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Hi!
It would depend on your uric acid history as well as on the reason your doctor wants to increase the dose.
In any case you should ideally be on meds that prevent attacks when starting allopurinol. Your kidney injury might make some of these medications dangerous for you but there are several alternatives so hopefully at least one would be suitable. Failing that, you could perhaps take an effective painkiller (not acetaminophen/paracetamol).
I would recommend that you discuss this with your doctor ASAP. Don’t allow them to brush off your concern or to minimize attacks because they cause damage, not just pain. And if your doctor isn’t very knowledgeable about kidneys or about preventing and treating attacks, consider seeing another (perhaps a specialist).Hello Richard,
I have read people claiming that sustained ketosis was fine but that going in and out of ketosis was the problem. That sounds plausible. I never tried sustained ketosis but failing to eat enough carbs for a day or two certainly seems to be an inflammation trigger for me… perhaps if ate even fewer carbs for longer periods, my body would adapt to that. Do you think it’s possible that the energy contained in the alcohol you drank might have taken you out of ketosis briefly?
There’s one problem with your theory however: one does not go from controlled uric acid for years to an “attack in my right wrist and hand that took almost 2 months to resolve” overnight (or even over a few weeks). It sounds like your uric acid wasn’t controlled but that symptoms were in remission (that sometimes happens without an identifiable cause). There’s no way to know for sure (for one thing, we don’t know for a fact that this attack was gout). But if your diet contributed to this remission without lowering your uric acid, while it could be beneficial for gout sufferers, it should be used in addition to and not as a replacement for uric acid control. That’s because excess uric acid is going to get people prone to gout in trouble sooner or later (though later is sometimes as good as never and in any case better than sooner!).Hello,
Gout symptoms typically come and go for no apparent reason. This unfortunately leads people to get invested in a variety of magical cures which do not work and which are sometimes harmful when used for very long.
It takes a long time to know if your gout symptoms are actually gone, and even then they might come back occasionally (especially during the first couple of years after starting a successful treatment and/or when consuming very few carbs). Additionally, were your symptoms actually gone for good, very high amounts of uric acid in your blood would still be a problem you shouldn’t neglect.
A harmful amount of uric acid in one’s body is not caused by the consumption of reasonable amounts of beer, fats, carbs or proteins.Hi!
I don’t consume alcohol and don’t know how long the effect lasts, sorry.
I wouldn’t assume that you can solve your problem by quitting alcohol and improving your diet anyway. Symptoms are a poor guide to what’s happening to your uric acid, except over many months (if not years). I would certainly encourage you to quit alcohol, but not by misleading you so I want you to know drugs work much better to control uric acid and more importantly to prevent future gout symptoms at this delicate stage of the evolution of the disease.
Animal products in general aren’t the problem by the way. Small cells are (at least as far as purines in general are concerned but you should understand there are additional concerns with animal flesh) so while you certainly want to avoid animal flesh, you should also avoid some non-animal foods as well. Milk is fine however, as are eggs and some other animal products. Vegans have been known to have uric acid issues (though this is by no means unavoidable). Again, drugs work so much better than tweaking one’s diet that I don’t think it’s worth wasting your time with the details unless you know you can’t tolerate the best drugs (and even then, you should make sure you haven’t been misled in this regard by incompetent doctors, as I was for too many years).Hi,
I didn’t see your question earlier because this forum has very little activity.
Many conditions can produce symptoms somewhat similar to gout. And gout isn’t usually something you get whenever you eat the wrong thing as some people imagine.
Could you clarify what exact uric acid values you got, and from what kind of test ? People who get tested at my lab and who get a uric acid value under their current range would be very unlikely to experience gout symptoms (unless they started treatment recently). But ranges are kind of arbitrary and change all the time. And you may have meant within the range (that’s what people usually call “normal”) as opposed to below the range…
Colchicine isn’t a good way to diagnose gout. People (including one of my doctors) do use it for diagnosis occasionally so I’m not saying you shouldn’t try it if you really have no other option but this is a dangerous drug and the results are likely to be ambiguous at best so you’re going to want to be working with a knowledgable doctor if that’s at all possible.Hi,
I don’t take allopurinol but, in theory, there’s not much benefit to spreading the dose over the day since the drug is metabolized over more than a day anyway. There might be a tiny increase in effectiveness when taking half the dose in the morning and the other half in the evening but I guess it’s mostly a matter of convenience and perhaps of managing certain side effects (which probably aren’t affecting you).
I suggest you ask whoever reduced your dosage when you get an opportunity.
And whatever you do in the meantime, make sure the amount of uric acid in your blood is checked after you reduce your dose (ideally a month or two afterwards).Hi,
I certainly experienced strange pain and weakness, but hasn’t everybody else (or at least everybody who isn’t young anymore)? Maybe a more specific description might be useful but this is probably something you should talk about with a doctor who would perhaps run a few tests to see if anything unusual is happening with your muscles. There could be many causes even if you didn’t change anything other than your allopurinol dosage (which didn’t change much).
Without looking at older UA numbers, it’s impossible to guess if you might still be experiencing gout symptoms (though unexplained metatarsal pain that lasts a few days is suspicious indeed!). If you still have solid uric acid in your body doing damage, this might end up interfering with your training. Uric acid has been known to move around the body and cause symptoms at the strangest of places soon after people drop their SUA low enough but I would be surprised if this happened to someone after three years of allopurinol (even if the dose wasn’t quite high enough). Damage caused by gout in the past might also end up causing problems (mainly bone issues) but so far as I know, there’s nothing that can be done to prevent it once the damage is done. So I would want my UA lower than 350 in your situation. In case allopurinol turns out to be an issue (which seems unlikely at this point), there are alternatives.Hi,
Regardless of the accuracy of your self-testing, 6.7 and especially 7.2 are high enough for gout. The normal range is irrelevant. And not everyone gets the worst-looking big toes (mine were never shiny). Obviously I can’t tell whether you have gout but I can tell you’ve had bad doctors (which is unfortunarely not unusual).
If you’ve had gout for 20 years, I would recommend finding a doctor with a clue and discuss blood tests and potentially a pharmalogical intervention (standard warning: beware of allopurinol if you have East Asian ancerstry). If you actually have gout, diet will probably not work wonders after allowing the disease to fester for so long. Don’t get me wrong: improving your diet would help in the long run if compared with not doing anything. Just don’t bet on that curing your gout at this point.
Yes, people have had gout triggered by weight loss and/or dieting and fasting probably does something similar. But lots of things trigger gout whereas the only way to prevent it is to get rid of the uric acid in your body so I wouldn’t give up fasting if it works well for you and you tolerate NSAIDs well (but you should get medical tests to make sure you are actually doing well when you’re fasting and that you actually tolerate this dangerous class of drugs as well as you think).
The NHS’s dietary advice is probably useless. Chicken is no good for gout sufferers for instance.If you actually have gout, depending on what your uric acid used to be, going on a gout prevention diet could actually prolong your symptoms. It would help in the long run and allopurinol can do the same thing depending on the dose so it’s not that such diets aren’t helpful, only that they’re rarely a quick fix. To simplify things a bit, it’s mainly what you ate last year that’s the issue rather than what you ate yesterday.
It’s of course impossible to tell based on a short description but this sounds like it could be gout. You would get some heat when inflamation is very strong but afterwards you could have big toe joint pain and reduced mobility (especially when flexing it towards you) that lasts for so long that you might need to strech it for months after the pain is gone to get most of the range of motion back.
But this could also have nothing to do with gout. Maybe an experienced doctor would make a good guess by handling your foot but, without imagery or joint fluid testing, I don’t think it’s possible to tell for sure based on a single episode.
One thing which does sound strange to me is pain is the pain location (at the tip of the toe and so forth). I wonder if pressure on a nerve might be involved somehow.I very much doubt gout swellling could possibly cause fractures, but injuries can trigger gout, in which case it would be easy to overlook the gout and blame the injury for all the symptoms.
There are ingredients you listed which I don’t recognize, which means they could conceivably be a problem. I only consume things I don’t understand occasionally or in small amounts, especially if they aren’t commonly found in food. It’s not only the effects on uric acid gout sufferers need to be concerned about but diuretics among other things.
An egg a day is totally fine. Eggs are only protein-rich relative to their size, and chicken eggs are pretty small. Don’t worry about that unless you know for a fact it materially impacts your cholesterol (more likely it’s other things you’re eating… or failing to eat for that matter). You should be looking at the total amount of proteins you eat anyway, not particular foods. And most proper foods (as opposed to sweets and whatnot) contain proteins. People do normally not need to count proteins but if you’re doing protein powders/drinks you need to make sure your unsupplemented diet isn’t already protein-rich!
You probably never needed to boost your immune system (FYI they give drugs which suppress the immune system for covid as well as gout) and I realize you said you would keep taking the D3 (which is of course the right choice) but please don’t skip your multivitamins if you actually need them for some reason. If they’re actual multivitamins made by a company that also sells regulated medical supplements, you should be fine as long as you follow the instructions.
Don’t worry over a couple of beers. Assuming you don’t have another disease which could make this dangerous, simply take care to drink extra water during the rest of the day even if you’re not thirsty.
You might find that there are foods and drinks which trigger symptomps but please wait until you actually get symptoms before being afraid of something which happens to trigger a couple of people on the Internet. And even then, coincidences happen so don’t jump to conclusions the first time you get symptoms after eating or drinking something.Hi!
Regular doctors do not have the tools to diagnose gout properly and it’s often diagnosed based on a pattern of symptoms over a long time or based on a simple guess. Sometimes doctors simply use gout treatments as a diagnosis tool. An MRI or simply an ultrasound would be useful provided it’s done by a someone with a clue. But what you would ideally want when gout is suspected even though there are other explanations for the symptoms is an analysis of the joint fluid, and you want a skilled hand for that job! So I suggest you see a rheumatologist if at all possible. Not only is that the speciality which is supposed to be most knowledgable about gout but an experienced rheumatologist should be able to recommend someone who knows what they’re doing when it comes to drawing joint fluid from gout sufferers.
Alternatively you could simply wait. Gout typically resolves for a while after the first times you get debilitating symptoms and it will become clearer whether you have typical gout symtptoms or not over time. If you elect to wait, be sure to repeat that uric acid test a few times over the next year even if you feel fine and stop worrying!
Regarding your only uric acid test, it’s high enough to develop gout but low enough that your risk of gout isn’t very high. It wasn’t the best time to get a reliable result anyway. It’s good you were tested at all but I wouldn’t make too much of the result until you get more values to see if that was a typical number for you or not.
Don’t worry too much about your diet or vitamins. It does affect gout but most of the information out there is terrible (including the dietary superstitions peddled by many doctors). You could eat less animal flesh but the main thing I would watch at this stage is supplement-type stuff or novelty foods made with strange ingredients. Plant protein is of course fine to eat in moderation but overeating protein affects uric acid and powder/drinks are easy to abuse. Besides, what else did they put in those drinks you’ve been using?Hi,
I’m not Keith but I can still tell you that the effectiveness of allopurinol varies quite a bit between individuals. Chances are, you do not actually require more than 300mg per day but there is no way around trial and error to find out what the appropriate dose might be. While 50mg per day is a very low dose, your doctor may have started you on that dose to see how well you tolerate this dangerous drug. Indeed, I would generally recommend people start with 50mg per day. If that was indeed only a starting dose, your doctor might want to look at the results of your next blood test before increasing your dose.Hi!
Switching to starches and/or to a more plant-based diet doesn’t help as such. The effect would depend on what you’re switching from (among other things). What does help is consuming dairy and reducing the amount of animal flesh you’re eating but this won’t matter much if you’re on an adequate amount of allopurinol anyway. If you don’t tolerate the drug well or it doesn’t work very well on you, it might be worth focusing on your diet but even then, you might want to look at things like the amount of proteins and minerals you consume rather than eating loads of corn or following some other hairbrained scheme.
Alcohol is alcohol. Considering you seem to have just started a daily pill which is know to stress some people’s livers, maybe wait until you get results from your next bloodwork before putting additional stress on your liver for recreational purposes?
Frankly, occasional drinks and diet are no big deal compared to a serious drug. Better make sure you really need to be on that drug and if so, that you end up taking the right dose for you!Hi!
Don’t waste your time trying to understand your SUA fluctuations. The amount of uric acid in your blood is going to vary randomly at this stage (even more than it would usually). Just make sure (with your doctor and a bloodwork including liver function numbers and whatnot) that you are tollerating allopurinol well and increase your dose a bit.
Your diet may be generally healthy (other than the alcohol), but isn’t good for uric acid. The information out there about diet and uric acid is mostly terrible. If you tolerate allopurinol, you won’t need to be very careful about your diet anyway. Just avoid eating loads of small animals or shrooms and in particular stay clear of the stuff made from single-celled organisms that is sometimes used as substitutes for animal products.Ah! I had heard of pegloticase, but not often enough that I’m confident about how to spell it (or aware of the brand names).
My understanding is that this intravenous drug works much better than anything else medicine has to offer. Most people have little use for it since AP (or equivalent) typically does the job if you take large enough doses but the trouble is there’s a limit to how quickly these oral drugs can get rid of extensive uric acid deposits because they do not actually break down uric acid. Pegloticase should in theory act much faster but as a result your body would have to deal with the byproducts of uric acid breakdown which I suspect might be dangerous for the kidneys in particular.
There might be other serious side effects I’m not aware of. This treatment is so rare that I’m basically ignorant about the risks so I can’t help you balance the risks and benefits. All I can tell you is that the benefits are real and that, in doubt, it’s generally best to get a second opinion from a different specialist if the treatment isn’t urgently required.About colchicine: I agree it’s a dangerous drug and people are often told to take ineffective doses as a result. It’s also not specific enough to be very effective at any dose.
You might recall there was a COVID scare about regular anti-inflammatories but if you can handle the side-effects of a large dose, they work well enough without the help of colchicine. And unlike colchicine, they are used often enough that people know by now what effect they have on COVID. I woudn’t be surprised if the anti-inflammatory they give for COVID nowadays worked well for gout by the way.
But if you can’t take large enough amounts of these other drugs regularly, then colchicine can be useful. If there’s lots of virus circulating in your area however, it might indeed be prudent to abstain from rare drugs which aren’t life-saving.I only used canes during some flares. Perhaps your immune system doesn’t react as strongly as mine (I was still in my twenties when I got the canes) but swelling in the feet sometimes makes walking extremely painful. I didn’t have extensive deposits so it was unsurprisingly the toe joints and ankle joint which gave me the most trouble.
I talk about the canes because it’s easier for me to remember the times I used them than to remember all the times I simply felt pain. But I know I had less frequent and less severe flares for a while after the last time I used the canes. The less severe symptoms are also less specific to gout so I can’t tell what caused every mild episode.
