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Hi Ron, it’s great to see that you are making progress. Sometimes I get fixated on meeting uric acid lowering targets. But, of course, the true test of Gout Freedom is doing the activities you want to do without worrying.
My gut reaction to your experience is that it’s a short gout flare. Probably a clump of crystals dissolving that got encouraged to free themselves through your hockey sprints. That’s one more deposit that’s never going to bother you again.
I might be wrong, but that fast-onset pain is more typical of gout than a sporting injury. It fits with my experience of gout attacks passing quicker once I’d got uric acid down to a safe level. I still remember the first time I got a gout attack under control in less than half a day. Bliss.
WOW! Look who dropped by while I was sleeping! Zip, you’ve made my day. 😀 I hope life is treating you right.
What I miss most is your way of getting straight to the point – a great contrast to my endless waffling. Here comes some waffling…
If you mean poor access because it’s sometimes slow, or unavailable, I’m working on moving to a shiny new server.
If you mean you can’t find what you want, or it doesn’t work when you find it, that’s a whole new story. I’m throwing floating orange Support buttons and black menubars, experimental chat boxes, surveys, and feedback forms at it to try and find out what I can do better. I’m trying to work out a way to see what users see so I can make it better. I’m making excuses now, but I find it hard to think like an unfamiliar visitor when I know where everything is. I’m probably over-complicating it.
I guess I’m better at fixing gout than making my knowledge accessible. I’ll focus on that more from now.
Any tiny thing that anyone needs to make fixing gout easier – please tell me.
Hey, Mark, thanks for the inspiration:
Please don’t take it personally, I’m aiming for the group, not an individual.
On an individual basis, I’m puzzled. You seem to know more about gout than most people, so I’m pretty certain that you know the dangers of uric acid at 0.47mmol/L. You hint quite strongly that your ostrich approach is probably not your best option. I hope I can find a way to convince you not to take your ‘do nothing’ option. Allopurinol is a pretty easy option, apart from the psychology. We can talk about that.
Lifestyle changes need more attention to detail, but you might enjoy the challenge of doing that.I’m worried that you’re putting so much store by the joint fluid test. It is the best mainstream test we have, but not 100% certain. Unless you can get access to a DECT test, you can’t have certainty. Without that certainty, you have to do what doctors do every day – balance the risks. You can’t see those risks with your head in the sand.
If it helps, let’s take any current discomfort out of the equation.
You have uric acid at 0.47 compared to the safe level of 0.30. As far as I know, you have no other health conditions that mean you have to settle for 0.36. You are over 50% higher than the safe limit. You have a very strong risk of permanent joint damage. Time period is hard to judge. Let’s say creaky joints in 10 years, mobility restrictions and osteoarthritic pain in 20 years, and amputation in 30 years. There are other long term risks outside of joints, but I’ll leave the organ damage risks for another day.
Balanced against that risk is barriers to lowering uric acid. You should list all the barriers that you can see. We can then discuss if it is a real barrier (psychological resistance to daily medication) or an assumed one (my problem is not gout-related). Is it choice of treatment that’s an issue? We can discuss options between pharmaceutical, herbal, and non-medicine alternatives. Is it cost of treatment? Let’s find a way to break that barrier.
All I ask, Mark, is look above the sand. See the risks. See the barriers. Make a plan, and balance the risks. I’d highly recommend completing your Personal Gout Profile, then for each issue you have, start a new topic. Don’t try to fix every issue in one conversation – it just get’s too woolly. That’s why I push focus onto your gout facts. Your profile gives a structure that we can use to move forward in a positive way. This long rambling thread is masking the real issue – doing nothing is not an option.
Great stuff, Benedict.
I’m confident, from what you’ve said, that your gout will soon be completely under control.
I’m tempted to ask you to make a post every time you have any sign of an attack. But that means that you’ll soon never come here. Why not post every day you have no pain, to encourage other gout sufferers? You’ll soon be here every day! 😀
Hi Benedict,
Without a DECT scan, there’s no way of knowing for certain if dissolving uric acid crystals is causing the pain in sites not previously affected by gout. If it is the cause, and if your uric acid levels are still below 5, then allopurinol will definitely cause more crystals to dissolve, until the risk of gout flares disappears altogether.
At this stage in your treatment, though we can’t be certain of the cause, we can assume that it is dissolving uric acid crystals. This is part of the waiting game. If you know uric acid is low enough, you can be sure that flares will get less intense and less frequent as time passes. If you are still getting discomfort in six months, then it’s time to investigate other possible causes.
It would be good to record your uric acid test results, and allopurinol dose changes in your profile. That way, it’s easier to see how you are making progress. I’m not certain if the 3.1 you mentioned earlier is before or after you increased your dose. I always recommend blood tests within 2 to 4 weeks of a dose change.
Kipper, you seem to be doing everything right. It’s good to know you are safe at 5, and especially good that you are going to keep an eye on your uric acid and get tested again. I wish all gout sufferers would follow your example and get uric acid tests at least once a year, with liver and kidney function tests of course.
I hope my recent website changes haven’t confused you. To log in now, click the link at the left of the black menubar at the top of the screen. Once you’re logged in, the menus change, with many member options on the right, where your name appears.
Hi James,
Getting uric acid safe from 9.5 without medicines is not easy. If you’re prepared to log in to the gout forums, start keeping your Personal Gout Profile, and post to the forum several times a week, it might be possible. You will need to be very vigilant, and be prepared to spend a lot of time trying to find your best food and lifestyle options.
I’m happy to help you every step of the way, but I have to say I’m not confident. I’ve offered this help to hundreds of gout sufferers who say they don’t want to take allopurinol or other uric acid lowering medicine. As soon as they see that it is going to take some effort, they loose interest. I hope you are different, James.
Personally, I go for the easy allopurinol option. For me, this works fine, but I’d love to work with other gout sufferers who want to find natural ways to reduce uric acid. To try and convince you, I have to point out that the slight gout symptoms you are experiencing now will definitely get worse if you don’t get uric acid below 6. You probably won’t notice for several years, but you are bound to be less able to cope than you are now.
There are 2 or 3 easy things you can change, and several more that we can investigate. You’ll need regular uric acid tests and an open mind.
Let me know if this makes sense to you, Jim. How much time per week are you prepared to commit to working with me on a natural treatment plan for your gout?
Hi Mary,
You haven’t given me any information about your gout, so I can’t really help at this stage.
Please log in to GoutPal, then add some facts to your Personal Gout Profile. Then I can see if diet changes will help you, and start to help you create your own personal gout diet.
If you do not want to do that, I suggest an alkaline diet or Mediterranean diet. Because these are naturally gout friendly. But we can often tweak them to suit your gout better.
This request about the PURIXA supplement, and buying it for delivery to Australia, was received via my helpdesk service (the orange Support button), and I’ve posted it here. Unless support requests are specifically marked as being private, I post them to the forum so that they might benefit other gout sufferers.
I received a response from PURIXA, saying: “Thank you Keith. I will contact this gentleman.”
If I get further information about buying PURIXA in Australia, I will pass it on.
For more information on this product, and other ways of lowering uric acid naturally, please see discussions and articles about PURIXA.
OK, according to my BMI Tables For Gout Sufferers:
the [BMI] calculation is very simple – weight(kg) divided by height squared (m2)
So, your BMI is 57/1.65/1.65 = 20.9. This is just below normal weight, so your weight is not posing an extra gout risk. Everything you have said so far suggests that diet is not causing your gout. It is almost certainly hereditary, though if you want to be certain, you need to arrange blood tests for excess iron, lead, and other toxins.
I’ll assume that you need uric acid lowering medicine. The sooner you start, the better. Allopurinol is usually the first choice. The first question for any gout patient who is considering uric acid is to ask if any of your ancestors are Han Chinese, Thai, or Korean?
Luke! You’ve made my day. I love it when the gout beast gets a kicking.
Because of the way allopurinol works, there is no advantage to splitting the dose. You can do it if it feels right for you, but it won’t make much difference to uric acid control. A single 300mg allopurinol is more convenient, but it’s your call.
I’m looking forward to your next update. Let’s open a book on it. I’m going for the obvious 5.7mg/dL
I’m still investigating this, and thank you to Yigal for prompting me. Let’s keep the conversation going, as that will keep prompting me to review my Cod Liver Oil and Gout information.
One thing that I have noticed is that this new information is based on levels of retinol and beta carotene in the blood. Given the complexity of organic chemistry, digestion, and nutrition, I can see I’m going to have to look carefully at how foods and supplements affect blood chemistry. If anyone has knowledge of this, I’d be pleased to receive it.
On Yigal’s response, I have to say I’m a little confused. How can a multivitamin supplement be a whole food? Please let me know exactly what it is that you are taking.
Generally, gout sufferers need to be careful with multivitamins. They are often fortified with iron, which is a very bad thing for gout. The best way to get vitamins is through healthy eating. If that still leaves you with a specific vitamin deficiency, presumably from another health condition, then supplement that specific vitamin, rather than a host of chemicals you don’t need.
Hi JJ,
I’d much prefer if you shared a little more of your story, and why you are interested in Purixa.
If you don’t want to expand on your experiences, I suggest you join in with other Purixa discussions. The latest is very current: Started Purixa Today. There’s many more Purixa facts and discussions at https://gout-pal.com/gout-search/?q=purixa
Hi Paul, nice to read your latest thoughts and experiences.
I hope other gout sufferers heed your wisdom, Paul.
What works for one person, might not work for another, but whether it’s Purixa, celery seed, lemon, allopurinol, or something else, you must monitor uric acid and other vitals.
1. Every gout sufferer should get blood tests for uric acid, kidney function and liver function, at least once a year.
2. Every gout sufferer should know the scale that their doctor uses for uric acid test results: mg/dL, μmol/L, or mmol/L.
3. Every gout sufferer should make sure uric acid never gets higher than 5mg/dL, 300μmol/L, or 0.30mmol/L
Of course, I would also like every gout sufferer to record and track their uric acid blood test results in their Personal Gout Profile. My 3 points should become law everywhere. This last point is optional.
As Paul says, people: do it now, because at 80 you will really struggle to control your gout if you don’t act now.
That’s the first time I’ve seen any reference to a 12 per course for colchicine. I believe caution needs to be exercised with any medicine, and colchicine is in the toxic area. I guess the reference to 12 is a caution against long-term use. Because that is not what it was prescribed for. Doctors have very wide prescribing powers. So, might give a totally different prescription in different circumstances. A good careful doctor will prescribe the least amount of medicine to do the job he was consulted for. So, my best explanation is that 12 is about right for dealing with a single attack. When used as a preventative, in the UK, you would get a 28 day supply maximum. Again, doctors can override this with private prescriptions that often work out cheaper than an NHS prescription.
The safety issue has to be determined on an individual basis. Some inflammatory diseases can’t be treated, so colchicine is the only hope. Familial Mediterranean Fever is one, where colchicine is taken daily for life. You should not have any serious adverse effects, but just be aware that colchicine works by suppressing your immune system (hence my infections warning).
Your allopurinol-colchicine plan sounds fair. I was recommended to take colchicine for 2 weeks after each dose change, then as required. There’s no set plan, but the important thing is: if you are not taking colchicine daily as a preventative, be sure to take it as soon as you notice a twinge. If you wait until a full gout attack develops, colchicine’s value is limited. It slows inflammation getting worse. It does nothing for existing inflammation or pain, though this will resolve naturally in a few days.
I need the constant questions, Al. I’ll explain why in a minute, but the variety is amazing. It is very rare for two questions to be alike. Even if they are, personal circumstances usually mean that the answers are different. Also, over time, the answers change. That might be new medical advances, or simply that I have learned more. Whatever it is, there are two important reasons for lots of questions.
Firstly, my business model. My life goals are arranged around my concept of spending my life doing what I enjoy, then finding ways to make money from that. So one of my eternal pleasures is writing about gout, especially in the context of helping others. If I wasn’t running this gout forum, I’d be contributing to other gout forums every day. I enjoy doing it and enjoy the challenge of finding better answers. So duplicate questions, rare as they are, are always welcome.
For every person that comes here and starts topics, or replies to other people’s topics, hundreds more read the information. A couple of those will click adverts. The advertisers pay a few pennies, and I can eat.
But if I didn’t need the income, I would not stop GoutPal – I’d just remove the adverts, or probably keep them for charity. That brings me to the most important reason for more questions, duplicate or not.
GoutPal.com has become my life’s work. It is a little disorganized at the moment. But slowly it will become the ultimate guide to best standard practice for gout management. What I’ve learned most is that general guidance is not enough. It is very useful for creating a treatment framework. Then identifying diagnosis and treatment options. However, all treatment has to be personal. The official guidelines stress that there is no “one size fits all” treatment for gout. Gout patient care must be individual. Therefore, my advice must be individual – a personal interpretation of general guidelines that suit each individual. In parallel with these developments, there is lots of research showing that treatment is much more effective where doctors provide individual follow-up care. This might be a mentor, specialized nurse, or gout patient groups. My take on this is to provide these gout forums.
I’ve combined all these improvements in best practice to put more emphasis on the gout forums. To bring that back to your point, Al, it shows that every question is individual. I certainly never tire of them. I just hope to be responsive enough and continue to improve my gout service levels. So, it’s best to start a new topic in the new gout forum.
Sorry if I’ve hijacked your thread for my own purposes, but I think it helps if gout sufferers understand why I do this.
Hey, thanks Al. There’s a story behind your last sentence that I’m itching to tell one day. For now, let’s just get on with controlling gout.
1. You’ll always need artificial help to overcome the genetic defect(s) that cause excess uric acid. Today, allopurinol is the first choice for most people. There are a few alternatives now, and more in the pipeline. I hope both of us see the day when there’s a true cure. For now, controlling gout is enough. Daily allopurinol is an easy habit to get when you realise it saves you worrying about gout. Once you’ve debulked, there is no reason why you cannot take a few months off, if uric acid levels and other symptoms are monitored properly.
I expect the next generation of uric acid lowering to focus on short term rapid debulking for a few weeks each year rather than daily meds. You heard it here first 🙂
2. Colchicine use is your choice. If I were in your shoes, I would consider one preventative each night whilst on holiday. However, I’d research general health conditions first, as colchicine is a no-no if you are likely to be exposed to any conditions where you need your immune system at full strength.
3. My preferred combination, for unbeatable inflammatory pain relief within hours, is ibuprofen and paracetamol. I would have considered naproxen if I had any problems with ibuprofen. There are other alternatives. Anti-inflammatories are the core of a good plan. As they reduce inflammation, they reduce pain, but gout attacks vary in strength. For bad attacks, the residual pain two hours after your anti-inflammatory can spoil your life. Enjoying life is paramount, but we’re already on maximum dose of anti-inflammatories, and good gout patients don’t want to risk the horrors of NSAIDs overdose. In that situation, analgesics that block any residual pain signals are a wonderful thing.
I’m no expert on the alternatives, as I found what worked for me first-time, courtesy of the kind Bradford Royal Infirmary nursing staff. When I was hospitalised with what turned out to be gout, they saw to it that I never suffered. Neither should any other gout sufferer.
I hesitate to suggest other viable combinations. Your doctor should know. Your pharmacist will probably know. Nurses know best. Date an intensive care nurse. You’ll be an expert on pain relief and much more before the second drink!
Look at the nonsense I’m writing, Al! I think you’ve got me in holiday mode. I’m enjoying this conversation. Enjoyment, for me, is what life’s all about. A great antidote to certain email and phone conversations I’m enduring today. Time for me to burst into my Life Of Brian song.
Hey, Mike.
I think your hypothesis is sound. I didn’t mean to disregard it, but I wanted to focus on what I felt was the best action, rather than the underlying cause.
Your description is typical gout:
the pain in my ankle switches on and off like a light bulb ? no pain at all for a few days/weeks and then just suddenly appears and lasts for weeks and then suddenly disappears
That doesn’t mean it can’t be something else, but gout is our prime suspect. That’s why I suggest max dose allopurinol during debulking, as it eliminates gout as a suspect quicker than lower doses. So, why is gout the prime suspect?
Your on-off pain is gout-typical, and one of the factors in the gout calculator.
I do now have (which I never have had before starting Allo) some constant largely unremitting low grade pain in my right ankle. It?s like a gout attack that rumbles on in the very initial stages without ever really getting going. It can lift for a few days but soon returns and is there some 80% of the time ? it?s unpleasant but I can just about walk without a limp. I?m left wondering if this is just the UA being released from tissues ?nibbling? at my most frequent and vulnerable historic gout location and hope that it goes altogether once the Allo eventually (6-12 months?) flushes all of the UA out of my system.
That is a fine description of gout-typical pain during uric acid lowering. It doesn’t matter if it’s allopurinol, a different uric acid lowering drug, a herbal medicine, or lifestyle changes. Anything that lowers uric acid below the crystallization point will produce these symptoms. Here’s how.
First, crystallization point. At normal blood temperature, uric acid crystallizes at 6.8mg/dL, but temperature and other factors mean this is a range. For convenience, let’s say this is 6 to 7. The point to remember is that 6 should be below crystallization point in most cases, and 5 removes most of the risk. In prolonged low temperatures, I think I recall 4 point something in one medical journal. Crystals forming at 3.8 would be making more medical history.
When crystals form, they do so very slowly. Most of the time, our immune system deals with them quietly. White blood cells engulf uric acid crystals, as they would with bacteria, virus cells, or other invading foreign bodies. Inanimate uric acid crystals can’t be killed, but they are hidden from further action by their immune system sheath. If the numbers get too big, for whatever reason, then you get a gout flare, as our immune system calls for reinforcements. The pain process is quite complex, but the trigger is always the same – too many uncoated uric acid crystals in one place.
As an organic compound, uric acid (or mono-sodium urate), follows laws of equilibrium. As concentration rises, crystals form. As concentration falls below the variable crystallization point, crystals dissolve. As they dissolve, two things happen:
- Immune system coating is shed
- Dissolved uric acid, i.e. the thing we measure in a blood test, rises slightly
If the crystal dissolves completely before being ‘spotted’ by the immune system, all is well. If it doesn’t, and localized numbers are high enough, then a gout flare is triggered. At the same time, that slight rise in uric acid level, might be enough to push concentration over the crystallization point. If you imagine this in places that have been subject to years of slow uric acid crystal deposition, you can see how low-grade pain from dissolving crystals happens. As far as I know, there’s no medical term for this – until now! It’s called nibbling.
Mike, you are inspirational!
Expect an article on Nibbling Gout Pain very soon.
Oh! I’m sorry that it’s 476. That’s too high for diet alone, but it’s great that you are staying positive.
Healthy diet, which encompasses food, exercise, and weight, is important for avoiding other diseases. It’s good to be positive about that. The way I look at it is – there’s no point controlling my gout, if I ruin myself by avoidable exposure to high risk of heart disease, stroke, diabetes, etc. There’s always room for improvement, but I try to keep fit and eat healthy. I hope you’ll take that as a positive, and improve your diet where you can.
That won’t be enough to lower uric acid down to 300μmol/L, which is your lifetime target, so you need a uric acid treatment plan. Positive thoughts about that are:
- All blood testing for uric acid, especially when you are taking, or considering any uric acid lowering, must include liver function and kidney function tests, so you and your doctor can monitor some good indicators of general health
- All gout patients must have blood tests at least once a year, so you can have a consistent high-quality health monitor for the rest of your life
- By taking action to lower uric acid now, you can avoid years of increasing pain and joint damage through your 40s/50s
I don’t think it matters too much if you start your uric acid treatment plan now, or after Cuba. The important thing now is that you’re happy with your ?Anti Gout Survival Kit? enough to enjoy your holiday. Then, you can add ‘Get Uric Acid Treatment Plan’ to your plan of action.
I know you are:
pretty worried about starting Allopurinol based on what I have read.
I am worried about rashes and big flare ups and also pain in other joints that didn?t suffer before.Rashes will either happen, or they wont. If they happen under a safe, managed, allopurinol treatment plan, they are a rare minor problem that can be dealt with. It’s right to be concerned and vigilant. It’s wrong to worry.
Big flare-ups are just as easy to control as small flare-ups if your ?Anti Gout Survival Kit? is working properly. So, no worries there.
Same goes for pain in previously unaffected joints.
I know that you know that doing nothing isn’t an option. Rather than your concerns spoiling your holiday, I recommend starting your plan when you come back. I’ll be here to help you every step of the way. We need to make sure that you are happy with your treatment plan, and safe from the worst ravages of gout.
Enjoy Cuba, Al.
Thank you very much, Moises.
I will look into this, and amend the guidelines accordingly.
I love it when visitors let me know about information on my websites that needs reviewing. I hope other visitors will follow Moises lead, and let me know where improvements might benefit other gout sufferers. There are lots of points available to push you up the gout leaderboard. Just tell me the page that concerns you, and your thoughts on it.
Al, I’m really pleased with your positive outlook, and I love your plan of action.
As far as the meat issue is concerned, I did it by cutting down gradually. At one point, I was eating sausage/bacon for breakfast, ham or other meat sandwich for lunch, then a meat-based evening meal. I changed slowly, especially reducing portion size of meat, in favor of more vegetables. Now I rarely buy meat, and just eat it as a treat when I’m out at places that have poor vegetarian options. If I’m cooking meat, I eat it over several days, with very small portions balanced with loads of tasty veg. I’m actually doing that more for heart health than uric acid control, and there are many health benefits from this Mediterranean attitude to meat.
Those changes, plus gradual weight loss, might well be enough to get your uric acid safe. However, once you are back from Cuba, if you’ve made no significant progress, you might also consider temporary allopurinol. That will stop gout getting worse, giving you time for lifestyle changes to take effect.
Ron, there should be a black menubar across the top of your screen that says Log in at the extreme left. If not, use https://gout-pal.com/wp-login.php
After logging in, the menubar changes, and you get several useful options on the extreme right. One of these is Log Out, or you can use https://gout-pal.com/wp-login.php?action=logout
I’m sure you’re right about people not needing to contribute once there uric acid is under control. However, I feel I might be doing something that is discouraging people, without realizing. If that’s the case, I’d welcome any ideas anyone might suggest for encouraging more posts here. Perhaps I’m just being impatient?
Hey Al, don’t apologise for long posts – the more info, the easier it is for me. You’ve started adding info to your profile as well, which is very helpful.
You are right about your interpretation of your uric acid test results. The ISO scales are used in the UK, so your ideal target is 300μmol/L, the equivalent of 5mg/dL. You are not that much over, so diet control may well be possible, if you can accept some restrictions. You might find that your uric acid level is higher 2 weeks after your gout flare subsides, as results are often lower during a flare. Even so, I would think you should be able to achieve a safe level of 350ish, even if you can’t get the safety margin of 300.
I won’t discuss the issues about allopurinol unless you specifically want me to. I’ll focus on lifestyle changes.
Without knowing more about your daily eating habits, I’d say your biggest problem is meat.
That is meat that you eat, and meat that makes up your weight. Both breakdown to uric acid. I accept that, as a bodybuilder, excess weight is not necessarily unhealthy. Unfortunately, for anyone disposed to gout, it is a problem. Muscle mass is the curse of gout sufferers, so many bodybuilders get gout. It’s possible to stay fit without building muscle mass, but that’s the choice you have to make.
If you do want to make lifestyle changes then losing weight is a good first step, but best done gradually so it stays off. Next you need to reduce meat intake. You can still have a varied, interesting diet. But, meat has to become more of a flavouring and an occasional treat, rather than an everyday meal.
Healthy diets include alkaline diets and Mediterranean diets. If this is the best way for you, I’m confident we can create some meal plans that suit you, and get your uric acid safe.
In the meantime, you might be at risk of gout attacks, so adopt a scout mentality, and Be Prepared.
1. Colchicine at first sign of an attack. To minimise risk on holiday, consider one before bed as a preventative.
2. Naproxen at gout strength, as prescribed by your doctor
3. Ask your doctor or pharmacist about a compatible analgesic to take between naproxen doses. This will block any residual pain, which should allow you to work or to enjoy Cuba.Other things you should do include: staying hydrated, blood donation, coffee drinking, avoiding prolonged exposure to cold. There’s probably a few more, and it’s high time I organised a list of them.
Hi Larry – very interesting.
I have increased my Allopurinol dosage by half a pill and eventually get the Gout under control. I am concerned now that with the increase I will be experiencing quite a bit of pain
I don’t understand exactly what you are concerned about. Can you clarify? Also what are your uric acid levels?
I’m picking up on:
As I?m on 3.8 UA presently, would it be prudent/wise to break the 300s in half for a while and see how things go, or best to tough it out on the 300s??
If I relate that with your first paragraph, I’m perceiving a view that you’re blaming your current discomfort on allopurinol. I just don’t see it that way.
Allopurinol is good for two things – protecting you long-term, and helping you get rid of old uric acid crystal deposits. Mainly, it protects you from excess uric acid throughout your life, so you never have to worry about gout. So, you once had a life where you never worried about gout, and in time, you’ll get back to it.
In-between, there was a slice of your life, the painful gout years, where you suffered. At the moment, you are in a very thin slice of your life that I call your Debulking Period. It’s very tempting to make decisions during this period that affect the rest of your life, but let’s focus on the real issue.
Allopurinol dose affects the length of the Debulking Period. The higher the dose, the shorter the period. Never forget sufficient daily fluid intake to allow allopurinol to work without causing additional problems. But, water aside, the equation is that simple.
Now, I believe that reactions to dissolving crystals, once you get uric acid below 6, are random. On a risk basis, the lower you get uric acid, the less risk you have of triggering your immune response. That does not mean that you won’t get gout flares, just that you are less likely. On the other hand, there is also a slight increase in a different risk from lowering uric acid. I’m thinking of the case where some deep-seated crystals might dissolve slowly at 4mg/dL, but 3mg/dL might just release a large deposit of crystals that don’t dissolve completely before your immune system spots them. My point is, that this is not something you can control. During the Debulking Period, you would have different gout flare profiles at 3, 4, or 5. It’s impossible to say which profile would produce the worst pain. It’s also impossible to say if your low-grade pain will get any less if you reduce your dose. It might happen, but you’d have to keep repeating your dose changes over 2-week cycles to be certain.
The only thing that you can be certain of is that lower uric acid = shorter risk period. That’s why I concluded that, for me, the best way was to aim for minimum uric acid, minimum Debulking Period, and deal with the pain as it happened. That suited me, but it might not suit everyone.
I don’t believe in adjusting allopurinol dose to try and change your gout pain experience. You cannot use allopurinol against specific gout flares, but you can use it to change the length of time you are exposed to them.
I hope that makes sense, Mike. I’m looking at things from a different perspective, and I know it’s not me who is suffering the pain. Get back to me if I need to clarify anything I’ve written.
On the phone thing, it is definitely something I’ve considered, but I can’t see how it would work in practice. More useful, might be a Google Hangout where anyone can join in from around the world. My only issue with that is complete lack of experience, but hey – how hard can it be?
Hi Dave,
Great first post, with more information than most non-member visitors provide. From your information, my gout calculator tells me you have at least an 81% risk of gout. If you have joint redness, hypertension, or cardiovascular disease, the risk will be higher.
Of course, this is a risk, not a diagnosis, but your PCP has completely misinterpreted your uric acid blood test results. A rheumatologist will take a joint fluid test, which has at least 81% chance of showing uric acid crystals – the absolute proof of gout.
Given such a high chance of gout, your choice is:
a) See a gout-competent rheumatologist now, and wait for results
Or
b) Proceed with uric acid lowering treatment now, and see if this reduces your symptoms to an acceptable level.Tell me which way you want to go, and I’ll help you with the best specific next step. You can ask in the new gout forum. Or use the feedback form near the end of every GoutPal page.
In answer to your specific last question: “Can this be gout lasting this long continuous???”
Yes it can!
Gout never goes away until you either remove its cause, or control uric acid through medical means or lifestyle changes. 6 mg/dL is the absolute upper limit, so you need to question the quality of any healthcare provider who accepts levels higher than that. 5 mg/dL is the realistic upper limit for acceptable safety margin in otherwise healthy people. 2 to 3 is a good target for the first year of uric acid lowering treatment.
As you can see, nothing you say convinces me that gout is not your most obvious diagnosis. Your PCP is sadly misinformed about the upper limit, so his opinion about gout being unlikely is worthless. Are there any other reasons why it might not be gout?
If it is gout, as I said, it does not go away. Even on days that you do not experience pain, if uric acid is over 6.5 mg/dL, then dangerous crystals are forming. As they grow and spread, gout attacks become more frequent, more intense, and more widespread. Your description of your foot pain is not dissimilar to the pain I experienced many years ago. This then spread into my ankles, knees, elbows, shoulders, hands and wrists. I also had doctors who didn’t understand the upper limit for uric acid, so I know how to fight and win.
I’d like to help you get your gout under control before it spreads beyond your joints. Once it gets to your soft tissues, then all organs are at risk. Better to control it now, before heart disease and kidney disease develop.
Gajendra, thank you for your email. I’ve posted your question to this forum. This is where I usually provide gout help, and I will also respond to your email directly.
The colchicine that your doctor has prescribed will help to reduce the amount of gout pain that you suffer. However, it is often not enough alone, and it does nothing to stop your gout returning.
I can help you with a better pain control package that will stop your gout pain, but we also have to get your uric acid from 8mg/dL down to 5 or lower.
The best way to start this is for you to Log in here and add your facts to your Personal Gout Profile.
I notice from your email that you are a Google account holder. That makes it very easy for you to use GoutPal. All you have to do is click the Google icon near the top right of each page. It is the middle of the 7 social log-in buttons where it says “Connect to GoutPal with:” Once you are successfully logged in, the log-in buttons disappear.
After you Log in, your welcome page appears that contains your Personal Gout Profile. You can also view and edit your profile using the dropdown menu that appears at the top of the screen once you are logged in.
It is a good habit to update your profile weekly, and post in the forums at least three times a week. You can post questions about your gout, and also share opinions and experiences. That way, I get to know more about you, and I can tailor my advice to your specific needs.
I can see from your first email that your father had gout. That means your gout is most likely to be hereditary. You cannot avoid hereditary gout, but you can control gout with your choice from a range of lifestyle changes and medicines. The most important thing to me is to get your uric acid safe. However, you need to tell me how you prefer to do it. In your Personal Gout Profile, tick the boxes that apply to you where I ask:
Uric acid treatment preferences (check any that apply) *
❑ Pharmaceutical Medicine ❑ Natural Medicine ❑ Lifestyle ChangesIf you prefer diet improvements, I need to know a lot more about you before I can give relevant advice. If you want good gout diet advice, I need to know your height and weight. I need to know how active you are. I need to know what you eat in a typical day, your favorite foods, and any foods you don’t like.
I hope this helps you get started here. I look forward to helping you get a personal gout treatment plan that works for you. This can take a few weeks, but it will stop gout from ever troubling you again.
Hi Shirley,
Allopurinol safety is not related to age or gender. It’s related to genetics.
The most at risk groups are Han Chinese, Thai, and Korean. Any doctor worth his salt should arrange a genetic screening test to test for the specific gene responsible for most bad side effects. If the test does not apply, or if it is negative, it is still important to approach dosing properly. That means:
1. Test the patient’s blood to get starting values for uric acid, kidney function, and liver function.
2. Start 100mg allopurinol per day.
3. Re-test within 2 to 4 weeks of starting allopurinol, and again every dose change.
4. Increase dose by 100 to 200mg until uric acid is low enough to dissolve uric acid crystals. Best to go as low as possible for about a year.The best thing to do, Shirley, is to post gout questions, opinions, and experiences as often as you can. That way, we can stop your bouts of gout in the fastest, safest way.
Thanks Ron.
I hope my recent website layout changes haven’t made logging in difficult for you. If so, please ask in https://gout-pal.com/gout-pal-forum/gouty/tech-stuff/ or raise a gout helpdesk ticket by clicking the orange Support button on the left.
Yes, you are reading that article correctly. This is the Joosten research that inspired my articles at https://gout-pal.com/gout-search/?q=joosten
Of most interest to me are some articles that have sprung from that research.
How interleukin-1? induces gouty arthritis is very technical, but notes that:
Overall, the study by Joosten and colleagues goes a long way to clarify the mechanisms by which IL-1? is produced in flares of gouty arthritis and the mechanisms that are thoroughly linked to endogenous signals that have considerable clinical validity. Thus, it is likely that gout could be classified as an autoinflammatory disease and, similar to other autoimmune diseases, is uniquely mediated by the production of IL-1?.
That ties in with lots of new research into new types of pain blockers that directly target these signals. That would seem to negate the effects of Free Fatty Acids.
My efforts, so far, have been heavily influenced by Purine-rich foods: an innocent bystander of gout attacks?, a fascinating editorial that combines Joosten’s research with additional research from Zhang.
Beyond that, prompted by your response, I’ve just searched for more current information about FFAs and gout. There is a remarkable amount of information – over 300 reports so far this year, of varying relevance. Perhaps one of the most interesting is a patent claim for treatment of gout pain and other inflammatory diseases using poly-unsaturated fats (PUFAs). The essence of the claim is that PUFAs only control inflammation with certain genetic types. That means I’ve got a task on my list now to understand more about “C allele at single nucleotide polymorphism (SNP) rs730012 (A-444C).”
I think the potential merits the investigation, as it looks like there is a strong possibility of treatment derived from various PUFAs including:
- Omega-3 and Omega-6 from borage, echium, flaxseed, canola, walnut (black, English, Persian), soybean, oat, hickory nut, butternut, beechnut, chia seed, marine algae.
- Omega-3 from fish, krill, crab, shrimp, lobster, mussel, octopus, oyster, clam
Practical treatments seem a long way off, but it looks like there might be help for gout sufferers in future, from both pharmaceutical gout pain blockers, and natural medicines.
Sorry for the delay in responding to this, @benedict – I missed your response.
I think magnesium stearate should be safe, though this is a knee-jerk reaction rather than properly researched knowledge. My thinking is that, since stearic acid has reacted with magnesium, it is no longer ‘Free’
I can’t find any obvious references to this, especially as the relationship between Free Fatty Acids and gout is so newly discovered. I will continue to look into this whenever I see some new research.
What do other gout sufferers think? If you keep this discussion alive, it will remind me to keep investigating FFAs
Thanks for your input, Benedict, and for your update.
I think you are right to try and stop colchicine now, though you can always try it later if inflammation gets out of control without it. Exercising is generally good for gout, so I’m hoping the twinges get less as your uric acid crystals continue to dissolve, and your joints start to recover. I don’t think you’re waffling – your experience and attitude are very relevant to Richard.
Also very good advice from you to Richard, especially about working with his doctor, and fellow gout sufferers here, to create a good personal gout management plan.
