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If you take enough allopurinol, what you eat and drink won’t matter (within reason).
But being careful with what you eat or drink might allow you to take smaller amounts. It’s not an inoccuous drug. In order to know how much allopurinol might be appropriate, it’s best to get your blood tested professionally more than once.
While you are still experiencing symptoms, it often makes sense to make more than the maintenance dosage you might need to take for the rest of your life. And while you are taking a more than necessary, food and drink matters less.If you do not know how good your body is at getting rid of uric acid, I would recommend drinking lots of water, avoiding alcohol and taking care to eat enough veggies as long as you are experiencing symptoms because your body’s capabilities could theoretically be overwhelmed by old crystals regardless of how much allopurinol you take.
Inasmuch as foods affect uric acid, it could take a very long time for what you ate to cause a flare. But allopurinol should take care of that.
Foods can also trigger flares through the immune system rather than uric acid but that should be a relatively rapid process (hours, or even less than an hour if the flare had already started). And once the uric acid crystals are gone, there will be no more gout flares regardless of what you eat.Crystals would normally form very slowly. In the blood, they are quicker to dissolve. Trouble is, crystals are often not bathed in blood. They are for instance found in joint fluid.
Ice does reduce inflammation a bit. It brings fast relief but, as you note, might make the problem worse. Anti-inflammatory pills are more powerful than ice anyway if you can take them.I’m fine, thanks. The remaining febuxostat side-effects seem to be subsiding very slowly.
Your hemo result is good news. The small drop in the previous test may have been a fluke. I wouldn’t make too much of it.
As of yet, you don’t have enough data to substantiate a link between SUA and hemo but you are having enough tests now that any correleation should become apparent before too long.I’m sorry but my experience isn’t going to be very useful. I’ve already told you the following but to recap…
I noticed 20mg seems to do most of the work that 40mg does. The litterature agrees. There are diminishing returns. But doubling the dose should still have more of an effect than that!
Then again your SUA should have been lower on 20mg to begin with. So it may be that febuxostat doesn’t work very well on you for whatever reason. You’ll find out for sure if you stick with it a while longer.
There is noise in test results. But you’ve had enough tests to be reasonably sure that your SUA isn’t dropping as quickly as it should.The simplest explanation for your tests in my opinion is that you’re still dissolving unburied (so to speak) crystals and that part of the reason it’s taking so long is that you are an under-excreter.
Do you remember how many months it took for allopurinol to drop your SUA well under its current range?The way forward seems to be: increase the dose until side effects become unacceptable, wait some more… and if your UA is still too high, either try allopurinol again or try to combine febuxostat with a drug that increases UA excretion.
I think it would make sense in your sitaution to increase your febuxostat does slower than your doc recommends so as to isolate unambigously any dose-dependent side-effects and allow your body some time to adapt. You’ve been on 40mg a while now… how about trying 50mg?It’s only one test. What matters most is the picture built by all your tests.
Good luck anyway!I don’t understand your question, or perhaps the underlying reasoning.
Surely you are not suggesting as homeopathy proponents do that the properties of molecules depend on where they’ve been.Hi Don!
The typical things people look for in bloodwork is uric acid as well as kidney function and liver function tests.
If your uric acid was too high on allopurinol, the dosage may simply have been too low. If it was a problem with organ function however, switching you to Uloric might have been the right choice.
Do talk about this with your doctor! They may have had a somewhat unusual but very good reason to have taken you off allo.Opinions are a dime a dozen and all but I don’t see your integrity being compromised by random ads. Random ads are everywhere.
I’d be more wary about the integrity of someone who sells premium content frankly. Not as such of course… it would depend on the premium content, how it’s pushed and so forth.There should be enough B12 in dairy.
I had violent enough pain when I first tried febuxostat that I thought about kidney stones even though the location of the pain didn’t seem right. Unlike UA crystal in joints, dissolving kidney stones could in theory cause pain by passing. Doctors dismissed the notion at the time.
Of course, doctors are sometimes wrong but the way the pain kept coming back long after I started the treatment would in retrospect seem to make the kidney theory exceedingly unlikely.Hi!
I haven’t experienced barfing but, in case you weren’t aware, there are alternatives to allopurinol. The main one is called febuxostat.
It looks like your body has convinced itself that allopurinol is some kind of poison. Possibly your new diet triggered that. It’s not uncommon for people to develop reactions to allopurinol.
Maybe this reaction of yours will stop on its own but it seems some people also had success with a desentization procedure which involves taking only a very small amount of allopurinol and increasing the dose slowly in the hope of fooling the body into treating allopurinol as a normal again.
In your situation, considering that you had attacks very quickly after discontinuing allopurinol in the past, maybe it would be safer for you to switch to febuxostat for a while before trying allopurinol again.
In any case, do not experiment with drugs on your own and do see a doctor about the barfing and possible solutions.I experienced a ~1 g/dl drop (I hope there’s no unit mixup) from which I have only marginally recovered.
I’d have thought you’ve been on 20mg or more long enough to rule out 20mg depressing your hemo significantly. Even if xanthine oxidase inhibitors end up not being a complete solution in your case, a small dose would still help with your UA on its own and should also make drugs boosting UA excretion less risky.A little dark chocolate should be harmless. It’s all about the amount you eat.
I’m wary of vinegar in general but it might just be indicative of an issue with one type of vinegar (or plain superstition) and I have no opinion about ACV specifically or raw beetroot.
Please do not start obsessing over food.It’s no big deal but I believe I did write tawrikt without shuffling the r and the k.
I’ve never seen Keith explain why “vegetable purine” would have a different effect from “animal purine”.
So I wouldn’t ignore spinach… except that the febuxostat you’re taking has got to minimize the effect of the purines you’re eating. I don’t know how much difference food would make in your situation. It’s easy enough to temporarily replace meat and fish with dairy and spinach with harmless veggies such as zucchini even if it wouldn’t do much good.
Consuming largish amounts of skimmed milk seems to help lower uric acid beyond the super-low purine content. Alkalizing your urine by eating lots of veggies containing magnesium, calcium and potassium might help with the amount you’re excreting as well.
I assume you’re already avoiding sugar and especially alcohol.Your SUA on 20mg was suprisingly high already.
I don’t know what’s going on in your system but as long as your liver and hemo are OK and you’re not experiencing horrible side effects, you can keep upping the dose and hope for a breakthrough. Maybe your current dose would be sufficient in the long run but we don’t know that and, assuming that febuxostat is working as it’s supposed to, higher doses will speed up the cleanup process.
At some point, your doctor will have to consider a drug combination to help with excretion. It’s in the guidelines. If your doctor won’t listen to reason, maybe try another. But it’s a bit early for that. As long as your febuxostat dose can safely be increased, sticking to a single drug may be for the best.
Increasing the dose slowly is also for the best I think. You don’t want to hemo to plummet and be unsure whether a smaller dose would be just as bad. If there’s a threshold at which febuxostat starts dragging your hemo down, you should spot it by taking your time.No, UA crystals can dissolve way before 350. It may take that much (or even less) to dissolve the crystals in the colder part of the body but you probably have crystals elsewhere.
The saturation concentration at body temperature is supposed to be around 405 but some studies come up with higher values depending on the assumptions made and of course supersaturation is a thing (else people wouldn’t test much higher). Your SUA is going to vary all the time anyway, as will the other factors affecting crystallization and dissolution. And once dissolved, the stuff won’t re-crystalize anywhere as fast.
When I had an average SUA substantially lower than your current test results, I still got the odd result around 475, for instance during an attack. But, outside of a post-ULT rebound, I never got the higher numbers I used to get when I ate meat and drank alcohol… make of that what you will but my conclusion was that crystal dissolution could raise my SUA about as high as your latest test results but no higher.The main reason I tried to stick with 40mgs in spite of the side effects is that doctors can pretty stupid when profiteers want them that way. Mind you, concerns about these (in hindsight easily avoidable) side effects is the reason I’ve had untreated hyperuricemia for so long in the first place…
Like I said, there isn’t much information in the difference between two tests. The thing is, it’s not just the latest difference which is discouraging: 491 wasn’t much lower than the previous result as well.
My lowest SUA test result was on 40mg, and the difference with lower doses wasn’t subtle. Neither did I need months on the dose to get there. It could have been an anomaly, but it’d be an anomaly which didn’t reoccur since (and I’ve gotten quite a few tests).
Studies also show the effect increasing with the dose, though there are diminishing returns. But your latest result on 20mg was also higher than could have been expected based on the effect of that dose on the average study subject.Hitting a wall around the level at which deposits start dissolving could in principle be explained by crystals accumulated since your discontinued allopurinol. But how much of that stuff could you possibly have in your system? You didn’t quit allo that long ago.
Have you ever done an UA excretion test? I’ve been assuming your blood condition caused an overproduction of UA but now I wonder…
I guess febuxostat could also not be working well on you for some reason.There still is hope that your results will eventually drop, whether or not you increase the dose.
You could try increasing the dose but don’t assume that there’s something magical about that dose if you finally see a drop in your tests results. It could be that what you had needed to make your SUA drop faster is a drug that helps with excretion (though being patient may be the safest course, kidney-wise). You’ll be able to test that theory by dropping your dose back to 40mg and see if your SUA shoots back up (my guess: it wouldn’t).In answer to your other post, all my test results on 20mg have been under 300 so your question about 350 is moot. I’ve not yet been willing to risk taking less than a quarter-pill.
Cutting these pills is hard enough that I’m not confident each fragment would contain at least 10mg if I tried to cut the pill into sixth equal parts. And the dividing line at the middle of the pill would make it difficult to cut the pills in five equal parts with the tool I’ve been using so far. How did you achieve 30mg doses by the way?It’s too soon for you to quit allopurinol but in time, if your blood tests stay good are you’re experiencing no symptoms, it should become safe to quit the drug and see if that helps with your weight.
Not ending up in the ER on account of one’s diet isn’t a simple matter of calories in/out, that’s for sure.
If I was going to lecture you, I’d tell you falling isn’t the recommended procedure to descend stairways or that 12 stone is OK if you have no medical issues like pre-diabetes which make it especially important for you to lose that unnecessary weight.Non-sustainable diets aren’t recommended for gout patients. I don’t know if what you’re planning to do is sustainable. Anything that would result in rapid weight loss is going to be a problem.
But I guess short fasts might not be a problem depending on your metabolism (if you don’t feel weak or very hungry, I’d take that as a good sign). I can do eat-nothing fasting but I wouldn’t recommend it for longer than a day. The shorter your fasts, the safer they’ll be.Allopurinol should keep you safe anyway, at least if you increased your dose a bit to accomodate an otherwise dangerous diet. In doubt, get a uric acid test after starting the diet.
Old crystals can take years to dissolve though they are often eliminated in less than a year. The longer you’ve had untreated gout, the longer the cleaning process is likely to take.
Colchicine doesn’t eliminate the crystals. It only makes them less troublesome.Low carbs diets seem to cause problems for gout sufferers. Perhaps you could try a less extreme diet.
Stuffing yourself with bread is not recommended while eating lots of veggies is. But you can overdo carb-watching. Eating some fruit is recommended (they’re not all equally carb-heavy). I don’t think you have to eat grains but if you’re avoiding grains, I think you should make sure you’re getting a decent amount of carbs from veggies and dairy.
Chicken and especially fish can be worse than red meat for gout sufferers but that should be irrelevant if your uric acid tests at 3.6 mg/dl. Are you sure it’s that low?Hi Micky,
I’m glad you and DQ have found each other because my febuxostat side effects have been a bit different (for instance I also had pain lying down). In my case, the side effects at 40mg were unacceptable but are much reduced at the lower doses I’ve tried.
Over time, I did notice the side effects getting milder but the progress seems very slow.
If you’re worried about damage, I would encourage you to take a close look at your “fine” tests results if you haven’t already to see if there are signs of mild stress in there. Doctors sometimes do not look beyond arbitrary thresholds for “normal” or “acceptable”.
If you suspect your pain might be related to digestion, maybe dietary tweaks could help. There are also products which make trasit easier.In case you weren’t aware, you should know 40mg febuxostat is in theory already stronger than 300mg allpurinol. 80mg is a very strong dose. Some people actually need that much but most people don’t.
Your uric acid blood tests are the main guide to how strong a dose you need. Your results being “normal” is irrevelant and you need to look at the numbers.So all your tests were done while you were on a “total vegetarian diet with very little sugar”? In that case, it could be that your symptoms were caused by older desposits.
My understanding is that gout is unlikely when the highest test result is under 360. But that reasoning assumes that tests were repeatedly performed before the subject started a diet or any kind of urate-lowering treatment.
339 on a serious diet is high enough for uric acid to have plausibly been in the danger zone before the diet. Since people seem to react differently to diets, it’s not a given… just plausible.
