What more can I do?

[DJ]

On the tail end of my recent gout flair, Dr measured my UA level at 6.6mg/dL. She prescribed 100mg Allopurinol to start and 0.6 mg of colchicine. Kidney and liver function looked good. More blood test followed and she upped my dose to 200mg of Allopurinol. UA levels went down to 6.2 mg/dL. She then raised Allopurinol to 300mg, which I have been on since January. I have seen a nutritionist who helped me understand how to manage gout with a diet of more flora than fauna. I am mostly vegetarian now with occasional meat or fish (no more than 6oz per day.) I drink Keifer and skim milk daily (2 cups/day.) I also take 2g of Vitamin C and 10mg of elemental lithium and 1.5g of black cherry extract each morning and evening (http://wrightnewsletter.com/2013/05/09/beating-gout-may-save/). I just purchased the EasyTouch GU meter for home testing. Today, 5 months after starting the 300mg of Allopurnol, my UA reading was 5.5mg/dL. While grateful, I was hoping to break the 5 point barrier. Is that misguided or is there more I can do (eg, drink more water)?

[Ron Avery]

Hi DJ,

I am definitely no expert but I would have expected your UA levels to drop more than they have after 5 months on 300mg a day Allopurinol. Having said that, everyone’s body is different. While 200mg gets my UA to 4.5 it may take 500 or 600 for you. Don’t lose hope as it sounds like you are on the right track.

I do know that drinking plenty of water each day is critical in flushing out gout crystals so you may want to up you intake. I try to drink at least 2-3 litres per day and even more on days I do strenuous activity or exercise. And, I believe, that the recommended amount may be even more than that but Keith will let you know for sure.

As I said, it seems you’ve taken excellent steps in controlling your gout with medication and diet so keep at it!

Cheers,
Ron

[Keith Taylor]

Hi DJ, that’s an interesting mix of medicine and myth.

The only reason for taking allopurinol is to reduce uric acid to safe levels. With no information about other diseases, the default setting for safe uric acid is 5mg/dL. So I don’t understand why your doctor stopped titrating your dose in January. As Ron said, the 300mg dose works for some people, but it is not, and never has been a standard. The correct procedure is to increase every 2 to 4 weeks until your target dose for the first year is reached. Target for the first year should always be lower than 5, if medically advisable, as it encourages more rapid dissolution of old uric acid crystals. I don’t understand why your doctor is not increasing your allopurinol dose, but I’d love you to ask her and we can discuss it further. There might be impact from your other health problems, but all that I have read indicates that allopurinol is beneficial to heart disease and diabetes (I’ll set myself a note to check latest research.

Drinking sufficient fluid is just as important during uric acid lowering treatment as it is with untreated gout. It’s especially important with allopurinol, as it’s by-products are excreted through the kidneys, and need sufficient urine volume to avoid oxypurinol stones. The fluid does not have to be water. Drink sufficient to produce pale straw colored urine. Increasing your proportion of skim milk in your fluid intake is good for encouraging better uric acid excretion.

Diet can play a part as well. More flora than fauna is an excellent maxim for all gout patients. Actually, all human beings. I can expand on that, but for now I’ll stick to the gout facts. Increasing plants in your diet will naturally increase urine pH. It has been shown that an alkalizing diet is good for gout. This does not mean becoming a vegetarian, though I can see it is a culture shock when 6oz a day of dead animal flesh is viewed as “mostly vegetarian.” That’s an observation, not a criticism. I’m aiming more for 6oz of fauna a week, but rarely achieving it. In any event, I’m at least 25lb overweight, so that excess meat makes my flesh intake rather insignificant.

So the “what more can I do” is:

1. Take adequate allopurinol
2. Increase skim milk consumption
3. Alkalize your diet scientifically

That’s the medicine, so what about the myth?

The extracts you are taking have little or nothing to do with good gout management. There might be minor benefits to some, but if you have healthy diet you should not need supplements. I don’t like the cherry reference that you give. What kind of doctor makes a scientific claim and justifies it with a link to his own ill-researched comment? It’s not that there is anything fundamentally wrong with the extracts you mention (though I have no idea what part lithium plays). It’s just that the contribution to your treatment plan is very unclear.

As for testing your own uric acid level, I really can’t understand why you need that when your doctor should be doing it as part of an allopurinol program. Much better to invest in pH test strips, and make sure your diet changes are actually working.

DJ, that’s just a simple snapshot with reference to the points you have made. As such, it’s a reaction to your comments and questions. I much prefer to create proper treatment plans that match your situation and preferences. Then, choices about dosage, diet, and supplements can be put into context. I hope you’ll return to explore other possibilities that lead to your improved quality of life. That, after all, is more important than the minute details of supplement benefits.

[Keith Taylor]

@yigaljoseph I mentioned latest research earlier. I’m not sure how relevant the following is to your situations. Maybe you could discuss it with your doctor and let us know.

Annals of the Rheumatic Diseases
Impact of Allopurinol on Risk of Myocardial Infarction

L Grimaldi-Bensouda, A Alp?rovitch, E Aubrun, N Danchin, M Rossignol, L Abenhaim, P Richette

Ann Rheum Dis. 2015;74(5):836-842.

Allopurinol may be associated with a reduced risk of [heart attack]. No decreased risk of [heart attack] was found in colchicine users. Besides its urate-lowering property, allopurinol might have a cardioprotective effect.

[Author]

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