[Keith Taylor]

By the way, @dandz I forgot to mention my Alkalizing Gout Diet Menu pages that start at http://www.goutpal.com/gout-diet/gout-diet-menu/

I’m constantly trying to improve these, so if you have any suggestions for better information, I look forward to reading your ideas. Of course, that invitation extends to anyone else who is interested in alkaline diets for gout. The invitation even includes ‘Benny’ but only if you can refrain from personal jibes.

Of course, dandz’s question still remains: how can gout continue if we have succeeded in alkalizing the kidney load? The answer is simple from a general gout management perspective, but difficult from a personal gout control perspective.

Simply put, there are many other factors that influence uric acid levels in the blood, besides urine pH. Even if those factors do not apply, it takes many months for old uric acid crystals to dissolve. I usually refer to this as the debulking phase of gout treatment.

So, your personal questions start with your current uric acid level. Is it low enough, or do you need more interventions to make uric acid safe? If it is low enough, how will you deal with the risk of inflammation from the gout monster in the debulking phase? With personal gout facts and a logical approach, dealing with the gout monster is just a matter of time.

[Keith Taylor]

Hey, @dandz I’m hoping you are still around from 5 years ago, as I need to correct my answer. At the time, I thought that alkalizing diets were only relevant to reducing the risk of kidney stones. If you have been following my progress over the last few years, you will know that I now advocate an alkalizing diet as a positive measure for long term reduction of uric acid.

My original answer:

I will be back to answer your question more fully soon, but the short answer is: body pH, measured either by urine or saliva, has almost nothing to do with uric acid. Alkalizing the urine will make uric acid more soluble and help avoid kidney stones but it will do little else for gout management.

You must, absolutely must, and at the risk of repetition, definitely must, measure your uric acid number. Depending on that value, and your gout history, you might be able to control your uric acid through diet and lifestyle.

Report back with your uric acid number, and we can help you better.

I’d like to revise that answer.

First of all, congratulations on achieving a urine pH of 7.5. This is the only measure that counts, as it relates directly to the acid load on your kidneys. Purists might argue that other medical factors are relevant, but these relate to chronic conditions that are beyond the scope of normal gout control in otherwise healthy individuals. My only concern is that some of this is achieved with baking soda. I’m aware that baking soda is associated with increased blood pressure. I’m not aware of associated long term health risks of chemically altering pH levels. However, personally, I prefer to improve pH with natural foods rather than chemical supplements.

Alkalizing the urine will make uric acid more soluble and help avoid kidney stones. It will also encourage reduction in uric acid levels. However, as with all interventions that lower uric acid, it is important to measure the response, so you must monitor uric acid levels.

This is best done by arranging blood tests at your doctor, when you can also check iron levels which have an influence on gout. For some people, a uric acid test kit helps, but you need to be able to adopt a meticulous approach to testing.

@dandz if you have recent uric acid test results, please share them. If not, please let me know if you prefer to get uric acid tests with your doctor or at home. It would be best to record your results and preferences in your profile ( https://gout-pal.com/users/dandz/profile/ ), then simply post here that you have updated your profile. When I have that information, I hope I can offer more personal help.

[Keith Taylor]

Hi @23september welcome to the gout forum. I’m guessing you are in the UK, so I will try to phrase my recommendations accordingly.

A clear diagnosis is fundamental to correct management of gout. We don’t have that diagnosis, so that makes life difficult.

Whenever gout diagnosis is in doubt, I recommend immediate consultation with a rheumatologist. Providing they have the right microscopy equipment on-site, you can get a clear diagnosis within minutes in almost all cases. If they don’t have a polarizing microscope, use a different rheumatologist.

Without that diagnosis, we are in guessing-game territory, but a logical approach might help.

Even if it is not gout, it clearly falls into severe pain category. By the time you read this, it is going to be another Sunday, so medical assistance is limited. I am concerned that your husband’s pain relief is not sufficient for the severity of pain he is suffering. Unfortunately, I’m not qualified to advise you about the maximum dose of your husbands meds. Does your doctor have an out-of-hours number? A local Sunday pharmacy might help, but you’d probably have more luck with the local hospital.

I have to repeat that this forum is not the place for personal medical advice. As a gout sufferer, I am advising you that standard doses of most over-the-counter pain relief is not sufficient. Female gout sufferers have told me that the pain of gout is worse than childbirth. How long would a midwife survive giving a couple of Voltaren for labour pains?

Information on GoutPal is provided by a gout patient to help you understand gout and related issues. Gout information is provided by a layman, with no medical training or qualifications. It should not be used for diagnosing or treating any health problem or disease. The information is given to help you understand your doctor’s advice and know what questions to ask. It is not a substitute for professional care. If you have an actual or suspected health problem, you should consult your doctor.

I think we have to manage the pain first, then manage the gout, once we confirm it is gout.

“The doctor has taken a blood test but says gout hasnot shown up?.I don?t see what else it can be?”
It could be pseudogout or septic arthritis, or a doctor who doesn’t understand uric acid test results.

A rheumatologist can distinguish between gout and other diseases that display similar symptoms. For more insight into your test results, I need to know the exact uric acid number. Many doctors get confused because they have a compulsion to look at reference ranges, which are meaningless for diagnosis. When that is combined with the fact that blood uric acid is often lower during an attack, you can see why gout diagnosis is frequently missed.

Because this is a gout forum, I’m heavily swayed towards the belief that this is gout, though please heed my advice about other possibilities.

If it is gout, the other things your husband should do now is to keep hydrated, keep the ankle above heart level as much as possible, and keep it warm.

Keep warm
Bed socks and microwave heat bags are good. Maybe it’s time for untreated gout sufferers to bring back the Great British Hot Water Bottle!
Keep hydrated
Around 3 litres fluid daily, but the real test is not the intake, but the fact that urine should be a pale straw colour. All fluids count.
Rest and mobility
Whenever the pain relief allows, keep the joint moving with gentle walking. Your husband might need a leap of faith here. I want him to wait 20 mins after taking pain relief, then push himself to walk at least half a mile. In my experience, the limping is almost gone after about 300 yards.

Gout attacks do tend to subside quickly, but every attack is different. We all hope it will end soon, but the most important thing is to learn the best pain control strategy that works for your husband.

For diet, please ignore everything about purines for now. They are not linked to gout attacks except as a long term measure for partial uric acid control. They might be important later, but for now, any diet changes need to focus on inflammation control. This means limiting saturated fatty acids, increasing polyunsaturated fats, and increasing vegetables and fruit, especially dark colourful veg. I’m working on better dietary advice for inflammation control, so if anyone can chip in with better advice here, your contributions are most welcome. If your husband is hoping for a big Sunday dinner for comfort eating, maybe today would be a good day to miss anything with animal fats (meat, gravy, cheese, pastry etc). You’re welcome to join me for veg curry.

[Keith Taylor]

I’ll cover your last paragraph first.

You are right about conflicting information. I always intended GoutPal to be the most reliable source for gout facts. I must be vigilant as information can go out of date, when new treatments and new recommendations are developed.

I urge all visitors to report conflicts, but please supply the details. Post the exact details of the conflict, and we can investigate. I can make corrections to GoutPal if it is wrong. General improvements are harder. I used to think I could provide set guidelines for all gouty circumstances. I now realize that is impossible, as gout must be managed on a case-by-case basis.

That means taking general guidelines, and applying them to your unique situation. It’s best to start by updating your personal gout profile as often as you can. That means adding new facts as you get test results, or as you learn new science that is relevant to you. It also helps to make a note of important questions. In that way, when you login and ask a question, people who want to help can make their responses relevant to you.

Without your personal gout facts, we are left with general responses. Such responses can be true, but they might not be relevant to you.

My general responses to your other paragraphs are:
1) Very few people are prepared for gout. You can ease the confusion about food and nutrition by realizing that gout diet is a part of gout treatment. That means deciding between short-term pain control, long-term uric acid control, or both. I urge you to login, and edit your profile to state which options are important to you now. You can change your profile whenever your priorities change.

2)It’s good to delay medication until you are more certain what is right. I think it is wrong to wait until you become more afflicted by gout, as this just makes it harder to control.
Beer and wine affect gout sufferers differently. You need to measure the affects on you, rather than make random changes.
Vegetable purines do not readily convert to uric acid, and animal purines are not relevant to you. Except that purines from your own flesh can form uric acid, so weight control *might* be an issue. You need to review the 5 foods that are bad for gout in relation to your own current eating habits: http://www.goutpal.com/gout-diet/what-foods-cause-gout/

3)Cherry juice and weight loss help many gout sufferers, but will they help you? How are you tracking if these changes are helping? What regime do you have for recording gout attacks and uric acid levels?

You can choose now whether to take control, or let your gout get worse.

If you want to take control, you need to decide your personal mix of meds v lifestyle changes. You also need to decide the relative importance of pain control vs uric acid control. These are the key choices that all gout sufferers must make. Record your choices in your profile, then we can focus on specific changes that will improve your quality of life.

[Keith Taylor]

I’m not sure your doc is a complete idiot, but I haven’t met him, so I’ll reserve judgment. He’s not wrong to think that allopurinol can shrink tophi, but every case is different.

From your information so far, I think you have had around 20 years of gout (?). I wonder, how many years of visible tophi?

This can be a major factor, as the longer tophi exist, the more they get “locked in.” By that, I mean that fatty deposits and other crystals and dead cells can build up around tophi, so the mass becomes isolated from the blood stream. In such cases, simply lowering uric acid might not be enough. Unfortunately, you haven’t told me your uric acid level, or even your allopurinol dose, so I’m not certain that surgery is your only option.

You need to be aware of the risks of surgery. Like all cases of gout, treatment has to balance all your circumstances. Surgery might be the answer, but it is extreme, and it does carry risks. You really must consult a rheumatologist.

Please don’t be tempted by a podiatrist unless you have exceptional reasons to trust them. I have seen many podiatrists who have conducted unnecessary surgery after years of mistreating gout patients. Do they do this through ignorance, or for the surgery fees? I don’t know, but I wouldn’t put my life in the hands of someone who deliberately accepts unsafe uric acid levels for many years, then decides that surgery is the only option.

Sorry this has taken so long to respond to. I only get notified when people login and post. If you post without logging in first, you have to wait for me to remember to check. I try to check regularly, but unfortunately, I’ve missed it this time.

Please let me know your current allopurinol dose, your last few uric acid test results and and the length of time you have had visible tophi. I might be able to suggest other treatments with more facts. However, the golden rule is: if gout is not straightforward, see a rheumatologist. That’s your best option to get rid of gout pain permanently.

[Keith Taylor]

The name of the report, that I forgot to include above, is: Body mass index and the risk of gout: a systematic review and dose?response meta-analysis of prospective studies. You can read the abstract at http://link.springer.com/article/10.1007/s00394-014-0766-0

[Keith Taylor]

Terry, probenecid and allopurinol are separate drugs, both used for lowering uric acid.

Probenecid encourages excretion of uric acid through the kidneys. It is only useful when the kidneys are not clearing uric acid fast enough (under-excretion). Allopurinol and Uloric both work by inhibiting production of uric acid. They are useful for over-producers and under-excreters.

For completeness, colchicine is an inflammation blocker. It should only be used until uric acid lowering treatment has removed the cause of inflammation, not as an alternative to uric acid lowering.

[Keith Taylor]

Thank you for the extra info @greg78. Just a minor point, but if you login before you post, your topics and replies get linked to your profile. This can be useful if you want to easily refer back to what you have written earlier. I guess it doesn’t really matter when you are adding replies to your own topic. I just thought I’d mention it in case you are having any problems logging in.

As for your uric acid level, 258?mol/L is a good result. Long term target should be no higher than 300. I got mine down to just over 200, and had no sign of gout after about 4 months. I had a doctor who was very responsive to increasing my dose, and I was on allopurinol. You might find a reluctance to go above 80mg Uloric, though in pre-launch trials it has proved safe at higher doses.

Doctors sometimes add probenecid to try to get old uric acid deposits out as soon as possible. Adequate fluid intake is important to allow uric acid to pass from the kidneys. Taking some of that fluid as skim milk might help, though this does vary from patient to patient, and I don’t think it’s been tested alongside uric acid lowering drugs.

I would talk about this with your doctor. If a rheumatologist can do more for you, that’s a good idea, However, as you have no complications, I’m not sure you will get much benefit.

As far as gout pain is concerned, some flares are to be expected. You are right that you might be looking at another 3 months, and you can only shorten that time by getting uric acid lower. On the other hand. the flares might stop next week. We don’t currently have easy access to the technology that can measure uric acid deposits in the body (DECT).

I know it seems hard to be still in pain when you are doing everything right. I found that the flares got less painful, and I could cope with ibuprofen after 2 or 3 weeks on colchicine. I did take colchicine later “as required” if I felt a twinge coming on, but gradually came to rely on occasional ibuprofen only. I was expecting to get pains where I’d not experienced them before, but also mainly in previously affected joints. This happens because uric acid crystals grow very slowly, and we often don’t notice. When they start to dissolve, they usually go quickly, and create flares as they are dissolving. I’m explaining this because I found it comforting. I knew that my uric acid level was safe, as yours is. Any pain therefore is part of the healing process. I know it’s not pleasant, but those thoughts helped me tolerate it more easily.

Greg, I think you are well on the way to recovery, but only you know how well you are coping with this. If you’d like to try and get uric acid lower, I’d see if your doctor can help, but if not, try for a rheumatologist. I had to discard 3 doctors in my group practice before I found one who agreed that 200 was a good target. The others thought 400 was good enough!

You could ask about colchicine. It’s only any use taken at the first twinge, before inflammation sets in, or daily as a preventative. It is associated with stomach problems, but some of that is because it used to be overprescribed. 1, or a maximum of 2 per day should be OK.

I hope that helps, and if you need any clarification, please ask.

[Keith Taylor]

Hi @greg78

My doc gave me a colchicine (Colcrys) prescription for a few months when I started uric acid lowering treatment. Has your doctor said anything about this? Or has he said anything about pain relief until the Uloric takes effect?

There are two major factors that determine how long you are at risk of gout attacks when you start Uloric or allopurinol. One is the length of time you’ve had gout. The other is your uric acid level now. I know the first answer is 20 years, but what about your uric acid level now?

Has your doctor suggested a target uric acid level?

There’s a few things you can do to reduce the pain, and to reduce the length of time you are at risk of gout flares. Can you let me know your uric acid level so I can suggest the best things for you to do next.

[Keith Taylor]

Thanks, joseph, and welcome to GoutPal Interactive.

There is more than one connection, and I need a few more facts about your gout before I can answer them. It’s best to login and keep your personal gout facts in your profile. That way, everyone can see important information that can help them keep responses relevant.

If you don’t want to give personal information, I can still help. Search for [I]gout and exercise[/I] using the search box near the top of each page. You can then ask for clarification, if you need it, after your read the search results. Please be careful to refer to specific pages when you ask your questions.

If you want a more personal response, I need more information from you.

How long since your first flare?
Is your second flare still giving you pain?
Can you give more details about what you mean by “small Works?”
What are your recent uric acid blood test results, if any.

Mobility and gout can be difficult to explain. Everybody is affected by gout differently, and everybody has different ideas about normal mobility, gentle exercise, and strenuous exercise. It’s easy to find the scientific connections between exercise and gout. It’s harder to put these into a personal context, but I can help you do that if you tell me more about [B]Your[/B] gout.

[Keith Taylor]

Hey winelover, thanks for posting at GoutPal Interactive.

Have you seen https://gout-pal.com/gout-help/how-to-treat-gout/ ? It tells you about keeping your personal gout profile. You can do that here by logging in and completing your profile, or do it using whatever note taking method you prefer. Whichever way you choose, I need some more facts:

Did you get gout pain from wine before you started allopurinol?
How long have you had gout?
How long have you been on allopurinol?
What are your uric acid test results? Your latest result is good, but a history is better. I can help you more if you login and add your uric acid blood test results to your profile.

As you love wine, I’d love to help you drink it without getting pain. I can offer some general advice without your personal gout facts. But that would only tell you what you can easily find by searching for [I]wine and allopurinol[/I].

If you don’t want to share personal information, I quite understand. Please just do the search I suggest, using the search box near the top of every page. You will find pages that give you some information. If it doesn’t give you all the information, just paste the link of that page into your comment, and tell me what extra information you need about gout pain, allopurinol, and wine.

• This reply was modified 7 years, 2 months ago by Keith Taylor.

[Keith Taylor]

Hey, gout runner, you haven’t given us much info to go on. You’ll get a faster response if you log in, and put some facts about your gout in your profile.

The media, and some of the medical profession would have you think there is a typical person that gets gout. OK, if you eat and drink too much, you have a higher chance of getting gout. But what if your gout is genetic, or what if it’s driven by other illnesses, other meds, or environmental toxins? In those cases, what you eat becomes less significant.

Your BMI, http://www.goutpal.com/2269/losing-weight-with-gout-foods-to-avoid/ , says you’re overweight, which means you are twice as likely to get gout as someone with normal weight. These are only guidelines, and every person needs to be viewed as an individual. To get a better idea, I’d need to know more about your typical daily diet. Just avoiding rich meats isn’t enough. There are 5 bad food groups, so may be lots of other reasons you are getting gout. Have you read my latest blog article about the 5 bad foods for gout?

[Keith Taylor]

Wow, that Rheumatology 2.0 magazine updates quickly. My link does not appear in the latest version. If you want to check out the science, please go to http://www.jrheum.org/content/supplements/92/33.abstract Urate-Lowering Therapy for the Management of Gout: A Summary of 2 Cochrane Reviews.

[Keith Taylor]

If you follow the Rheumatology 2.0 link, my article is in the “HEALTH” section on the left. It’s a review of gout treatments.

There is currently moderate quality data supporting the efficacy and safety of allopurinol, febuxostat, benzbromarone, and probenecid in gout. Pegloticase, while efficacious, is associated with more withdrawals due to adverse events and infusion reactions. There is insufficient evidence currently with respect to the cost-effectiveness or the most optimal sequencing of urate-lowering therapy.

Interesting that benzbromarone was more effective than probenecid at lowering uric acid levels, yet it is unavailable in America.

[Keith Taylor]

Hi @bhen
Great news that Purixa is helping you. Are you monitoring uric acid levels, or keeping a gout pain record, or just relying on how you feel?

That’s the first time I’ve thought about a gout pain record for a long time. Basically, you make a record each day on the scale of the pain that you feel. Then you can compare your average before treatment with your average after.

I once thought about providing a form you could use to keep pain score records. Is anyone interested in that?

[Keith Taylor]

Thanks @thefridge for the update. I’m still unsure where the allopurinol comes in with respect to blood test results.

However, if you are down at 4.1mg/dL without any allopurinol (it takes up to 2 weeks to stop affecting blood tests), then gout is highly unlikely unless you are exposed to prolonged low temperatures.

I hope you can find the cause of your pain and find a way to treat it.

Good Luck
Keith

[Keith Taylor]

Hi kiteman,

I’m really not sure what you are asking, but here are my thoughts.

Gout is a progressive disease. That means, if you do not treat it, it will get worse. You are right to fear long term damage. When uric acid crystals form in and around the joints, they cause painful swelling as your immune system sees them as invaders. Unlike viruses and bacteria, uric acid crystals cannot be killed, but your white blood cells will surround them and try to make them harmless. But they are not harmless.

Part of this process is these deposits eat into tendons, cartilage, and bone. They cause permanent damage. This will get worse every day. It is a slow process, but you can be quite certain that if you do nothing now, then in a few years you will start to lose mobility. Instead of looking forward to retirement on the golf course, you will spend your senior years in constant pain.

Is that what you really want?

You can go that way, or you can learn to know your uric acid level, keep it no higher than 5mg/dL (0.30 mmol/L), and stay pain-free. There is a simple way out at http://www.goutpal.com/3425/simple-gout-treatment/

Meds may not be necessary, depending on your uric acid level. You can get help here (but better to use the new forum at the links above). It is usually easy to control gout, but it needs a little effort, otherwise gout will control you.

[Keith Taylor]

The purpose of allopurinol is to lower uric acid to a safe level. Without knowledge of your uric acid number now, and during your gout history, it is impossible to suggest reasons.

Allopurinol Medication: Why It Hurts To Get Rid Of Gout

Allopurinol Medication: Why It Hurts To Get Rid Of Gout

[Keith Taylor]

Welcome back rockymountainhigh.

I’m pleased you have not had a gout flare, but I hope you are keeping up with uric acid tests every three months or so. I guess you could relax this to once or twice a year, as you are not getting attacks. As Ravenwood pointed out, the test has most value when you have not had a recent flare. Knowing the number gives you a chance of assessing if you are managing gout, or just getting lucky. Uric acid crystals can grow slowly, especially in the 6.5 to 7 range. This means you can be suffering damage without realizing – until the pain hits.

Also welcome to the PTSD club. I am not convinced that there are any specific gout-anxiety links. Generally, I can see that the trauma of gout pain, and worries about medications are almost certain to cause stress, but individuals will deal with this differently, as they will with all anxiety and trauma. I have a half-baked theory that many reported side-effects are caused by anxiety.

The most important consideration for me, is dealing with PTSD, which I know is not medically linked to gout, though there must be personal connections, just as there are personal connections between all aspects of our lives. In my understanding, my problems are relatively minor, though I think there is no real scale for “cannot cope” – it’s on or off.

How do you feel about joining me on a new project to investigate the best layman’s approach to PTSD? I beat gout by creating a website to encourage myself to learn about it. I’m sure we can help ourselves and others by doing a similar thing with specific PTSD or more general stress. Any thoughts?

Coincidentally, today is the anniversary of the source of my PTSD. Time to thank my loyal gouty friends for the support and encouragement I have received. I almost feel I should be celebrating my first birthday today, though I didn’t revive until the 11th, so maybe it should be tomorrow. For newcomers confused by this, see https://gout-pal.com/goutpal-on-the-mend/2011/04/

[Keith Taylor]

Amazing link. It is written in a very similar style to mine, yet has serious errors. I think I’ll rewrite it properly.

Never confuse targets (purpose/rewards/objectives in my vocabulary) with strategies. You are certain to lose your way.

[Keith Taylor]

kryptonium said

…
What I meant was we target 200 mg and then assess with blood tests. I just read the national guidelines here and that also seems to be what they suggest. …

Where in the national guidelines does it suggest that? It is seriously wrong, and if that is what they are saying, I must write and correct them. The target is the uric acid level. The dose is a transient stage during titration to reach that target.

Sorry to bang on about this, but it is the most serious aspect of uric acid lowering treatment, and the most significant point of failure.

[Keith Taylor]

@BelieveInScience Thank you for the clarification. Misunderstanding was caused by my typo – I originally typed allopurinol where I should have typed uric acid.

You have described the situation exactly as I see it. All uric acid lowering treatment will cause this, though it may not result in a gout flare for everyone. What seems to prolong the pain most is where uric acid is lowered to just below crystallization point. Then, dissolving crystals add back enough dissolved uric acid to raise the level over the crystallization point. This leads to a constant melting and reforming of crystals – and therefore a constant series of signals to the immune system, resulting in a constant series of inflammatory responses.

[Keith Taylor]

“not going away anytime soon”
Why not?

Please do not tell me you are waiting for a case study facility to fix your gout!

The process is simple enough – which is why there is no urgency for the new features I mentioned.

1. Confirm your gout diagnosis
2. Agree a gout treatment plan with your doctor
3 Assess your diet to see if any aspects conflict with your treatment plan
4 Fix your gout, and get uric acid tests at least once a year for life to ensure gout stays away.

Most of those four steps are simple, but if anything is not, that is what the forums are for.

[Keith Taylor]

We need an example to understand what you mean, so please let’s start with your personal case study, Binh

Later this week, I will be opening up new ways to contribute, which will suit longer posts, and beyond that I will be introducing tracking facilities that let gout sufferers build their own case study as it happens. If you cannot wait for that, please send me a message on the contact form (https://gout-pal.com/about/contact/), and I will give you access to the long message features.

[Keith Taylor]

Wisescarab said

Donating blood helps? I suppose it clears out Ulric crystals or otherwise?

It removes dissolved uric acid in your blood, then when you drink fluids to replace the donated blood, you are lowering the concentration. For more information see http://www.goutpal.com/2525/alternative-treatment-for-gout-blood-letting/

That experiment is fairly extreme, but even normal blood donation will have some effect – whether it is sufficient, depends on your numbers.

[Keith Taylor]

Do not target 200mg allopurinol. Target a good uric acid level, and accept whatever dose that needs. Some will say 6mg/dL is a good target – it is certainly your maximum. I prefer 5mg/dL, and this is becoming the new standard.

Those targets are good when you have got rid of all old uric acid deposits. They will dissolve quicker if you get levels lower, which is why I am targeting 2 to 3 for a year – I want the tophaceous lump on my arm gone. My point is, at the risk of repeating, set the target, and that will define the dose.

Doctors frequently advise not starting allopurinol during a gout attack, but the evidence to support this is weak. If you are taking colchicine, which I recommend when you start allopurinol or febuxostat, it will be OK – especially with only 50mg allopurinol, which is almost certain to start some scathing comments from other contributors, because it is too low to have much effect. It will, however prove that you can safely tolerate allopurinol, which is good.

There are two forms of gout googling. One is the standard use of google, where you type gout terms into the search engine at google.com. The better one is where you type gout terms into the search box at the top of this page, and all GoutPal pages. The first choice is polluted by self-serving misinformation promoters. The second choice is pure gouty goodness that will lead you to many an interesting page on tendinitis, bursitis, and other conditions that are related to gout. It is complicated, but needs individual case-by-case study. Uric acid deposits from gout can cause destruction of cartilage, tendon and bone. Tophi can block bursa. They can all co-exist from different causes. Best to get the uric deposits cleared ASAP, then if sore joints continue, the medics can look for co-existing conditions and treat them.

This is similar to my view on allopurinol. I have a knee injury, but I also have gout. I am maxing the allopurinol in a desperate attempt to dissolve all the old deposits as quick as I can. That takes gout out of the equation, so if I still have a knee problem, I know it is damage that may need surgery to fix.

[Keith Taylor]

pen said

So it’s not the food I eat, it my body producing it now. I’m on a different level for gout treatments then since I don’t fit the typical treatment. I have to search for “Ways to lower uric acid produced by body.” I guess I’ll have to test and see. Thanks for the info and I’ll continue to seach the forum and from my experiences.

Uric acid always has two natural sources. One from food, which in theory you can stop by cutting out all animal purines. The other is from your own meat – your cells produce purines as they die. Most of this gets re-used in building new cells, but some will raise your uric acid. You cannot stop this completely, except by dying, but if you lose weight, especially muscle mass, that will lower uric acid, but you must do it slowly to avoid the uric acid increase from starvation.

There is also an unnatural source of uric acid for gout sufferers on uric acid lowering treatment – old crystals that dissolve. I’m sorry if my typo caused confusion in my earlier reply (Thank you Hans for pointing that out – I’m encouraged to know you actually read my ramblings). Once these are gone, they are gone, and will not return as long as you keep uric acid at a safe level. Safe is 5 or 6 depending on who you listen to – I prefer 5 for maximum safety because it gets cold in winter here.

You could lose some of the free uric acid by donating blood.

@DL35 – great words, and I am very pleased that your treatment is progressing so well.

[Keith Taylor]

hansinnm said
Keith, is your body or your mind or both on vacation???

Since when does natural cell turnover produce ALLOPURINOL???

If Allopurinol has no effect on dissolving old crystals, why do we take it then??? If it weren’t for the EFFECT of Allopurinol to reduce the formation of uric acid and lowering the amount of uric acid in our bodies no crystals would dissolve.

OK you got me Hans. Typo now corrected.
You just don’t understand the pressures of typing whilst a beautiful lady hovers, waiting to take you to the pub.

[Keith Taylor]

pen said

How long does it take to lower my uric acid level if I keep up the good work? I made a date with my doctor to get another blood test in 3 months. If it gets lower than 4 and I’m still getting the attacks I’m going to be very dissapointed.

Well Keith I wouldn’t know where you would file this as you mentioned “under bad allopurinol dose or avoiding pain during first few weeks of uric acid lowering treatment?”

This, pen, is the crux of the matter. A bad allopurinol dose is a dose that is too low to get you to your target uric acid level.

A significant benefit of allopurinol is that it is almost always 100% effective against uric acid from food/drink. Therefore, restricting diet when on allopurinol will have almost no effect – unless you are on the worst diet in the world, which probably means you will die of heart attack or stroke anyway.

Next we have uric acid from your natural cell turnover. Allopurinol seems to be about 50% effective against this. Long-term, losing weight and getting more active will help reduce uric acid, but this needs to be done slowly, so it will take several months. During that time, additional temporary allopurinol should help.

Finally, we have old crystals dissolving. Allopurinol has no effect on this. This is the reason why I say aim below 5mg/dL rather than the old standard of 6 – it gives you some safety margin if your level jumps due to a large number of uric acid crystals dissolving all together.

Now, until all the old crystals have dissolved, you are at risk of a gout flare. It does not really matter how low you get your uric acid. If a large number of crystals start to dissolve all at once, you have the chance of a gout flare. Nobody can say for sure how long this will take, but the lower you get the level, the quicker the old crystals dissolve, and the sooner you can stop experiencing gout flares. In my experience, the flares get less intense, disappear quicker, and are less frequent each time. Still one or two per month after about six months. They do not bother me much, and usually go without any treatment. I took 2 ibuprofen Monday, expecting a couple of days limping, but everything was OK in a couple of hours.

As for where to file this, it is borderline. It certainly has to go under “pain during uric acid lowering treatment” But, as we have both seen, that is soon fixed with an anti-inflammatory. “Bad allopurinol dose” is less certain – if you are happy at 5.9, then I would say the dose is OK. Personally, I prefer lower for the reasons stated, but many people do fix their gout with the level at 6 or less. I am impatient, and I want the lowest target possible until the lump on my arm shrinks to invisible. The standard is 5mg/dL (0.30 mmol/L), but everyone has the right to determine their own target, as long as they understand why they are doing it.

[Keith Taylor]

Wisescarab said

Perhaps it would be prudent to maintain a strict diet

OK, percentage-wise, that should get you to the theoretically safe level around 6.5 – I say theoretically safe because 5 is the safest level giving a good safety margin. 6.5 should be safe if you keep reasonably warm, so pack those extra socks.

In your situation, I would focus on keeping calories down, and reducing meat in favor of dairy proteins. Green tea, coffee, 500mg vitamin C, and onions are associated with lower uric acid. That does not mean you should stick to these alone! Just sensible eating avoiding excesses of calories, iron, and animal purines There are few foods to avoid completely, but daily gout diets that lead to excess calories, excess iron, or excess animal purines are definitely foods to avoid with gout. Donate blood as frequently as possible within health medical guidance, and you should be able to stay safe.

[Author]

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