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Cathie said:
I have no idea what is going on with my testing. I have normal readings for uric acid in my serum, but it has been sooo high in my 24 hour urine. I think the last test result was something like 1100. I have not been diagnosed with gout as a result. I see an Internist and a Rheumatologist and still do not know what is wrong with me.
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You are not alone in being confused about your testing. In? my experience, most doctors do not understand it either.
There is a well known mathematical model called a 'normal distribution.' I'm not up to giving good explanations of this, but the point is that it just describes how averages usually work, and has got absolutely nothing to do with the state of your health. I'm completely mystified why doctors persist with this nonsense, and I have started a campaign to try to improve uric acid testing, though lack of interest has caused me to lower the priority. Due to the sampling process, it is almost inevitable that the average (i.e. normal) will include people with gout. In any event, every lab has a different normal range because they base the numbers on a different sample – which proves just how ridiculously pointless these ranges are.
The only thing that matters with a uric acid test is the actual number. That is not the full story, as the number will usually fall during a gout attack, but at least it gives you a firm basis to work from. Without that number, everything else is speculation.
Everything you have said makes me believe you have serious gout, but without that number, I cannot advise you what to do next, or how you should approach your doctors. It is very unfortunate, but something that many of us have learned here is that, when it comes to gout, we often have to train the medics before we can get proper treatment.
Ah Shreela, thank you so much for persevering, and sticking with this forum. Your story is very moving.
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On menopause, it has long been thought that female hormones reduce the risk of gout, and there is some evidence that hormone replacement therapy (HRT) helps. I'm certainly no expert in this matter, but I do recall reading something about other health risks associated with HRT, so that is definitely something to discuss with your doctor. My feeling is that it is equally likely to be associated with iron. I've enough on at the moment fighting for better uric acid testing, but when that battle is won, the next one may well be to get better investigation of the links between excess iron and gout. The evidence that I have seen points to a strong link, yet there seems to be no official recognition of this in any country.
On uric acid testing, I have long thought that tests should be given as a matter of course to all siblings and children/grand children of gout patients. It is nice to meet someone who agrees with that.
On diet, whilst bad diet can make gout worse, it is most often caused by genetics. As I'm very fond of saying – no amount of dieting will change your parents. Even vegetarians get gout. Why? Because humans create their own meat. Our bodies are the biggest source of uric acid. Giving up meat might reduce the uric acid level slightly, but if genetics puts the number above 8, cutting out meat will not bring it back below 6.
Like you “I'm also interested to see if eating anthocyanin-rich foods might help lower uric acid blood levels,” so I look forward to reading about your results, in due course.
Water intake includes all fluid intake.
Overhydration is rare, but occurs when the intake is higher than the excretion rate (excretion includes sweating, urine, moisture in expelled breath etc). Normally the body compensates, but if there is a health issue with heart kidneys or pituitary gland, then over-hydration might occur.
Anxiety can often be a problem when you are very concened with a health issue. A little quick research shows that, though vertigo can cause anxiety, there is only anecdotal evidence that anxiety causes vertigo. More research needed there, and the best place to start is a visit to the doctor. Side-effects are not to be taken lightly, and your doctor is the only one who can help you determine the true cause of your vertigo.
My take on drowsiness is that it is more a reaction to uric acid lowering than to allopurinol itself. Normal gout attacks are often accompanied by feverishness and drowsiness, but who feels drowsy with a knife stuck in their foot?
Lowering uric acid exposes dissolving crystals to the immune system, and battle commences. This may not be on a tightly concentrated scale as in a normal gout attack. More often, it is widespread, but much less intense, as uric acid crystals dissolve throughout our bodies – often from places where the slow buildup has previously gone un-noticed.
For myself, I celebrate this. Fight the drowsiness with a victory dance round the floor. Or just a refreshing snooze
Please continue discussing uric acid testing in Uric Acid Blood Test Debate
Testing inevitably leads to treatment, but please discuss that in Gout Cures.
The survey, along with one for home test users is now at Uric Acid Blood Test Debate
drknow said:
?I am very curious to know my SUA once and for all.? I really wanted to do this naturally but can't take the pain and the not knowing.
Just a gentle reminder to every body.
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Even if you want to choose “natural” Gout Treatments, you must always, always, always know your uric acid number. How else can you tell you are making the right changes?
For driving, I always recommend regular breaks to walk around outside, but I do not think you should do this when flying.
Book an aisle seat and keep walking. Unless all the passengers believe you have a serious toilet-related problem, you are doing it wrong.
Airlines should have advice about foot exercises, as this reduces the risk of deep vein thrombosis, as well as helping gout sufferers. If they have no leaflets, it's not rocket science – just keep moving toes, ankles and knees as much as you can, in all directions. Unless all the passengers believe you have serious St Vitus Dance, you are doing it wrong.
Think about how colchicine works.
When white blood cells see uric acid crystals, they grow so that they
can engulf the crystal invader, and send out signals for more, which results in exquisitely painful inflammation. Colchicine prevents inflammation spreading by slowing down your white blood cells. This is compromising your immune system, but most gout sufferers will accept the benefits of stopping the pain getting worse against the increased risk of infection. As far as I am aware, colchicine has no analgesic effect, so once the pain has started, it will prevent it getting worse, but not reduce it. That is why it is most effective when taken at the first twinge.Any dose beyond two per day is totally unnecessary.
If you have left the colchicine treatment too late, give an anti-inflammatory a chance. Naproxen is reputedly the best, though personally I have not tried it, and rely on double dose (under medical supervision) of ibuprofen. This can be further supported by other painkillers like acetaminophen (paracetamol). Your doctor or pharmacist can advise safe combinations for maximum relief.
I cannot see the point of trying to invoke diarrhea. The pain will subside naturally in a few hours, so wait it out or take something else, or get very very drunk. All choices have their benefits and drawbacks, but excess colchicine is pointless at best, and potentially very dangerous.
Hans said it nicely in blue. Let me add
Do not stop taking allopurinol once you have started it.
There are some exceptions, but I do not want to cloud the issue. If you stop and start allopurinol randomly you will cause many problems.
I've tried to find out about KOH, and I'm assuming this is the chemical symbol for potassium hydroxide. All I can find out about that are danger warnings. I'm feeling a bit lost here. Am I on the right track, Hans? If so, please can you explain a litle more about this, as all I see is trouble.
As well as the dehydration, there is the problem of restricted blood flow which, like driving long distances, has been known to give my knees and ankles a gouty going-over.
Alkalizing diets are very confusing because few people understand the process, opening the doors for charlatans to make money promoting unnecessary products.
An alkalizing diet (or intake of a bicarb such as baking soda or similar) helps gout sufferers who are at risk of developing kidney stones, especially those taking probenecid or other uricosuric. This is because the pH of urine can be raised, but not, as esabogal points out, the pH of blood. On that point, there may be a benefit of moving from 7.35 to 7.45 as even a small movement can affect uric acid solubility, but this is mere speculation (unless anyone knows about relevant studies).
You cannot fix a bad diet with a few scoops of water, but I'm happy to help advise anyone who wants to plan their own alkalizing diet.
Go away, yer Red Rose Rotter – yer barred
(apologies to the rest of the world – it's a long running thing across the Pennines – we love each other really
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6.3 is borderline, but during a gout attack, your “natural” uric acid level can drop. I recommend regular testing, though the frequency is something you need to discuss with your doctor. Certainly an annual check, but more frequently if you are making lifestyle changes, as this will give a clear indication of your progress.
The good news is that, with a 6 to 8 range, you should be able to get this below 6 with some dietary improvements (unless you are already perfect). Excess iron is a common problem for gout, as is excess calories. These two are as important as purines, if not more so. Moving some of your protein from meat and fish to dairy will help the purines. Eating less and doing more will help the calories (bet you didn't know that!). Iron is a tricky one as it's a very slow build. Personally, I do not have a very good plan for dealing with iron, but blood donation is good, as is reading food labels.
Some of us have found cider a little more gout friendly, but it still has alcohol and calories, so drink in Moderation (wherever that is – turn right at Clitheroe and ask).
hansinnm said:
Iconoclast said:
? is it important that I have them extract the serum from my knee as well?? ?
Not really, unless there is serious doubt that/if you have gout. It's generally done if a person has other arthritic problems and deposits other than MSU, like, frequently Calcium deposits. X-ray and MRI don't show Urate deposits but Ca deposits. So far only that new equipment: DECT-Somatron, is capable of showing Urates and distinguishing between those types.
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For a few years, there has also been an increasing number of mentions of ultrasound in the gouty journals. Much of this has been speculative, but it does appear that uric acid crystals have a unique ultrasound “signature”(contour)? that the experienced technician can recognize. This technology does not seem to have the clarity of the exciting DECT imagery, but neither does it have the outrageous cost.
Ultrasound is not a mainstream diagnostic tool yet, but I'm encouraged by recent developments enough to report them in?Can You Hear Your Symptoms Of Gout??
To paraphrase the conclusion:
musculoskeletal ultrasound is reliable for detecting urate crystal deposition in knees and big toes in gout and in high uric acid with no symptoms of gout.
Maybe there is hope for something more accessible than dual energy scanners and less invasive than a joint fluid draw? It could also help assess treatment by tracking tophi reduction during urate lowering therapy.
That's a tricky one Hans, but it raises issues that strike at the heart of gout management.
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My view is that statistical gout studies can give us pointers that suggest ways that we can understand our own gout better. However, only personal analysis can tell us as individuals what we might get? most benefit from.
Thus, if we live in a hot climate, and dehydration is a risk, it is a fairly easy self-experiment to try drinking 2 to 3 liters of water during the course of the day to see if it helps.
Going a stage further, we know that individuals react to uric acid crystal deposits differently. Some people get the intense, painful swelling at the first hint of a crystal floating around. Others can spend years growing beautiful invisible tophi, and barely notice!
I fall between the two, with (up until recently) frequent swollen joints, but nothing that a few ibuprofen couldn't handle. And going back to day one of my gout journey, I failed my inexperienced doctor's gout test because the swelling was in my ankle, not my big toe.
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When it comes to gout, it's very much “each to his/her own.”
Da5e said:
Thanks for all the comments, everyone. (You sure lead an interesting life Hansinnm!) Just to recap on the subject discussed:
Climate: Yes, I agree with you Hansinnm. There appears to be a correlation with well-being under sunny, dry climes when it comes to gout and arthritis and an increase in misery under grey, wet and cold conditions. Probably explains the annual exodus of the English oldies to Spain around the end of October. The link between gout and arthritis is not clear to me from the available scientific data but my own body can attest to it.
Most people with inflamed joints (whatever the cause) will attest to the increased aches in damp weather. However, for gout sufferers, there is also a possible situation where gout increases in hot weather, unless you stay hydrated.
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Diet: I read Keith?s last post concerning Gout Food Lists and I agree. I can only report on what has worked/not worked for me. At 6 foot and 12 stone I could hardly be described as overweight. So, after I returned from a gout free holiday in Thailand only to celebrate with a rare 10oz rump steak at a local restaurant followed by exploding knees for two weeks, I took the general internet advice about ?red meat?. I cut out all beef and lamb for the rest of the summer and replaced all my favourite recipes with ?white? pork . . . until someone pointed out that pork is also considered ?red? in some dietary circles. So I cut that out as well. So far so good, but the nagging question of what it is particularly about ?red meat? that causes gout led me to more research. I assumed it was fat content but it appears that it is the purine content, something that is all-prevalent in foods and the body, which is the culprit. Fair enough: except when you see that chicken is also fairly high in purines yet much of the internet advice suggests that it isn?t a big factor in acerbating the gout condition. Anybody have experience of gout under a chicken diet?
And if you hadn't had the steak, but still got the gout attack, would the conclusions be the same? Statistically, you need 50 incidents of steak eating followed by gout every time for the connection to be considered safe. You're right about the purines, but don't forget that excess protein can sometimes trigger inflammation. Simple abuse of your body through overeating can trigger metabolic reactions that increase your cell turnover (the major cause of uric acid). It's hard for those with an established meat eating habit, but 10oz of meat in one meal is twice the limit for gouties. Always remember though, that 10oz of meat pales into insignificance compared to your own human meat, and anything that upsets the metabolism will always produce far more uric acid than any meal can.
Alcohol: Similarly, what is it about the medical profession?s obsession about alcohol? I know that my alcohol consumption was greater in sunny Thailand than at home but the gout was non existent. From what little information I can distil from the internet it would appear that the alcohol threat comes under three general headings:
- What little statistical research has been performed suggests that gout is more prevalent in beer-drinking males. This may be so but it hardly takes into account other relative environmental factors such as stress, climate, eating habits, etc.
- As with ?red meat?, beers and lagers do contain purines although measurements are in mg per litre as opposed to mg per 100 g in foods. I admit this could be a factor, hence the reason why I latched onto the relatively low purine concentration of cider. Also interesting is the number of web sites that conclude that wine has no demonstrative influence on gout attacks. Again, does anyone have more data on purines in alcohol, or any other component of alcohol that might present a risk?
- Whilst a high purine diet may increase the quantity of serum uric acid produced by the body, the other side of the coin is the body?s ability to excrete it. Simple balance sheet: if you produce more than you can excrete then the difference builds up as crystals. Excessive alcohol is said to inhibit the body?s ability to excrete the uric acid (presumably, the ?dehydration? effect). That suggests that the answer is to drink moderately and ?take plenty of water with it?! That, by the way, doesn't mean I would subscribe to the government?s diktat of Four Units A Day (or one unit if you?re over 65)! I reject any One Size Fits All government policy as a matter of course.
Sorry if this is all a bit simplistic. I have no biology education; in fact, all this is an existential attempt to understand what is afflicting me. I would be very happy for someone to put me right here.
Most medics, when pushed, will admit that they have no idea where the recommendations on alcohol intake come from. It doesn't stop them from pushing the “cut down on drinking” mantra. My approach, recently adopted is simply lie when they ask how much I drink. They are asking stupid questions as a matter of rote, and deserve stupid answers. On a personal level, all you can do is spend a month or two drinking at different levels, and see if it has any effect. But in my current mood, I'd say that is pointless. Common sense tells me that there has to be more health benefits to enjoying social drinking with friends compared to boring abstinence alone or with tee-totallers. There seems little doubt that excessive drinking raises the risk of liver and kidney damage, but this will vary enormously from person to person. The best advice for general health is to have annual health checks, which should include kidney and liver function tests (mine are fine, and four units a day does not come anywhere near). The best advice for gout health is to take allopurinol, and stop worrying.
One Postscript: My local pub (which is a mere 30 seconds walk from my house) sells Thatchers and Stowford Press, Keith. In the interests of furthering scientific endeavour, I?ve switched allegiance to the latter for the duration (it?s cheaper than lager, too).
That will be a Weatherspoons then. I had a nice inexpensive session on the Thatchers in one of their Leeds branches yesterday. Heaven would be the middle of a triangle of Weatherspoons, Sam Smiths and Joseph Holts pubs, but I'll settle for a train ride, because living there would be just too much temptation.
Beware conflicting information! Also beware misinformation about purines, as a simple count of total purines is not relevant (though not a trap I have always avoided
). Most authorities now accept that vegetable purines do not easily convert to uric acid. Meat and fish will, but mushrooms fall somewhere between (as do other fungal products like yeast).Bear in mind that we never eat one food in isolation, so total purine intake is what matters. Also non-purine proteins mixed with any gout-purine food will reduce the potential effect on uric acid as they promote purine excretion. Would you like my recipe for cheese stuffed mushrooms?
Dare I suggest a perusal of How Purines Affect Gout in preparation for an analysis of Purine Rich Foods?
One of the many good things about allopurinol is that you can stop worrying about diet. A good thing, as alkaline water and cherry juice will do nothing to lower uric acid. For your general health, you should still plan a healthy diet with respect to calorie intake, and a good range of nutrients, but you can forget about purines, which the allopurinol will handle.
There is always a slight risk of temporary rises in uric acid levels as old deposits dissolve (to be clear, this is a function of allopurinol, not alkaline water). The best way to handle this is to make sure your allopurinol dose is sufficient to lower uric acid level to 3 or 4 mg/dL. That way, any temporary rise will not cause a problem, and it also means that old uric acid deposits dissolve quicker. Once you have gone 6 months without any signs of a gout flare, you can relax the dose to maintain uric acid level around 6mg/dL
Allopurinol reaches maximum effectiveness in around two weeks, though whether you see better numbers will depend on the dose. For example, I started on 100mg (which is a good starting point to check that there are no allergic reactions). This had no effect on my uric acid number, and I am now on a schedule of 4-weekly assessments to increase the dose until I get it where I want.
I have not experienced any bad effects whatsoever (currently on 400mg). I have been taking 1 colchicine morning and night for one week from the dosage increase. I've reached the end of the week, so stopping the colchicine today. I'll keep the bottle nearby just? in case I get a twinge (colchicine works best if taken at the first sign of an attack).
Some people have reported allopurinol side effects of drowsiness etc. I think you have to be careful here. Taking new medications, doctors visits, and general concerns about gout can easily invoke anxiety, and many of the reported side effects are very similar to symptoms of anxiety. I say, Relax and enjoy a worry-free life.
1. How Your Uric Acid Level Changes and morning (though consistency is preferred to any specific time).
2. Which particular type of food? Excess purines: 2 to 3 hours. Excess calories: I'm guessing a few days. Excess iron: I'm guessing a few months/years.
In my view, excess calories and excess iron are almost certainly worse offenders than excess purines.
I've not made my mind up about fructose yet. There seems to be a lot of noise about it, but little solid investigation work (by which I mean double-blind randomized controls). Common sense tells me there must be a point above which fructose consumption is bad, but I've seen nothing that clearly states what that limit is. An apple a day seems sensible, but a gallon of apple juice probably breaks the “everything in moderation” rule.
Iconoclast said:
? He said that my uric acid level was already down to 3.9 which I was very surprised but happy to hear.? He said that I should reduce my dosage of allopurinol to 100 mg.?
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Don't you dare reduce the allopurinol until you have gone six months without a gout flare (even a hint of one).
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I can't promise to get to Japan to beat the living hell out of you and your doctor if you do, but I can promise eternal damnation (or at least eternal gout pain)
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3.9 is a lovely number (you are certain it is mg/dL aren't you) and very close to the bottom value in my chart on Lower Uric Acid Gives Faster Gout Cure. 2.9 mg/dL for a year would be even better to speed up clearing out the old crystals.
cjeezy said:
Keith are you finally making the Jump to AP?
cjeezy, I haven't laughed so much since my daughter sent a Fathers Day card with a cartoon of SuperDad flying through the air, accompanied by her inscription '… if only you could fly!' Nice to see the warped GoutPal humor is hereditary.
I'd sooner say the fall to allopurinol rather than the jump to AP, but yours is much funnier. You've inspired me to update GoutPal On The Mend – click on the photograph I've now added properly. And? please don't be upset if this is news to you – you truly have made my day. A tonic for the incompetence of medics.
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Speaking of which, as you've spent good money proving that you have a more accurate testing regime than your doctor, perhaps it is time to press him on his procedures. You know what happens to the blood you test yourself, but what are the storage conditions for your lab test blood? Maybe you could take the meters to your next blood draw, and test a drop of vintage venous cjeezy juice on both meters? This would rule out any discrepancy between capillary and vein blood.
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To hansinnm and anyone else who is interested in the incompetence of uric acid test results, I'm going to start a new topic soon. A second doctor has just called me normal, and I don't like it.
cjeezy said:
I'd hate to jump up to 400mg of AP but if I have no other choice?
Everything I've read convinces me that 300mg is the lazy dose. Lazy for doctors, not you cjeezy
I've got my first assessment tomorrow, and the doc is going to have to justify why I can't have 800mg per day!
That's after I've tested him to see if he has remembered my explanation of what a uric acid test result means (no smiley – I'm seriously disappointed by his fixation with the meaningless 'normal').Hi Sailorboy,
This crops up fairly often when allopurinol isn't managed properly. Dosage should be set by reference to uric acid levels, with blood tests every month when dosage is being established, relaxing to once or twice a year when levels stabilize. Up to 800mg per day is recommended for adequate urate control, though some doctors have suggested that this upper limit can be stretched if necessary, and if monitored.
It is all too easy, with a “staandard” (frequently useless) 300 mg dose, to get into a bad situation where uric acid fluctuates around 6.5, with crystals partially dissolving, then reforming. Who knows if this is your situation? Only blood tests will tell.
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When to stop colchicine? Normally after a month or three with uric acid levels held below 4mg/dL, but that is a very general rule that I've just made up – the real answer depends on individual circumstances, which your swimming buddy should be a bit more concerned with.
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I am not sure if the colchicine helps with getting rid of the UA crystals or if that is strictly through the AP (allopurinol)
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No, colchicine just helps with the pain. It has no effect on uric acid. It works by stopping white blood cells reproducing, so it is important to keep dose down to one or two pills per day. It works best when taken at the first sign of pain, or as a daily preventative.
It stops inflammation increasing, rather than reducing existing inflammation, so I believe, if it does not provide enough pain relief, it is best to support it with an anti-inflammatory such as ibuprofen or naproxen rather than increase the colchicine dose (but I know others will disagree).
Hi Jim,
The first bit of advice is to stop thinking of uric acid levels as high/low/normal. Get to know your number, set a target, then work towards lowering it.
The medical profession understates the importance of genetics in gout. You should be being treated for uric acid lowering, as there is almost certainly very little you can do lifestyle wise (though this of course depends on your uric acid numbers and a proper assessment of your current lifestyle).
The other aspect of gout that does not get enough credence is the permanent damage caused by uric acid crystal deposits. This is in addition to the painful swelling of a typical gout flare. Even without gout flares, if your uric acid level is above 6.5mg/dL you are almost certain to have some uric acid deposits in your joints. These eat into bone, cartilage and ligaments, causing permanent damage (osteoarthritis).
Please discuss allopurinol with your doctor today. You have a genetic defect that dieting will not fix. The longer you wait, the more your joints will be damaged.
Da5e said:
The doctor has just put me on Allopurinol (and, yes, it does hurt to start with!) and ordered me to cut out the beer. Anyone have an informed opinion on switching from lager to a couple of pints of cider a day?
In my very well informed opinion, the response to this type of ill-informed “order” is to politely agree, then ignore it.
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On allopurinol, there is no difference between types of alcohol, though if you can find Stowford Press cider locally, it's worth switching for taste.
I'm due for urate, liver function test, and kidney function test next week, so I'll ask some UK specific questions about standard formats, etc.
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Thanks for the health concerns (and Idle comments), nokka. I'm currently discharged from outpatients, as they are only really bothered about broken bones, and they have healed. There seems to be some long-term damage to my knee, which was the least of my concerns during the crisis, but now looks like becoming a permanent reminder, though replacement has been mentioned. My other main concern is difficulty in sleeping which is giving me attention span difficulties during the
