[nobody]

Jean, in my opinion your should use actual numbers instead of “normal uric acid levels”. How “normal” is defined changes from place to place and changes over time as well. It can also be defined higher for men than women. But gout pays no heed to what anyone defines as “normal”. It’s the numbers which matters.
The diagnostic criteria I’ve seen imply that gout is common when uric acid is on the high side of the “normal” range (depeding on how it’s defined). But gout is not expected when uric acid is on the low side of the “normal” range.
And if you have’t been tested regularly, you don’t know how high your uric acid has been for the last few years and therefore how likely it is for you to have gout. Gout isn’t caused by the uric acid in the most recent test result.

And yes, it makes sense that poor circulation, hereditary factors and so forth might contribute to gout.
Studies have shown that other factors have an impact as well. The amount of uric acid in the blood is very important but it’s not the whole picture.

I have nothing to add to DQ’s answer to Stephanie’s original question.

[nobody]

I would normally drink more than 3 liters a day anyway and I don’t know if the exact amount I consumed changed when I started the drug.

It’s way too early for me to try quitting the drug. I’ve had hyperuricemia for decades and so I doubt my system is close to being purged.
In my opinion, a more reasonable next step for me would instead be to lower my dose so as to get my SUA closer to the recommended maintenance level.

[nobody]

Homeopathy is something else.

I don’t understand your blood condition but I would imagine that it causes higher UA through purines (just not dietary purines).

I’m not sure what “heavily alkalise your diet” means but I haven’t noticed any effect on SUA from the amount of magnesium, calcium and so forth in my diet. Then again, because of the noise and the sparse data any effect would have to be quite large to get noticed.
I have no reason to doubt it has an effect but I would assume the effect varies quite a bit depending on how much UA someone’s body produces, kidney function and so forth.

Unsurprisingly, some of the information on these pages is wrong or presented in a misleading way. For all I know, most of it might be accurate but I certainly wouldn’t bet on that. The anti-pharma verbiage and the fact that a product is being sold are quite the red flags.
Do you have any reason to trust these sites? Is there any particular morcel you found intriguing or illuminating?

[nobody]

Sorry, but there’s not much I can help you with beyond what I already told you. I keep thinking that our cases are quite different.

I would normally drink a good bit more water than 2 liters anyway and I didn’t get liver imagery while on the drug.
The back pain you describe seems rather different from what I briefly experienced.

In addition to abdominal pain, I did experience chronic constipation while on the drug, especially when I took 40mg. The usual solutions helped. Also, it seems my body adapted very slowly (gradual improvement).

I tried taking the pill fragment at different times but I noticed no difference. Then again I didn’t try very hard or systematically. I’ve typically taken it with lots of water out of habit, the way I’d take any pill.
For what it’s worth, the corporation which developed the drug says the peak concentration of the drug will be higher if taken on an empty stomach, as expected.

[nobody]

I have no idea what’s going on in your body but theoretically, histamines make more sense to me than purines as a cause to your reactions. It may also be something else that is often found alongside histamines in foods. Anything that gets the immune system in high gear could potentially end up triggering gout symptoms.

[nobody]

Uric acid can indeed rise higher after stopping allopurinol than it was before you started taking it. There is a difference with glucose and such however: it’s not the uric acid in the blood which is damaging your body. The main point of taking allopurinol is to get rid of the solidified uric acid that can build up in your body. Lowering the amount of uric acid mixed in with the blood is the way to do that. But once the solidified uric acid is gone, having a moderately high amount of uric acid in the blood for a while isn’t an issue.
The flipside of that it: it will likely take more than a few weeks to complete the cleanup.

[nobody]

Some doctors do not realize how powerful febuxostat is. Why would 250 be such a surprising result on 80mg? That dose is easily sufficient to account for a 50% decrease in the amount of uric acid in the blood.
If your husband is going to take an even stronger dose, make sure the side effects are being carefully monitored. In particular, some doctors seem to be oblivious to liver function test anomalies until the values reach a very high level. And don’t allow the doctors to keep his dose that high after gout symptoms have stopped.

Good luck!

[nobody]

As far as purines are concerned, you won’t know how well your diet plan is working until you start seriously cutting back on the amount of allopurinol you take. Gout is a lifetime problem so you’ll have plenty of time for that down the road…
But in the meantime there’s more to diet than purines. Some people get improvements in their symptoms by cutting on sugars, fats or salt for instance (but it should be said that different people report all kinds of things as affecting their symptoms and that it’s easy to be deceived by coincidences). Sugars also affects uric acid proper, not just symptoms. Alcohol too should have an effect separate from purines, as should weight loss. And if you weren’t eating enough vegs, you might see a difference in test results as well after improving that.
You could spent quite some time reading about all the dietary experiments that have been found to affect uric acid…

I don’t know if cide apple vinegar helps. All I can tell you is that it’s not generally recommended.
There are non-drug things which are known to be helpful such as cherries. Your gout problem is bad enough that I would go straight to pharmaceuticals but it’s something to keep in mind if you intend to quit allopurinol down the road.

[nobody]

I think you should devise your own diet-making process. Then ask the questions which would inform your own process or do your own research.
As you say, your head could easily start spinning with all the information available if you don’t start by deciding what kind of information would be useful or useless.

Lists of high/med purine foods is only one of the ways to go about it. Such lists do not encompass all that matters about it but if that’s the way you want to go right now, fine. You need to start somewhere.
But in order to make it a good start, you need to use accurate lists. And in order to have accurate lists, you need to decide on what basis foods are supposed to end up on one list or another… if you watch carefully the amounts you’re eating, you might want to have lists based on weight or volume. If one the other hand you like eating your fill, you would probably find lists based on the caloric content of foods more useful.
Do I sound like I’m splitting hairs? Let’s look at a “green leafy veg”, spinach: one spoonful of spinach is certainly not high in purines. Spinach has got quite a lot of purines compared to most vegs but it’s still a fairly small amount. There are way more purines in meat. The thing is, how much are you going to eat? If you wanted to live on spinach, you’d have to eat a whole lot of the stuff (you might be surprised how much some people eat) while you could live on a much smaller amount of meat. So if you’re looking at how many purines there are compared to the amount of proteins or energy in a food, yeah: spinach is pretty high in purines.
And in order to end up with accurate lists, you’d also need to put an actual number on “pretty high”.
If that sounds too complicated to you, maybe forget about lists and try something else?

Limiting your meat intake to once a week is simple and does reduce uric acid for instance. But what are you going to eat instead?
The low-purine answer is simple: eggs, milk and so forth. But maybe you don’t want to eat or shouldn’t be eating dairy?
The good stuff in oily fish, you could possibly get through complements. Or maybe ditch meat altogether and eat oily fish once a week instead?

If you’re not eating a whole lot of vegetables anyway, you can ignore their purine content.
But if you’re going to eat lots and lots of vegs on a regular basis (which would generally be recommended), maybe lookup the ones you’re planning to eat in large amounts several times a week? Any amount of cabbage is fine for instance. Lots of vegs are totally fine.

Pills are so much easier!
And in case you didn’t know, allopurinol effectively neurtalizes purines so you can eat your fill of broccoli as long as you’re on that pill.

[nobody]

In your situation, I don’t think a diet-only approach would be likely to succeed. And your gout would certainly be more painful for longer if you tried.
So taking the allopurinol you’ve been prescribed is the most reasonable course of action. Only, if you’ve never taken allopurinol before, starting with 300mg is not recommended. People would normally start with 50mg or 100mg per day and increase their dose every couple of weeks or so.
If you increase your dose progressively while getting regular blood tests (the tests are strongly recommended!), you’ll learn from the results how much allopurinol you actually need. 300mg is OK for lots of people which is why doctors sometimes default to that dose but it should ideally be tailored to each patient.

While you are taking allopurinol, you could also work on a gout diet. It will take some time for you to find a good diet you can live with for years on end.
Once your gout is cured, if you’ve made good progress on the diet front, you could try quitting allopurinol while monitoring your uric acid carefully. Blood tests will tell you if you need to get back on the drug.
Once you are fully cured, you’ll be able try various solutions over the years without risking your health and sanity because it’s a slow disease: curing it takes time but it also shouldn’t come back very quickly.

[nobody]

The lastest recommendations I’ve seen say it’s OK as long as you test above 3. And even if you test under 3 once, it’s no big deal. So far as I know, there only is cause for concern if your uric acid is super-low for years on end.
That said, allopurinol is not an innocuous drug and so I think it would be prudent to take as little as you actually need. Have you tried taking 200mg?

[nobody]

More frequent attacks could on the contrary be a sign that the treatment is working more efficiently (as well as a sign your husband might benefit from beign constantly on colchicine for a little while).
Individual attacks being more severe and lasting longer however, I would not see that as a good sign. The thing is, you could easily get the impression that attacks are getting worse when they’re merely getting more frequent if you’re not taking into account numerous shorter and milder attacks.
The following might sound like reading tea leaves (I certainly can’t cite medical research to back it up!) but I think the duration of the average attack (taking even the mildest ones into account) matters more than the frequency of the serious ones.

I don’t know that there’s any treatment that can entierly prevent debilitating attacks during the “de-bulking” phase, especially after many years of untreated gout.
But one downside to febuxostat (as well as allopurinol) is that it does not directly help the body get rid of the uric acid which is released in the blood during attacks. Usually that is not a problem but with kidneys which are not working very well, I guess it could sometimes cause undesirable spikes in the amount of uric acid mixed in the blood. Tests done between such spikes would not show high uric acid.
80mg febuxostat should already be doing a very good job of preventing the body from producing much uric acid but maybe the doctor you’re seeing tommorow could determine if some other treatment in combination with febuxostat might help the kidneys in evacuating the uric acid which had formed before your husband started taking febuxostat. But I have no idea what if anything would be appropriate given your husband’s kindey problem.

[nobody]

Hi!

In my opinion, you’re being obsessive about food.
To the extent that gout is caused by what you ate, it can easily be due to what you ate three years ago rather than what you ate yesterday. So you shouldn’t be too quick to blame particular foods for your pain.
Sticking to a vegetarian diet is reasonable because it works and it’s an easy rule to follow, especially if you happen to tolerate milk or yogurt well (these are generally recommended for gout by the way).
But I’d say worrying about a few strawberries is taking dieting way too far. If for whatever reason your body doesn’t like strawberries, fine: don’t eat any. But you should be comfortable eating a wide variety of plants, including fruits.

It doesn’t matter if you’re taking drugs or not as long as your tests are good.
But if your joint problems are indeed due to gout, 7.3 is too high. What’s your average?
If you need uric acid control and you don’t want to take drugs, you’ll have to treat your naturopathy as if it was a drug: you need a large enough dose, you need to be regular about it and you need to watch for side effects. There are plants which are known to lower uric acid but taking a small amount from time to time won’t work, and neither will wishful thinking.

[nobody]

The highest preventative colchicine dose I would be comfortable using for an extended period is 1mg per day. But I do not have a kidney problem.
And Keith is right to stress that every case is different. Do not increase the dose without a doctor’s approval and, in case of a large dose increase, pay attention to side effects (write them down) and do not wait too long before the next blood test which could potentially come back with a red flag.

Blood tests will also tell you if the febuxostat dose needs to be adjusted. Urine testing might also tell if your husband’s diet is kidney-friendly enough.

While your husband is still experiencing attacks, I would recommend making sure he drinks plenty of water (especially if the ambient temperature is a bit high or if he’s been sweating) and being careful with anything that can potentially cause dehydratation such as alcohol.
But most of all, your husband will need patience.

[nobody]

Hi Brenda!

I don’t feel knowledgable enough to give you advice considering all the health issues your are dealing with. I’ve never had white exude coming out for instance.
It’s good you are seeing a rheumatologist. If you can’t get in touch with them to ask if what’s happening to your toe is normal, perhaps your GP could take a look at your toe and contact your rheumatologist on your behalf if they think there is any cause for concern?
If you are experiencing much pain, redness or swelling you shouldn’t be shy in complaining to your doctors about this because there are other things they might be able to do to help. I don’t know what would be safe in your situation so I can’t recommend anything.

There’s general information about gout and uric acid you may be missing. Have you read the recommendations for patients issued by your local arthritis/rheumatism-focused organizations or your government?
It’s encouraging that your uric acid dropped so much with 200mg allopurinol but it’s still too high. If it would not be safe for you to take a bit more allopurinol, perhaps you could try to tweak your diet and drinking habits in order drive your uric acid a little bit lower? Let us know if you want more information about that.
There are also drugs or less powerful remedies you could possibly take alongside allopurinol but that would probably be more risky in terms of side effects, drug interactions and so forth than simply tweaking your diet. Even with foods and drinks though, I would recommend you check with your doctors before doing anything drastic.

[nobody]

Uloric would be the logical next step. The effects aren’t necessarily worst than allopurinol. It depends on the person. But I would recommend trying it CAREFULLY. See if she can get 40mg pills and cut them in half or even in quarters as 10mg is a good dose to start with (20mg isn’t too bad either). Your mom would most likely need to take more but there’s no sense in risking serious side effects when you can test a smaller dose first and see how she tolerates that.

Something else may be worth looking into: how did she come to have so much uric acid? If she always had more than most people and it gradually got worst with age, there’s not much else to do than finding a drug such as Uloric she can tolerate.
But if her uric acid increased suddenly and you don’t know why, I think that would be worth investigating. If for instance another drug caused the increase, finding an alternative may be the best course of action.

As to the gastro-intenstinal side effects you mentionned…
-diarrhea is a very common side effect of colchicine
-stomach pain is a common side effect of indomethacin and of many other anti-inflammatory drugs but that reaction can be prevented with a class of drugs called PPIs which can be invaluable during gout attacks if you a prone to that dangerous side effect

[nobody]

Since Keith didn’t answer and in case you’re reading this Liz:

a) Genetics is usually part of it but it’s often also got to do with aging and/or people’s lifestyle (not just what you choose to eat). Sometimes the disease can be prevented and other times the genetics are unfavorable enough that there’s nothing to be done besides taking strong drugs every day once you reach a certain age.

b) In order to guess what would or wouldn’t likely to be a solution in your case, blood test results would be very useful. The number relevant to gout is uric acid.

c) I don’t know how much you take but I doubt fish oil is a major contributor. Your body might react to fish oil in a way that makes it seem like it’s the cause (the triggers people report for gout flares are often separate from the underlying causes) but something else is probably be going on. The same goes for aspargus unless you eat ridiculous amounts. Some mushrooms can in theory be a real problem but you’d have to eat a lot of them. Some drugs or medicinal herbs might also be contributing to the problem. But the main problems with what people eat and drink are typically animal flesh (meat, fish and so forth), alcohol and sweeteners (sugar, corn syrup and so forth). There are some differences between the effects of different types of meat but the amount consumed is a big part of the problem, with people eating a lot of meat being more likely to develop gout over time.

[Author]

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