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Also, thanks to Keith’s latest post I noticed this page which is relevant to your original question:
Good on you to have found a drug that keeps your symptoms down!
Like you said, diet isn’t a cure-all when it comes to gout. So I don’t think you should focus on diet right now.
Likewise, I wouldn’t worry about allopurinol side effects unless you already suspect you are experiencing side effects. But do rush to a doctor if you get a serious akin rash or allergy-like swelling because that could be serious. Getting your blood tests in due course is also useful when it comes to potential side effects because that’s an opportunity to monitor your liver and kidney function.I’m not aware of there being a synthetic score with a normal range for amino acids. But of course there are lots of things I’m not aware of…
In any case, having had the test done wouldn’t make drastic calorie restriction any safer.I think I’ve got an inkling of what you’ve been through since I’ve been treated as vegan enough for concern by doctors and nutritionists. I’m also aware there is misinformation out there about the nurtritional value of some plants.
But that’s no reason to deny that there are potential pitfalls with any diet, including veganism. Making this some kind of “us versus them” contest and resorting to barguments (you can bet people who intent to profit from raising livestock are going to make sure their animals are getting more than enough B12 to grow!) isn’t the most prudent way to go…Hi!
If your elbows (or any other place) are starting to get a bulge, it should be possible to make sure what is causing the problem by examining the bulge.
If it’s gout, it sounds pretty severe. Gout is typically worst on the toe joints and the rheumatologist I’ve seen doesn’t think gout would normally affect shoulders (as opposed to the joints on the arms and legs). But if gout’s bad enough, I guess it could affect anything. What do your uric acid blood tests look like?
If you’ve only started getting pain all over after starting allopurinol however, that’s a things that’s known to happen. It seems people have caught the phenomenon with medical imagery so it may not be all in our heads.The main thing with allopurinol isn’t to tweak your diet but to make sure you are getting an adequate dose. That takes blood tests (and possibly some arguing with your doctor if they’re not proactive enough).
You can follow mainstream diet recommendations for gout sufferers like not eating animal flesh but allopurinol makes diet less important anyway. The main things you want to do once you have started allopurinol in my opinion are: drinking lots of water, abstaining from alcohol or anyhing else that could cause dehydratation and consuming milk or yogurt (assuming that is a reasonably healthy option for you).If you aren’t doing OK in spite of the colchicine, there are other things you could potentially take in combination with allopurinol. If you’ve just started colchicine though, give it a few days.
Yes, I think everyone should get ALT and AST tested at least once after starting febuxostat.
The liver is of course a vital organ and it’s common enough for febuxostat to cause liver problems that preventing damage is well worth the cost of testing. Liver stress isn’t painful so it can get quite bad before you notice it. This is why people are told to be very careful with common painkillers using paracetamol: excessive doses or prolonged use can cause liver damage and by the time people realize they are getting seriously ill, sometimes it’s too late to save them.The standard blood test for kidney function measures creatinine. You will probably need the help of a doctor to interpret the result. And a doctor who knows you well will know what other tests might be appropriate in your situation.
But everyone should get standard liver function tests. There are a few of these and you might as well get them all but the most useful in order to observe the effect of febuxostat are called ALT and AST. If you have no other illness which is affecting these values, they are a bit easier to interpret than the kidney test but it would still be best if you had access to older test results for comparison. There is also a test called bilirubin which is not standard everywhere and may be relevant as well but I don’t think there’s much point in insisting on it as long as your ALT and AST values are OK.
Long story short, best arrange the blood test with a doctor! Febuxostat is not such a common drug so doctors can not be expected to know all about it, but any doctor surely is familiar with standard blood tests so you can simply ask for liver function tests and they’ll know what to do.You shouldn’t stop the medicine because the point of the test is to observe the effect of the drug.
In addition to measuring the amount of uric acid in your blood, it is very important in your situation to get standard liver function tests. The drug is known to affect the liver. People usually tolerate 40 mg daily but that dose was too strong for my liver. There are a few other routine tests like kidney function that are worth doing to make sure your body tolerates the drug well.If you tested at 398 before starting the drug, you shouldn’t increase your dose! You should instead get a new test.
But in all likelyhood, you are already taking more than strictly necessary which means you are on the right track (assuming that gout is indeed what causes this pain).
That also means that there’s probably not much sense in avoiding meat in your situation. You need to verify my guess with blood tests but, assuming you weren’t taking another drug which also lowers uric acid when you had your blood drawn, I think that 40 mg is strong enough for someone who used to test at 398 that eating meat won’t matter much. Consuming milk and avoiding alcohol for a few months on the other hand, that should help even if you are taking a stronger dose than necessary.The idea behind the febuxostat therapy is that reducing the amount of new uric acid created in your body will lower the average amount of uric acid in your blood. This can be verified with blood tests.
Then, since the amount in the blood is depleted, the troublesome stores of uric acid in places like the big toe joint will slowly dissolve in the blood.
Finally, the uric acid in the blood will end up in the toilet, same as always. Except that instead of mostly getting rid of newly created uric acid, you will be getting rid of a lot of old uric acid as well.
It should all happen naturally once the creation of new uric acid is reduced thanks to febuxostat. Only you need to give it time. You can help the process along by drinking lots of water (within reason: don’t torture yourself!) and making sure the places where uric acid is stored (like the joints in your feet) remain fairly warm (you for instance want to avoid clothing or chairs which would prevent blood from flowing easily to and from your feet).Hi!
The test result you mentionned is too high. Was your blood drawn after one month on febuxostat?
If so, you have the choice between testing again to make sure (results can vary quite a bit) or increasing your dose without further delay. I think you could try one pill and a half (60 mg) per day. You’ll have to get tested again after a few weeks on the new dose to see if it works. You want your test results to read 350 or lower.
It’s also important you get tested for side effects and liver function in particular whenever you increase the dose and of course after starting the drug. Febuxostat is not an innocuous drug and serious side effects are fairly common.It takes more than one month for febuxostat to work anyway. If you have as you suspect been suffering from gout for many years, it could easily take the better part of a year to eliminate gout pain.
You can however reduce gout pain and make it last shorter by bringing your uric acid tests under 300. You may even get extra benefits from bringing them under 250 though nowhere (to my knowledge) is that officially recommended.While febuxostat greatly reduces the formation of uric acid in your body, it doesn’t destroy the uric acid which you are already burdened with. So while your body is slowly getting rid of the stuff, I recommend drinking plenty of water, regularly consuming milk or milk-based products if you tolderate that, abstaining from animal flesh (you can eat eggs instead to get a similar nutritional value) as well as alcohol and making sure you have drugs which suppress gout symptoms on hand. Some people even take a colchicine pill every day during the first months after starting febuxostat.
B12 isn’t a protein. You need very small amounts of B12 so it’s easy to get that from supplements or processed foods to which B12 has been added. On the other hand, you need more protein than can fit in a pill.
Protein deficiency has been measured in vegan populations. It’s not a routine mesaurement like B12 (or at least it’s not routine in many countries) so most people never have the test.
It’s not about eating enough protein or loving food. It’s about the protein mix in plant products. Anyone eating lots of plant protein needs to eat too much protein if they don’t get the protein balance right, which is nearly impossible. When you eat way more protein than you need, you naturally get enough of every type. But dieting makes it hard to eat so many proteins that the mix doesn’t matter. Tofu and other soy products are so popular because the protein mix is similar to typical animal products.
If you did get most of your protein from beans, chickpeas and lentils you would not get the type of protein deficiency most common in vegans. You would get other deficiencies instead. Since there are lots of protein in grains for instance, it is rare for people to actually get most of their protein from legumes. But people who are trying to cut calories may well cut grains and end up in trouble that way…There is the matter of cost which might justify your doctor’s approach but, if that were financially realistic, I would recommend getting the second blood work on the drug sooner.
First, you could otherwise potentially be exposed to quiet but dangerous dose-dependent side effects (impaired liver function for instance) for 3-4 months.
More importantly, the dose ought to be initially set based on your blood tests whereas your doctor seems convinced she is able to divine how much you need. There’s nothing magical about 300mg. If you need more for instance then taking an inadequate dose for several months may cause you weeks of pointless gouty misery. If you should indeed have been taking this drug for 15 years, your body is probably riddled with deep uric acid crystals so it would be prudent to aim for uric acid test results well under the maintenance target.So, side effects…
There is such a thing as psychological side effects so obsessing about lists of side effects may be counter-productive. Most people do fine on that drug.
Unfortunately, the side effect you are most likely going to experience is gout, gout and more gout. So make sure you have pills to suppress gout symptoms on hand. It seems the longer you’ve been delaying therapy, the longer the gouty cleanup phase lasts.
About the deadly reactions, my understanding is that the risk is greatly reduced if you have no East Asian ancestry. If you do, I understand there is a genetic test you could take before trying the drug.
Anyone can get pretty bad side-effects but they are normally annoying rather than deadly (or least not immediately deadly). I’ve been told the one thing to watch for carefully is a skin rash. If you get a proper rash and not mere itching, stop taking the drug and report to a doctor pronto. Signs of an allergic reaction such as lip swelling are of course also grounds to stop taking the drug and get help. If you get other weird symptoms, as long as they are not serious I’ve been told I could keep taking the drug and see if they go away. Sometimes one’s body simply needs time to get used to changes.
If you want to play it safe, you could start with less than 100mg. That seems to be a pretty safe dose and I’ve never seen a professional recommendation for taking less than 50mg as a first dose but that doesn’t mean smaller doses are actually harmful. In the unlikely event you do react badly to the drug, I think it is reasonable to expect very small doses to be less uncomfortable.It makes sense not to count the calories in things such as lettuce.
It does not however make sense to aim for 800. That’s kind of crazy on a sustained basis, especially for a vegan. Some people get potentially deadly infections when dieting too hard for instance. I don’t know how your body works but if you’re pretty average, 1200 should be the bare minimum.
And you’d have to be very careful to get all the proteins you need if you’re undereating. Tofu is fine but since you’re vegan, pea protein shouldn’t be your main protein source. It’s far from the worst protein source and I’m not saying you should avoid it, only that taking a reasonable amount isn’t going to fully cover your needs.Do you still have gout symptoms?
If you’ve finally gotten rid of them but are still taking allopurinol and your blood tests keep showing pretty low uric acid as a result, your risk of facing a gout attack should have become quite low by now.
Mild gout which is treatable without horrible side-effects shouldn’t dictate what you can and can’t eat for the rest of your life. You want to be especially careful during the initial phase of the therapy but hopefully that’s behind you now. So researching the potential impacts of dieting on completely different aspects of your health might be a better use of your time.
If you find a diet that works for you, you could get a blood test done to see what if anything it’s done to your uric acid. That’d be more useful than scientific evidence in a way because the evidence is about other people’s bodies. If you test fine, you’ll know you’re safe. If not, you could always take a bit more allopurinol to compensate. Don’t rush to do the test since any diet you’re trying may not work out for you over the long haul anyway.There’s one easy thing you can do if you try a crazy diet to lower the risk a bit: drink lots of water (more than if you were eating normally). If your diet is really crazy, you’ll also need minerals with that water (especially salt). Dehydradation is especially bad for gout which is why drugs and additives which make you lose water are known to cause gout.
Since you obviously don’t have nearly enough fat on you to warrant surgery, the most straightforward way to lose weight would be, in addition to exercise and a balanced diet, to limit your calories to a reasonable number (not 800!) every single day. Of course, that’s easier said than done. Come to think of it, it might be even be easier to live with that extra stone…
So far as I know, the tablet doesn’t affect protein intake.
Eggs for instance contain plenty of proteins. Whether it would be a good idea for you to eat lots of eggs depends on other aspects of your health. Provided your puricos dose is sufficient, you could eat meat as well. Regular foods are safer than processed supplements but you can always get your blood tested to see what the supplements you take are doing to your body.
You should probably get tested anyway if you’ve recently beeen exercising or bodybuilding a lot more than you used to. Depending on your test results, changing your puricos dose might be prudent.It looks like 35mg might be too low. I have never taken that drug myself so I don’t know what taking an insufficient dose would feel like but people are often told to take insufficient doses of colchicine and the problem with that is that, while it does help, it doesn’t stop the flare.
The reco about waiting 2-3 weeks is old-fashioned anyway but how long will you have to wait for that unending flare to be cleared? The main risk I think isn’t the flare going into overdrive so much as moving from one place to the next and lasting way too long… which isn’t much of a risk in your case seeing that it’s already happening.These doses seem to be on the weak side, especially considering you’re a large guy. But not everyone can take large doses so you should check with your doctor before doing anything rash.
You’ve noticed what’s immediately painful. If you went by the signals your body is sending you’d lie down and even raise your leg above your body. Beyond the immediate pain though, opinions differ somewhat. But I think there’s general agreement that, however painful, standing for a little while is typically more helpful than not. Some people would recommend you even try to walk without crutches. I’d be much more careful and avoid putting your body’s weight on the painful location, especially if you’re not sure what causes the pain. Instead you could perhaps lift small weights or something to get a little exercise without stressing your foot.
