[nobody]

Yes, only some of the UA production is prevented. Putting a number on it would be extremely challenging but you could prevent more production by taking more allo.
Sure, in principle you could slow down your treatment by frequently eating loads of stuff you shouldn’t be eating. Realistically though? It seems you’re being careful enough and 0.29 is a value low enough to give you a decent buffer against eating the wrong thing.
It’s not just food that affects UA by the way. Fasting wouldn’t help. And one of the recommendations for gout patients is to refrain from seriously strenuous exercise.

That said, food has many effects. Old deposits don’t cause inflammation automatically. Your immune system has a role to play and some foods could affect it in various ways. Certain fats for instance might promote flares.
If you notice that some foods seem to trigger flares, you could try eating something else for a little while and see if that helps.
But if you haven’t run into anti-inflammatories side effects yet, there’s little sense in obsessing about that stuff. While the problem sorts itself out, you could perhaps just take a pill to nip your symptoms in the bud whenever you feel warning signs. Now that your UA seems to have been low for a while, you are less at risk of abusing such pills.

[nobody]

I noticed something vaguely simlilar with lentils.
This isn’t about purines. Purine content varies across legumes but relative to the protein content, spinach is much worse. Some mushrooms are in a different league as they contain potentially dangerous amounts of purines.
If some foods bother you, there are many alternative sources of protein. The foods you listed have for the most part (soy beans would be an exception) a poor protein mix in the first place. What they are useful for is lysine (which is lacking in grains and nuts). And there’s lots of lysine in dairy. Skimmed milk, yogurt and such are generally recommended for gout as people consuming large amounts seem to have less uric acid. If you’re actually vegan, there are plants containing surprisingly large amounts of lysine (check a nutrition database).

[nobody]

Depleting your iron stores (bloodletting should do that) could also alleviate gout.

So your SUA tested at 0.41 on 100mg allopurinol and 0.29 on 200mg? The drug seems to be working but another uric acid test will be required to confirm that your latest result isn’t a fluke and that UA-lowering treatment is a success.
I’m not aware of any hard evidence that lowering your uric acid further would be beneficial. It would make sense if it was marginally beneficial but has so far as I know only been shown to be beneficial when people have visible tophi.

[nobody]

Yes, “these medicines are masking symptoms”.

Unfortunately allopurinol is not a quick fix. It’s quicker and more effective than lifestyle modifications so that’s not an argument against allpurinol.
I only bring up the bad news because I’m seeing red flags in Smith’s post:
-podiatrist
-“terrible acid reflux”
-“he also gave me methylprednisolone”
-no mention of a PPI
The side effects of these drugs sometimes get worse over time… much, much worse. And chances are this isn’t the last time Smith will need to take anti-inflammatories.
I obviously can’t know what’s going on in Smith’s stomach (doctors need to push a camera down your throat in order to assess that) but prolonged use of that drug combination is known to involve a risk of stomach damage which a drug class called PPI can at least delay if not completely prevent. And once stomach damage becomes obvious, it’s too late to prevent it.
If you think gout on anti-inflammatories is hell, try gout when you can’t take anti-inflammatories anymore because of stomach damage!
So I would recommend seeing a doctor who understands GI side effects better than the average podiatrist. Maybe that podiatrist is awesome and understands well things outside of their specialty. But if not…

[nobody]

That’s if people are even looking at the number… for instance Choi (who published quite a few papers about gout) called peas and beans “purine-rich vegetables”. The categories people use are ridiculous. Nevermind that it’d be the wrong number to look at (most of the modest amount of purines in soy is actually harmless guanine for instance). No wonder people aren’t finding clear evidence that “vegetable purines” do anything to uric acid!
The information out there about purines is so poor that it hardly matters whether “vegetable purines” increase uric acid. People wouldn’t know how to manage their intake.

[nobody]

Hi!

The bottom line is: eating meat, fish or seafood is associated with having higher uric acid. Eating vegetables isn’t.

The bit about vegetable purines is a bit confusing.
I guess the article is written that way because the word “vegetable” has been used in many studies in a counter-intuitive way. Keith might disagree with the following but I think you should read “vegetables” as “land plants” or simply “plants”.

Mushrooms aren’t plants. They aren’t necessarily bad but are more likely to have a dangerous purine content than plants. It depends on the type of mushroom. And dried mushrooms naturally contain a lot more purines than fresh ones. I’m aware of at least one study about people getting higher uric acid when they consumed mushroom-based food whereas I can’t recall a study showing elevated uric acid due to the consumption of plant-based food.
Likewise single-cell organisms like spirulina and yeast aren’t plants and can contain dangerous amounts of purines. Some algae might be more like single-celled organisms than plants so I’d exercise caution with dried algae as well.
In the end, it’s all about the amount you eat so anything dried or otherwise concentrated can more easily be abused.

Roots, grains, peas, seeds, nuts and beans typically do not contain a lot of purines in the first place. Potatoes, onions and carrots contain virtually none for instance. Seeds contain more purines since they typically contain little water but you would normally not eat a whole lot of dry seeds anyway seeing that they’re so nutritious.
You are actually more likely to consume dangerous purines by eating certain vegetables such sa broccoli, eggplant, aspargus or spinach than by eating beans and such. But consuming vegetables is generally healthy so purines are certainly not a reason to avoid vegetables.

[nobody]

As you noticed, there’s lots of nonsense out there about gout and food. And the trustworthy information one manages to find is too often quite vague. There are some things reasonable people disagree about but there are a few things we do know about gout and food. If you really want to, I’d be willing to discuss that with you, tell you where you can find reliable information and so forth.
But if I may… in my opinion, it would probably be a waste of time. Indeed, the most important thing you said was that your boyfriend takes allopurinol daily. That changes everything. Getting allopurinol right is more important than getting food right!

Most people can easily control their uric acid by taking allopurinol regardless of what they eat… on one condition: they need to take enough!
If you think your boyfriend still has too much uric acid, maybe he should be taking more allopurinol. In some cases, it’s more complicated but in many cases the only thing that needs changing in order to fix gout is the daily dose of allopurinol. The typical dose isn’t appropriate for everyone.
A warning though: allopurinol is a serious drug. Your boyfriend should be monitored for side effects and the dose shouldn’t be changed without discussing it with a doctor.

Something else about allopurinol: it’s an old drug and you can stock it for years. It should therefore be quite cheap.
If you’re paying a lot for it, it may be because you’re paying for a brand. If for some reason there is no cheap brand of allopurinol for sale in your locale, perhaps you could plan a short holiday some place where you can buy a personal supply of the stuff cheaply.

Finally, if you want to experiment with your diet and measure your uric acid, that’s great! I’d be interested to know the results of your experiment.
But your experiment wouldn’t help your boyfriend much because taking allopurinol changes the effect food has on your uric acid. Everyone is different anyway but your experiment would be more likely to help someone who wants to lower their uric acid without drugs.

[nobody]

Usually, febuxostat is taken once per day.
Sometimes people need to take more than 40mg per day. If your UA tested around 8mg/dl while taking 300mg allopurinol, you probably need more than 40mg per day. You could however start by taking 40 mg per day for a few weeks before getting a blood test and adjusting the dose based on the result.

Febuxostat has an effect very similar to allopurinol. But the amount you need to take is different.
With both drugs, you need to reduce UA to less than 6 mg/dl, ideally to 5 mg/dl or even less. And you need to keep UA there for many months (sometimes more than a year) in order to be cured. Attacks are unlikely to ever stop if UA remains around 8 mg/dl.
You can sometimes experience relief from your symptoms after taking febuxostat or allpurinol for a few days but that’s not the point. Even if the drug did stop an attack, it may cause more frequent attacks for a few months.
People typically take anti-inflammatories to get relief form attacks. Colchicine is often used in order to prevent attacks immediately after UA reductions.

Like allopurinol, febuxostat is known to have serious side effects. In particular, it often affects the liver. Most people can take it without issues but you need medical supervision when starting febuxostat. In particular, since liver problems are often initially painless, you’ll need a blood test for liver function after about 2-4 weeks on the drug.
If it turns out your body doesn’t like febuxostat, you could perhaps take a larger dose of allopurinol instead.

[nobody]

I don’t think the “normal rate of dropping the uric acid levels” is relevant to your situation. Everyone is different. For instance, you are older than most study subjects and you don’t seem to have very good kidney function.
But if you were an average gout patient who tested at 519 before taking allopurinol, I’d expect your uric acid to test around 320 on 300mg. Understand I’m only giving you a number because I don’t want to avoid your question. It’s just a number I made up based on studies I’ve read and it’s not necessarily a problem that you test higher than this.
You do test too high, mind you. But that’s why allopurinol doses have to be customized to the individual. And it looks like you could use more than 300mg. There are random variations so your next test on 300mg could be a good bit lower. But since your results on 200mg were already a little high, I think your latest test result might be further evidence that allopurinol isn’t as effective as one could hope in your case.

What allopurinol does is to reduce the amount of uric acid produced by your body. So if your body isn’t making a huge amount but is instead having trouble getting rid of uric acid, allopurinol is going to be less helpful. It’s going to help a bit in any case and we can see from your test results that it is helping. But maybe your body also needs help getting rid of the stuff in order to get your uric acid down to a healthy level.

In light of your older kidney function tests, 102 is clearly not unusual for you so my concern that allopurinol or colchicine might be raising your creatinine test results seems unwarranted. So perhaps you could take even more allopurinol?
Obviously, your doctor may have access to other test results (creatinine isn’t the only relevant test) and will in any case have a much better picture of your situation than I do. Also, I’m no doctor. So this is something you ought to discuss with your doctor or doctors before taking any action.
All I can tell you is that your uric acid test results aren’t satisfactory yet, that another blood test on 300mg would give us a better understanding of what’s going on and that in some of the more difficult cases, other drugs are used in combination with or instead of allopurinol.

[nobody]

Hopefully indeed. It’s probably too early to tell but you may be one of the more difficult cases who would benefit from using another drug either on top of or instead of allopurinol.
Quitting meat entierly (or being careful about what parts you eat) might bring about a small improvement. And there are other dietary tweaks you might want to try besides getting rid of meat.
But you’d make more progress with drugs. If allopurinol is hard on your kidneys (I don’t know how your tests looked liked earlier or to what extent the raised creatinine is due to colchicine), maybe it’s time to see a rheumatologist.

About your earlier post, my doctors think the same way about colchicine vs. ibuprofen.
But my rheuma says diahrrea may be a sign I’ve taken too much colchicine. I guess it depends how bad it is but it’s apparently more like a sign telling you that you’re pushing against your body’s limits than a problem as such. Certainly mild diahrrea doesn’t mean you ought to stop taking colchicine. Be sure to drink enough water though.

[nobody]

The good news is that you have more data. It affects your average result which is what matters most.
I don’t think the difference between individual results is significant. If you had done more testss, you’d know how stable your results normally are. All I can tell you is that mine randomly vary by a good bit more than 0.02.
The difference might not be totally random though. Depending on the exact circumstances of these two tests, the extra heat might explain the slightly higher result.
In any event, there is definitely no cause for worrying as long as future tests do not come back with even higher numbers.

[nobody]

It’s not uncommon for gout therapies to take more than 6 months to work.
In order to say more about your situation, we’d need to know:
-your uric acid test results
-for how long you’ve had gout

Maybe try getting used to drinking a bit more water? It’s not going to hurt. That way, you’ll get enough even on the days when you don’t feel like drinking much.
You need to add stuff to water when you aren’t eating. Unless you have a terrible diet, there are enough minerals in your food.

[nobody]

Coincidentally, 8.0 has been my highest symptom-free and pharma-free test result since I first developed gout-like symptoms. I wasn’t taking any of the supplements you take.
It would be intersting if your symptom-free test results got much higher but I fear you won’t remain symptom-free much longer.
There’s not much difference between 6.9 and 8.0. Have you had enough test results to make a reasonable estimate of how noisy they are? My pharma-free results have been as low as 5.3.

It is common for gout sufferers to have long symptom-free periods. I don’t know of any demonstrated trigger or enabler for these periods.
When you have no symptoms while your UA is well into the danger zone, that suggests your immune system is currently not bothered by UA crystals. And we know that anti-UA antibodies contribute to UA crystalization in the same way that clouds are seeded by tiny particles. So you immune system being relaxed about UA crystals should enable higher amounts of UA to be retained in the blood. Trouble is, if the amount of UA gets high enough no help is needed for crystals to form and your immune system will sooner or later attack them if you are prone to gout.
There are other factors which inhibit crystallization such as high ambient temperature and (apparently) low amounts of iron in the blood.

Another reason for the amount of UA in your blood to rise would be a decreased ability to eliminate it. That doesn’t seem very likely unless you are slowly increasing your alcohol intake or something. I assume your supplements do not damage the kidneys.

[nobody]

Yes, allopurinol inhibits production and does not eliminate existing uric acid. If you take enough allopurinol (it’s not clear that you do), it’s only old deposits which can give you trouble.
People who have had gout and high uric acid for many years often have a great variety of deposits.

My understanding, partly based on guesswork and therefore highly suspect, is that taking enough allopurinol to radically alter the amount of uric acid in your blood is likely to make many previously stable deposits unstable. In some cases, they’re going to be inherently unstable and in others physical activity or accidents are required for the instability to become apparent.
In addition, when your immune system starts to get worked up about uric acid but doesn’t find obvious targets, it’s going to notice deposits which would otherwise would have remained under the radar. Taking allopurinol is likely to create situations in which unstable deposits excite the immune system but are dissolved into the blood before the immune system’s excitement is exhausted, effectively setting it on a search-and-destroy mission.
The larger and least stable deposits are likely to be in the foot rather than in the hand. It seems it’s not uncommon to get gout-like symptoms in ridiculous places after radically lowering uric acid. Hands don’t rate as ridiculous as they are a fairly commonly affected area. I got hand symptoms after changing my diet which only resulted in a relatively small decrease in uric acid.

7-10 days is too long. You can have even longer attacks without treatment but in my opinion, long-lasting attacks a sign of inadequate treatment. And if you can tolderate aggressive pharamaceutical treatment, you might be able to reduce your attack duration to hours instead of days.
Have you discussed colchine or corticosteroids with your doctor yet? That might spare you trouble and reduce your need for large doses of Ibuprofen which can cause nasty side-effects if you use it for too long.

[nobody]

Uloric doesn’t seem to have the same allergy-causing record as allopurinol but it has its own serious side-effects (get you liver function monitored after starting it!).
You probably have other options than Uloric considering your uric acid seems to have been borderline rather than markedly high. Have you already had a uric acid excretion test (it involves pissing in bottles for a whole day)?
One problem with Uloric in Canada is that, according to another form member, it’s only available in 80mg which are very hard to cut. And would be insane to use 80mg daily in your situation. See if you can get the round 40mg Uloric pills which look like they can easily be cut down to 20mg (precision is not required). Or maybe your doctor can write you a script for custom pharmacy work (it should be possible to get the pills professionally crushed and repackaged). If you can get other febuxostat brands than Uloric somehow, the Japanese corporation which developped the drug sells 10mg, 20mg and 40mg pills. 40mg is very strong already and the maximum dose they offically recommend is 60mg daily. The 80mg Adenuric pills sold in Europe can easily be cut to 40mg and you can cut them to lower doses with commonly-available tools.

Something else: the foods you listed aren’t equally high in histamines. I don’t know how much you think you can take but skimmed milk should be OK and balances the protein mix of grain (if you drink enough). Drinking lots of skimmed milk is also recommended for gout.

[nobody]

Hi again,
Swelling, redness and pain does look like gout. But the redness is normally around the joint(s) and not at the tip of the toe. Gout symptoms are not always typical though.
You started lowering your uric acid not too long ago so you could still have gout symptoms. But so far as I know, there is also a chance you never had gout in the first place. If your tests results keep coming back under 5.5 mg/dl but your symptoms do not go away next year, you may want to ask for a more thorough investigation of your problem.
There are things other than gout which cause swelling, redness and pain. You might want to watch for signs of infection in particular like whether you cut yourself recently or your temperature. See a doctor if there is any doubt.

[nobody]

Hi. Here’s a quick feedback…
There’s noise in test results so 397 and 406 are basically the same.
Both of these values are too high. There was some uncertainty when all you had was the test result from June but it’s now become quite clear that 200mg is not a sufficient dose for you at this stage. So unless you know that there is a medical reason preventing you from taking more, you should talk to your doctor about increasing your allopurinol dose.
The status of your liver and kidneys should have been monitored along with your uric acid so your doctor should be able to tell you if your body is already struggling to deal with 200mg or if it looks like you could handle a larger dose.
Good luck curing your gout!

[Author]

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