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Fire Titan,
It seems like you’re unclear on something: You get gout for one of two reasons, either your body produces too much uric acid or it can’t excrete enough. If you clear the crystals with meds and then stop taking them, your body is bound to re-accumulate more, and unfortunately you’ll most likely be right back to having attacks again. And you probably won’t know it because crystals accumulate over long periods of time before reaching a point where they cause attacks. To be honest, it doesn’t seem feasible to me that you’ll be able to get your blood tested often enough to track the UA spikes that cause crystal formation over months and years.The meds will keep your body at a non-saturation point for the duration, so if you can find a med that works well for you without side effects, maybe you should try to get out of the mindset to stop taking them as soon as you’ve cleared your current accumulation. If your gout has become chronic, and it sounds like it has (I’ve never experienced anywhere near the prolonged symptoms you’re describing, especially after taking colchicine), you’re treating a lifelong condition now, not a temporary one. And I’m sorry you had trouble with the Allopurinol, I started recently and it’s working wonders for me with zero side effects.
Hypothetically, if 100mg brought my UA down 1.6 mg/dL, and if adding 50mg brings it down half that again, it would put me around 5.6 mg/dL. Why would you advocate 200mg? Not so much questioning your judgement as looking for the reasoning behind it. Is an SUA of 5 really going to make that much of a difference vs maybe a 5.5?
I definitely do want to remain at 150mg for the moment and have it checked again in four weeks or so. More out of curiosity and for accuracy than concern this time.
I just got my first blood test results after being on 100mg Allopurinol for four weeks. My uric acid is down to 6.4 mg/dL from 8.0 in January and 8.3 last May.
With a target level of <6.0 for gout patients, I’m guessing increase dosage to 150mg and check again in about four weeks?
My other Comp Metab Panel numbers have remained consistent over the three tests and are in safe range. Overall, I am pleased with these initial results!
Excellent advice as always, thank you. That second toe joint has been flaring regularly for a while now as I said, every week or two for a few months. I assumed it stays puffy because it hasn’t gotten a break, pointing to as you said, consistently elevated UA levels, not having a chance to shrink down enough before the next flare puffs it again. It was just about normal looking when I had a flare the second week after I started the Allopurinol, and it twinged a little two days ago.
I had the blood test done today, so I should have results by the middle of next week. Then my doctor and I will discuss what to do about dosage based on initial results. And of course I’ll report everything here, and ask what the opinion is.
Oh crap, you are right! I edited my original post so no one gets confused by my mistake, they are indeed 0.6mg capsules. Sorry!
And just to be clear, I take two 0.6mg at first sign and attack is going to be bad, and a third 2-3 hours later. So three doses in the first 24 hours, which totals 1.8mg. That initial high dose in the first 24 hours was prescribed to me to really knock back a serious attack, and it’s worked every time so far. The other two examples I made are kind of self regulated.
Any flares I’ve had that have topped out at 4 on the scale haven’t lasted more than a couple of days, and have been well within my range of tolerance. At that level, I focus diligently for any increase in pain or swelling beyond, and that’s where I pop a pill or two.
Also now being familiar with the Gout Pain Scale, I’d say I never take colchicine for pain levels under 5. Pain levels 5-6 I do a “flare” dosage, 7+ and aggressive “attack” dosage.
I understand that “flares” aren’t a technical medical term, I literally meant “you” as in the members of the forum. I’m curious how other sufferers are gauging their own experiences. I saw the “Monitor Your Gout Pain” graph after I posted this, and I’d basically say levels 1-5 I’d call flares, and 6-10 I’d classify as an attack. The attack that started this ten month run was probably an 8 on that scale, and I’ve been bouncing between 0-4 regularly since, with a couple of forays into the 5-6 range.
My primary source of discomfort these days isn’t my big toe at all, it hasn’t bothered me in months. In fact, the big toe joint has flattened back to totally normal looking. For whatever reason, my crystal deposits have migrated one joint over to the base of my second toe. It sometimes looks like I have a little marble in what you’d call the Proximal Phalanx. It’s looked slightly puffy for months, and it swells a bit more roundly when I “flare”.
Gout Flare VS Gout Attack
How do you gauge the difference between the two? What’s your threshold considering pain and swelling as factors?
I’ve what I considered four full-blown attacks in my first four years of experience with this affliction, skipped two years, had a bad one last April, and one other not quite as bad a few months later. But I’ve been riddled with flares for the rest of the past nine months.
I’d say attacks entail significant swelling, with possible displacement of the joint, accompanied by excruciating amounts of pain. As they’ve always occurred in my foot, so mobility is severely affected and swelling will make putting a shoe on practically impossible. I thankfully have never had an attack severe enough where “the weight of a bedsheet” on my foot was painful.
Flares on the other hand, have been far less severe in both pain and swelling, varying from annoying or slightly uncomfortable, to moderate swelling with bearable pain, possibly strong enough to result in a limp, but not cause severe mobility issues.
So what’s your barometer for attack vs flare?
Have you had an attack before, or is this the first? I know absolutely nothing about steroids, but…
Colchicine has worked wonders for me for treating an acute attack, it seems to cut straight to the source for me luckily, and with no side effects other than some minor stomach rumbling and a little mental fog. I usually take 2 – 0.6mg pills at first sign it’s a true attack, another a few hours later, and then one a day for the next couple of days. I’ve also backed it up with 500mg Naproxen for serious pain. I feel relief within hours, and my attacks (pain and swelling) have abated fully within 2-3 days, with maybe some residual ache for a few more days.
I’ve used it at a lower rate for some of my more serious flares (gauged by if the flare is serious enough to cause a limp), one or two pills the first day, and again one a day for the next couple of days. I don’t think I’ve ever used it for more than four consecutive days. I plan on never having anything less than ten doses on hand at any given time, probably for the rest of my life.
Off topic, I know… haha.
I have my first blood test scheduled tomorrow since starting 100mg/day Allopurinol four weeks ago, trying to be prepared with as many questions/observations pending results, and much of what I see online lends itself to the thinking that you find a dose that works, and stick with it forever.
So does anyone have any history of varying Allopurinol dosages throughout their treatment? For example: Gauging an initial dosage of 300mg, but eventually lowering to 100 or 200 as a maintenance dosage? Or bringing it down with a higher dosage and then lowering to a maintenance dosage.
Or the other way around, finding a dosage that worked, but eventually having to increase because that dosage stopped being as effective for one reason or another over time?
I guess I’m curious if the effects of the drug tend to improve or decrease over time. In regards to SUA numbers, is there a tendency toward a long term positive cumulative effect, or toward building up a resistance negatively.
I don’t love drinking milk, never a fan, but it looks like I’ll be forcing down a glass of organic skim milk a day. Haha! Thanks for that info, there is indeed plenty out there on the subject, oddly hidden in plain sight. I usually drink a big glass of water both before bed and first thing after waking in the morning. I probably sub one of those out with the milk.
I’m a huge proponent of natural eating. Part of the problem with modern diet in my opinion is it’s existed for only a short span of human history… Refined sugars and oils, modified starches, chemical preservatives and artificial colors and flavors. Mother Nature never intended for us to rip the sugars or fats out of plants with heat and/or chemical processing while discarding the other nutrients, fibers, and roughage included. How we treat our foods and eat them has become totally counterintuitive to millions of years of evolutionary design.
In regards to cooking fats, I’d recommend expeller or cold pressed safflower or grapeseed oils for higher temperatures (sautéing, searing, deep or pan frying). You want “neutral oils” for higher temperatures that don’t have compounds that will burn and turn carcinogenic with high heat. “Neutral oils” are also relatively flavorless, which is good for recipes where you don’t want added distinct flavors.
For non- or gently cooked fats I’d stick to cold pressed extra virgin olive oil and other expeller pressed nut or seed oils like avocado, coconut, sesame, walnut, peanut, etc, accounting for their distinct flavors where you choose to use them.
Cold pressed oils are the most natural and healthiest, with minimal heating. Expeller pressed is done at a higher temperature to extract more oil, but with no chemicals and still below what’s considered to be heat levels of toxicity, not too bad. Solvent pressed are the bad ones, oils extracted at even higher temperatures and with chemicals for the highest yields, and how a vast majority of your mass produced vegetable and seed oils are done. Not good for you at all!
I’m also all for using animal fats, health permitting (calorically they’re the same, so it really just boils down to cholesterol intake). The body is far better designed to digest animal fats, which are very natural and we’ve been eating as a race for our entire history.
All great information! Thank you.
It’s funny that cherries, maybe the oldest and definitely the most mentioned “gout remedy”, have virtually no clinical evidence to back them up. In fact the best information on cherries and gout I’ve seen surmises that they’re most useful as an anti-inflammatory from their anthocyanin content.
I was also under the impression dairy was recommended more so for its use as a low purine protein replacement, not so much because it “lowers uric acid”. Helping to lower uric acid through substitution, not inherently. I think the low fat dairy recommendation comes from the summary assumption that most gout sufferers are generally, overweight, have high cholesterol, or have other conditions such as diabetes. If these aren’t the case and weight/other health factors aren’t an issue, I wouldn’t concern myself with “low fat”.
Talking about fat, fats were much maligned during the second half of the Twentieth Century. People started getting fatter in conjunction with consuming mass produced, processed, preserved, and heavily sugar laden foods. Refined sugars were the culprit, but fat and its additional 5 calories per gram, got the blame. As someone who is in good shape and eats an excellent diet of natural, whole and nutritionally dense foods (now with my hyperuricemia taken into account too), I embrace good quality fats and incorporate them properly into my diet rather than avoiding them.
A bit of nutritional advice to anyone who cares to listen: Avoid processed and modified fats as much as possible. Soya bean oil (which EVERYTHING preprepared is made with!), canola oil, “vegetable” and corn oils, and butter substitutes such as margarine and other substitute spreads, all terrible. These fats are so heavily processed with heat and chemicals that the body fails to recognize them as the vital macronutrient they should be, and instead treats them like toxins. The body is confused by them, and anything the body doesn’t know what to do with gets stored as, you guessed it… Fat! Body fat. Much the same as High Fructose Corn Syrup and many preservatives, which are also in almost everything “pre-made”, they confuse the body and get stored in fat cells.
Can I eat Pork on 100 mg Allopurinol?
The couple of fairly relevant looking purine lists I have looked at do list by how much of each purine various foods contain and/or a number relative to the amount of uric acid the food produces. Not that I know exactly what the numbers mean, I only assumed these were good for watching for an overall intake balance or putting foods to scale. Case in point, common mammal muscle meats (beef, chicken, pork) seem to be pretty close in purine content, yet many gout diet guidelines espouse lean meats such as chicken as better options. Meanwhile, meat like pork belly which is very high fat actually has fewer purines than lean chicken breast.
I’ve also read that some people obsess over higher purine vegetables and legumes (spinach, asparagus, lentils, etc) and have claimed them to cause attacks, while other sources say to basically discount any plant derived purine intake. Common sense tells me one should probably worry about plant based purines in conjunction with the bigger offending animal based ones and/or alcohol intake. Cumulative effect would make sense to me.
And just for the record, I assumed that clinical studies that have taken the time to analyze purine contents of foods for hyperuricemia/gout related studies have done the legwork of pre-distinguishing the bad purines for us. Of course, we all know the old saying about the word “ass-u-me”.
So if tracking purine content/intake isn’t a wise option, what guidelines would you suggest?
I also just saw in another post you suggested “eating foods known to lower uric acid”. I’ve only seen clinical evidence for one thing consistently lowering uric acid in trials, vitamin C. And that is only by a percentage too low to be of any real relief to someone with hyperuricemia.
Taking this all with a grain of salt, alcohol is known to inhibit excretion of uric acid, making it a generally unwise choice for a gout sufferer. Beer can be a double whammy because it also contains varying levels of purines. Lower malt beers, such as Pilsners, have significantly less purines and are generally lower in alcohol than ale styles. Numerically, any beer doesn’t seem that bad under analysis, but purines are measured by 100 g servings, making a pint of beer (especially ale style beers which are considered a “medium purine food” by 100 g serving) five “purine servings” in one glass, add up quickly.
Some opinions also believe that Lager yeast (cold, bottom fermenting) has substantially less purines than Ale Yeast (warm, top fermenting). Lagers also tend to be lower in alcohol, 4-5% on average, where ales can go as high as 15% naturally, although 5-8% is a good average. Every beer variety in the world is either a Lager or an Ale, depending on the yeast strain. And again, some opinions even look at filtration because filtered beers contain less of the yeast lees (dead yeast particles) which physically contain more purines. Finding any information online is like finding a needle in a haystack, and of course every beer is different, and I’ve yet to find definitive purine information for specific beers.
I’m a huge fan of the American Craft IPAs, strong, unfiltered Ales which are the only thing I can say for certain are triggers for flares. I’ve been able to enjoy a few Pilsners with no discernible effects on flares at all.
Wine has virtually no purines, and is mostly known to be problematic only in relation to excretion, and of course wine is most commonly paired with food, and we all know the old saying, “red wine with red meat, white wine with fish…”. So wine itself isn’t a purine problem at all, but it makes the UA derived from that steak or shrimp you ate with it that much harder to pass. In theory, some wine consumed on an otherwise low purine diet shouldn’t be problematic in terms of dietary SUA.
Again, all of this “in theory”.
Hm. I do eat very healthy, not much of a sweets eater, I don’t drink sweetened beverages at all, and I’m by no means a problem drinker. I enjoy a few drinks a week, and I’d like to not fear eating meat for dinner a couple of times a week. I’ve long since all but eradicated processed or artificial foods and refined sugars from my life, autonomous of my gout issue. Now that I’m taking my gout treatment more seriously, I’m also hyperaware of my meat and beer related purine intake. I was just curious how strict one needs to be when treating the problem with medication vs not.
I know nutritional science is a lot of speculation, but I do consider myself to be more savvy than the average person on the subject. You could say I’m hyperaware of my nutritional intake in general as it’s a big part of what I do for a living. I guess I was hoping for a more scientific correlation between Allopurinol use and dietary SUA, but it’s likely that kind of information doesn’t exist. Wishful thinking I suppose.
Fine tuning my questions and curiosity a bit… They say diet only accounts for 1/3 of SUA, they rest is produced by the body. I’ve been pretty good with my diet, not saintly, but good overall. If I am gauging my Allopurinol dosage under a purine conscious diet, how should one take wanting to get closer to a normal diet into account eventually?
I do understand that I should never overdo it or go totally off the rails with my purine intake, but I have read that many people say they’ve returned to a normal lifestyle after getting their UA under control with Allopurinol. What’s the perception on diet in relation to dosage around here?
Your advice and wisdom are truly appreciated. I already had it my head that if needed I’d only go up 50mg if my levels don’t come down enough on 100mg, at least until I have a month to see how that worked. I’m secretly hoping 100mg will do the trick, but I’m if not I’m really hoping it’ll be less than 300mg. I hate taking medication of any sort, and I really want to minimize the stress on my liver and kidneys.
Just to be clear, once levels have dropped and crystals have had time to dissolve, I’m looking to stay anywhere between 5-6 mg/dL? Is anything under 6 considered to be too low for crystal formation/accumulation?
So irrespective of gout, dietary guidelines recommend moving from saturated fats in cuts such as pork belly. And that is doubly important for gout sufferers. As for beef, chicken, and pork being “pretty close in purine content”, that is roughly true. And especially so for gout patients on allopurinol. But it still avoids the context of starting with a good eating pattern that gives balanced nutrition by considering weekly and daily allowances. Then you can make choices about individual foods within the boundaries of weekly total food consumption.
So start with good gout foundation dietary patterns. Or a uric acid eating pattern plan. Then discuss your pork consumption with your doctor in that context. Because there are too many personal variables to give a one-size-fits-all answer to the allopurinol and pork question.