Forum Replies Created
-
Posts
-
360 is supposed to include an adequate buffer but it looks like there is a growing recognition that a lower target is beneficial or even necessary in some cases. Obviously there is more of a safety margin at lower values but 360 seems to be low enough in most cases. And you should in principle be able to reduce the need for a safety margin by behaving carefully.
Don’t worry about the acidity thing. This stuff often goes above my head so if you’re curious, best read the literature yourself. Bottom line: SUA isn’t the whole story, beware of diuretics, be sure to eat veggies and drink lots of water.
You’ll probably still have a few bad days but your average day should get better over the course of the year. In time you will stop being paranoid about every foot ache.
The generally recommended target is 350 or 360 so you should be OK. Barring exceptional circumstances, all crystals are supposed to be eliminated in due course by dropping SUA to such values, with some safety margin to spare.
As far as I know, this is what most studies find. I remember one study showing ongoing bone damage in some cases but I guess this might be OA or something rather than persistent uric acid crystals.You might benefit from lower SUA values than 340, and I’m confident you’ll achieve them in time.
But don’t let our host’s bullishness about dosage get to you: in most cases, lower values are to be filed under “nice to have” rather than “necessary”.I’m not aware of any stats about treatment vs. maintenance doses but some guidelines mention lowering the dose after symptoms have gone away.
Not to confuse you but it might be drinking water affects acidity in your body. I’ve been somewhat simplistic above and in my last few posts, talking as if it was all about SUA but acidity is a complicating factor, and is part of why diuretics trigger attacks (SUA can decrease slightly while the amount of uric acid in the whole body as opposed to the blood increases). Hence people promoting baking soda as a gout cure and so forth.
Ultimately, we will only know whether 60mg or some other febuxostat dose works for you by its effect on your symptoms over the years. Blood tests are our best guide in the short run but they aren’t the whole story.
Crystals dissolve at higher values than 388. But crystals aren’t all equal with respect to temperature and isolation from the blood. More importantly perhaps, SUA varies from day to day as well as throughout the day. The generally recommended target value is lower so as to afford a safety margin, not because crytsals can’t dissolve above 400. Indeed, tophi shrinkage has been measured when patients tested no lower than you do now (though shrinkage happens faster with lower values).
There’s also the matter of largish crystals being suddenly exposed to consider: dissolving crystals will raise your SUA, potentially saturating your blood so that the crystals in question may stop dissolving until your body is able to get rid of enough UA through urine and so forth. That may be bad news in terms of attack duration and joint/bone damage, especially if you excrete uric acid slowly as I suspect.80mgs should be enough.
There are diminishing returns to increasing one’s dose and the maximum dose recommended by the original manufacturer is only 60mg. Of course people take more than that all the time but I wouldn’t push it unless it actually was necessary.Hi!
The generally recommended maintenance target is 6, not 6.5. After clearing all their crystals, some people are apparently able to substantially exceed that value for months or even years without experiencing gout symptoms but that is obviously risky.
Perhaps you could try taking 200mg (two 100mg pills) for a month or two and see what test results you get on that dose. It may be prudent to lower your dose slowly (or that may be a pointless precaution, I don’t know).Very good news.
You could begin by trying for 70 mg, without paying much attention to the exact amount you shave off the pill before taking it. A couple of mgs won’t make a difference at this stage.
Your SUA is above the recommended value and, assuming side effects aren’t an issue, we would generally recommend aiming lower anyway. I expect future tests would in time yield lower results on 60mg but you can’t rely on that.
Your liver markers and so forth being OK, it comes down to how you feel about the unmeasurable side-effects.I don’t think you can rule out crystals forming completely considering the variations in SUA and temperature but the main point of lowering your SUA from here is to speed up the dissolution of existing crystals (they can still cause damage, and the drugs you take for gout symptoms have side effects as well). There seem to be benefits in lowering SUA slowly but you’re doing it slowly enough already.
The type you develop as an adult and which can be mitigated by cutting out sugar. I don’t have it but some relatives did/do, which is why I took action when the doc pointed out the worrying blood tests. The tests are better now, not great but stable.
As a skeptic, I don’t put much stock in the unseen (or in feel-good words).
I’m not sure what you meant with that last question but the latest guidelines I’ve read do speak of reducing the dose after symptoms have disappeared when the initial target has been set at 300.
Considering your uric acid has never tested all that high, I very much doubt you’re in for 9 painful months. It may indeed take 9 months or more for your symptoms to go away entierly but, after a few months, your symptoms will hopefully become quite mild.
Hi!
I haven’t noticed such mood swings but see if you can spot other changes happening at the same time like lack of sleep, abnormal sweating, constipation or water loss (very rapid weight loss). I guess one’s diet (and salt in particular) could also trigger both mood swings and attacks.
It’s not the end of the world if you don’t quite reach 300. If the coldest joints of your body (toes, fingers) never developped uric acid deposits for some reason, a slightly higher value might be fine.
As more uric acid gets flushed out of your body, the average attack should get progressively shorter.
Maybe it’s too soon for you to risk it but at some point you might want to try not taking any colchicine when you normally would because the “magic” might not be in the colchicine pill.Hi!
Your symptoms do not sound like typical gout symptoms to me but your test results will be an important clue.
Suggestions in the meantime:
-take something for the pain
-drink lots of water
-eat something nutritious and soothing to your stomach (in other words don’t wreck your health with dubious diets)I’ve taken pretty large proton pump inhibitor doses, and I haven’t noticed an effect on my SUA. The data I have is very limited (expensive blood tests and so forth) but it looks like the effect is either specific to a subset of the population or somewhat subtle.
Ammonium chloride is an acidifying agent which is known to trigger gout. But is there enough of the stuff in Turkish perpper? I don’t know.
Ammonium chloride seems to lower the amount of uric acid excreted by gout sufferers who aren’t on a low-purine diet. The extra uric acid retained by the body doesn’t en up in the blood but in the cells (and possibly the joints?) as the acidifying effect of ammonium chloride alters the transfer of uric acid from/to the blood.Hi!
Indo isn’t a painkiller but an anti-inflammatory. It reduces swelling. Now that often also reduces pain but you might want to take it even if you don’t feel any pain. It’s a fairly dangerous drug so I don’t want to encourage you to abuse it but it’s mainly prolonged use which is risky.
Trying to walk on a swollen foot is also a bit risky so there’s a balance to strike. Also, taking the drug for a couple of days and writing down the effects on your foot may help with the diagnosis.There is such a thing as mild attacks, only what you describe doesn’t sound very much like gout to me. But every case is different. I guess you’ll have to wait and see what your doctors have to say. The result of your uric acid test may be a strong clue, though you may want to repeat it in a month or two.
If it’s gout, it’ll likely get worse before long. At that point, it should look more obviously like gout.Crystal dissolution can take years. What you’ve experienced is just the start.
I don’t think of my diet as strict since I could probably have lowered my uric acid much further through caloric restriction but some people are appalled at all the things I don’t eat (or only in small amounts). As you may remember, I lowered by SUA by about 25% without drugs or phytotherapy even though I was already on a weak gout diet before losing that quarter.
I’ve only relaxed my diet a little bit because I’m used to eating that way by now. The only thing I want to do that might significantly raise my uric acid is to keep reducing my dairy consumption.
The two things that are shown to make a big difference to uric acid are to quit alcohol and to replace animal flesh with dairy. And uric acid aside, I’m not a big fan of either. Sugar/fructose comes third I guess but I’ve got diabetes as well as gout in the family so I’m not going to be eating much sugar anyway.Malnutrition aside, the data I’ve seen so far about supposedly beneficial foods has been distinctly unimpressive. It seems both heart and brain function just fine on any diet which doesn’t kill you. Clogging your arteries through consumption of fatty meats will for instance kill. A lack of faddy foods won’t.
You can take supplements containing the stuff reasonable people want to get out of fish by the way. For instance over here regular shops sell fortified rapeseed oil.About aubergines and peppers: mind you, you have to eat a lot of that stuff for it to make a material difference. Unless you eat at least 5 times more of that stuff than fish, it would be pointless to change anything.
Tomatoes are a practical way to lower your urine’s acidity so on the one hand they might be useful to some gout sufferers but on the other there are all these reports about them being gout triggers… they could be triggering people for the same reason they (in some cases?) increase OA inflammation.
I never noticed an issue with tomatoes myself. As usual with triggers, you need to carry out your own experiments.@DQ: I very much doubt walnuts would increase your uric acid when consumed in moderation.
As far as the potential to increase uric acid is concerned, I would be more concerned about aubergines and peppers if you eat unusually large amounts.
And yes: I am of course saying that these types of fish are very likely to contain a lot more toxic stuff than actual rice (I’m not talking about what might be cooked with rice).In addition to the above, excercise has an immediate effect on the amount of uric acid in the blood as well. So moderation and regularity are therefore recommended. 15 miles per day is arguably excessive, especially if you’re not used to walking anywhere as much.
I dare say your rice is likely to be healthier than such fish. Whatever.
I don’t know that the vitamin C thing is definitive. But there’s not much that’s definitive about nutrition. You go with the evidence you have, which suggests that supplements work. Kiwi fruits might be the next best thing but you might want to eat a small bunch daily if you want to do everything to lower your uric acid while avoiding supplements.
Any nuts could potentially be a trigger but walnuts may be among the most risky, not least because people then to like them too much to eat only a few.
Why should it worry you though? You’re going to be triggered by something or other anyway. You might want to avoid your triggers (either sometimes or all the time) but as long as you haven’t noticed anything, no worries.Well yeah: there’s sugar in fruits.
Clementines aren’t the best or the worst. Fructose-wise, a clementine could be worth about three-quarters of a teaspoon of honey per clementine. That will of course vary a lot from one clementine to the next.
So there’s little point in obsessing over half a teaspoon of honey per day or a couple of clementines but I figure it’s better to eat more fruits and less honey and that it’d be better to eat more of the ones containing less sugar than clementines such as cherries.
As to vit C, there’s a good bit more of the stuff in kiwi.Walnuts are very easy to abuse and could potentially be a trigger when abused but if you’re going to avoid fish, walnuts would be especially valuable nutritionally.
