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Likely drug caused high uric acid
My diet has never been bad regarding purines, but have been on blood pressure meds for 35 years. Diuretics are the only thing that can get it below 130/90. Am on 50 mg of HCTZ, and last BP (Sept, 2015) was 112/72. But my uric acid was 10 mg/dL. I had gout a year ago after eating a good amount of chicken liver (haven’t had any since). I have also been taking a daily supplement of 500 mg of Niacin due to heart history in my family.
My doctor recommended Allopurinol, but didn’t like side effects I saw. So we switched my ACE inhibitor to Losartan and I stopped the Niacin.
There is so much confusing advice about diets (don’t eat cabbage, do eat cabbage; don’t eat oatmeal, do eat oatmeal, etc). I get lots of exercise, but hear exercise raises uric acid. One of your articles said to not worry so much about diet.
Since my problem seems to be the diuretic, lose some weight, but otherwise stick with what I am doing. Does that sound reasonable? Think I would go crazy with all the conflicting advice about what to do or not.
The problem with advice is that it needs the right context.
Generally speaking, it’s good advice not to carry sharp knives. But that’s poor advice for a surgeon or butcher.
So, that’s why I always say, start with your gout facts, and what worries you most. Then we can create a plan together that removes those worries. In the process, we might uncover other worries so we deal with them. Ultimately, the biggest worry for all sufferers is “how do I maintain my uric acid at a safe level?”
So, Mike, we’re doing well so far, as you have a great plan to switch diuretics and lose weight. It’s a brilliant plan, so we have to measure it properly. Please record your weight in your Personal Gout Profile so that we can compare that in six months. Also, try arrange a blood uric acid test every month or so, and post the results here.
To help you on the plan, let’s get rid of some of the other minor worries.
1) Allopurinol: no need to think about that for now. We’ll try to manage gout without it. We can consider it in six months if you don’t reach safe uric acid levels on your current plan.2) Confusing diets: it’s all about context. Individual foods don’t matter. Your total food intake and your body mass are what creates uric acid. Cabbage and oatmeal won’t affect uric acid unless you gorge on them. I’d like to know which of my articles said not to worry about diet, so I can understand the context better. Some people should definitely worry about diet. But most who already eat a healthy balanced diet should stop worrying about every single thing they eat.
3) Exercise: though this can raise uric acid during strenuous activity, it lowers uric acid in the long run. Best to avoid exercise designed to build muscle mass. That’s because muscle mass is a source of uric acid – and why gout is a common topic among body builders.
Good luck with the plan, Mike. If I can help with the weight loss, or any more worries, just ask. I really hope you can post your weight and uric acid each month. It will really help you to achieve your goals if you post those results here.
Thanks for your comments Keith. I couldn’t find the exact article regarding diet, but you said something similar to what you noted above; eat a healthy balanced diet and don’t get too caught up in each little detail. Most sites seem to agree that mushrooms are bad, so that is really the only thing I am cutting out since I don’t eat organ meats, rarely drink, eat little red meat, and don’t drink sugary drinks. I do eat canned tuna, but am going to limit it.
To help loose weight, I started on a popular calorie and nutrient counter and have lost 8 lbs. My nutrient mix was 50% carbs, 29% fat, and 21% protein which was almost exactly the recommended proportions according to the app. The carbs may be a bit higher than recommended for gout, but they are primarily complex carbs so not worrying about that at this point. The weight loss has been over a period of two weeks and am watching that it doesn’t come off too fast.
My exercise is regular but typically not strenuous. It is primarily cardio, but some limited weight machines perhaps twice a week. I track my steps through my cell phone and they run 6,000 to 10,000 a day. I don’t get concerned if I have a busy day and can’t hit the 6,000 target, but most days I do.
I am hoping with the changes I have made I can get the uric acid down. I am going to be talking with my doctor about getting another blood test within a month or so.
On the face of it, it sounds like you have a great plan Mike. It’s good to know you are planning a uric acid blood test in a month or so. I’d be really interested to see if you can see significant improvement.
Try to sustain the weight loss. It doesn’t have to be 4lbs a week – one or two is good. I like how you’ve combined diet and exercise.
Keith – I posted on your Facebook site. But you suggested to come here. I was asking if anyone had developed a homemade spice mixture that could be applied to food that included herbs that at least some people thought might be helpful in dealing with high uric acid. A search of this site and the internet generated information about individual spices but no mixture with proportions of each spice/herb. There are no miracle cures, but if something you would be doing anyway (seasoning your food) can make a contribution without causing any harm it seemed like it might be worth trying. I usually just use salt and pepper or grab some spices out of the cupboard, so might as well have a mix ready that might be helpful. I created two mixtures, a Mediterranean one and an Indian one. The Mediterranean included garlic, basil, oregano, cinnamon, parsley, rosemary, coriander, marjoram, thyme, nutmeg, and lemon peel. The Indian one included cumin, coriander, ginger, turmeric, dry mustard, cardamom, cinnamon, and lemon peel. My plan is to create a shaker of each of these and use them to season meats, rice/pasta, vegetables, and salads depending on what the food is and my mood at the time. Perhaps experimenting with proportions is the way to go or changing some of the ingredients. For example, I am not sure the cinnamon goes with the Mediterranean, but thought I might try and see. If there are any good herbs or spices that are missing they could potentially be added. Does this seem like a reasonable idea?
Thanks Mike, I didn’t make the Facebook/Forum connection.
Everything you say about spices is very reasonable. So, going back to my first reply here, we have to set the context. Herbs and spices are a part of gout diet, and diet is an optional part of gout treatment. For some gout sufferers, diet changes can be the whole of the gout treatment plan. As I said earlier, to Breanden : Gather facts, consider options, do plan.
The first step in gout treatment is to establish the facts. I turn to your profile and read “My uric acid level: 10mg/dl”
I don’t know how to say this best. There is no way that seasoning your meals differently is going to halve that number and get you safe.
Mike, you remind me so much of myself. I went through years of this type of thinking before I realized I had to take proper control. Basically, it boils down to this: if we are going to fiddle with diet, do it after we get rid of the years of uric acid crystals that are causing gout attacks. The logic for this is:
1. You have a buildup of uric acid crystals.
2. To get rid of them quickly, you need to get uric acid well below 5mg/dL. Let’s say a quarter of your 10.
3. Diet changes will take many months, probably at least 2 years, before they can have significant impact.
4. Every day that uric acid is over 6, your situation is getting worse.
5. Until old crystals are gone, they will confound all your attempts to measure the effects of diet changes.
6. Therefore, reduce the uric acid burden immediately, so you can safely stop meds while you experiment with diet.Having said all that, I’m extremely interested in your ideas. I think the starting point has to be agreeing that two preparations are necessary. One aimed at reducing inflammation. The other aimed at reducing uric acid. Of course, we have to accept that the impact will be tiny compared to the meals we are seasoning.
I have to say, I’m in the middle of some quite intensive reorganization to my GoutPal sites, so my time is limited. However, I’m determined to complete my database of gout treatments and other resources. I’ve always intended to include natural gout medicines in the database. I feel that your ideas fit very neatly with that. As you’ve already done some of the groundwork on individual herbs and spices, that information might make a great start. Would you want to get involved with filling the database? Or, would you prefer to share the information here, so I can start inputting it?
You mention proportions, but to me, the issue is more about taste. I.e. I believe the main objective would be to advise people how to make gout-friendly meals more tasty, and also slightly more gout-friendly.
What would be the next best steps for you? I’m asking both in terms of a gout herbs and spices project, and, more importantly, where do you want to take your own gout treatment plan?
Thanks for your reply Keith. I do understand that the herbs and spices are a small part of the big picture. Since my blood pressure medication was changed to losartan (which has been shown to reduce uric acid) in place of one which is associated with increased uric acid, I want to see what kind of effect that has. In addition, my diuretic was reduced and have increased my water intake. Reducing the diuretic has raised my blood pressure a bit, but I am still within a safe range. As you stated in your response to Breandan, medications have a trade off, and a slight increase in my blood pressure will be worth it if I am better hydrated and my uric acid is lower.
Regarding the herbs, the proportion of each is directly related to the taste. People won’t stick with it if it tastes bad. If you put on a pinch of salt and a huge amount of pepper, food will taste bad. Thyme has been described as peppery, so too much would probably not be good. I have looked at a number of Mediterranean mixes, and there might be two teaspoons of basil to 1/2 teaspoon of thyme. So correct proportions are probably as important was what is in the mix.
In my reviews of articles, I had not really thought about one for reducing uric acid and one for reducing inflammation, though that is an interesting notion. Mine were focused around two different tastes to provide some variety. But the idea of reducing inflammation would be appealing for me. Although I have only had one gout attack several years ago, I was told recently that I shouldn’t take NSAIDs. I have had reactions to three different NSAIDs, the latest a few months ago after a few days of a prescription NSAID, and the doctor said that I shouldn’t take any NSAIDs due to the potential of anaphylaxis, even from aspirin. It was recommended that I use acetaminophen which is a pain reliever but not an anti inflammatory. I have started using some tart cherry juice and perhaps that can be useful, but natural anti inflammatories would be great.
As far as the database, I would certainly be willing to help out, though I am a beginner in terms of trying to figure these things out. I would also be willing to provide input on the website itself if you are interested. It didn’t seem appropriate to comment on it before, but since you are making changes the amount of information does feel overwhelming. For three years, I managed a website for an animal rescue group and have some experience with trying to figure out how to organize a lot of information in ways that people can find it. It appears you are using WordPress and I am not familiar with their functionality since I was writing my own HTML and CSS code, but would be open to being a sounding board for ideas or providing comment on changes you are considering if that would be of any value.
Oh wow, if you can write your own HTML and CSS, then inputting into WordPress will be easy. I might even give you the job of styling it so it looks nice. My priority for the weekend is to get that project going properly. I’ll be in touch. Now for the gout stuff.
Blood pressure and gout are often linked. Choosing the right BP treatment is often all you need, so I’m glad it seems to be working. I’ve a couple of points:
1. If the reason for the switch to losartan is uric acid related, how come you haven’t had a uric acid test to confirm that both aspects of the change have worked?
2. Have you ever tried testing your own BP? The only reason I ask is that I suffer from what is commonly called “white coat syndrome.” I see a doctor (or nurse) and my BP rises. A nurse suspected this when she wasn’t happy with my BP, and retested. The next 2 tests went higher! She suggested I try the self-test room they have at the clinic. Sure enough, my BP was normal, and this was also proved by a 24-hour portable test machine. It might be completely irrelevant to you, but I can’t help mention it when the topic of blood pressure is raised.Acetaminophen is quite a strange drug. It’s not classed as an NSAID, but it does have some slight anti-inflammatory properties. I’ve used it in conjunction with ibuprofen, as well as on it’s own. You do have to be careful about maximum dose, as overdose does cause irreparable liver damage. I’m not aware of any safety issues at normal dose. Obviously, it’s much wiser to limit any pain medication, and try and remove the cause.
I have to leave for work now, but I’m looking forward to an interesting weekend. If you, or anyone else has any ideas about making my gout information more accessible, please feel free to deposit your messages in the suggestion box.
They had no one else who was willing to do the web site, and it was quite an adventure since I had to teach myself HTML. Although still a self taught amateur, it did help me understand how difficult it is to organize large volumes of information. And I found that some of it comes down to opinion. A model that one person finds easy to maneuver through is confusing and complex for someone else.
Regarding the questions:
1. My doctor thought that retesting now would be too soon. He suggested we wait until the three month mark since we are working on several approaches including changing one BP med, reducing diuretic, losing weight, watching diet, and maintaining my exercise. As I have learned from this process, diuretics not only reduce fluid volume leading to higher concentration of uric acid, they also appear to interfere with the kidneys ability to remove uric acid. Although weight loss helps reduce uric acid, losing weight too fast can raise it so that has to be a juggling act. So waiting a bit seems reasonable.
2. Being able to do my own BP readings has been important for me. High blood pressure has been a long term problem, with my first diagnosis in 1982 when I was 170 lbs and played sports daily. A whole range of tests, including kidney scans, have never identified a cause. A decent electronic arm cuff is reasonable in price and seems to do a good job. The ones that go on the finger are not considered reliable. The readings I get are pretty comparable to what the doctor gets. During this transition period on meds, I take a reading several times a day just to see what is going on.Totally agree on keeping pain meds to a minimum and addressing the causes if possible.
Just found the link that might be helpful to people looking to buy a blood pressure cuff that is has passed testing by various US and British agencies:
http://www.dableducational.org/sphygmomanometers/devices_2_sbpm.html#ArmTable
@mjinpa Mike, thanks for that BP testing info. I’m sure it might help many gout patients who are also having blood pressure problems. I’ve been delayed with the Gout Resources website, as I’m putting forum updates as a higher priority.
@giddsey Paul, the anti-clunkiness program is underway. Let’s hope it doesn’t take the shine off the brilliance! 🙂I have an update on my high uric acid issue. To recap briefly, my uric acid level was 10.7, and my doctor prescribed Allopurinol. I didn’t like the potential side effects, and after doing my own research (which many healthcare providers discourage), asked for a change in my blood pressure medications. Based on a recommendation from Keith, I asked to have my blood test redone and just received the results. My uric acid went from 10.7 to 5.9 in three months. My blood glucose went from pre-diabetic to normal. In my case it appears clear that I had “drug induced hyperurecemia” as well as elevating my blood glucose. The main guilty party was 50 mg of HCTZ. For those with high uric acid and high blood pressure, you might want to take a look at your BP medications to make sure they are not contributing to the problem. It apparently is not something that physicians routinely consider. If high doses of HCTZ are the only option, then deal with the side effects, but otherwise consider alternatives.
It’s great to read that switching blood pressure meds has saved you from the terrors of gout.
Over the year, there have been many posts here about this problem. I would have thought that it would have been dealt with by now, but clearly not.
To gout sufferers of the world, who are on BP meds, use this as a warning. You have to discuss this with your doctor. If there are no alternatives, then use uric acid lowering meds to make your blood pressure meds safe.
I am providing an update to my gout situation that I hoped I would never be writing, but I guess I am a slow learner.
A few nights ago, I awoke with what I knew was the start of a gout attack. Since I have been gout free for over a year, primarily from changing my blood pressure medications to reduce my uric acid, I was puzzled by the recurrence. My first thought was too many holiday sweets, since I still don’t eat much red meat or fish, rarely drink alcohol, and never drink sugary sodas. But I had a prostate inflammation and the urologist prescribed an antibiotic and a special diet. I specifically mentioned the gout since the diet excluded cherries and yogurt which I consumed daily since some believe it helps lower uric acid. What he didn’t mention is that antibiotics reduce the kidney’s ability to excrete uric acid. I think it is highly likely that I am experiencing a second episode of medication induced hyperurecemia with a different doctor involved. What I have learned from this are:
1. My kidneys are sensitive to medications which inhibit the excretion of uric acid. In the case of antibiotics, they also kill good stomach bacteria which could further exacerbate the problem. This sensitivity does not mean it is true for everyone, but appears to be true for me.
2. I cannot rely on physicians to take into account my health history when making treatment recommendations. Although I like both of the physicians and feel they are knowledgeable about their craft, they operate in a way which I have seen very commonly over the years. They look at what is in front of them, not what is all around them. The first doctor prescribed Allopurinol without even reviewing my blood pressure medications until I asked him to do so. The second doctor was informed of my gout, but didn’t think to mention that the antibiotic could be a problem and suggest some ways to mitigate the potential of a gout attack.It concerns me that I have now had a second attack, and this time it is in two joints; both the first and second joint of the big toe. It was so painful last night that I probably got no more than an hour’s sleep. I now realize that even though I brought the uric acid under control before, it can easily be disrupted if I become complacent and don’t check what is being prescribed for me.
Aw Mike, that’s terrible!
How upsetting that it might be avoided if doctors had thought a bit more about uric acid implications. I have to say that I’ve seen it from there point of view. Doctors have explained to me that it’s very difficult to check all possible side-effects when they have a problem to deal with right now. Maybe they could do more. But, the common approach in medicine is to deal with the immediate problem, then make adjustments if more problems arise.
All we can take from your experience Mike, is the need to be vigilant. Anyone who has ever had any worries about gout needs to ask the question about any other treatment. I have a list of meds on my gout guidelines site that can increase uric acid. The trouble is, it is not a static list. Therefore, gout sufferers need to adopt a strategy for other meds:
1. Always ask the question.
2. Always get a blood test after starting a new drug. You’ll have to wait for the drug to reach its full effects. But, your doctor can easily find out how long this is for different drugs.I really hope it doesn’t happen to you again, Mike.
And, I hope other gout sufferers will take note, and maintain vigilance against similar problems.
Keith
Thanks for your reply. I agree with you that doctors would have trouble knowing all the possible side effects of any particular drug. But since I had mentioned my gout diet to him, he might at least have suggested I check the side effects on the internet, or pulled up the PDR to see is there was any contraindication with gout. There seems to be a fairly cavalier attitude about the possible side effects of the medications they are recommending. Although I didn’t mention it earlier, I also injured my arm recently which I also believe to be a side effect of the medication. I thought it was just getting old, but was surprised to see it in the list of possible medication side effects. It could be pure coincidence that this injury occurred while on this medication, and would not have expected the doctor to know that this med can cause tendon tears in men over 60.
As you note, we must maintain our vigilance and not be intimidated about using the internet for information (because it will make us imagine all kinds of problems???). Ultimately, we are the one who have the time and investment to ensure our healthcare; physicians are hired help.
Mike
I think we’re both probably defending errant doctors more than we should. But, your last paragraph says it all.
I’m aware that people look up health information on the Internet. Then, guess what, they suddenly get the symptoms next day (or imagine them). I know it’s a problem for doctors, but I don’t think it’s changed much over the years. Pre-Internet, the source was ‘my mate down the pub’ or ‘my sister’s brother-in-law who once went out with a senior nurse’ etc.
I think it’s different when we’re actually prescribed something. I’m heeding your words Mike. Next time I get a prescription, I’ll definitely be researching the active ingredients before I start the treatment.
Perhaps in the years to come, we will have physicians who are more comfortable with the internet, and patients who are less in awe of their physicians. As I was growing up, physicians were people who were more like teachers, mentors, and authority figures. I am still uncomfortable about the next visit with my urologist and trying to not hurt his feelings since I think he is a genuinely caring person. But we can’t rely of physicians without supplementing that with our own research. Yes, people can come up with all sorts of imaginary illnesses, but we can also be proactive with some knowledge that physicians don’t necessarily have the time for. When I mentioned my yogurt due to the gout, his response was, “Well, try to eat less.” Now that I have looked it up. better advice would have been “Try to time your antibiotic so that it is between meals, preferably two hours after eating and two hours before eating. In addition, take some probiotic while you are on the antibiotic to help keep healthy bacteria in your stomach.” Ultimately, unless the error is egregious and they get sued, physicians don’t deal with the consequences of poor advice. I am sure he will be sorry I experienced the gout (unless he tries to blame it on something else), but he wasn’t the one how could barely walk for a week. Most physicians are great people, but they are not omnipotent or magic like we were taught years ago.
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Drugs or Diet Causing High Uric Acid?
This discussion predates my introduction of different approaches for different types of gout sufferer. But it introduces all the elements of the typical GoutPal Student. Because Mike is considering drugs, diet, or herbs. Then we establish that it’s best to investigate all options. Before selecting a combination of treatments that match what the gout sufferer wants to achieve. At one point I summarized this as “Gather facts, consider options, do plan.”
For people interested in learning their uric acid control options, I recommend a GoutPal Plan for Gout Students.