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It is a puzzle with so many people having different views. One thing everyone agrees – it has to be below 6.0mg/dl. Even the Allopurinol information by the drug companies say that.
The question is – how much low should we go and does it depends on the history of Gout for the patient?
I visited the specialist today and told him about my UA numbers of 4.3. He was happy that numbers are so low but was concerned that it should not go too low like below 4. He feels that aggresive treatment is needed for those who have tohpies or a history of more than 2 attacks a year without any visible trigger( like toe injury). It is not for everyone.
He said Uric Acid is critical for body and those having slightly higher UA levels, say 7, would have their body functions adjusted to slightly higher levels as compared to someone who has level of say 5.
Lowering it too much may have negative impacts on some other essential functions, hence it is to be weighed aganist the benefits. For example, for recurring Kidney stones, level of below 4 is also OK to avoid Kidney damage. He feels that for someone having history of one or two gout attacks, the levels of 4 is low. In his opinion, level around 5 is ideal with medication and diet control. The diet control in first 6 months is more critical and then it can be relaxed.
He told me to monitor the UA number and if it gets too low like 4, reduce the Allopurinol dose and bring it to the range of 4.5 to 5, not through eating high purine food though in first 6 months.
Any thoughts /comments/suggestions? What could be negatives of getting too low on UA numbers.
It's definitely interesting. My last 3 tests on 300mg of AP were 4.0 (lunch), 4.7 (dinner) and 3.8 (after fasting for 10 hrs).
I don't think there are negatives associated with too low a uric acid level…most species don't excrete any at all any because they have enzymes to instantly convert it to allantoin which is readily soluble.
Excretion of urea, allantoin, uric acid are ALL ways that species get rid of poisonous nitrogenous wastes because ammonia, the first product of protein breakdown, is highly poisonous.
But your doctor is wise because what he is not saying is that while there might not be harm from too low a number there MIGHT be harm by the methodology employed to GET that number. He is operating from the baseline that the less allopurinol, the better.
What is clear is that uric acid is a poison with only a very few useful functions…it helps people with MS MAYBE. It is implicated in hypertension, kidney disease, heart disease, diabetes and the SOLE cause of gout. If we all had serum uric acid of 3.0 we'd all be a lot healthier BUT not if we had to take 1000 mg./day allopurinol and 2 grams of probenecid to achieve it.
These “desirable” uric acid numbers are generated by averages and the averages are for a society that eats far too much meat in the opinion of many. Certainly far more meat than was consumed by the average Joe 200 years ago who had Sunday chicken. The pcsture of Henry VIII with his bandaged leg chewing on a leg of lamb is valid.
It's like somebody in a society where EVERYONE smoked (like 1950 America
) with a horrible hacking cough and his doctor tells him to cut down from 2 packs a day to 1. The FACT is the right amount of cigarettes is ZERO but society accepts norms.Another parallel might be that people live very long if they have blood pressures of 100/60. But if they normally run 150/95 and to achieve the 100/60 they needed to take a beta blocker, an ACE inhibitor, an angiotensin receptor blocker, several diuretics, and a calcium channel blocker while popping nitrates under their tongue, they WON'T live very long.
So your doctor is compromising saying that you could have attacks at 6.0 but probably won't at 5.0, and if you need to get rid of tophi you might need 4.0 but that is good enough. Nothing BAD about a 3 but no need to slave for it.
What about the role of UA in the immune system as an anti-oxidant , as discussed on here, a while back?
While not worth risking gout or other bad effects -a too low level UA may not be optimal on this account… also -extremely hard to detect on any negative effects in the immune dept., I would hazard!
trev,
I always leave any talk about anti-oxidant advantages to others. I am a chem engineer with biology and medicine as hobbies and to me an anti-oxidant is a reducing agent like wood and paper and sodium. It is burned by an oxidizing agent like oxygen or chlorine. All life is basically a cosmic interplay of oxidation-reduction (Redox.)
If anti-oxidant means a substance capable of stopping oxidation in the body, then the very best anti-oxidant is a large dose of cyanide…all oxidation will stop instantly as the deoxidzed person hits the floor for the last time.
Not to offend anyone, but to me “anti-oxidant” is merely the latest buzzward to sell junk supplements…today's copper bracelets, and mercury treatments.
Now, in uric acid's praise I must say that I have seen a couple positive correllations between IQ and high uric acid.
How, what, why, where, when…don't ask. But it DOES seem we are all pretty smart.
On the immune system: I guess none of us has any doubts that uric acid can “stimulate” the immune system but perhaps it's in the same way that pneumococcus, cholera, tetanus, or influenza can. After all what is a major gout attack but a really GOOD stimulation of the immune system while it tries to remove a toe? Perhaps “TORTURE” might be a proper synonym for “stimulate.”
I think the emphasis is on 'Free Radicals' here Zip.
There's a lot of chat about these and I must admit- there's some hype too.
By lateral thinking, I would say that the ease of producing vitamins (many of them antioxidants-or immune support) would make them a poor business market compared to drugs and therefore their relative value could be judged higher ie:Cheap & backed by much anecdotal evidence and often very necessary for health.
Death by Scurvy or a Vitamin overdose are not the only positions one can hold- so with your sharp intellect could you appraise the possible role of UA in free radical erasure?
Without this argument satisfied it's not possible to downgrade the risk of too low a UA level.
Oh! & and I nearly forgot- possible lowering of IQ too…
cjeezy said:
It's definitely interesting. My last 3 tests on 300mg of AP were 4.0 (lunch), 4.7 (dinner) and 3.8 (after fasting for 10 hrs).
Hi cjeezy,
I tested UA again today morning. This time, I had a cup of tea with 3 cookies and then went out for a walk of about 3.5 miles in 50 minutes. I did not have any water during the walk.
Came back home and tested it within 15 minutes of the walk. The reading is 4.4 mg/dl. I was trying to see what would be the effect of the exercise.
One interesting fact is that my readings have been very consistent in last 4 days. It was 4.3 on 9/28( lab reading was 4.4) with 5 hrs fasting, 4.2 on 9/30 tested 90 minutes after lunch and 4.4 today 10/1 after 50 minutes walk. I will test in the night and on fasting to see what the readings are.
I do not know if it is good or bad to have consistent readings and what does it really mean?
Since we are in a very similar situation and have generated similar numbers on similar AP doses, it wouldn't surprise me to see your numbers fall around 3 after fasting in the near furture. I think consistent readings are good, however I had consistent readings of 4-6 for 2 weeks and still ended up having an attack. I think numbers consistently 4 to low 5's is very good since you'd never be approaching the 6.4 mark. Keep us posted on how you do
I think the debate is going on if it should be 3 or 4 as the minimum level. Some interesting facts are coming up though like the oxidation theory and immune system impacts.
You and I both seem to be new Gout patients and we may not have that many tophies or crystals to resolve. So, we may be OK with 4 plus numbers or near low 5 like you said.
Any thing more than low 5 means strict diet control till time we get them below 5.
Quote – Any thing more than low 5 means strict diet control till time we get them below 5.
I meant – diet control or medicine.
trev,
All chemical reactions occur at the instantaneous free radical stage. Thus all oxidation by oxygen is by NASCENT oxygen or O+ or even O3+rather than the sleepy O2.
The term “free radical” has no more meaning than “anti-oxidant.” Both exist and neither is a selling point for unnecessary chemicals. Without oxidation by free radicals life is IMPOPSSIBLE. Usually when someone uses the term free radical or antioxidant he is saying to me that he has no background or training in chemistry but rather is fond of paperbacks advertising quack cures for something pill or other or other, usually ascorbic acid overdose.
Selling voodoo meds using terms like free radicals or antioxidants doesn't change the fact. The terms ALWAYS change to make nostrums sound NOW. I am curious how they sold radium treatments for arthritis or bloodletting for schitzophrenia.
cjeezy, of course 3.0 is safe…and probably fleeting…enjoy it
And yes, Utube…a steady 5.0 is fine, proably 6.0 is also okayish but diurnal swings to 7 is not.
So what we want is control to a number that guarantees us freedom from ALL gout atttacks! Nothing more or less is required. But I doubt there has ever been a death to anyone caused by a uric acid of 2.0, if such a thing is possible.
While 5.0 or even 6.0 may help me be gout free “most of the time,” that is not good enough for me. I want to live gout free “all the time.” I want to exercise, eat and drink what I want without worrying about this stupid disease. So I guess it just boils down to what's your magic number and how much do you want to put with? A UA of 5.5 isn't helpful if it jumps to 7 while I sleep :). Maybe I'll I'll eventually try and ween back down to 200mg of AP, but I think I'll worry about that once I can go a while without any pain
Once established on Urate Lowering Therapy and through the bad patch maybe it's just fine tuning.
Gout tendency is a liability and it's not reasonable to expect to carry on as before it occurs. Zip hits the trail with gusto and knows the risks-personally I think to fight ones body or overload it is counterproductive. Grab life by the throat -but prepare for the 'reverse flange' 🙂
Drugs are very useful and pain is something to avoid with all due dilligence- in the end drugs can't cover for an imbalance in lifestyle. They are not magic, neither do they come cost free!
I'm sure , as mentioned many times on here by others ,that diet and lifestyle are important whether ULT is used or not- Gout is just a rather sharp reminder that we are all on a knife edge, often without wanting to think about it, and it certainly sharpens the focus.
I'm glad that, nasty though it is, there are many things worse in life.
Till the next time that is … but in the meantime if some sufferers can manage gout without ULT then the same processes can be used to work with drugs & with higher success.
Absolutely trev.
For myself I am reasonably sure that I could be completely gout free with zero antigout meds but for one single fact of my life. My blood pressure goes up dramatically in the absence of a daily diuretic. I am a salt sensitive volume driven hypertensive and there is no diuretic that doesn't cause the retention of uric acid by the kidneys. My gout was, plain and simply, caused by a decade of hydrochlorothiazide…nothing more, nothing less.
If I COULD stop eating salt I could stop both drugs but I CANNOT conceive of life with less than 2 grams of sodium unless I spent all day in the kichen preparing everything I made from scratch…and then suicide would become a risk factor to consider.
So for ME, my diet/gout/allopurinol analysis must always include the hypertensive risk of stroke, heart attack, or kidney damage. I curse diuretics but in the same way that some diabetics probably curse their daily insulin. At least I am happy to have found Lasix (furosemide) which according to a couple sources raises uric acid only a quarter as much as thiazide.
I'm surprised some enterprisingly rapacious pharmaceutical company doesnt patent a combo drug: allopurinol-hydrochorothizide. They could call it PISSURIL and sell it for $5 a tab. Remember, you guys are my witnesses…I thought of it first so you may need to testify on my behalf against Pfizer or Merck.
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