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  • in reply to: BBQ veggies #21721
    Keith Taylor
    Keymaster

    Personally, I cannot see how such small amounts of food can have any affect on gout diet.

    The right approach is to analyze total diet. Then review with respect to the 5 bad foods for gout. Or, at least, the most important 3.

    Cooking methods can affect purine content, but so can season, variety, growing conditions. Micro-managing all these small diet factors will not change uric acid significantly. It’s best to consider 3 of the 5 main factors:
    Purines – sounds to me that by reducing animal purines to an occasional treat, you’ve done as much as possible. Increasing alkalinity might improve purine excretion slightly. It’s a question of personal testing.

    Calories: There’s an issue of socially acceptable weight vs medically advised weight which we’ve discussed here in the dim and distant past. An ideal weight for gout is commonly viewed socially as being very thin. Nevertheless, the facts indicate that BMI of 18.5 is best for gout. For six-footers, that’s 136-7 pounds. That’s related to purines, as most uric acid comes from purines in our own flesh.

    Iron: Iron metabolism in food is very complex, as not all of it raises blood levels. One sure-fire way to combat excess iron is blood donation

    FFAs are more to do with controlling gout attacks than uric acid. The “bad habits” such as dehydration, processed foods, fasting and feasting should always be avoided.

    If sensible approaches to the three main diet factors don’t reduce uric acid enough, then there might be a benefit from supplements. But I feel that those follow healthy diet, not replace it.

    in reply to: Your GoutPal Suggestions #21698
    Keith Taylor
    Keymaster

    The GoutPal Suggestion Box is now up and running.

    I’ve added one suggestion, just to test that it works OK. You can add comments to this suggestion, and add your own suggestions.

    You might not have any ideas about improvements, but you can certainly tell me what you think about each idea with the simple rating system. Please review each Idea when you see it. You can make sure you see all new ideas by subscribing to my gout forum update service. You can rate each idea with 1 to 5 stars. The stars in the rating system mean:

    1. ☆ – Bad
    2. ☆☆ – Poor
    3. ☆☆☆ – Regular
    4. ☆☆☆☆ – Good
    5. ☆☆☆☆☆ – Gorgeous

    Please let me know how I can help make my gout support services better for you. I’m offering a $20 Amazon voucher to the first person who makes a suggestion that gets 20 5-star votes. I will make suggestions, but these won’t be eligible for the prize.

    in reply to: My first gout attack #21696
    Keith Taylor
    Keymaster

    Hi Carol,

    I’m pleased to know you’re going to get a uric acid test. I can’t wait to read the results.

    I was told recently that I’m lucky to only have gout! Whilst that’s not strictly true, I certainly don’t have health issues that might compromise my treatment plan. I am aware that certain gout medications are restricted. It’s important to know about other health conditions that might affect gout treatment. Other health conditions and medicines for non-gout issues will complicate most gout treatment plans.

    I’ll consider your complications when we get your uric acid test results, and start planning the best way to stop your gout. While we wait for your results, I have a couple of points.

    Weight loss can help gout a lot, but it is best to do it gradually. One or two pounds a week is best. It doesn’t sound much, but over a year it makes a tremendous difference. And weight lost slowly is more likely to stay off – as long as it’s due to healthier eating, and not some unsustainable diet ‘tricks’

    Turmeric is good for inflammation, but I don’t think it is much use in a full-blown gout attack. At this stage, for pain relief, I feel the complications need the input of your doctor, or a rheumatologist. I would normally recommend colchicine, an anti-inflammatory, and a pain-blocker for any residual pain. If you get chance, your doctor or a pharmacist should be able to advise you about gout-strength pain relief that is safe with your medical history and other medicines.

    in reply to: The Pain on taking Allopurinol #21693
    Keith Taylor
    Keymaster

    Hi Aki, and thanks for sharing your thoughts about allopurinol, colchicine, and Arcoxia (etoricoxib). We don’t hear much about that anti-inflammatory in UK or USA, but it might be common in Malaysia and other countries. In that discussion that I linked to, and other Internet sources, it suggests that the best Arcoxia dose for gout is 120mg per day. I think you should definitely discuss this with your doctor. Whilst you are there, ask about compatible pain-killers that you can take alongside Arcoxia.

    When do you take the 2 colchicine? I think it’s best to take one at night, then, if you need it, take another in the morning. Again, it’s a good idea to ask your doctor about this.

    It’s a good idea to drink lots of fluids when you are taking allopurinol. Usually there’s a recommendation in the patient information to drink a certain amount. I believe, rather than a fixed amount, you should aim to keep urine the color of pale-straw.

    The thing that puzzles me most is the idea that you would get more attacks as uric acid goes lower. I can see that, at least in theory, low uric acid should cause more crystals to dissolve. I’m struggling to understand how this is a bad thing. In my mind, it’s good to dissolve crystals as fast as possible. I guess it’s easy for me to say that, as I learned how to control my gout pain many years ago.

    My choice was to take allopurinol well below 5. In fact, I insisted on maximum allopurinol to go as low as I could. I haven’t kept my records very well, but I think I got down to around 3mg/dL. I’m not saying this is right for you, Aki. I just wonder what you think of my way, compared to yours.

    Obviously, forum discussions are not science fact, and every gout sufferer is different. But, the zone that I warn against most lies between 5 and 7. In that zone, you can easily get to a situation where uric acid crystals start dissolving. That increases the level of uric acid in the blood, which could start the crystallization process again. Obviously, this is just my theory, so I’m very interested to know other people’s opinions.

    in reply to: Allopurinol #21692
    Keith Taylor
    Keymaster

    Mate, don’t take this the wrong way but…

    I’d rather deal with gout on a yacht with Stella, than in a Bradford Council death-trap with a wife that hates me! #JustSaying 😉

    in reply to: Allopurinol #21690
    Keith Taylor
    Keymaster

    Barry! Is there ever anything minor about brain surgery? After that, gout should be a walk in the park. You seem to be coping well with uric acid lowering.

    I’m sure, with our encouragement, @dennis will have great success. A 4 week gout attack is extreme. It just shows, you can never really give a general answer to the “how long does a gout attack last” question. Gout is very personal.

    in reply to: Allopurinol #21682
    Keith Taylor
    Keymaster

    This is turning into a great discussion about the psychology of allopurinol. First, I should warn I’m about to have a rant here. It is definitely not aimed at Dennis or Barry. It’s a general rant about misplaced fears of allopurinol. Those fears are fueled by ignorance spread by certain sections of the medical community. Aye, ’twas Barry’s mate’s doctor what set me off!

    Scared of allopurinol – I take that to mean scared of another gout attack. But, you are *not* bound to get more attacks with allopurinol. You *are* bound to get more gout attacks if you don’t control uric acid. The resulting uric acid crystals will bring much, much worse.

    I’m not sure if Barry’s apprehension was pain-related. My apprehension about starting allopurinol was the fear of turning into an old man who’s only raison d’etre was to discuss his daily lifelong meds. Fears of allopurinol = fears of old age.

    Barry’s mate’s doctor epitomizes the strange attitude to allopurinol that it is meant to stop immediate gout attacks. Is attitude part of psychology, or is it philosophy? No matter – this attitude is bloody stupid, and from a doctor too!

    Allopurinol exists to lower uric acid. It has a reputation for scary side-effects. But now we know that these are largely genetic-based, and can be screened for. Healthy fear of dangerous side-effects is one thing, but what’s with the fear of pain? You’re gonna get the pain anyway when the next attack comes from untreated gout. Then you’re gonna get more pain, as uric acid crystals cause crippling joint destruction. Then you’re gonna get more pain as uric acid stones rip through your kidneys. Then you’re gonna die when tophi block your heart valves.

    That’s how important safe uric acid is. Gout patients might not understand that, so I’ve made it one of my life’s missions to spread the word. But when doctors and other healthcare workers start putting gout attack treatment before uric acid control, my hackles rise. Are they stupid, or they just trying to make money from gout misery?

    [rant over]

    Sorry Dennis, for hijacking your first post. I can assure you, I’m not always like that. I’m sure I speak for all GoutPal members in wishing you well, as you take control of your gout. It’s a great feeling when you realize you’ve done it.

    Despite my rant, it’s natural to be apprehensive. As Barry has so brilliantly shown, we’re all rooting for you. Any time you have any concerns, just post a message here. Also, be sure to tell us when it’s going well.

    in reply to: My first gout attack #21660
    Keith Taylor
    Keymaster

    Carol, I ought to add a few other points about your original post.

    You think you might have brought the gout attacks on yourself through certain diet changes. It’s not right to worry about that without considering all the facts. It’s more likely that it’s passed down to you in your genes. Without the full facts, I wouldn’t like to guess, but don’t beat yourself up about it. It’s good to manage meat consumption carefully, but that is just as true for heart health as it is for gout.

    Information about amino acid effects on gout is limited. From what I’ve found so far, they tend to increase excretion of uric acid, and reduce uric acid in the blood. However, I can’t find any gout specific research, so the jury’s out. They are probably not bad for gout, but this type of relationship needs individual analysis. Often factors such as an individuals weight, uric acid level, eating habits, and exercise levels can change things like amino acid supplements from good to bad.

    Spinach is generally good for gout, but again, it has to be assessed on an individual basis with respect to total diet, and the factors I mentioned for uric acid.

    I think a simple approach is best for gout diet. Start with a good healthy eating plan. That’s also a good starting point for a range of diseases that are associated with gout, such as obesity, heart disease, diabetes, and high blood pressure. Once that is in place, it can be tweaked for better gout health, without increasing risks for other diseases.

    Then, we can consider appropriate supplements where your individual needs suggest they might be beneficial. I believe supplements are only useful when you can identify specific nutrient deficiencies that can’t be achieved by changing food choices.

    in reply to: My first gout attack #21659
    Keith Taylor
    Keymaster

    Thanks for that information, Carol. I understand your situation now.

    Carespot Urgent Care deal with day-to-day wellness issues. Great if you’ve got a burn or bruise. Not so good for a lifelong disease such as gout. They are set up to treat your pain, so it’s in their best interests to keep the attacks coming back. They won’t earn a cent from you if you control your uric acid properly, because you’ll never have pain again.

    I’m tempted to rant about the injustice and inhumanity, but I’ll wait until I’m asked. What I need to focus on is getting you safe from further attacks. That means managing your uric acid, so you will have to get tested.

    I’m so unhappy about all the bad information you have been given, but me moaning about that isn’t going to fix your gout. I can explain why the info is bad if you want me to, but I’m trying to encourage you to start again with a new strategy.

    How do you feel about starting with a uric acid test? Is it easy for you to arrange one? Or do you want me to explain why it is important?

    in reply to: Years of numbness before attack? #21649
    Keith Taylor
    Keymaster

    I’ve just closed down the only other discussion of numbness associated with gout. That was about numb lips, and someone asked if they could be caused by gout. At the time, I thought it unlikely, and I could not find any medical references to it.

    I still cannot find any medical references to numb lips caused by gout. But I now know more about the insidious nature of gout. It really can affect any part of the body (probably with the exception of the brain). As such, I’m not sure how much value there is in discussing specific parts of the body. I’d like to get a better understanding of gout numbness in general before I repeat anything like my earlier statement:

    Numb lips are much more likely to be something else. It is very common for gout sufferers to have other medical conditions.

    To restart the discussion of gout numbness, I’d like to ask other gout sufferers to describe there experience of numbness.

    in reply to: Black cherry juice #21638
    Keith Taylor
    Keymaster

    The first takes some thinking about, and the second is untouched. 🙂

    Sorry, Ervin, I couldn’t resist.

    Please can you give me a bit more information about yourself and why you are asking, so I can respond properly.

    in reply to: Uricol #21637
    Keith Taylor
    Keymaster

    Do you mean Uloric, Sam?

    in reply to: Gout levels #21636
    Keith Taylor
    Keymaster

    Hi Parker,

    I agree with everything Ron says (apart from his spelling of Uloric! Sorry Ron 😉 )

    If you are not having gout symptoms now, you don’t need medical intervention. I guess there is an argument for early intervention to avoid pain in future. For now, I recommend a watching brief.

    In many cases, this is an early warning that your lifestyle needs a makeover. What’s your weight and diet like?

    in reply to: My first gout attack #21635
    Keith Taylor
    Keymaster

    I don’t understand who diagnosed your first gout attack.

    Please can you explain your gout diagnosis, together with your uric acid test results. When I have that information, I can start to put a plan together to help you control your gout.

    in reply to: Gout Pain #21634
    Keith Taylor
    Keymaster

    I don’t know of any alternatives to colchicine, though there may be some in development. In fact, I recently wrote about the potential for an alternative to colchicine. Even if that is likely, it’s many years away.

    For now, as I said in my note on How Do I Stop Gout Pain, just omit colchicine, and rely on anti-inflammatories. Work with your doctor and pharmacist to get the best gout pain package that suits you.

    If you are not sure what to ask your medical professionals, or if you don’t understand their responses, please let me know. I’m here to help you work with your healthcare providers to get the personal care that every gout patient needs.

    in reply to: Intolerable Allopurinol Pain Saved By Uloric #21633
    Keith Taylor
    Keymaster

    Hi Andrew,

    It’s fantastic to know that you can see a way forward with your gout, at last.

    I’m always saddened by doctors that don’t respond well to their patients concerns. On the other hand, I see a lot of bad patients who ignore good medical advice.

    It seems to me that you’ve done the world a great service here. You’re a good gout patient, and care enough to pass great information onto others.

    Gout patients are luckier than they’ve ever been. They have several alternatives to allopurinol now. Uloric is obviously great for you, Andrew. Just be sure to get liver function and kidney function tests at the same time as your uric acid blood test. If your doctor is as poor as he seems, he might forget these important gout tests.

    Thanks for sharing!

    in reply to: mushrooms #21632
    Keith Taylor
    Keymaster

    Hi Kelly,

    I hope I can make the information less confusing. I assume that the page you refer to is http://www.goutpal.com/gout-diet/purine-rich-foods/

    I’ve added a note(4) at the end of that list of high purine foods. I didn’t want to be misleading, but I wanted the table to include all the foods that I have purine data for. It is useful for gout sufferers who want to reduce purine intake to select foods with lower purine counts. So, yes, there are a few gouty purines in that vegetable medley, but not enough to worry about. The addition of edamame makes it even more gout-friendly. If you are still worried, try replacing the mushrooms. How about eggplant or squash? Let me know how that works out.

    I hope the information is clearer now. If it isn’t, please let me know.

    Thank you for helping me improve my website pages. I love it when people take the time to question inconsistencies. By doing so, you help yourself, me, and gout sufferers everywhere.

    in reply to: acute attack – what to do with tophi #21630
    Keith Taylor
    Keymaster

    Hi Tim,

    Squeezing it out is probably the best thing you can do. Otherwise, it’s only going to harden into a solid lump that might cause you problems with footwear and walking. As your skin has burst, you need to be careful about infections.

    Tophi are a clear sign that your gout is seriously out of control. This episode has damaged the largest organ in your body – your skin. The spread of uric acid crystals will not stop there. All organs are targets, except the brain. You’ve spotted the tophi in your toe, as it got large enough to see. Those in your kidneys, heart and other organs are growing every day.

    As soon as you can, you need to get uric acid down to safe levels. Long term, that means no higher than 5mg/dL. For the first year, you should aim much lower. That should get rid of the microscopic tophi that are set to cause damage throughout your body, before they become noticeable.

    in reply to: Gout and Itching #21610
    Keith Taylor
    Keymaster

    I’ve just rediscovered this thread about gout and itching.

    We introduced acupuncture here first. Since then there have been several discussions of the benefits of acupuncture for gout. In this context, acupuncture was introduced as a potential treatment for itching. @odo made the point:

    • No need to delay acupuncture, as it will not have an adverse effect on any other treatment; in fact, will probably make everything else work much better. I can understand why people might not want to take herbs when starting meds, which is why I only mentioned acupuncture.
    • As forums do, we digressed to general aspects of Traditional Chinese Medicine for treating gout. I’ve moved those to a new thread: Traditional Chinese Medicine for Gout.

      Returning to discuss how gout causes itching: what do you think about the number of gout sufferers who reported itching as one of their gout symptoms?

    in reply to: How do uric acid crystals cause different pain? #21579
    Keith Taylor
    Keymaster

    That’s a brilliant question about colchicine, Barry. I’m sure I’ll be thinking about that for months.

    My understanding so far is that colchicine reduces the ability of white blood cells to split and multiply. That process triggers inflammation, so colchicine effectively stops inflammation getting worse, or at least slows it down. This is obviously not the best way to treat our immune system. Doctors justify this, as with just about all medicine, by balancing the risk. So, the argument for colchicine is that a little bit of immune system poisoning is justified if it stops the immobilising agony of a gout attack. The argument against is that it reduces the number of white blood cells available. Balancing those two things is an individual decision, that might vary depending on your stage of a gout attack and your stage of gout treatment. In the past, colchicine has definitely been oversubscribed. I hope modern doctors are aware of the need for caution when balancing the risks. They should always limit prescriptions to no more than two colchicine a day.

    I usually add a caution to avoid colchicine if you are at risk of infection. I believe this as I think you need the best available white blood cell army to fight any bacteria or viruses. Until today, I never thought about colchicine compromising the ability of white blood cells to engulf uric acid crystals.

    This is quite complicated to me, because I don’t think that uric acid crystals should be there anyway. If white blood cells merely hide them, is that good or bad? Maybe there are enough cells in most cases to deal with free uric acid crystals, and the intense inflammation might be an over-reaction?? I just don’t know. 😕

    I think it’s always right that the patient should choose whether to take prescribed treatments, but the doctor should explain the risks so we can make informed choices. I feel it’s my job to try and see things from the patient’s and the doctor’s points of view. Then try and agree a plan that best balances medical risk and patient aspirations.

    I take it seriously because I love problem-solving (nearly 50 years as a Sherlock Holmes fan). I have been affected by gout physically and mentally, but I learned to deal with it. Mentally, I’ve been more affected by the terrible lack of consideration, communication, and care that exists in the world of gout. Some days it’s frustrating, but I always enjoy the challenge. This latest challenge – the curious case of the colchicine and compromised white blood cells – is fascinating.

    Maybe I should get out more 😉

    in reply to: How Long For Food To Trigger Gout? #21575
    Keith Taylor
    Keymaster

    Though quite old, this topic is still very popular. Things have moved on. As I responded recently to a related question about the length of time for a meal to affect gout:

    1. How quickly do uric acid levels respond to purine intake?

    Just a few hours. If you eat a meal rich in animal purines, uric acid crystals will rise within a couple of hours and peak a couple of hours later. It varies from individual to individual. I?ve got some specific research on this if you want the details. I?ve learned that speed of purine metabolism is not particularly important, except for the timing of uric acid tests. Temporary uric acid highs will not usually cause gout flares. Uric acid crystals grow very slowly, and gout flares are usually triggered by something else. Never forget though ? if you have no uric acid crystals, you cannot have a gout flare. The thing that is most overwhelming here is the “something else”

    Scientists are learning about new triggers, and getting better understandings of how a gout flare starts. Because there are many factors, in real life, the start of a gout flare seems random. Despite that, we all tend to get hung up on avoiding gout triggers. That is a truly overwhelming task. My best advice is to split your gout management plans between long term control of uric acid, and short term control of gout pain. That applies whether you choose pharmaceutical or alternative treatments.

    So, what does this means in relation to the original question: How Long For Food To Trigger Gout?

    If we’re talking purines, it’s many months. After you eat animal purines, uric acid levels rise in around 2 hours. But that rise has no immediate effect, other than to change blood test results. Even when the uric acid crystals do form, there is evidence to suggest that crystals alone do not cause gout attacks, or at least not in mind. Current thinking is that it is likely to be Free Fatty Acids (FFAs) that stimulate our immune system to attack invading crystals. One FFA, stearic acid, has been identified as a contender. Other FFAs might have a positive or negative influence on our inflammatory response.

    The best thing you can do is to observe your own reactions. Make notes in your Personal Gout Profile if you really must understand how long it takes for a meal to affect your gout. But never let such minor temporary details deflect you from the main task in gout control – keep your uric acid safely down at 5mg/dL (or whatever is your appropriate personal target).

    Also, see explanations in Dangers Of Gout Triggers.

    in reply to: How do uric acid crystals cause different pain? #21574
    Keith Taylor
    Keymaster

    That’s a great question Barry, so I’ve split it from Tom’s post so it doesn’t get caught up in discussion of allopurinol and blood test results. I’m now going to try and explain the concept of uric acid crystals and different pain levels.

    The science is confusing, and a lot of recent research reveals that we are only just beginning to understand the complexities of gout pain.

    It’s all to do with our immune system. I understood the basics of this when I saw the white blood cells attacking uric acid crystals at http://www.goutpal.com/1810/uric-acid-crystal-pictures/

    That made me realize that gout is an immune system disease. Nothing to do with “needle-like crystals” grinding into your joints. Having realized that, it’s the key to why we might get gout flares during the first few months of lowering uric acid. It also partly explains why some people see tomatoes as bad for gout – they’re probably lowering uric acid and releasing old crystals.

    Because I bang on about it so much, many GoutPal visitors now know that dissolving uric acid crystals might cause a gout flare. We accept it because we know the importance of getting uric acid safe. But the actual pain process is very complicated. It relies on signalling processes within our immune system that the brightest brains on the planet are just beginning to understand. I’m struggling to learn all the terms involved in cellular human biology. Macrophages, leukocytes, interleukin are foreign to me, but one day I’ll understand it well enough to explain to a six-year old.

    As I understand it, white blood cells attack free uric acid crystals. Once they’ve engulfed them, the coated uric acid crystal is hidden from the immune system, and inflammation stops. The complex stuff is why inflammation happens. Not all white blood cells are alike, and they can change. Some promote inflammation – presumably to signal for more reinforcements. Some inhibit inflammation. The organic chemical reactions that form the signalling processes are beyond my understanding at the moment. However, I do know that other substances, besides uric acid, are involved in the process. Recent research suggests that Free Fatty Acids (FFAs) are probably involved. A study on mice showed that uric acid crystals alone do not produce gout flares.

    One way I try to think of it is like fire. We heat our homes as safely as we can, but if fire gets out of it’s cage, we call for help. We might first try to smother the flames. A wet tea towel on burning toast is probably enough to combat the risk, but what about the smoke? That might be a signal to nearby people to lend a hand. But what about our fire alarm, or smoke drifting out to the attention of neighbors? It’s easy to imagine several scenarios from “No Dramas” to “Fire Service wrecking the house” Different signals produce different situations, and that is what’s happening with our immune system tackling the threat of uric acid crystals.

    I’m not going to pretend that this shoddy explanation will enlighten you, Barry. But, I’m hoping it will lay the foundation for the sort of discussion I love. We’re pushing boundaries here my friend.

    I’d better finish with an @bazzer mention to ensure you know I’ve moved your message here.

    in reply to: Folic acid and gout #21532
    Keith Taylor
    Keymaster

    Though this is a very old post, I’ve decided to see if there is still any interest in folic acid as a herbal medicine for gout. The first two posters are no longer members, but I’m sure other gout sufferers are interested in folic acid for gout.

    I’ve had a quick look to see if there is any recent research about the effects of folic acid on uric acid. Previously, I couldn’t find anything conclusive. That hasn’t really changed, though there could be good news for the many gout sufferers who also have high blood pressure.

    I’ve seen old references that suggest that folic acid could be a xanthine oxidase inhibitor. A kind of natural allopurinol!?? However, real facts are hard to come by, and the main reference for folic acid and uric acid I found is quite certain that folic acid does not lower uric acid:

    [folic acid] administered in doses up to 1000 mg orally a day did not significantly lower the serum urate concentration

    At least that study found no toxicity with high doses of folic acid.

    A recent investigation on high blood pressure patients reveals that folic acid combined with enalapril does reduce uric acid. Enalapril is marketed as Vasotec or Enaladex. The study, Effects of combined enalapril and folic acid therapy on the serum uric acid levels in hypertensive patients: a multicenter, randomized, double-blind, parallel-controlled clinical trial, concludes:

    the present results demonstrate that the administration of a daily dose of 0.8 mg Folic Acid combined with enalapril, compared to that of enalapril alone, may be beneficial in lowering the serum Uric Acid concentrations in patients with baseline elevated Uric Acid concentration or hyperuricemia

    I’m left wondering if folic acid for gout is best used in conjunction with other compounds. Combinations are often used in medicine to get more effects than can be achieved by individual compounds. Another point revealed in this report also has me wondering about how research has been conducted in the past. This study divides groups between different uric acid levels. The medicines were much more effective at lowering uric acid where it was higher at the beginning of the trial. In fact, for the group with the lowest starting uric acid, there levels rose very slightly after taking the medicine.

    So, I’m pondering these folic acid issues, and also wondering if food folates are more effective than folic acid supplements. Whilst I ponder, I’d love to read your thoughts on folic acid and gout.

    in reply to: Allopurinil #21527
    Keith Taylor
    Keymaster

    @tdeffley – Tom, it’s good to see you are getting proper medical care now! I’m looking forward to seeing better results from your future blood tests.


    @bazzer
    – Barry, it seems like you’ve struck lucky! You’ve got a doctor who understands what is needed to keep you safe.

    I hope both of you can take the time in future to keep everyone updated about your progress. It’s really useful for the silent majority to see that gout can be controlled easily if it’s managed properly.

    in reply to: re introducing animal proteins #21525
    Keith Taylor
    Keymaster

    It’s very hard for me to take one food item, such as chicken, and give sound advice that suits your individual diet. Of course, the Internet is full of people who think otherwise. Some will tell you to avoid all meat. Others will say small amounts of chicken in moderation are OK.

    I say, it’s all about balance. Small amounts of chicken in a balanced meal as part of a healthy eating plan are OK. A meal that is almost all meat is never good for gout sufferers. This raises as many social issues as it raises health issues. Many people see the healthy approach to meat eating as too restrictive. There are various recommendations about how much meat you should eat per day / week / month. I believe the best approach must be personal.

    To keep it as simple as I can for now, I recommend a maximum of one or two 4oz portions of chicken per week. Then compare uric acid test results to try and see the effect. This is hard, because other changes in your diet might affect results. Therefore, you get better data by repeating 2 weeks on, 2 weeks off.

    Protein is mainly good for gout because it encourages uric acid excretion. But there are two potential problems:
    1. Protein is acid forming, so it meat should always be balanced by 4 times more plants (all part of alkalizing gout diet menus, which I’ve touched on before)
    2. Total calorie intake is important because excess food produces more flesh in your body, and that meat becomes a rich source of uric acid. Therefore, removing skin, and cooking methods that don’t involve added fat are important.

    Safer proteins are those that do not contain animal proteins. Skim milk, whey protein, and fava beans have all been shown to have uric acid lowering properties.

    I think this is just a start, Dorian. I’ve been very busy this week, but I hope I can find more time after next week to provide more detailed help if you need it. I’m thinking of recipes for meat with good acid alkaline balance and better protein balance. Also, some of the research that I put on GoutPal.com about weight loss and lower uric acid is a bit dated. I must see if there are newer, and better, references.

    in reply to: Allopurinil #21518
    Keith Taylor
    Keymaster

    Tom, I’m wondering if the naproxen is a prescription dose, or are you self-medicating? It’s not my place to question your doctors instructions, but 250mg per day is much less than the usual gout dose. Gout is one of the most painful inflammatory diseases, and usually requires an appropriate dose of anti-inflammatory.

    As for your uric acid, the British Rheumatologists recommendations are very clear. Your allopurinol dose should be adjusted upwards in order to maintain a maximum uric acid level of 300 μmol/L – I would recommend a year lower than this in order to dissolve old crystals faster. It is common in the NHS for doctors to be unaware of this as I found at my group practice. I saw 3 doctors who were quite happy to leave me in the 400s, until I found a 4th doctor who took the trouble to get it right.

    It’s a bloody disgrace.

    in reply to: Gout attack #21517
    Keith Taylor
    Keymaster

    1 colchicine and an NSAID such as ibuprofen, naproxen, Indocin, or similar, as prescribed by your doctor at the recommended dose for gout.

    Next morning, repeat if your gout attack persists.

    Ask your doctor or pharmacist. about a compatible painkiller that can be taken with your chosen NSAID, e.g. paracetamol. If pain is still unbearable 2 hours after taking NSAID, then take the additional pain relief.

    in reply to: trying to get a personal gout treatment plan #21513
    Keith Taylor
    Keymaster

    Hi Dorian,

    I do not have a ‘formal’ treatment plan template, because each gout sufferer’s needs are different.

    Instead, I make note of the history and facts that you record in your gout profile. I use this information to advise you of different options for treating your gout. It is important to record as many relevant facts as you can in your profile.This should include every uric acid test result, with dates. It should also include any herbal medicine that you take, with dosage.

    I know you have ruled out pharmaceutical treatments, so I will proceed to advise on your other choices. Most significant for now is diet. Again, I do not believe in a “one size fits all” diet plan. Good gout diet is all about permanent changes to eating habits, and it must include foods you like, and avoid those you do not.

    Let’s start with your gout profile, and let me know as much relevant information as you can. In addition to what I’ve mentioned, I also need to know your height, weight, and activity levels.

    The daily sequence would be to update your profile, then post questions, opinions, or experiences in the forum. This need not be every day, but less than 3 days a week is usually insufficient.

    Keith Taylor
    Keymaster

    Hmmmm. Some of the authors of the Horopito/Winter Bark report have also released another gout study with more explanations of cellular biology in gout.

    I think I need to review my layman’s explanation of the inflammatory gout process and how to inhibit it. There are all sorts of scientific phrases that are a little headache-inducing, so I need to study “Colchicine suppresses neutrophil superoxide production in a murine model of gouty arthritis: a rationale for use of low-dose colchicine – a gouty story of mice and colchicine.

    One thing’s for certain – there are some diligent researchers looking at better understanding of the gout pain process, and new ways to treat it. As gout sufferers, have we ever had it so good?

    in reply to: Too Young for gout! #21486
    Keith Taylor
    Keymaster

    So, Squilliam, you were right in your headline – you are “Too Young For Gout!”

    Really good to hear from you again, especially with such good news. I hope you’ll continue to keep us updated every few months. It’s very encouraging for other gout sufferers, especially young gout sufferers, to see you overcome the difficulties. I know there’s only you and I in this discussion, but over 40 people per month are interested in your progress.

    I wonder if the silent viewers are as inspired by your progress as I am. Do any of you visitors who’ve kept quiet so far feel like sharing your experience? As Squilliam has shown, if you are too young for gout, you are never too late to control uric acid.

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