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

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I got my first gout attack on Jan 24th and my uric acid levels were 8,4mg/dL. Sinse then I have been on a very strict vegiterian diet eating only low purine foods, no alchol and smaller portions.  I have also be excersising a lot.  My firends & family have all been commenting on how much I've changed.

But I'm still getting gout attacks and somewhat worringly, today I found out that my uric acid levels have rissen to 8,9mg/dL, after all the lifestyle changes I've made how could they rise so much?

Could something else be causing my high uric acid levels?

The doctor also did a blood test to check how my kidneys are functioning and it came back normal.

The doctor put me on a course of Allopurinol to dissolve the uric acid in my blood for 6weeks and take it from there.

I'm wondering if my situation is normal or if anything else could be causing my goute attacks rather than diet and lifestyle?

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  • Posted

    Never start Allopurinol until the attack had subsided as it is known to increase uric acid when first taken in some patients.
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  • Posted

    Hello, 'fructose' .......... and it's in everything.

    As you know this gout thing is stupid, please look up fructose corn syrup and possible that is it.

    ( I do all the junk you do, no purines, alcohol, yeah, yeah , and am allergic to all the 4 major gout drugs .

    All I can say, check it out fructose corn syrup.

    Hope it helps.

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    • Posted

      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.

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    • Posted

      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.
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  • Posted

    Most purines in your body (85%) are caused by catabolism. That figure is higher if you are at all overweight.each day some of your cells die (around 20-50 billion, and more if you have a disease. These cells are destroyed by your immune system and carted off - in the process of digesting the uric acid is made. Playing around with your diet is like moving the deckchairs on the Titanic. There areourevegans who get gout.

    What is worrying is that a) during an attack your levels were at 8.4; b) that the doctor measured them during an attack. During an attack blood urate acid levels fall drastically. Your actual level is probably 10+.

    The next mistake your doctor made was that he didn't tell you that *allopurinol causes gout*. His next mistake was to ignore medical advice and give you allopurinol within several weeks of a gout attack. I wonder - did the doctor bother to tell you of the danger of allopurinol during the first week and that if you start to scratch and itch you should stop taking it and go to get medical attention immediately? I'd alsoguess you are on 100 mg as per the protocol which for most people (and definitely for you) is not enough. 100 mg is to allow the body to get used to it and to check you do not have the gene for the deadly skin reaction. After a couple of weeks you should certainly be on 300mg and then test a week later to see if it's working. Did the doctor explain that probably the most important things you must do is:

    a) drink lots of water

    b) reduce drastically alcohol and consider not drinking

    c) cut all sugars out of your diet most essentially fructose and HFCS even worse

    d) drink loads of water

    e) drink enough water to urinate at least 2 litres per day.

    Then your doctor gave you the idea that you can dissolve the uric acid in your blood and that's it. There are stores of uric acid all over your body. You have probably had high blood urate (hypereuricemia) for 3 years but could be a decade or so. On average with allopurinol it takes 3 - 36 months to get rid of these stored urates. By taking enough allopurinol you will quickly reduce the blood urate, but you have to dissolve all the monosodium urate crystals. Your doctor should have given you colchecine to calm down the immune attack causing the pain.

    However - now ....what is causing it?

    a) are you overweight?

    b) genes

    c) do you drink alcohol

    d) are you male

    e) are you over 40?

    f) do you have any other diseases or take any medication

    g) do you take aspirin?

    The allopurinol *at the right dose* will get this under control but you will have several months of attacks and then lesser attacks over a period of at least a year. This is why you need Colchecine- your doctor has aggravated this situation by starting you on the allopurinol during an attack - however what's done is done - stick with it now.

    Did your doctor bother to tell you you'll probably be on allopurinol the rest of your life?

    Finally drink more water... and don't worry...this will get sorted out but little thanks to your doctor.

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    • Posted

      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.

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    • Posted

      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.

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    • Posted

      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

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    • Posted

      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).

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