Tried some things but not getting permanent results

[Keith Taylor (GoutPal Admin)]

I am 30 years old and have been suffering with gout attacks monthly/weekly for past 2 years (I had attacks when I was younger but were more spread apart).  The attacks prevent me from working out as it takes 1-2 weeks to heal after swelling of my toes or ankle.  I weigh 235 pounds and I am 5'9″. 

Last year my uric acid was at 11.5-12 mg.  I got it down to 9.5 in the past 6 months (checked 2 blood tests).  I have removed beef/lamp/pizza/tuna/salmon and many things from my diet.

I was on Allupurinol and Colchicinne but all they did was send me to the washroom every 5 minutes.  My body wasn't feeling comfortable on the drugs for to long so I stopped both of them.  I was told of a homeopathic remedy and started drinking honey mixed with milk (in cold months) and water (in warm months).  This brought me down from 11.5 to 9.5 mg.  I am trying to add more fruit in my diet in hopes of lowering it further.  I try to eat less, not starve, but eat less in hopes that my acid wont increase.

So, I am currently having a gout attack in my left toe (usually right toe or ankle).  I ate half a bowl of new england clam chowder, mashed potatoes with gravy, 1 pc fried chicken and a salad the day before.  I wasn't aware that gravy or clam chowder can raise my uric acid. 

Gout is really wrecking havoc on my life as I can't do the things I want.  I used to enjoy going to the gym, walking, jogging and riding my motorcycle. 

How does one cure this once and for all?  I can drop 20 pounds if I am able to get into the gym and run.  I really haven't been able to go on a treadmill for 2 years and have started using elliptical machines in order to protect my joints when the gout attacks are not flaring.

Any advice is greatly appreciated.

[Keith Taylor (GoutPal Admin)]

Colchicine is a pain-killer with the unfortunate side-effect of diarrhea. You do not have to take it – there are alternatives, or you can simply grin and bear it.

Allopurinol reduces your uric acid to a safe level. Reducing from 11.5 to 9.5 is useless. It might mean one attack per year less, but the uric acid is still forming crystals in your joints and under your skin. You must get back on the allopurinol and get your uric acid down below 6.

This is no fast cure – it will take a few months to get all the uric crystals out of your tissues. Aim for an allopurinol dose that will get your uric acid down to 3mg then review it every 6 months. If you do not do this, the mobility restrictions that you are experiencing now will get worse.

If you do make a start on getting rid of uric acid then your mobility will increase, and you will have a much better chance of losing weight. Also, weight loss increases uric acid, and the allopurinol will protect you from this.

[odo]

  I wasn't aware that gravy or clam chowder can raise my uric acid. 

Meat gravies (especially) & clams are high in purines. If your UA levels are already high, this could well have been the trigger for your flare up.

[Keith Taylor (GoutPal Admin)]

Yes, thanks odo, I'd missed that point.

Gravies, stocks, sauces soups and broths are all potential high purine sources as they can often be highly concentrated.

That said, all the research that I've seen points to limiting purine intake only being effective for getting uric acid down a couple of points or so. This is believed to be due to purine excretion rising in line with purine intake – i.e. the more purines we ingest, the more we get rid of, though the net effect is a slight increase.

So purine restriction might be effective with uric acid around 7 or 8, but not when it is over 9.

Weight loss can help in the long term, so a combination of weight loss and purine restriction, perhaps supported by an increase in some of the foods that appear to help uric acid, might get 9.5 down to the safe range. The problem is, rapid weight loss causes increased uric acid in the early stages, so it is much better to protect yourself with allopurinol or some other urate lowering therapy whilst you lose weight.

This is no easy option, as I know from personal experience. I'm only slightly taller than Harry, so our target weight is similar – about 140 pounds! Even in my teens, I was heavier than that. Whilst my head tells me that 1 pound a week is easy, and will only take 2 years, my heart baulks at the challenge.

Time for a bowl of chowder to help build some resolve.

[zip2play]

Start with allopurinol 300 mg./day and plan on being on it for the rest of your life. THere is no need to do a trial at a lower dose because you have already used it and found no hypersensitivity. Allopurinol does NOT cause extra trips to the washroom.

There really are no other choices since you have already determined that the best you can do with dietary restrictions is to lower your SUA from 11.5 to 9.5 and that is not even CLOSE to being good enough…you need to be below 6.0 and after the years of attacks being a good DEAL below 6.0 is good treatment.

Homeopathy is quackery…some people get placebo relief for certain condition (the vapors? :D) but nothing more and there is no such thing as placebo relief from gout.

[Author]

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