merged your topic about Quorn here as the subject doesn’t generate enough interest to warrant 2 topics. However, if you want to ask about personal help planning a low-purine diet, then start another topic. But please see my comments below.

Secondly, I agree with Nobody’s reply to Jason’s post. I believe Jason should acknowledge it.

Thirdly, I want to share some science about Quorn (mycoproteins) and Purines.

Quorn and Purines
As far as I can see, the only study that directly addresses this issue is:
Havlik, Jaroslav, Vladimir Plachy, Javier Fernandez, and Vojtech Rada. “Dietary purines in vegetarian meat analogues.” Journal of the Science of Food and Agriculture 90, no. 14 (2010): 2352-2357.
Which concludes:

Protein‐rich vegetable‐based meat substitutes might be generally accepted as meat alternatives for individuals on special diets. The type of protein used to manufacture these products determines the total content of purines, which is relatively higher in the case of mycoprotein or soybean protein. While appearing lower in wheat protein and egg white‐based products. These are therefore more suitable for dietary considerations in a low‐purine diet for hyperuricaemic subjects.

However, there is a 2016 study which references that 2010 study:
Lockyer, S., and S. Stanner. “Diet and gout–what is the role of purines?.” Nutrition Bulletin 41, no. 2 (2016): 155-166.

That refers to different types of purine bases discussed in the 2010 study (more later). Then it summarizes some earlier relevant work:

Finally, 100 subjects consumed 20 g dry weight mycoprotein in cookies, an amount comparable to an average retail portion of Quorn^TM products, or control cookies for 30 days, separated by a one-week washout period (Udall et al. 1984). There was no significant change in Serum Uric Acid (SUA). A smaller study reported in the same paper (n = 13) also stated that SUA remained within the normal range after consumption of mycoprotein for 16 days.

Now, the more I study purines, the more I realize that they are only an indicator of what might happen to uric acid levels in your body. Because different types of purines have different effects on uric acid. Also, people process purines in food differently. So foods that raise or lower uric acid in one person might have no effect or the opposite effect in another person.

More importantly, most gout sufferers do not manage their diet in a way that allows them to monitor the effect on uric acid. In fact, of all the thousands of gout sufferers I have corresponded with over the years, only a handful have ever tried to correlate diet changes with uric acid changes. Fundamentally, if you are not prepared to monitor those changes, then you are much safer if you discuss allopurinol or it’s alternatives with your doctor. Because that makes all foods low purine. Allowing you to focus on eating healthily.

Which brings me to my final point on Quorn and purines. In my opinion, Quorn is not a healthy source of protein. Instead, I recommend you plan your gout diet around healthy whole foods. With my mantra being EFSEP:
Eat Food (avoiding processed food-like substances).
Sufficient (avoiding being overweight).
Especially Plants (avoiding excessive animal consumption which is linked to gout and many other diseases).

[Keith Taylor]

OK, as many visitors are interested in this topic, I’ll give my thoughts about the general considerations of diarrhea with allopurinol or colchicine. But never forget the overriding advice relating to this type of problem. Because with any medication, you must read the label and you must consult your doctor or pharmacist if you are worried by any unexpected effects of your medicine.

The first set of considerations are not specific to these gout medicines. Because there are common difficulties with nocebo effects that are not specifically gout-related.

Next, we should consider the specific gout medicines: allopurinol and colchicine.

Firstly, colchicine has a long history of association with diarrhea. But modern colchicine dosing recommendations should eliminate the worst of this. So for anyone who wants more help with colchicine and diarrhea, you really must describe your exact daily dose and when you take it.

Secondly, diarrhea is mentioned as a known minor side-effect of allopurinol. But this has been mentioned many times before in the forums. So I recommend you use the “Google Gout” search box near the top of every GoutPal page. Then you can see if the experiences of how other allopurinol patients have coped relate to your situation.

Finally, I remind you of my earlier comments about getting professional help. Because there are lots of ways to resolve problems of taking uric acid and gout medicines. But if you don’t take active steps to make sure you are taking your gout meds the right way, you might seriously delay your gout recovery.

[Keith Taylor]

Hi Danny ( @fxdc-fxdc )

Thanks for your post.

I split it from the GoutPal Testimonials topic because I think you’ll get better responses as a separate topic.

You don’t say much about your history, test results, or current meds dosage. Also, it’s not clear to me exactly what symptoms are causing you concern. But I’ll have a think about it and come back later with some general facts about managing gout medications.

Did you ask your doc about your concerns? If so, what was the response?

[Author]

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