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The result that seem to say that coffee lowers gout risk is first called a PROSPECTIVE study…to me that means it hasn't been done yet???
Quote:
The June 2007 edition of Arthritis & Rheumatism reports, in Coffee Consumption and Risk of Incident Gout in Men: A Prospective Study
Secondly, what I see is a look back…that is NOT a study. A proper study is a controlled study that looks FORWARD and compares groups to test a hypothesis.
Thirdly, the slim look back results shows that men with gout drank less coffee than men without. If your first diagnosis of gout came with the warning from your doctor to give up, or moderate your coffee wouldn't that “result” be predetermined.
An example might be that people with rheumatoid arthritis are told to stop running. A look back will discolose that those without arthritis tend to run more and therefore falsely indicate that running cures arthritis.
These gout-coffee studies are terrrible and as a result I smell the money influence of the multi-billion dollare coffee industry here.
My best evidence is intuitive: xanthines are purines and purines cause/exacerbate gout. Uric acid is basically a slightly modified xanthine molecule…it is therefore most compelling that caffeine (trimethyl xanthine) theobromine and theophylline (dimethyl xanthiines) break down to uric acid. And the quantities are enormous for heavy coffee drinkers. I get a GRAM of caffeine/xanthine in my coffee
Until someone takes two LARGE blinded groups (or as blinded as one can arrange) dries them out for a couple weeks and feeds one lots of coffee and one lots of SANKA or water, and then measures the average differential in serum uric acid BEFORE and AFTER a suitable amount of time…maybe 14 days…we shall NEVER know for sure.
WHY a simple test like this was not run/published/trumpeted is anyone's guess. But I am reminded of the many decades that no testing, or at least no results of testing released, was done to determine whether or not cigarettes caused cancer and heart disease. Big money talks loudly.
I am CERTAIN that the coffee industry has done definitive studies, as ANY multi-billion dollar industry would…so their NON-publishing speaks volumes.
As for the diuretic effect of coffee, for myself I have PROVEN that it is nonexistant, one of those old saws that is repeated ad-infinitum with zero facts to back it up. If I driink lots of coffee on an empty stomach, as I do for 3 hours every morning, I am considerable HEAVIER than when I started, not lighter. The same goes for BEER (although other spirits and wine are very dehydrating.)
opa,
You are not alone in your confusion. I have been trying for YEARS to get a resolution of the problem. Here's the gist: the literature says that the source of dietary uric acid (as opposed to natural cell breakdown liberating nucleic acids) is PURINES, primarily xanthine and guanine. These purines in humans have as their natural end point, URIC ACID.
So, what is caffeine? Chemically it is tri-methyl XANTHINE, chemically VERY close to uric acid…or xanthine with three small methyl groups hung on. Now, restrictions on the amount of purines is strict for gout sufferers, on the order of a half gram a day or less.
The AVERAGE amount of uric acid produced in a day is about 700 mg. Since a gram of caffeine seems logically to yield close to a gram of uric acid, caffeine would seem to be a problem especially since an average cup (8 ounces) has about 160 mg. caffeine. I drink about 50 ounces of strong coffee per day…I'm extremely addicted.
But look at the dietician's link that pops up prominantly on a search for gout and caffeine and she says point blank: “CAFFEINE IS NOT A PURINE.” Well, I am a chemist and if the definition of purine is xanthines and guanines, then caffeine, being tri-methyl xanthine, sure as Hell IS a purine. Alass, the web can be the source of some pretty rotten information.
Like I said, I am as confused as you are. If I thought FOR SURE that drinking coffee vastly increased my pool of uric acid, I would stop drinking it. But I don't want to stop for NOTHING…and beside Betty Ford for kicking the addiction is EXPENSIVE.
I have stockpiled enough allopurinol that I can take 400mg./day for the foreseeable future and this my my current (1 month so far) self-prescribed dosage. I hope that the little extra allopurinol will give me the <5.0 that I desire but I haven't had it confirmed with a recent serum uric acid asssay…I'll go as soon as I can decide who I want as primary provider with my new insurance.
Adjunctive to my treatment is the use of 50 mg. losartan (for hypertension but uricosuric as a bonus…the ONLY BP drug that is) and mildly uricosuric atoorvastatin for cholesterol.
I have heart disease and REALLY would love my uric acid below 4.0…and I may arrange for proper agents to get that.
Here's a WONDERFUL but HUGE read on the tie-in between uric acid and heart disease…you'll find it interesting:
medscape.com/viewarticle/472684_1 [login required]
metamorph,
Explain to me what you mean by black bean BROTH. If it's not the soaking liquid then is it the liquid after COOKING the beans and discarding them (such a waste)?
Or is it a puree of the beans with a large excess of water…what I call black bean soup?
I think the evidence is growing that high uric acid is damaging to the linings of blood vessels…this doesn't surprise me becasuse I have coronary artery disease. I'm sure the uric acid is causative rather than the other way round. (As far as heart failure goes, of course diminished coronary artery flow is ultimately its primary cause.)
I have a pet theory that is not getting any play in the literature anymore that uric acid plays a LARGE roll in all the arthritic diseases. Thus it does not surprise me that gouty people have, in addition to the increased risk of heart disease, bad backs, ruined knees, wonky shoulder rotator cuffs…I have all three.
After all, any inflamed or injured joint become acidic and therefore may be the concentration point for uric acid. Just because it is in subclinical amounts that are difficult to aspirate does not deny its presence.
A prominent rheumatologist of several decades ago treated ALL his bad back patients with INJECTIONS of colchicine and claimed remarkable results. His claim was that almost all the pain of a bad back, whatever its cause, was from uric acid.
I take Magnesium oxide every day providing 250 mg. of Mg++, I;ve recently added, in order to alkalinize my urine (and system) another ounce of magneesium citrate (liquid) that provides .1.7 grams of mg. citrate or about 255 mg. more of magnesium. It seems ann easy thing to try so I hope for some of the same relief Martin got. I've got nothing to lose.
Yep, my shoulder crucifies me, my knees are breaking down, and I have been on diuretics for centuries…god knows what a mess my electrolytes might be.
monty,
It sounds VERY MUCH like gout and you should have your uric acid tested. If it is high, you should get on a regimen of allopurinol or febuxostat if you are in a country that has approved it.
If you want to be ALSOLUTELY sure its gout you have two options:
1.the next attack have your joint aspirated and the fluid examined under a polaroid microscope to look for dendritic crystals
2. take a course of colchicine…it it quickly stops the pain it is gout.
Longer term evidence is if the incidence offoot pain decreases markedly over the months of treatment to allopurinol, it was gout.
But there is one that is the easiest diagnosis: IF you awaken at dawn with a bunion joint that hurts like Hell, is almost impossible to step on and if in the ensuing hours it gets purple, hot and hurts worse and worse and worse, and you know you didn't injure it the day before, it's gout!
The only realistic treatment is allopurinol (in the U.S.)…the alternative is a shortened painful lifespan.
That's very interesting metamorph.
I make black bean soup often (Pureed with lots of cumin, a squirt of lemon) and have been discarding the soaking liquid except last time when I incorporated it (in a much smaller quantity) into the soup for enhanced BLACKNESS.
God, I imagine it the soaking liquid straigt up tastes like bitter death though. Better a foul liquor than acute gout, eh.
I'll try it for my next attack, but I am going on the assumption that there will never BE one. I've upped my allopurinol to 4oo mg./day and will soon get a uric acid test…it's been a couple years since last testing due to a lapse in my insurance (hideous U.S. medical system.)
Mark,
Yes, as predicted I strongly recommend colchicine as the singulary best “cure” for an acute attack of gout…in fact, it has almost no other function and is often considered DIAGNOSTIC if it works.
For me too, indomethacin (Indocin) cause some stomach discomfort but a great deal of severe dizziness. I almost fell down an escalator.
In the States another good NSAID is available OTC, generic naproxyn aka Aleve or Naprosyn. I believe it is strictly prescription in the UK though. Give it a try. DON'T ake aspirin unless you take it by the handful and don't bother with acetomenophen…called paracetamol in UK, it's really worthless.
But however you get through it, you will probably want to start allpuurinol afterward if your uric acid is higher than 6.5. The alternative is to wait for another attack and THEN start the allopurinol.
I don't know WHY doctors are so reluctant to start colchicine…yes it causes diarrhea but what a small price to pay for fast relief. I stopped a crippling 9 day attack completely in 22 hours. (Stop at 16 pills or pain relief.)
A good thread.
Let me throw in my $.02 on a couple topics.
The proper response to “my doctor told me that if I only suffered a few attacks per year, then why take a pill everyday” is:
“Why, because gout is a disabling disease that eventually leads to DEATH by kidney destruction.” That response should do the trick. 😀
I have just read a good article by an expert rheumatologist who says that doctors are too focused on 300 mg. allopurinol. We are not automatons who weigh the same, metabolize our foods the same or have the same degree of uric acid buildup…why then would we all need the same dose. The literature says the effective dosage is 300 – 800 mg. of allopurinol to treat hyperuricemia. Why then do doctors consider allopurinol a failure if gout attacks still persist at 300 mg.
On febuxostat: Remember allopurinol was around for decades until some people began to show reaction to it, primarily skin rashes. That's pretty paltry for a FOREVER drug. Few drugs on a forever basis are as benign. I would not be too quick to switch to febuxostat until it had been in common use for at least a decade or I developed a REAL problem with allopurinol (none yet.) Remember too, the glowing performance of F over A was at that magical dose of 300 mg. whereas 2 or 3 different dosages of F were used. Also, it will be, at least in the United Ststes HIDEOUSLY expensive for the first 20 years of its patent life. Doctors of course will prescribe it like CANDY because they would earn points towards their next Mercedes. :D:D
I for one THANK GOD that there is a drug like allopurinol that costs $4 a month and saves me from a life of misery…I wish I had gotten on it 5 years earlier than I did (almost 15 years ago.) I've had no side effects from it.
I got a new GP several years ago and despite my having taken 300 mg. allopurinol for YEARS and getting consisten readings of 5.0- 6.0 mg./dL uric acid he keeps yammering about my going to 200 or 100 mg. allopurinol becasue they are finding “all kinds of problems with long term allopurinol use.”
He bases his recommendation for the lowered allopurinol on the fact that my gout is well controlled. I many have actually said “Well, DUH!” to him after he said this. Against my better judgement, I went to 200 mg. for a month and saw my uric acid go to 6.5 (which his lab CHART says is in the “normal” range….”DUH” again)
THEN I began to get those certain ankle pains in the morning and the tophus on my pinky began to ache when it got cold.
I put myself back on 300 mg./day.
Yes, doctors can be VERY detrimental to gout! What I need my doctor for is to draw my blood, order the tests I want, and write me the Rx that I ask for. Once he realizes this our relationship will be perfect.
(After I trained my OLD doctor to do precisely what I want we were fine…and then the bastard retired!)
Mary,
I'm surprised your doctor has waited so long because a LOT of joint pain can occur in 10 years.
I agree with everything GoutPal has stated but let me add that you must mean 50 mg. x 3 per day, becasue 500 mg colchicine x 3 would probably kill you by day's end.
You can almost certainly discontinue the colchicine after a few months when the allopurinol has done its work and kept your uric acid at suitable levels and any tophi (often hidden) at stable or nmonexistent sizes. If you jump the gun and have an attack then you can always go back on the colchiciner for a while longer.
I was lucky! In spite of a couple visible small tophi, from the very first day of allopurinol (300 mg./day) I didn't have another acute attack dewspite taking NO colchicine. But I would never be without a bottleful in the medicine chest. I'll take 2 or 4 if I suspect any “suspicious” foot pain in the morning.
Over 10 years, my tophi, never big, shrank almost to invisibility…only the teeniest on my right thumb and another teenier one on my right little finger.
Kevin,
I wouldn't risk another colchicine exposure. Allergies only get worse and worse with repeated insults. Once you've reached the hive/swelling stage, you are risking not reaching the hospital the next time. Most immediate threat is throat closure and suffocation.
Are you taking daily allopurinol to control your serum uric acid?
PS…Tylenol is a waste. I think you might get more pain relief with ALEVE <naproxyn> and a narcotic (like codeine?) and if you can;t get a combo pill just het the RX for the narcotic and buy your naproxyn OTC!
Kevin,
It's a SHAME about your developing an allergy to the colchicine. How does it manifest, a rash, hives, or angioedema (swollen lips, eyelids, tongue?) The diarrheah is very normal and I don;t give it a second thought. I LOVE how quickly colchicine acts and would hate more than anything to get allergic to is.
hot foot,
I'd never mix colchicine with any NSAIDS, especilally ibuprofen (Motren) which chews up my stomach real bad all by itself. Not to prescribe but if I were in your boat, Id do another day of colchicine, just colchicine and I'd go to the maximum 16 pills…2 to start and one an hour for the next 15 hours, or even a COUPLE more (I know that 22 didn't kill me 🙂 :). Maybe it's just me, but I find that diarrhea and pain relief go hand in hand (or toe and ass or whatever!) : > ) What I'd also do if the pain stopped is to take perhaps 4 colchicine a day, maybe every 6 hours for several days afterwards to prevent recurrence.
I sympathize with your pain!
I assume you are on daily allopurinol?
Dave,
I strongly recommed colchicine for an acute attack…it works a lot better than NSAIDS from my experience.
I, like you, dealt with my earlier smaller attacks with NSAIDS and the attack seemed to go away soon, I suspect they would have done so with NOTHING.
BUT, then I had the visitation from Hell in the form of screeching pain in my big toe on awakening one day. I had to crawl to the bathroom with my foot elevated behind me…otherwise stay in bed. It lasted for 9 days and nothing helped including ibuprofen and indomethacin (or tears.)
I called and begged my doctor to call in a prescription for colchicine. I took 2 and then one an hour (nobody told me how many was max, so I took 22 pills all totalled. Well, the most vicious diarrhea of my life ensued but with the first dump my foot pain suddenly vanished. Alas the diarrhea continued for a pretty tough 24 hours. Since, I've learned that absolute max iis about 16 pills but probably 8 is enough.
It really is the BEST drug to stop an attack in its tracks.
I presume you are on daily allopurinol. If not, you SHOULD be with perhaps a prophylactic 2 ibuprofen every day for 6 months or more along with the allopurinol until your uric acid goes low and stays there.
Quote:and after a week it certainly seems tohave dissolved the lumps of tophi …whether it can free me of piroxicam long term remains to be seen
Wow, that' quite a testimonial for baking soda, Scotty. Any updates?
Jason,
I'm in the same boat with about 6 weeeks of severe knee pain which keeps me off the elliptical trainer and the stationary bike. But I don;t know if it's gout or not. I've controlled my uric acid to <6.0 for at least 10 years with daily allopurinol and manage the occasional toe twinge with low dose colchicine for the rare attacks.
But I cannot decide whether this knee pain is a gout attack or is it bursitis or tendon inflammation and what part uric acid is playing in it. I don't trust my GP to have the slightest ability to help me and even a rheumy will have to make a guess and I'll STILL walk out with only analgesics. (I tend to be my OWN doctor except when I need a blood draw or a prescription written.)
If you and your doctor agree the first attack was gout, check your blood uric acid levels to amke an educated guess about the knee and whether or not you should be on allopurinol. (They usually want TWO likely attacks in a year before drug therapy.)
Try Aleve (naproxyn) for your knee…it's a good temporary drug.
Carlos,
Are you treating your gout? Have you had a uric acid test lately?
I've had pain in my instep (top,) my ankle, an THE joint (big toe bunion) but never any involvement my Achilles tendon. But it didn't matter much because all three had me using a crutch for the affected foot.
Hot Foot,
No, I don't take colchine for EVERY twinge because I know well the likelihood of the joint pains of aging especially with daily workouts at the gym (when I'm being GOOD.)
But if I feel that CERTAIN twinge in my right toe in the morning on awakening I take two colchicine. If I still feel it an hour later I take two more. Usually the first two stop it, ALWAYS the second two…I'm glad for that becasue by pill 6 I get a diahrrhea like Niagara.
Probaly some of the other aches and pains are uric acid related but I don't use colchicine for them becasue they aren't disabling and Aleve works for well.
Steve,
For most of us, the “cure” is a life on daily allopurinol. Has your doctor put you on it yet…blissfully, it is among the cheapest drugs.
Have you taken or are you currently taking any blood pressure medications, specifially anything containing a diuretic (like thiazide or Lasix?)
That doesn't surprise me in the least. Uric acid as an end product of purine and nucleic acid degradation is a defect in man's metabolism. Although gout is the most overwhelmingly OBVIOUS manifestation of the defect, it would be unreasonable to assume it is the ONLY one.
There is good science implicating hyperuricemia in heart disease, primarily in men.
I have seen some good theory relating it to back pain as well. In fact one man made a distinguished career out of curing “bad backs” with colchicine injections.
I SUSPECT that UA is involved in many many arthritic diseases, not just the ones where joints are filled with crystals. After all, even in gout, the pain presents LONG before lasting crystallization becomes evident.
Thus I have no doubt that one's eczema reacting favorably to allopurinol is more than coincidence.
Women menstruate up to a certain age and lose copious amounts of blood containing the iron rich molecule hemoglobin. As a result we are bombarded by a need for iron supplementation. Alas, men have no such automatic bleeding cycle and have no means of disposing of excess iron, which I agree can be extrememly detrimental…although I hadn't heard of the gout connection but don't doubt it. (Some European research has connected free ferritin with a large increase in heart disease risk as well.)
What REALLY infuriates me is when all choice is removed and the government mandates the addition of extra iron to ALL grains and that means every grain of rice and every noodle sold in the United States. Thus I, as a retired man treating gout for 20 years MUST subject my body to assaults of iron supplementation with every plate of pasta and every slicee of bread whether I want to or not to make up for my regular loss of blood.
Well, if I ever start menstruating or take up prizefighting, I guess it will be all for the best.
Comparable nonsense would be requiring all people regardless of sex to have annual prostate exams.
I doubt that colchicine would interfere with your body's ability to fight infections. Basically the way I understand it is that colchicines roll is to alkalinize the area of gout inflammation that is being made acid by the inflammation. This acidity can precipitate more and more uric acid but it's a localized thing.
In general, most people can safely stop the colchicine after a time with colchicine-allopurinol. It is pretty much useful only until the allopurinol has gotten to steady state lowered levels of serum uric acid. I would think the colchicine might only be needed for a couple months or so.
But keep it at the ready in case of a gouty flare up…no drug is better than colchicine for the quick relief of the pain. I would NEVER be without my bottle of colchicine even if I have only used about 10 pills in the last year.
I'm with GoutPal right down the line here. Nothing is so infuriating than to have a dimwitted doctor say “Your uric acid is fine” when he's looking at a lab printout that shows a range extending to 9.0 mg/dL as NORMAL when in fact, for someone with gout anything over 6 is DISASTROUS.
I'm old school on this VERY old disease and instead of this “aspiration” crap for a diagnosis to use colchicine. If colchicine stops a sore joint in its tracks quickly, it;s GOUT.
After all, when Thom,as Jefferson and Benjamin Franklin had flare ups of their gout, I doubt any doctor was required to aspirate their joints and send the goo off to QUEST DIAGNOSTICS.
