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Yes, thanks odo, I'd missed that point.
Gravies, stocks, sauces soups and broths are all potential high purine sources as they can often be highly concentrated.
That said, all the research that I've seen points to limiting purine intake only being effective for getting uric acid down a couple of points or so. This is believed to be due to purine excretion rising in line with purine intake – i.e. the more purines we ingest, the more we get rid of, though the net effect is a slight increase.
So purine restriction might be effective with uric acid around 7 or 8, but not when it is over 9.
Weight loss can help in the long term, so a combination of weight loss and purine restriction, perhaps supported by an increase in some of the foods that appear to help uric acid, might get 9.5 down to the safe range. The problem is, rapid weight loss causes increased uric acid in the early stages, so it is much better to protect yourself with allopurinol or some other urate lowering therapy whilst you lose weight.
This is no easy option, as I know from personal experience. I'm only slightly taller than Harry, so our target weight is similar – about 140 pounds! Even in my teens, I was heavier than that. Whilst my head tells me that 1 pound a week is easy, and will only take 2 years, my heart baulks at the challenge.
Time for a bowl of chowder to help build some resolve.
Interesting indeed.
Thank you, Utubelite, for that information. It confirms my thoughts about the variability of tests. Quite right to focus on a 3.5-4.5 range than an absolute number.
Uric acid concentrations vary in the body, as it is constantly being regenerated and disposed of. A spot test is just that, so averages are important. There are hundreds of factors in play, so it is no use looking for specific cause and effect – it just happens. The highest reading is probably most significant, and the reason why I say 6mg/dL is a safe upper limit because it is highly unlikely that natural variations will take the levels over 6.8 where crystals form.
One aspect of “official” testing is the lack of sample control between drawing the blood and testing it. There has to be an element of variety here unless time and temperature are always exactly the same. So even with lab tests, you should look at the average range rather than specific tests.
I live next door to a dentist, and his experience is that most infections of this type clear-up by themselves within a week. He will not prescribe antibiotics until a week has passed, but then a longer course to make absolutely sure that the infection is killed and cannot come back stronger.
Is your doctor available by phone or email for a second opinion?
I believe the walking will help her gout, but only a doctor who has examined her joints properly can assess whether the benefits of walking outweigh the risks of aggravating damaged joints.
My mom is approaching the same age, and I would certainly advise her to go back on allopurinol if she were in this situation. It might be too late to save her from foot pain, but should prevent it getting worse, and should prevent spreading to other joints and kidneys. Get the doctors advice ASAP – I cannot see any downside of getting back on the allopurinol, but there should be some benefits.
I can't add much to zip2play's answers, but I would like to point out that allopurinol is generally considered a safe drug. Apart from a tiny percentage of intolerant gout patients, the main problems with it fall into 2 very similar categories:
- Insufficient monitoring to check that the dose is correct for bringing uric acid to the correct level. This occurs as both over and under dosing, as a result of practitioners assuming a standard 300mg per day fits all.
- Patients not taking it every day. You can get away with missing one day, but stopping and starting allopurinol is very, very naughty.
The other major consideration is the risk of not taking it (or other appropriate urate lowering therapy).
Once you have had a gout attack, high uric acid means buildup of uric acid crystals. You might not get a gout flare everyday with uric acid levels above 7mg/dL, but you will get uric acid deposits. As you get older, and less able to cope, these will show as tophi, joint erosion and kidney stones. This is not a risk – it is a certainty.
High uric acid is also associated with an increased risk of heart disease, stroke, and diabetes.
Of course, nobody wants to be reliant on medication, and it pays to be as aware as you can be about any possible side-effects. However, you need to be equally aware of the problems of no medication.
You also need to be aware of the long term effects of pain relief. NSAIDs (ibuprofen, naproxen, indomethacin etc) are associated with increased heart disease risks in long-term use.
You don't say how long you had gout before the allopurinol regime. You may have had quite extensive uric acid deposits that are still dissolving and causing the discomfort.
Best advice I can give is to stick with the allopurinol and keep checking uric acid. It might take a while longer, but you are doing everything right.
Colchicine is a pain-killer with the unfortunate side-effect of diarrhea. You do not have to take it – there are alternatives, or you can simply grin and bear it.
Allopurinol reduces your uric acid to a safe level. Reducing from 11.5 to 9.5 is useless. It might mean one attack per year less, but the uric acid is still forming crystals in your joints and under your skin. You must get back on the allopurinol and get your uric acid down below 6.
This is no fast cure – it will take a few months to get all the uric crystals out of your tissues. Aim for an allopurinol dose that will get your uric acid down to 3mg then review it every 6 months. If you do not do this, the mobility restrictions that you are experiencing now will get worse.
If you do make a start on getting rid of uric acid then your mobility will increase, and you will have a much better chance of losing weight. Also, weight loss increases uric acid, and the allopurinol will protect you from this.
I have been taking allopurinol for 14 months now with good results. I had a month long flare up when I started, but my UA levels were down to 4.0. This was most likely due to the dissolving of the UA crystals in my joints. I have been able to eat everything in moderation, still stay away from red meats and limit alcohol. I have missed at most a one day dosage here and there. My prescription is for 300mg and my levels stay constant at 4.0. I am happy with the results, but my ankles and feet constantly are aching especially when I first stand up, or wake up in the morning. I have a constant limp because of this pain. I do not want to take ibuprofen constantly so I deal with the pain. Lately my joints have been crunching when I walk and continue to ache. Is this a side effect of the UA dissolving still after a year? I have been to Orthopaedic surgeons who have done xrays and everything looks fine. Also, my rheumatologist says my joints are fine. What is this pain from? Now that I have been free from gout attacks for 9 months, why am I still in such pain? I cannot find any answers to this problem. Has anyone suffered from similar symptoms? Do they eventually go away? Any info would be appreciated.
phofab said:
Back on the subject. Both Vegemite and Marmite, from their Sites are claimed to be Vegetarian and there is no mention of Iron content for either.
PS Vegemite is OK on the spellcheck, but Marmite does not compute.
Everything in moderation, gentlemen.
Howzat!!!!!
I'm certain that the UK Marmite site used to have iron listed, or I got it from the label, but now it is on neither. Marmite NZ shows 25% RDA (1.8mg) in one 5g portion! I get more than 5g just licking my fingers.
I cannot find anything definitive for Vegemite. Nutritiondata.com lists yeast extract with only 0.2 mg, so maybe Marmite (at least in NZ) is fortified.
I've decided to avoid labels and just enjoy the stuff. After all, I contribute enormously to the availability of the main ingredient.
I was going to suggest you change spellchecker, until I realized you meant the spellcheck on this forum. Oops
I'll build a specific advice topic somewhere once I've updated the forum software.
In the meantime, could people post uric acid test meter problems here, and good experiences, and I will summarize them in the new forum.
On the specific issue of blood samples, I would advise people to practice drawing blood before wasting test strips. There are 3 tips above for encouraging blood flow. Vigorous wrist action may also help.
The lancet device has 5 settings. Start on 3, and adjust up if you get an insufficient drop size. I use a different digit for retesting, but I have no scientific reason for this – it seemed logical at the time. It is a while since I've done this, so I cannot be specific, but I did notice that some digits were easier to bleed than others. As blood oozes from the pin-prick, it tends to form a droplet, and you should be able to judge if this is big enough to fill the test area. If not, don't waste a test strip – just draw more blood. You might have to sacrifice a couple of test strips to poor samples in the early days, but a methodical approach will minimize this.
You have to be methodical. You are using a scientific instrument.
Zip2play said: I think this discrepancy in the amount of blood delivered is the single cause of erroneous reading.
That is exactly right. When these machines were tested under lab conditions, blood drawn from the vein compared exactly with tests done by a full size Hitachi lab unit. The capillary blood tests were not quite so accurate, with the results being put down to the problems of sampling capillary blood.
If you can't get a drop of blood big enough to cover the test strip hole, you will not get an accurate reading. The American Academy of Family Physicians recommends:
If you get blood from your fingertip, try washing your hands in hot water to get the blood flowing. Then dangle your hand below your heart for a minute. Prick your finger quickly and then put your hand back down below your heart. You might also try slowly squeezing the finger from the base to the tip.
Good question john, and one that is absolutely fundamental to managing your gout.
Colchicine stops gout pain by fighting the inflammation caused by uric acid crystals. It does nothing to get rid of those crystals, which build-up as urate deposits in the skin and joints. Soon, the urate deposits start damaging bone, cartilage and ligaments. No amount of colchicine will help you once that has gone too far.
Allopurinol reduces the amount of uric acid in your blood, which stops new crystals forming, and helps dissolve old ones. It is vital that you carry on taking it every day, and make sure your uric acid levels never rise above 6mg/dL (0.35 mmol/L).
I always found that a swim in the ocean was a great cure for lots of things. Colds, Cuts/Wounds.
I don't see that it could do any harm.
Maybe the water draws the crystals and stuff out of the affected joints (when you get that wrinkly look).
There seems to be beneficial qualities in salt water. Not sure about chlorinated pools though?
Cheers,
Paul.
Goutpal,
So, my uric acid tests came back at 3.05mg/dl, after bumping to 1.5g of probencid a day; plus up another 500mg. Right on the money. Uric acid measured after a meal and about 4 hours after my meds.
Discerning cricket. I cannot find his best, but here is something to ensure it’s continuing attraction… 😉
http://www.stephenfry.com/2009…../glory-be/This really needs professional medical advice.
Here is an image (not very good quality) from “Effects of aminoglycoside antibiotics on renal antioxidants, malondialdehyde levels, and some serum biochemical parameters”
The first shows an increase, the last a decrease, and the other 2 little change. I have absolutely no idea if these antibiotics are relevant to your condition.
I think the best approach would be to pick the best antibiotic for the job, and check uric acid before and weekly, then balance any increase with allopurinol
metamorph said:
Faith,
If you do not mind the trouble, try Black bean broth. Recipe at the following Gout Pal link –
http://www.goutpal.com/natural…..-gout.html.
If you wish to find out more about BBB do go to :
https://gout-pal.com/gout-p…..e-for-gout .
Hope it works for your dad too.
ok i will thanks
GoutPal said:
Do you start with two pills, then one an hour or just keep it to one?
i think hes taking one
An Anglo-Australian dictionary is in preparation
Leave the Marmite alone guys – we took Rolf Harris of your hands, didn't we?
[GoutPal exits in search of toast and Marmite, wondering who is going to explain all this to our North American friends]
See this colchicine post for the best way to take it to get rid of the pain.
to vegetarian guy: you say you were taking Berocca supplement which contained B vitamins and niacin among other things. i also was taking a supplement that contained B vitamins and niacin among other things. Isagenix. i had been on this for about a month and a half. could there be a correlation? i also had started a pretty vigorous exercise regimen of pilates 2 x a week, yoga 3 x a week and running 3 x a week.
Thanks for the feedback,
Yes, Vegemite is a yeast extract product (exactly like Marmite).
Might lay off it for a while.
Will eat some eggs on toast instead!
Thanks again
Paul.
I haven't seen a vegemite label, but I was put off marmite by the amount of iron in it – harder than giving up smoking
(iron is very bad for gout, and most of us get too much)Eggs should not be a problem for gout, but lots of them might be bad for cholesterol.
I've had similar negative experience with multi vitamins.
I threw them in the rubbish after the 2nd attack.
Have had a similar problem/flare-up now with vitamin c tablets. I'm going to knock them on the head too.
Cheers,
Paul.
Thank goodness everyone is discussing twinges instead of roaring with pain.
Reminds me of when I used to fix computers. If it didn't work, the fix was usually pretty easy to find. An intermittent computer twinge is like a gouty one – could be almost anything. And at the moment, I'm far more bothered by computer twinges than gouty ones
When you are starting allopurinol, the weaning-on process MIGHT trigger an attack, but the chances are less than if you did nothing. The only way you can increase your chance of an attack when starting allopurinol (compared to doing nothing) is to get the dosage wrong (i.e. you take enough to start exposing old uric acid crystals, but not enough to get rid of them).
Best to start at 100mg just to see if you are one of the extremely rare people who has a bad reaction. Weaning-on can then be as fast as you like to get to your target uric acid level. Doctors often suggest increasing by 100mg at a time, but quite often a bigger increase is justified. The sooner you get to 3 or 4 mg/dL the less chance you have of triggering an attack.
Many gout sufferers who start allopurinol never get a gout flare. All gout sufferers who do not reduce their uric acid to a safe level WILL get another gout flare.
The weaning-off process comes after you have kept your target uric acid level for 6 months without a gout flare. You can then be almost certain that all old crystals have gone, unless you still have signs of tophi (in which case, wait longer).
Your target is now 6mg/dL (forever), and you can slowly lower allopurinol dosage. Proceed with extreme caution. Wait at least 2 weeks between each reduction, and get uric acid levels checked before you reduce the dose. If you are well below the 6mg/dL mark, you might drop by 100mg. Between 5 and 6, you should go for a pill-splitter and make smaller reductions. Also, as you go above 5, you should make sure that at least 2 consecutive tests confirm that your level has not risen to 6. That will ensure that you do not get a gout attack ever again.
If excess weight was causing your gout, and you have managed substantial weight loss, then you might get the dose down to zero. If not, you might have to continue with a smaller maintenance dose of allopurinol – I hope it is for a very, very long time.
