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Hi,
I am a 33 yo male who was diagnosed with gout 5 months ago (after waking with a red, swolen ankle with no known cause, that took 3 weeks to heal).
After the initial attack, I have cut out alcohol pretty much, started drinking 2 litres of water a day, cut down meat intake and increased fruit/veg intake, however after 4 months I had my second uric acid test and it went up! it is now 9.8 (was 8.9 originally…but this was at the time of attack).
What is a realistic goal to aim for in terms of uric acid reduction via diet (I know the level should be under 6 ideally)? How long does diet take to lower uric acid level?
My doctor doesn't want to prescibe allipurinol due to my age (plus he says he had a patient that had serious complications using the drug).
Other doctors tell me to do nothing, as they say I may go the rest of my life without a second attack. I'm not sure what to do!
btw, I have spent hours and hours reading content on this site- it's a great resource 🙂
You can only realistically lower uric acid through diet if bad diet is the cause of your gout. If your gout is due to other factors – e.g. hereditary or kidney problems, then it is almost impossible to have any significant affect with diet.
Obviously, a healthy diet is good for you generally, so I'm not suggesting bad habits, but you need to do more to tackle the uric acid issue.
If you are overweight, it will certainly help lower uric acid if you can lower BMI to the low end of normal. This is a long-term project, as you need to lose weight gradually – say one pound per week. I now recommend that you support this with allopurinol until you reach your weight goal. This will protect you from the bad effects of uric acid during your weight loss program. You may be able to reduce the dosage or drop it all together.
Similarly if your diet has led you to excess iron, a low iron diet with appropriate iron chelation (and perhaps blood donating to help gout), then addressing this might help. This is also a fairly long-term endeavour, so again I would recommend the protection of allopurinol.
Most drugs have a risk, but one patient with complications is hardly a reason to not even try a well-tolerated appropriate treatment. If you want to wait for the second attack, then you are probably in the majority. Just remember that not all attacks are the full blown crippling variety – unexplained stiffness in the joints is a sign that crystals are forming.
Just don't wait for a third attack. If your doctor is still reluctant to prescribe allopurinol in future, I'm sure I can find 10 pages of benefits of allopurinol for every page of problems that he can find.
Thanks for your reply GP.
I am at the lower end of the BMI scale and have followed your site's advice and had kidney function test which is normal. I'm guessing it's hereditary (although no one claims to have had it in my family!). Not much family history is known however.
With a uric acid that has gone from 8.9 to 9.8 trust me, you do NOT have very much time before your next severe attack. Have your doctor put you on 300 mg. allopurinol immediately and have him prescribe colchicine, 60 or so, to have on hand to combat an attack at the first sign of eruption. Perhaps one or two colchicine a day propylactically is a good idea while you brring your serum uric acid down to 5.
THat furiously high uric acid concentration is just LOOKING for another place to crystallize and the odds are good for it to find your bunion joint…and then you will know the pain of the damned…with SATAN chewing on your foot.
Forget diet! If you had a uric acid of 6.5 maybe it would help, but NOT with an 9.8.
Time is of the essence here, lancer. It really is. I hope you act fast enough.
A doctor who would NOT prescribe allopurinol (or probenecid) to a person with a uric acid of 9.8 and proven gout is guilty of MALPRACTICE. NO jury would disagree.
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