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Sounds like a good plan, though I am not convinced it has any additional benefits once the dose is right.
As zip2play says:
The long term oxypurinol lasts for days, so it doesn't matter much when you take the allopurinol in that regard.
So you have a fairly constant dampening effect on uric acid production because oxypurinol (that breaks down from allopurinol within hours) is always there to protect you, as long as you take at least once a day.
I know of no research that considers changes in uric acid amongst patients on urate lowering therapy – I guess it is just not necessay as it is clear from the so called Treatment-Failure Gout, that the failures are due to incorrect dosage or patient non-compliance (the report I linked to also lists “Inadequate response to adequate dosing of urate-lowering therapy” but I just see that as inadequate dosing).
DinoSS100 said:
I told the Dr. I thought I had gout because I've had right big toe pain off and on over the years (I can remember seeing a Dr in 2001, but it was never this bad) and my brother has gout. The blood test showed my euric acid was too low to be gout.
Never accept “too low” or any other descriptive analysis. You must get the exact number from your uric acid blood test result.
It's strange how a simple question about allopurinol dose taking time can open up so many other questions.
There is an inference that matching allopurinol ingestion to a uric acid production peak will be beneficial, but how can that be determined? vegetarianGuy mentions excercise causing a peak, and zip2play mentions high purine food. I've also seen information about a natural peak in uric acid production while we sleep.
I think zip2play has got it right with the last two sentences. A) it doesn't much matter, and B) with food.
Ligament hypertrophy (a special type of swelling where cells are enlarged) can be caused by many things, including mechanical stress, pseudogout and gout. In the cases of pseudogout or gout crystal deposits, the limited number of reported incidents are confirmed by delving into the joint, digging around for bits of stuff to analyze (they call it arthroscopy).
So with your history, Utubelite, not an entirely conclusive MRI. Given your allopurinol intake, it is unlikely that any further investigation into your joints will reveal any urate crystals.
As you have had 6 months without flare, it is perfectly in order to start to slowly reduce allopurinol to maintain uric acid level around 6mg/dL.
Looks like you are stuck with a less than perfect diagnosis, but allopurinol seems to have done the trick anyway.
zip2play said:
As an overview to this question, perhaps gout is a disease ultimately caused by too acidic a synovial fluid. As as adjunct, long ago I read a good long article (on paper actually) about how colchicine worked and why it was so specific to gout. THe writer said with some certainty that colchicine alkalyzed the synovial fluid. Sounds logical to me.
And another “side” to this: inflammation tends to lower pH in the affected area as acids are released by White Blood Cells during their attack on urate crystals. I imagine this must increase the risk of additional urate crystals forming.
Similar to colchicine, I've seen a study that shows how steroid injections lower acidity of synovial fluid, despite the injection being an acid. Tests showed immediate lowering of pH as the acidic steroid hits, then gradual increase over (from memory) 72 hours as the medication reduces inflammation.
Interesting stuff, this organic chemistry / microbiology.
Hard to search for though, in this instance. It seems many researchers have the initials PH, and many more have PH.Ds
Just read your post properly, and I see from the NHS reference that your being [mis]treated in the UK.
Are you near enough Yorkshire for me to send the boys round?
[from duplicated post] i dont know why he wouldnt share it it may be because he is an idiot is what im guessing
I think you're guessing right – reluctance to share data is a sure indication that the holder doesn't understand it.
Please add replies to the original topic.
Dizziness is one of the reported side effects of allopurinol. Interestingly, it was also reported among the top 10 side effects for febuxostat (Uloric / Adenuric).
I can't speak from personal experience, but if you search for allopurinol dizziness in the search box above or below, you will see a few mentions of it. I have had a quick look, but I cannot see how long this is reported to last.
It is certainly not the type of thing I endorse. My circumstances force me to accept advertising at the moment to keep the gout sites running. I'm hoping other projects will fund GoutPal, and allow me to stop, or severely restrict, advertising in future, but it is early days.
Unfortunately, without more details, it is very hard to stop this. I'll try to find out exactly what you are referring to, and remove it / ban it, and do whatever I can to prevent it from happening again.
More importantly, I beg all gout sufferers who are tempted to spend money on products to discuss them here first. We might not know everything (present company excepted
), but collectively we are pretty good at assessing what will help, and what will uselessly drain your pockets, or even worse.There are better uses for your money. I always say that home test meters are not necessary where you have a responsible gout care provider, and yours seems better than most.
The flares are almost certainly the result of old uric acid crystals dissolving. When this happens, there is a possibility (not certainty) that partially dissolved crystals can cause a gout flare.
Gout pain is not caused by “sharp” or “needle-like” crystals stimulating nerve responses. It is caused by an immune reaction. Just like a virus, your white blood cells (WBC) attack microscopic uric acid crystals. As they are trying to kill the crystals, they send out messages for more reinforcements. The combination of message signals and fighting WBCs is what gives gout its exquisite pain. At least with flu, there is some respite as the virus cells are killed, but gout continues until sufficient WBCs have isolated all the uric acid crystals.
This leaves clusters of protein-wrapped uric acid crystals of varying sizes. Most times, the lower uric acid concentration encourages crystals to dissolve unnoticed. However, a larger cluster might not get chance to dissolve between the protein coating falling off, and the immune system recognizing its old enemy.
I firmly believe that all a uric acid meter will tell you is that you are experiencing a flare during low uric acid concentration. Had you seen test results in the 5 to 6 range, I might think differently, but even then, a dose increase would produce a much better result than over-testing.
trev said:
MS and Parkinsons are mutually exclusive with gout on recent research
Not quite – lower incidence of these, but not impossible to co-exist
earthmuzk said:
Gout and itching. I have been itching on my feet and heels for several months. Sometimes all over my body, feet and hands. Recently I had an extreme gout attack. During that time my itching went away and when the attack stopped, the itching came back. I have tried every cream made, including steroids, hydrocortisone and fungal. I am now convinced that the itching is a buildup of uric acid that is huge. I am 62 and for the last few years have been trying to lose wight by eating a high-protein diet. Now, I am trying to following a low protein gout diet, etc. I am beside myself with the itching tho. Just found out about the baking soda and will try that. Any other suggestions. I have tried Atarax, nerve therapy, etc. I think the solution is to rid my body of uric acid. How do I do this naturally?
Uric acid crystals can certainly get under the skin, causing psoriasis of varying degrees. Everyone has different sensitivity levels, but the truth is, it may be the gout, or it may be something else.
We can really help with the gout here, and might be able to give pointers to other conditions.
It is utterly pointless to discuss the merits or otherwise of different cures, until we know your uric acid levels. As much history and information as possible will give us the best chance to help you.
As odo says, We start with current uric acid levels and I would also like to see recent history. We develop a plan together. We fix your gout. This may or may not fix the itching, but it will definitely fix the gout.
metamorph said:
I took pictures to show the differences between black soybeans and black turtle beans but did not know how to post the pics here.
Picture upload is by clicking the tree icon in the button bar that appears when you create a message. More instructions in Tech Stuff – Gout Pictures.
Welcome John,
Allopurinol is much cheaper than Uloric (febuxostat), and has been around long enough to prove it's safety, so it makes sense to try that first.
Side effects are minimal, but a possibility. They vary from person to person, but chances are you will be fine with it.
Main reason why allopurinol fails is that people forget to take it daily, or the doctor dose not prescribe the correct dose. Be sure, whichever drug you choose, that you get tested regularly for uric acid, and that your levels are low enough to clear existing crystals.
I've been trying to get the fully researched answer to this together all day, but too many interuptions.
The short answer is that, if you are on allopurinol (assuming your dose is right), you have absolutely no need to worry about exercising raising uric acid levels.
Long answer, with references, mañana
Do you have recent uric acid levels to prove your dose is right?
Nice to see we are getting somewhere with this, though I am totally at a loss to know what the real problem is.
Before I suggest a way forward, I am intrigued to know where the gout suggestion has come from. We know that blood uric acid can fall slightly during a gout attack, as uric acid leaves the blood as crystals are formed. However, this is unlikely to fall much below 350, and certainly not as low as 216.
I feel the only way you will get satisfaction is to see a rheumatologist as soon as possible. It is not a good idea to treat with indomethacin for long periods.
My next statement is directed to your doctor, not you. It is ridiculous to offer dietary advice, or even look for dietary solutions, when the diagnosis is not clear, just as it is ridiculous to wait for a reading of 700 before prescribing uric acid lowering medicines (an eye-watering 11.77 mg/dL
).Ah, nice one ouch – I was just going to write something similar, so you've saved me the trouble.
Now, I have to ask why the uric acid level is so low. You cannot have gout at such levels unless you are on uric acid lowering drugs such as allopurinol or febuxostat.
So that we can help you better, please can you give a bit more information on the history of your condition?
At the moment, I can only see 2 possibilities. Either you are on uric acid lowering therapy and the pain you are experiencing is from old crystals dissolving, or you have something other than gout. This is vital to know, as what you do next is entirely different in each case.
I didn't twig this at first, but now I see you're branching out into a new treatment area.
Your closing paragraph leaves me wondering also, and I assume he wood go for rest room.
My response crossed with Juliana's. I hope it doesn't look like I'm disagreeing with her.
I should have stressed the gentle in gentle exercise. What I found with complete bed rest is that I felt very stiff after a couple of days, and if the original attack was, for example, in the ankle, then it felt like my whole foot was difficult to walk on. If I keep walking a little, and then resting with the affected foot raised, the attack seems to go quicker, and I get back to full mobility quicker.
On the work side, I found that sitting or standing for long periods makes the gout attack last longer. I have put this down to restricted blood flow, but it could also be due to aggravating the swelling due to too much excercise. The key is as much rest as possible, but not total immobility – Juliana's advice is sound and clear on that point.
The official advice is to rest, but it is not strong advice – i.e. not backed by strong evidence.
My personal experience is that gout attacks go quicker if I keep mobile. That does not mean over exerting the joint, but trying to get as much gentle exercise as possible. Also keep the joint warm and avoid restricting blood supply. This can be difficult when traveling because often the knees are bent, which doesn't help.
What are other peoples experiences?
Hi tmonter,
I'll echo Richard's welcome, and his thoughts on allopurinol dosage. There's nothing to link higher doses of allopurinol with increased gout flares (at least, nothing I've seen), and the reverse is probably true. Certainly, the lower you get your uric acid, the faster old crystals will dissolve.
Pennsylvania said:
“The only way to be sure is to have fluid from the joint analyzed by a rheumatologist. This is quick and painless, and rules out other conditions, as well as confirming gout.”
GoutPal — Someone told me that the fluid extraction is very painful. Don't they have to do it with a needle?
Like any medical procedure, it can be done wrong by those less competent. I suggest a rheumatologist, as they should have the experience to ensure it is painless.
You must explain your pain fear to whoever is going to carry out the procedure, and if they cannot reassure you, then find someone else.
In my own case, I was still waiting for the needle long after the doc had got his sample – I never felt a thing. The area (my foot) was washed in a fluid that was quite cold, and I guess i was distracted by that. I really could not believe how quick and simple it was.
And please stop worrying about cauliflower! The only chance of it harming you is if you cut your finger during preparation – and if you do have gout, the blood loss would be a good thing.
It is common for uric acid to fall during and immediately after a gout attack, so you can be at 5.5 and still have gout.
I doubt this is the case if the only attack you have had was the one at the beginning of January.
The only way to be sure is to have fluid from the joint analyzed by a rheumatologist. This is quick and painless, and rules out other conditions, as well as confirming gout.
Hi ouch, welcome to the forum, and going back to your original post, yes this is the right place to discuss food and drink.
On gout diet generally, individual foods mean very little – it is your total diet that will affect your gout. Though even that pales into insignificance when compared to the 20 pounds of purine-rich human flesh that is with you constantly.
Gout diets only really make sense when you know what your uric acid level is. At 7 or 8 mg/dL, you might be able to lower below 6 with dietary changes, though this obviously depends on the scope you have to improve existing diet.
Even if you do fall into the group where gout diet can be effective, you can only judge it's effectiveness against uric acid levels. If a 'meal' of tomatoes and chillies gives you a gout flare, it is not necessarily bad. If the flare arises from old crystals dissolving, the pain is bad, but if you have a few less crystals to trigger subsequent attacks, that is good.
I haven't got round to summarizing the skim milk evidence yet, but all the evidence points to good benefits for gouties. As mentioned about vitamin C, the improvements are not massive, and not enough if your uric acid is high.
One interesting point about the vitamin c and uric acid study is that improvements were better in groups with higher starting uric acid.
More scaremongering at http://www.cdc.gov/mmwr/previe…..039742.htm and a fuller review by an MD at http://www.raysahelian.com/kombucha.html
The MD reckons it's OK once or twice a week, prepared under hygienic conditions.
No human benefits found, yet risks are not proved, which still leaves me wondering if it's any good or not. Until somebody shows me some properly prepared before and after results showing reduced uric acid levels, I'll take my fermented beverages in the usual way.
paulevans said:
do you have any opinion on Kombucha?
There is little scientific research on this, and certainly no known connection to gout (at least that I can find). Up until recently, the scientific view was that there was no evidence of any benefits, but it seemed safe. However, a report from Los Angeles last year states:
INTRODUCTION: Kombucha “mushroom'' tea is touted to have medicinal properties. Here, we present a case of hyperthermia, lactic acidosis, and acute renal failure within 15 hours of Kombucha tea ingestion.
CASE PRESENTATION: A 22 year old male, newly diagnosed with HIV, became short of breath and febrile to 103.0F, within twelve hours of Kombucha tea ingestion. He subsequently became combative and confused, requiring sedation and intubation for airway control. Laboratories revealed a lactate of 12.9 mmol/L, and serum creatinine of 2.1 mg/dL.
DISCUSSION: Kombucha tea is black tea fermented in a yeast-bacteria medium. Several case reports exist of serious, and sometimes fatal, hepatic dysfunction and lactic acidosis within close proximity to ingestion.
CONCLUSION: While Kombucha tea is considered a healthy elixir, the limited evidence currently available raises considerable concern that it may pose serious health risks. Consumption of this tea should be discouraged, as it may be associated with life-threatening lactic acidosis
Personally, I would have nothing to do with it.
Juliana said:
BTW do you really think you can pee out 200mg uric acid a day? Do you remember where Zip's rough assessment is? H cant understand (or me) how you can have an alkaline urine whislt excreting uric acid.
From “What lies behind serum urate concentration? Insights from genetic and genomic studies”
In healthy males, the urate pool averages about 1,200 mg, with a mean turnover rate of 700 mg/day. Under normal circumstances, two-thirds to three-quarters of daily urate disposal is excreted by the kidney.
I make that around 500mg/day uric acid excretion in urine. Allopurinol will lower this.
Uric acid is a very weak acid, so will have very little effect on pH of containing fluids. I'm absolutely the wrong guy to give the chemistry lesson, but I can tell you that on the Ka scale that measures acid strength, uric acid presents a weedy 1.30 x 10¯4.
Apparently it has something to do with pH and molarity, and I'm not here to lecture on molarity (boom boom).
hansinnm said:
zip2play said:
… and add to it 10 cans of brew.
…
Zip, I don't think I can measure up to your expectation. Even when I belonged to one of those beer-drinking fraternities in Germany (for barely 6 months b/4 I had it up to here) was I able to drink that much. 10 cans/bottles is about one gallon and that is beyond my belly's capacity. I am only 5-8 and 165#'s.
Capacity is no problem for me
, but doesn't this involve digit pricking?I struggle to get the key in the door after a session. Who knows what might happen with a drunken prick!!
