On strict Purine low dies for 6 weeks but Uric Acid Levels have rissen

Do you not think that the doctor should know that?

Thanks Eddie but I'm pretty sure I'm not consuming any 'fructose corn syrup', I've cut out all sweets, chocolate, and sugary drinks(never was much a fan anyway).  I'm drinking water,teas, coffee, and fresh lime and water.

Lime contains fructose. Black tea (is usual English tea) is known to be an aggravant of gout. (I still drink it though). But as I said most purines come from catabolism.

Thanks Rusty,

That's a lot of useful information. Interesting that uric levels in blood are lower during an attack. So this is likely to be why they where higher on this last test.

To answer some of your questions, I'm 36, male, no history of gout in my family, no other conditions or on other medication including aspirin. I do drink alcohol but not since the last attack. I am overweight at 6'3" weighing 110kg.

I've drastically reduced the amount of sugar I consume but still eat fruit, including about one banana a day, blue berries both of which I hear can be good for gout. I also some times have melon and on a few occasions sinse the attack I've had some chocolate or desert. Should I be more strict and cut all these out completely?

I've been trying to loose weight by eating less and working out and am doing pretty well but could reduce my portion sizes more, I'm eating less than before but still take large portions for some meals. I did not realize that most purines come from catabolism.

I'm drinking lots of water but maybe not always 3litres a day, I'll become more regimented on this.

The doctor did tell me the risk of allopurinol causing gout, he also gave me Naproxen, an NSAID to help relieve the attacks. It's been working well so far, I believe it's an alternative to Colchecine. I'd rather get this treatment started to get rid of it all together and risk some more attacks. The attacks have become much less severe already. You're right, he did prescribe 100mg per day and said we could re-evaluate in 6 weeks. I would like to increase it sooner as you suggest and get this thing under control.

The doctor did not say I might be on Allopurinol for the rest of my life, I hope with my lifestyle changes I won't.

I really hope this doesn't continue for 36months, I really miss being able to have a beer. I was hoping to go off this strict diet and be able to have a few drinks in about 2 months. Is that unrealistic?

Thanks again for all the info, I found it really helpful.

That's a lot of useful information. Interesting that uric levels in blood are lower during an attack. So this is likely to be why they where higher on this last test.

**The reason for this is that during an attack the monosodium urate precipitates from the blood into the joints (where it is attacked by the immune system; it is the attack which causes pain, not the crystals per se )

To answer some of your questions, I'm 36, male, no history of gout in my family, no other conditions or on other medication including aspirin. I do drink alcohol but not since the last attack. I am overweight at 6'3" weighing 110kg.

**In an ideal world you'd reduce your BMI to say 22-23. Be aware that most people the hypereuricemia is caused by lack of excretion by the kidney. However 10% is caused by overproduction, and it tends to be the under 40s. This is a liver, not kidney issue. I am unaware though if there are any treatment implications though.

I've drastically reduced the amount of sugar I consume but still eat fruit, including about one banana a day, blue berries both of which I hear can be good for gout. I also some times have melon and on a few occasions sinse the attack I've had some chocolate or desert. Should I be more strict and cut all these out completely?

**I'd get rid of sugar, the worst is high fructose corn syrup. You should reduce sweet fruit e.g. Very ripe banana, strawberries etc. Maybe during an attack you should cut them out totally till it's under control, but you have to make a balance in life. HFCS is to be avoided at all cost though.

I've been trying to loose weight by eating less and working out and am doing pretty well but could reduce my portion sizes more, I'm eating less than before but still take large portions for some meals. I did not realize that most purines come from catabolism.

** You should be aware that reducing weight increases catabolism (you are eating your own body), and therefore triggers gout. However once the weight is lost you reap the benefit. Colchecine has the effect of reducing the immune attack, and is why many people take it when first on allopurinol. It is advisable if dieting too.

I'm drinking lots of water but maybe not always 3litres a day, I'll become more regimented on this.

** I'm afraid the recommendation to flush out the crystals is to urinate + litres per day - not drink 2+ per day.

The doctor did tell me the risk of allopurinol causing gout, he also gave me Naproxen, an NSAID to help relieve the attacks. It's been working well so far, I believe it's an alternative to Colchecine. I'd rather get this treatment started to get rid of it all together and risk some more attacks. The attacks have become much less severe already. You're right, he did prescribe 100mg per day and said we could re-evaluate in 6 weeks. I would like to increase it sooner as you suggest and get this thing under control.

**The doctor did the right thing. Revaluation could be done earlier though. However a pain killer is less effective than colchecine or similar. Why? Because it reduces/stops the immune attack and protects the inner lining of the joints, rather than just stopping the pain from the joint destruction.

The doctor did not say I might be on Allopurinol for the rest of my life, I hope with my lifestyle changes I won't.

**You probably should be on it all your life. Remember gout is a symptom. The problem is hypereuricemia- which causes heart disease, colon cancers, kidney disease, arterial disease if left untreated. Allopurinol also reduces cholesterol levels while increasing the food cholesterol. I read some research that while there are many potential side effects from allopurinol only 0.7% who take it for a couple of months cannot tolerate it long term. Problems occur when people are taking several other drugs.

I really hope this doesn't continue for 36months, I really miss being able to have a beer. I was hoping to go off this strict diet and be able to have a few drinks in about 2 months. Is that unrealistic?

**The allopurinol will work in a couple of months, but it may take a couple of years to clean out the tissues with crystals. You will know it's worked once you've not had an attack for 6 months to a year. If you are taking allopurinol I think that occasional evening with a few drinks won't make any difference- but you'll have to try it!

Thanks again for all the info, I found it really helpful.

** I'm glad you found it useful.

Hi Rusty,

Not sure if you saw my last comment but it was deleted by the moderator, I think because it had links to another website.  I only added them because they said green tea was good for gout.

Anyway, thanks again. I really appreciate it and am going to speak to my doctor about Colchecine, and I see your point why it's wise to stay on Allopurinol.

Thanks

In my opinion websites are of little interest unless they have some serious organization behind them. What really counts are the peer reviewed research, and lectures given by qualified doctors (there are loads online of people calling themselves doctors who are in fact chiropractors and "naturalist doctors" who would not be able to call themselves such outside the USA).

Thanks, that's interesting.  I'll check it out more and talk to my doctor before trying, just in case it doesn't play well with the other medication I'm on.

You will find there is a lot of conflicting advice on the subject of gout... possibly even Rusty's.

As this condition is on the increase a clear guide is required. At present the N.H.S sadly lacks one.

I tried that on advice from a fellow sufferer and to no aviail. Also cider vinegar seemed to do little as did Cherry Juice.

I then tried eating blueberries and cherries.. bingo.

Ultimately i think people have individual triggers and ailments.

For sure Roger every body works in different ways and it's all about trial and error with gout as it seems we are pretty much on our own as far as NHS is concerned.

Please do consult your dr as yes some medication does not agree with it. Me I just took a stab at it as I felt that I had no other choice as nothing else worked and thankfully it has paid of so far for me. Good luck 😇

Finding out what triggers gout is all very well, but it does not address the underlying condition: hypereuricemia. Untreated hypereuricemia is associated a host of conditions- arterial diseases, heart disease, kidney disease as well as an increase rate of intestinal malignancies.

I dont for 1 second disagree.

That is not true. There are very clear guidelines issued by NICE. The guidelines are clear and every doctor has access to them. However, I can only assume because they do not have time, doctors do not all read the guidelines, or if they do, the choose not to follow them.

There are no doubt times when they are not followed because the patient has other medical problems. The fact that gout is associated with metabolic syndrome and other comorbidities no doubt complicates the issue and means that in an ideal world the patient should get out do more exercise and lose weight - and may not be what the patient wishes to hear.

Is there a standard purine chart for all food?

Yes, you can Google it. Type purine chart.

Search purine table acumedico

Sodium bicarbonate is as the name suggests a form of salt. One teaspoon of bicarbonate is giving you about 2/3 of the total salt you need in a day. Bicarbonate also interferes with calcium absorption. In the long term can cause kidney stones. It is to be taken with particular care with those over 60 or those with suboptimal kidney function (like those with gout).

I'm not saying don't take it - if that's what floats your boat - but be aware of the long term risk.

I still dont know what purines are in spring onions....

I won't be taking it all the time but at that moment it was what helped and would only take it if I have another bad attack . I know what the risks are with it but the pain I was in was that bad I would have tried anything.

And taking it in a moment of crisis, or even several weeks of crisis, seems like a very good risk-benefit profile. I'd rather thought you were using every day as prophylactise as some recommend.

Purines are molecules in DNA - anything that is alive has got it...even bacteria.

Sorry. I meant to ask. How many Purines are in 100g or spring onions, or snails without shells, or lychees???

Onion is "13" (not sure what that means) about the same as Apples. But there is something in onion which may trigger gout in some people.

Not sure about lychees and snails.

I tell you what is the highest purine food there is by far - theobromine - for those that don't know - it's the drug in chocolate. How much theobromine there is in a bar of chocolate though - not a lot I guess. It'd be interesting to know if it triggers gout in some though.

Being a chocolate lover for a few years,I can attest to the fact that chocolate does not cause gout. But then I only eat dark chocolate and I've never seen theobromine as an ingredient.

I saw theobromine and investigated it. I do eat chocolate but rarely. It seems that this is not entirely clear either. I.e how much theobromine is in a 30g milk chocolate bar.

roger, I highly doubt these foods will cause gout. I'm a lychee eater, I use to eat snails almost every week for years and years. I eat onions like crazy, almost every day, raw and cooked and to be honest these foods have very low purines, except for maybe the snails which is part of the group like shellfish, that is considered to cause rheumatoid arthritis in gout patients, but as I said, every body is different.

 

Ah, so it's in milk chocolate. I don't eat milk chocolate, only dark chocolate.

Theobromine is in all chocolate - it's the reason that we love the stuff, and it's what kills dogs.

Generally there's 64mg of theobromine for every 40 grammes of chocolate as a rule of thumb. How that translates into purines I don't know.