[nobody]

There’s no need to go back to dairy in your situation if you don’t mind taking a little allopurinol.
I don’t know what’s good about dairy exactly. I suppose it’s a bunch of stuff, including calcium and the low purine content compared to alternative protein sources. I wouldn’t be surprised if the effect of dairy consumption on gut microbes was a big part of it.

I hope you won’t mind if I answer your other post here as well…

0.30 mmol/l is fine as maintenance target. It’s also low enough to cure gout. But there’s an argument that pushing uric acid a bit lower while you are still suffering from symptoms might cure you faster and in the meantime make attacks shorter or less severe. I think that makes sense and so I’ve pushed my uric acid a bit lower than 0.30.
If you didn’t have many blood tests while on allopurinol, there’s also the chance that the result you got was anomalously low. Your average value might conceivably be 0.34 (or 0.27 for that matter). From that perspective, it also makes sense to aim a bit lower in order to have a safety margin.
Then there is the issue of your feet often feeling cold to consider. If they are indeed colder than most people’s feet, that would warrant a slightly lower target.
Some people would advocate pushing your uric acid much lower (like 0.22 or even less) and that is in my opinion questionable outside of unusually severe cases.
But I think it would make sense for you to take 150mg instead of 100mg until you are confident your symptoms are gone (assuming of course that your doctor thinks you could tolerate the temporary dose increase). That would still be a very small dose compared to what most people take. Then you wouldn’t have to worry about the modest amount of purines in soy and such.

[nobody]

I don’t know what your doctor means by “just below the borderline” exactly but it sounds like you might benefit from taking a little more allopurinol, if only temporarily.
Your doctor should have been monitoring how your body handles the drug (liver and kidney function especially) and so should know whether you can safely take a higher dose.
Some doctors are slow to tailor the dose to each individual and need their patients to demand it.

There’s no need to make foot baths very hot, just hot enough to get your feet a little reddish and a tiny bit puffy. I think that might be helpful if you tend to have cold feet.
If you also have stiffness or loss of joint mobility due to your bunions, that could also contribute to getting gout symptoms in the feet and you might possibly benefit from gentle exercise or physical therapy. I have for instance very gently used my hands or a towel to forcibly flex a joint a bit more than it would on its own power.

About food…
In my experience, arthritis can react quite quickly to one’s last meal. Only I don’t think that’s the purines at work. Food affects the body in many ways.
There is for instance a known link between digesting fat (or is that only some fats?) and the type of inflammation involved in gout. I get reactions from large amounts of egg fat for instance (I’m vegetarian, not vegan). But that’s not the only type of food that gets a reaction from my body. For instance I’ve noticed reactions to salt and some yeasts and/or fermentation products (not just alcohol).
I’m not convinced vegetable purines are all that different by the way. Vegetables simply tend to have much less purines and to boot they tend to pack nutrients that help the body get rid of uric acid. Vegans can have pretty high uric acid anyway, in part because dairy seems to be helpful in limiting uric acid and is generally recommended to people suffering from gout.
You might want to experiment with different types of beans and lentils, not combining them with oil or with eating smaller amounts in any single meal but I’m sorry to say that in my experience milk and yogurt are the safest protein source. Then again I’ve not experimented much with things like quinoa and amaranth so that could possibly be an option. Some vegetables like cauliflower and spinach pack a little useful protein as well.
Hopefully in a few months’ time you won’t get attacks any more and you’ll be able to forget about trigger foods.

Finally, this might seem obvious but I don’t know what drugs you’ve tried: some drugs which do not cure gout are nevertheless very useful to deal with gout symptoms, either to prevent attacks or to suppress them before they bloom. Some of us have taken quite the cocktail to deal with attacks.

[nobody]

Hi,

A gout attack is no reason to stop taking allopurinol.
Possibly you are a special case (drug interactions?) but if someone advises you to stop taking allopurinol, they should explain their reasoning.

Having attacks for many months after you’ve started allopurinol is expected. How many months seems to depend in part on how long you’ve been having high uric acid or gout before starting the drug.
One thing you might want to check though: it’s important that your uric acid has been reduced sufficiently. Reducing it “a lot” might not be enough. There’s a handy colored chart on the rightmost column of this page you could use to interpret your test results.

As to bunions, I don’t know for a fact but I guess it would make sense if they caused you to have more gout attacks.
Do your bunions sometimes feel particularly cold to the touch after you’ve been outside in the winter for instance? That would cause uric acid to crystallize there. As you may be aware, such crystals are the cause of gout.
Some people bathe their feet in hot water to help the bloodflow.

[nobody]

If you are still taking allopurinol, that should allow you to induldge a bit.
But since you are taking a small dose, you should be careful. The amounts you are talking about aren’t excessive so that ought to be fine.
If you are worried, get a blood test a few weeks after changing your habits. I doubt you would see a statistically significant difference.

That said, there are other concerns than uric acid. I wouldn’t recommend the smoked salmon one finds in most shops and I don’t know how you handle alcohol. There are many reasons to avoid alcohol such as having liver problems.

Generally, I think most people who have a serious gout problem would do well to avoid alcohol until they stop having attacks.
But you never had really serious attacks or high uric acid, right? So the risk is minimal in your case.

[nobody]

People usually take allopurinol for life. Because if you need it, you need it.
But you don’t have to take it for life.
People who do not have a very bad uric acid problem and who change their diets, lifestyles and so forth might be able to quit the drug. Others might be able to make do without the drug for a few years before needing it again.

The first step is to figure whether you would need allopurinol, and how badly. And that starts with getting a few blood tests. There are other tests which might be called for as well, depending.

Rich,
I would think: a bit less than a week. But I don’t know exactly because I’ve never gotten several of these tests during the same week.

[nobody]

Hi,

About the persistent swelling, there might be a few things you could try. But what you already done for that foot treatment-wise? And what tests (if any) were done on the painful location?
Some of us have had lingering symptoms for more than a month after what we assumed to be a gout attack. Insufficient treatment might be part of the reason why the symptoms lingered so long.
I’ve not experienced this problem recently. Perhaps it’s because my uric acid is lower and perhaps it’s because I’ve been taking more colchicine when dealing with worrying arthritic symptoms.

About your uric acid, my concern with your doctor’s approach is that a single blood test is insufficient as a basis for long-term treatment (you shouldn’t try to lose that weight over a few weeks). But maybe your doctor had more data than you posted here.
Also, do I understand correctly that your blood was tested during or shortly after an attack? That sometimes skews the result.
If all you have is the one blood test, I strongly recommend you get at least one more test. When you’re experiencing gout symptoms and especially when uric acid is borderline rather than very high or safely low, test results can randomly vary a lot.

It is possible to manage uric acid without allopurinol, even if the average amount of uric acid in your blood is actually a bit higher than 0.41. But it would be easier if your average was a bit below 0.41.
And I’ve got to warn you that you’re likely to experience more pain and disability over the adjustment period than if you temporarily took a drug such as allopurinol. The higher your average uric acid, the more hardship you would likely face.
The reason is that gout is mainly caused by uric acid crystals which build up in your body over the years and not by what you ate or drank yesterday or even by the amount of uric acid currently in your blood. If you eat right and start losing weight, these crystals wouldn’t go away instantly. Instead, they would slowly start to dissolve in your bloodstream which would likely cause both minor and serious gout symptoms. As a result, you risk feeling worse instead of feeling better for a while.
The same thing usually happens with allopurinol but you’d get over the bad patch quicker. You might also experience less serious symptoms while in that patch.

If you want to try lower your uric acid without drugs, there’s more you can do than drinking water and cherry juice by the way. But maybe you already know all about that…

[nobody]

Hi,

I can’t tell what caused this bump.
But I can tell you that having 11.6 mg/dl uric acid is a serious problem and that you ought to see a doctor about that. Excessive uric acid is the main cause of gout, not what you just ate. It would be helpful if you had older test results. If that is your first uric acid blood test, you would ideally do a second blood test and see a rheumatologist afterwards. You’d be able to show your bump to that specialist who may be able to make an educated guess as to what it is or suggest a technologically-assisted examination of the elbow and/or bump.
But if seeing a specialist quickly would not be possible in your situation, you should at least see a general doctor, show them this bump and ask firmly that they do something about your uric acid without delay (assuming the second test doesn’t come back much lower).
You’ll likely end up taking a drug called allopurinol because there’s little hope of addressing such a dangerous level of uric acid without strong medication. But it may be worth doing some tests to try to determine what causes this excess of uric acid in the bloodstream because you might possibly benefit from more sophisticated treatment than simply taking allopurinol.

In the meantime, it’s good that you’re drinking a lot water (but don’t overdo it!). You should ideally also avoid alcohol and make sure you eat lots of vegetables. This won’t be sufficient to solve your uric acid problem but it may help prevent kidney problems.
Not eating food very high in purines is also prudent but if you’re not used to a vegeatarian diet, take care to avoid nutritional deficiencies (if your body can handle lots of dairy, that’s the easiest way to be safe).
And as long as you don’t know why exercising your elbow is painful, I think it would be prudent to refrain from doing anything that hurts a lot.

[nobody]

Uric acid in the blood can fluctuate a lot.
I have had results between 5.3 and 8 while on a similar diet when I wasn’t taking allopurinol or similar drugs. My average test result was 6.6 which is high enough for crystals to be a problem, especially since I evidently had old crystals from the years when my uric acid always tested above 8.
But your results look different: they are consistently low. A few crystals might occasionally form (for instance after physical exercise) but it shouldn’t matter because any new crystals should dissolve quickly considering the average of your test results. And if you had many old crystals, I think you would see more fluctuations in your test results.
I guess you could still have a few old crystals in various locations. Lowering your uric acid with allopurniol may have destablized them, causing pain. I felt temporary discomfort in many locations when my uric acid fell under 5.

If you are often out in the cold or have cold joints because of poor blood circulation, crystals can form even if your uric acid is relatively low.
There is also evidence that the amount of ferritin in your blood affects uric acid crystallization.

[nobody]

Hi,

What would be the purpose of this diet plan?

The main cause of gout isn’t what you just ate but uric acid crystals which can accumulate in one’s joints over the years. So the main point of a gout diet is usually to reduce the amount of uric acid in one’s blood. But assuming the test result you mentionned is 3.3 mg/dl (perhaps you could double-check both the number and the unit with your doctor’s office), that indicates a very low amount of uric acid already!
Now because these crystals accumulate over the years, it’s possible you might be suffering from gout even though the amount of uric acid in your blood is currently low. Indeed gout pain can be triggered by an improvement in one’s diet. But this type of gout is temporary. You might think of it a residue of past diets or lifestyles. The residue slowly dissolves and once the process is completed, one’s gout is cured.
I think you should get another blood test (if your last test was done only a few days ago, wait a few weeks) because the result of your last test might possibly be exceptionally low. It happens, especially after flareups.
But if the amount of uric acid in your blood is consistently that low, there is no point in changing your diet in the hope of lowering it further.

A ketogenic diet is something which might bring about uric acid problems but maybe your body can handle that well. Still, if you often carry out such dietary experiments and you suspect you are prone to gout, you might want to keep monitoring your uric acid.

But perhaps you have a goal other than minimizing uric acid such as preventing inflammation… in that case, please explain what you are trying to achieve.

[nobody]

The attitude of your doctor(s) is insane! Random fluctuations would be a reason to do MORE tests, not less.
Surely there must be some kind of patients association or other consumer organization in your country which defends people against technocratic abuses and profiteers. They might advise you on the best way to proceed in order to obtain rational care.

That said, you aren’t clear about your old test results (how much is above 300?). I can only assume you concluded from your old results that you could get by with 300mg.
In case you weren’t aware, getting flareups 14 months into allopurinol therapy wouldn’t be unheard of in a case such as yours. It doesn’t necessarily mean the 400mg dose was insufficient. You might have avoided that flareup by taking more allopurinol during those 14 months but increasing the dose after a flareup isn’t necessarily helpful. Blood tests would have helped to determine whether more allopurinol was needed.

Any allopurinol side effects could take a few weeks to go away.
And you should get a blood test done about a month after lowering your allopurinol dosage to make sure that hasn’t allowed your uric acid to reach an unsafe level.
If the dose reduction you devised doesn’t solve your problem and considering you have been gout-free for a while, you could also simply stop taking allopurninol for a few weeks and see if you feel better.
You will probably need some drug to keep your uric acid under control in the long run but it seems people who aren’t experiencing flareups can often take relatively short breaks without ill effects.

If you are indeed suffering from unacceptable allopurinol side effects, there are alternatives to that drug.
The most obvious one is febuxostat. It might help or it might not but it’s important to get blood tests done if you try it in order to prevent liver damage.

[nobody]

It was obvious that would be the next question you’d ask. So if I had meant to answer it, I wouldn’t have waited for you to state the question, would I? 🙂
We’ve got to stop somewhere.
And talking allo is pointless since that’s probably behind you. I’ll however answer your febuxostat questions if you have any.

[nobody]

No need to be sorry about what I’m going through. It wasn’t such a big deal and it looks like it’s over anyway.

I wouldn’t recommend you avoid colchicine just because my previous doctor was foolish enough not to prescribe it to me and I was able to get by without it for many years. If your blood condition rules it out or something, fine. But recall your UA problem is worse than mine.
About that… I also tried allo but yes: I’ve spent over 10 years with gout symptoms and no ULT other than diet. I figure that might have done 70% of the job or thereabouts.

[nobody]

Hi Brian!

If you’ve not already been taking an anti-inflammatory drug (the ibuprofen type) for your ankles, do ask your doctor about that.
That won’t cure you and it’s not a type of drug you should take for too long but it’s the simplest thing you can do to stop swelling and pain.
I recommend you ask specifically about the maximum dose you could take if you were hurting real bad. Just in case.

I also recommend you quit alcohol for a while, especially if you’re going to try unfamiliar drugs or stronger doses than you’re used to.

[nobody]

We can’t replace your doctor.
If for instance your doctor wanted you to do a blood test after the break from Milurit, you should get that test done before restarting the drug.
If on the other hand your doctor only wanted to give your body a break from the drug, you could start taking it again witout delay.

If you can’t get clear isntructions from your doctor, look for another one.

[nobody]

You’ve got even more questions? Best give you an overview then…

I’ve gout in the family and had hyperuricemia basically my whole life. Back when I had my first weeks-long big toe nightmare, febuxostat wasn’t even on the market. I only figured out that the stuff might work for me this year, the assumption having been that my liver couldn’t stand it (and indeed a regular dose had done a number on it when I gave it a try). So irrational optimism aside, I should have been expecting serious flareups and not just minor ones.
I haven’t had a really bad attack in many years and instead I’ve been living with mostly mild chronic arthritic symptoms which is why I shrugged off frequently abnormal white cell fractions. That’s nothing you ought to be afraid of.

As to my current status, I’m of course doing much better but this flareup has been surprisingly long (and therefore most annoying). By the looks of it, that’s because it has been a multi-stage thing with different areas in and around the joint involved successively. So I’m not sure I’m out of the water yet.

As to the unrelated questions:

I’ve got no idea if and when your lingering symptoms would go away on their own. It’s not a given colchicine would help but I think it’s worth a try.
All I can tell you is that I did once experience more or less constant inflammation on a big toe for about 4 months (though in my mind there were several discrete attacks). That situation resolved on its own (though the foot took many months to heal fully once the inflammation was gone).
I also had other very long episodes which resolved themselves without colchicine. These things can’t last forever.

There must have been about 2 weeks between my strangely high test result after quitting ULT and the next one (which came back typical).

[nobody]

I’m not surprised you were recommended colchicine in your condition. It’s not good at relieving acute inflammation but it’s good at putting it to rest, slowly but surely.

re: “hardcore”
I was talking about SUA, as you did when you used that word. Starting from a lower level than yours (thanks in part to my diet), I ended up with lower SUA test results than yours even though I’m only taking a small dose.
I never took a very strong dose of febuxostat. I wouldn’t dare as my liver is touchy.

re: overconfident
I was overconfident in terms of how I neglected both to baby my joints and to take a prudent (meaning pretty large) amount of colchicine at the first sign of trouble.

re: my hemoglobin
The dip showed up in my last test. I would usually not get tested for this stuff as I have no blood problems (well, I routinely have abnormal white cell fractions but I suppose that’s to be expected when someone’s got chronic inflammation) so I’m probably not going to be able to tell you if it was a temporary dip anytime soon. If it turned out to be permanent or even if it got a bit worse over time, that wouldn’t be an issue for me.

re: your SUA test result
I warned you about this. I also got a surprisingly high result shortly after quitting ULT (that was before my current ULT). But I’ve got to say 760 is even higher than I would have guessed!
I don’t know why SUA rebounds that way. The crystals must be part of it but it’s possible your metabolism tried to compensate for your lowish SUA by overproducing and hasn’t adjusted back yet.
For what it’s worth, going by the tests my SUA seemed to have dropped back to normal fairly quickly after that ULT-discontinuation spike.

[nobody]

Of course that’s not what I’m saying. I wouldn’t know because I never tried taking more than 1mg colchicine at a time, as I was told not to do so. But really, do you think it’s possible colchicine could work that fast?
The timeframe I was talking about was the one you originally were talking about: a day. My flareups have previously gotten worse by the next day when I took less than 2mg. But every time I took 2mg or more, whether it got worse over the next few hours or not, by the next day the flareup had started abating. It could of course be a coincidence.
What really makes no sense to me is to take the same amount the first day as during the following days. The stuff is going to build up in your system so if you’re not afraid of what that’s going to do to your body on day 3, why not take more colchicine the first day and get the full effect quicker?

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