[nobody]

If you are as I suspect talking about a product sweetened with something containing lots of fructose, that’s not recommended.
Of course the amounts you eat matters more than the exact product. And what matters is your whole diet. Generally though, it’d be best if you could get used to eating unsweetened stuff.

[nobody]

Apparently some Quorn products are now vegan. But they are not plants products and so I wouldn’t recommend them to anyone with gout or even asymptomatic hyperuricemia. The vegan products are probably even worse than the Quorn products made with eggs.
My assumption would be that mycocultures contain nowhere as many purines as yeast but still quite a bit more than legumes. At least one study has compared this stuff to soy products but of course the various ways industrial products are processed could yield various amonuts of purines in the final product. Maybe ask the manufacturer…

Plants are safer. What’s wrong with lentils?

[nobody]

You may have taken less Naproxen than (as Homer would put it) iron-stomached, steel-livered Keith would have used. I would certainly not take that much.
And if you take more NSAIDs in order to be mobile, it makes sense that inflammation is stopped quicker. That’s what taking a very strong NSAID dose is supposed to do.

About painkillers:
I think taking painkillers to be mobile is riskier than taking anti-inflammatories for the same purpose. Even considering that crystals can cause mechanical damage besides inflammation, anti-inflammatories do reduce the risk of damage. And crystals can cause damage outside of attacks.
Sorry if my insistence is annoying but effective doses of paracetamol are hard on the liver. If you’re already taking other medications which are known to cause liver problems, be careful. And if your liver function hasn’t been tested since you’ve started one such medication… well then, I would recommend not touching the stuff. There are other painkillers.

Now as to your questions:
I don’t know whether ignoring pain and walking during an attack might cause OA. What it definitively can cause is immediate and non-permanent problems. Slow damage is harder to understand, as are things like OA. There seems to be an interaction between OA and gout but I don’t know what processes are involved.
It stands to reason that abusing your joints, tendons and so forth could in some cases cause permanent damage. You also risk accidents when you push yourself.
But then, not being mobile for very long also involves a risk of long-lasting and possibly permanent damage, right? The same goes for not using the full range of movement of a joint, I guess.
My assumption is that minimizing risks is a balancing act. As far as attacks lasting a few days are concerned, the risks invovled in immobility seem very small compared to the risks involved in mobility. When you’re talking about symptoms lasting months however…

I’d be interesting in knowing the opinion of your current rheuma.

[nobody]

Rapini is a green cruciferous vegetable. You might call it something else. Supposedly that type of vegetable is helpful for people who want to suppress estrogens. That type of vegetable also tends to have lots of lysine (relative to other vegetables or to the calories they contain).

I’d be surprised if you didn’t eat enough protein. More likely, you’re not eating the right proteins.
I realize it’s not that hard for adults to eat a healthy vegan diet but it’s harder than for non-vegans. And it seems quite common for vegans to have deficiencies in practice.
What test was used to establish that you used not to have a protein deficiency? It might not be specific enough. Such tests aren’t routinely done here so I can’t possibly guess what was tested in your case.

[nobody]

Sure, keep eating hummus and peanut butter for the time being. You’re avoiding enough foods already!

I don’t know what the controversy about multi-vitamins is about but lysine ain’t a vitamin and the most multi-vitamin pills wouldn’t have it. For one thing, you need a much larger volume of lysine than all vitamins combined.
There are blood tests for lysine. Sometimes it’s tested as part of a full amino acids test. But such tests aren’t routinely done here, except perhaps of infants.
I don’t know what your diet is like so I have no idea how likely you are to have serious deficiencies but the way you talk about purines and phytoestrogens is worrying.
If it’s only soy you avoid, fine. You could even avoid all beans as well as green peas if you ate enough lentils and chickpeas. I don’t know how much muscle there’s on you and so forth so I don’t know your requirements but my guess is that about 80g lentils (uncooked and unsoaked) plus 80g chickpeas (uncooked and unsoaked) per day would cover your requirements. If you’re eating loads of cauliflower, rapini, turnip greens, spinach and such, that could cover part of your requirements and lessen your need for legumes. Quinoa and potatoes would also lessen your need for legumes but not by all that much.

[nobody]

A vegan trying to avoid phytoestrogens sounds like a recipe for protein deficiency. There are alternatives to soy of course but they’ve supposedly got a fair amount of phytoestrogens too.
I guess you could in principle eat loads and loads of cauliflower and rapini but realistically…
Are you taking a supplement? If not, have you been checked for lysine deficiency lately?

About hummus and peanuts, I wouldn’t be surprised if they were trigger foods for you. Fats and salt can be an issue. But possibly it’s something else entierly that gets your immune system worked up.
If you’re talking about industrially-processed foods, there could be a common ingredient. Otherwise, one attack per food doesn’t even qualify as a coincidence yet.

[nobody]

I don’t recognize the side effects you mention but I might have misattributed “urge to drink water” to stress and/or inflammation when it’s actually a colchicine side effect. Drinking water is healthy anyway.
I might also have shrugged off slight headaches.

I’d put the side effects I experienced in two categories:
-weird initial side effects
-dose-dependent gastrointestinal side effects and liver stress
The second category does not go away quickly even if the dose is lowered and and should not be triggered by a single pill. It seems I typically need to take quite a lot of colchicine before such effects become noticable. These are potentially serious side effects and I’ve been told to see them as a hint that I might be taking too much colchicine.
The first category though, I can get that on the first pill especially if I take a full 1.0 mg (I often cut these pills in half and spread the intake over time). In fact, I often get them only on the first pill after a while off colchicine. The most noticeable side effects in that category are itching eyes and feeling like I’ve got a slight fever. But I got other seemingly nonsensical and harmless side effects which go away on their own within hours to a day even in the face of dose increases.

[nobody]

The purine problem is solved by allopurinol. Maybe a small dose increase could reassure you but based on your latest test result, it’s not strictly necessary.
Protein deficency on the other hand… that’s not going to be solved by any drug. And vegans are at risk of protein deficiency (especially lysine). The solution isn’t eating more protein but more plants containing a better protein mix.
So it seems to me your priority should be clear: you should eat soy, beans and so forth. Peanuts and wheat do not contain as much lysine.

About “high purine plant Diet”, we can go over the numbers together if you want but the bottom line is that there seem to be very few plants which have a very high amount of purines. So one plant-based diet can certainly have more purines than another plant-based diet but it’s nothing like the amount of purines you could be getting from animal flesh (or yeast). What matters is the numbers and not relative judgements like “high” or “low”.
Yes, dairy has less purines and a better protein mix than (most) plants but if you pick the right plants, the difference isn’t such a big deal.

We can also go over the protein numbers together if you want but I think you’ll get basically the same information from pretty much any mainstream dietary advice for vegans.

[nobody]

I suspect the problem here is not so much the product as such but how you’re going to use it.
So far as I know, people generally use protein powders to live on bad diets. Protein powders also make it easy to consume too much protein which can indirectly make gout worse (but at that point you’d have bigger problems than gout). Normal foods are generally safer.

Another problem is that you’re vegan which means you can easily end up with a protein deficiency by diversifying carelessly. So far as I know, hemp proteins are kind of like the proteins in most nuts: a poor choice for vegans, except in small amounts.
Vegans should get much of their protein from stuff like soy, cauliflower, beans, spinach or lentils.

[nobody]

I’m going to disobey Keith and decline to “leave now”. Sorry.

What I’m seeing here is confusion between different things:
-habitual exercise (that is, when you’re NOT having an acute attack… and I do mean “acute” as opposed to whatever you might have that lasts for months)
-exercise during an attack
-weight-bearing exercise involving a joint affected by an attack

Consensus is, habitual exercise is healthy.
There are conditions other than gout causing more or less constant joint pain or even inflammation and as far as I can tell, the recommendation is to keep exercising if you have that. Sometimes people confuse these conditions with gout but gout is different in that attacks typically stop and give you plenty of time for exercise before the next one starts.

Based on my experience, I do think exercise during attacks helps a bit. BUT. Not any exercise. In particular, you don’t have to be mobile to exercise. And I don’t think it needs to be actual exercise to help.
Being mobile has in my experience been most helpful for joint problems in the hands and arms. Let the painful joint rest and get your heart pumping my moving your legs. Easy.
Typical attacks involving feet are another matter. Staying immobile is fine for a while (I’ve used one of these things designed for people who have foot injuries for instance) and can bring some relief because part of the pain is due to muscular tension but I find remaining immobile for too long doesn’t help.
People find that bathing their foot in hot water helps. Hot showers work too. Even simply sitting before going back to elevating your foor helps a little bit. My working theory is that you need to get blood moving into and out of the affected area during attacks. Exercise obviously does that.

When your feet are OK, the simplest kind of exercise is walking, running and stuff. But if you’re having a acute attack in the foot, that’s a recipe for disaster. Trying to walk on an inflammed foot puts you at risk of debilitating ankle problems in particular. Protecting my foot by using crutches during attacks has consistently led to better outcomes. You can however exercise using weights and such without putting weight on the affected joint.

[nobody]

Makes sense.
If you’ve been on the same colchicine dose for 6 weeks, you know exactly what to expect. If you got some side effects last time, you might want to try a smaller dose. But there’s no particular reason to avoid going back on colchicine for a couple of weeks.
You don’t need to start taking colchicine now in order to get some protection in September. But you could take it today because you feel an attack is starting.

[nobody]

It’s not clear to me what sort of justification you’re looking for but the pharma company didn’t make the rules of this game.
Approved drugs which very few people use need to be very expensive if their development is to become profitable. The fewer patients, the more revenue is needed from each patient in order to recoup costs.

Again, malic acid clearly doesn’t do what pegloticase does. It is not an alternative.
Pegloticase treatment typically causes SUA to fall to a very low level. You took malic acid and your SUA increased from 6.9 to 7.6 which is consistent with a placebo and isn’t consistent with an intervention that does much to liquefy large tophi.
It is at this stage not a fact that malic acid has been instrumental in anything during your trial, just speculation.

[nobody]

I’m not sure what question you mean to ask… perhaps you looking for information about health care regulations, prosecution of white collar crimes, patents or capitalism?
The practical matter at hand here is more straightforward: if someone’s health costs are covered by some form of insurance or government program, of course they’re going to want to make use of whatever therapies are available. Would you want them to refuse therapy for the sake of whatever superior good you have in mind?
Another practical matter is that the class of drugs in question is uniquely effective for people suffering from large tophi. And it happens that Krystexxa is to my knowledge the only drug of that class to be approved for use in cases of gout. Now there are doctors willing and able to use different drugs. But Krystexxa is probably your best chance if you live where it is available.

[nobody]

I would be surprised if you couldn’t get a pharmaceutical alternative to allopurinol in a neighboring country if not in Belize.
Teijin (The Japanese company which developped febuxostat) claims it is available in Belize. But Belize being such a small country, they could of course have their facts wrong. Maybe you could contact them. I did have a quick look on the web and found pharamcies claiming to stock a Latin American brand of febuxostat in Guatemala. Did you look for Latin American brands as well as Uloric (the gringo brand)?
As to probenecid, it’s only one of a type of drug called uricosuric. You could look for others (keeping in mind that in Central America drugs might be sold under a variety of brand names). I should however warn you that this class of drug is not appropriate in every case and is usually not as effective as allopurinol and febuxostat.

I don’t know about herbal medicines but there are dietary choices which are correlated with lower uric acid. With your uric acid at 7.6, it would likely be difficult and very slow to get good results that way but it’s not totally hopeless. Certainly it would be better than doing nothing.
Do tell if you want more information about that but I have to stress that febuxostat works much better.

[nobody]

I’m OK. Hope you are too.

I think we already went over this (or at least part of it) so I’ll try a different, synthetic approach…

Painkillers work quickest but only make you feel better and do not prevent damage.
NSAIDs work fairly quickly to reduce inflammation as well as violent damage but in my experience do not reliably put a stop to existing inflammation.
Colchicine works slowly but, in addition to its use as a prophylactic, actually seems to put a stop to existing inflammation. It won’t quite stop slow damage if crystals are forming obviously. And because it acts slowly, it’s not as effective as NSAIDs in preventing violent damage. It does however help prevent all kinds of damage including indirect damage such as the effects of long-lasting mobility loss.
Simply Waiting is the slowest solution. It works every time if you’re patient enough. But like painkillers, it does nothing to prevent damage.

I don’t have enough experience with corticosteroids and suchlike (never used that orally or intravenously) to comment on where they fit in the picture.

By the way, since you had asked about that the other day, I tried febuxostat+colchicine+NSAID+PPI (the last is apparently not something you require) during a flareup and it went well. Like I had told you, I didn’t take a very large amount of colchicine (less than I would have if I hadn’t taken an NSAID) because I like to experiment by starting with what seems the least risky before moving on to what might cause more side effects.
I also tried a PPI without an NSAID to pin down the cause of minor side effects and oddly enough, that did seem to relieve inflammation. Probably a coincidence.

[nobody]

Urankjj,
Malic acid clearly doesn’t do what pegloticase does. You should know since you’ve tried.
Stopping flareups isn’t the point. Indeed, effective treatment may initially cause flareups and flareups often subside for a while without any treatment.

If I thought Tophus Sufferer would read this thread, I’d have brought up pegloticase myself.
By the way, rather than allopurinol alone, an alternative to pegloticase (which isn’t always successful and isn’t available everywhere) might be high-dose allopurinol (or febuxostat) combined with an uricosuric. Obviously such a drug cocktail isn’t advisable in every case.

[nobody]

Hi again,
I used to have similar fluctuations in my test results even though I didn’t go back to meat or vary the time of the day when blood was taken. But maybe you’ll manage to find an explanation for the fluctuations and confirm it if you do more tests.
In the meantime, unless your 7.5 mg/dl test was carried out after a meal or physical exercise, I would take it as a sign that you need to do more to reduce your uric acid. Your body may for instance have been struggling to get rid of dissolving uric acid which is not a situation you want to perpetuate.
Maybe further testing will reveal that test to be an anomaly but you shouldn’t take that for granted. 7.5 mg/dl is simply too high for someone who is still suffering from symptoms. When there is that much uric acid in your blood, it put your recovery on hold and makes your symptoms worse.
Unless you want to keep suffering from gout for several years, you should consider taking a drug which lowers uric acid. You may be able to achieve consistently acceptable levels of uric acid with the help of more herbal medicine, further dietary restrictions, hydration, alkalization, dairy, vitamins, cherries, salt, coffee and so forth but that may require you to be thorough, patient and disciplined. Pharmaceuticals are easier and more reliable. And people such as yourself who do not have very high uric acid need not necessarily keep taking drugs to prevent the symptoms from coming back after the therapy has succeded.

[Author]

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