Urate levels and controlling Gout

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I had my first Gout attack on 19th December.  It went and then returned mid way through Jan.

I went to GP who tested Uric acid levels during the attack (I know not good).  My levels were 7.7mg/dL.  The GP refered me to a rheumatologist.

I gave up meat and all alcohol for 1 month.  In that month I had a further attack and was then re-tested for Uric acid levels.  The level had fallen to 6.9mg/dL.  At the start of the month I weighed 97.5kgs and lost 4kgs in the month. (I am 1.85m tall - so above the magic BMI of 25!).

Rheumatologist doesnt seem too concerned by uric acid levels and will only perscribe Allopurinol if I have more attacks (3 she says) as at 36 years old she believes it is not good to be on a long term daily pill. 

The questions I have are as follows:

1. Given the fall in levels of uric acid is it possible to get them down further with diet and / or weight loss?

2. 6.9mg/dL still seems to be a dangerous level, what are the other issues with high Uric acid.

3. Do other people have experience of managing Gout long term without pills?

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10 Replies

  • Posted

    Dear Omega

    Congratulations on supplying all the relevant information!

    First the bad news. You are fat and you aren't very good at maths :-)

    At 185 cms the maths for BMI is:

    1.85 x 1.85 = 3.4225.

    3.4225 x 22 gives your perfect BMI of say 75kg

    3.4225 c 25 gives your max healthy BMI of say 85 kg

    Presently your BMI is about 28.

    Most of your purines come from catabolism i.e. Your own body being recycled. Therefore you can cut out all meat and your body is still "eating" about 2kg of red meat a day - you. Even vegetarians get gout. 85% of your uric acid comes from you not from your diet.

    The recommended level of blood urate for somebody with gout in the UK is under 5 mg/dL because that is low enough that the stores of monosodium urate are being dissolved.

    As for you not taking a (cheap) pill for the rest of your life - I wonder if she takes the same attitude with diabetics and heart patients? She is however correct that taking allopurinol now isn't appropriate because you've only had two attacks - even though two attacks in one year is according to NICE the definition of gout. However, let's be super optimistic and assume you are going to drink loads of water, give up alcohol and fructose and wheat and never have another attack. That could happen - but it's the long odds. But those 100:1 horses do sometimes win.

    Btw by losing weight you are catabolising even more of your own cells than usual which will probably trigger more attacks. I'd have some colchicine at hand.

    What you need to do is drink loads of water and cut out from your diet completely all forms of fructose especially HFCS (High fructose corn strip).

    To answer your questions

    1. Yes.

    However *probably*the issue is your kidneys are slightly out of whack and aren't removing enough uric acid. *probably* that will only get worse with age...the only thing that gets better with age is male wisdom.

    2. The other issues with long term untreated hyperuricemia- gout are: damage done to joints, damage to veins and arteries, a massive increase in heart attack risk and stroke risk, kidney disease and an increase chance of certain cancers e.g. Bowel. All this takes a decade or so.

    Your rheumatologist should have given you a run down of your blood lipids. If your cholesterol is too high then you need to reduce it - lose weight, by a bike - and the hard part - use it for half an hour or so every day.

    3. I'm sure that it can be done for some people esp women, but you are large (1.85) which is a lot of purines being made every day. It's not impossible, but you could give it a go.

    Good luck and good health.

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    • Posted

      Hi,

      Thanks for the response.  Very useful... Just one quick question, why do you say I am bad at maths! I know exactly what my BMI is, indeed I said above: "I am 1.85m tall - so above the magic BMI of 25!"

      It is funny that the Rheumatologist doesn't seem worried about the real issue which is the high uric acid level.  To me gout is just a symptom of that so thanks for your response as I will push a bit more on the Allupirinol when I next see her for a followup in June.

      Does anyone have experience of using a pill to get the uric acid levels down, whilst also reducing weight and then coming back off the pill?

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    • Posted

      Firstly, apologies. There's nothing wrong with your maths, but there is with my reading comprehension.

      I had the good fortune to have been read the riot act when I was first diagnosed by a university professor at a university hospital. He told me very clearly - if anyone ever suggests to you this won't kill you if you don't get it under control change the doctor. They also sent me to see a nephrologist and cardiologist to see there was no damage already. I worked in a university at one time so research is second nature - and I've been corresponding with the research scientists in this field. They all agree - gout and high uric acid is nasty. What is less sure is hyperuricemia for those who never get gout - should they treat it or not?

      I have the experience of dropping from BMI 32 on diagnosis to about 25 now and moving towards 22/23. It has vastly improved my blood urate from 10+ to 6.5 without allopurinol and about 4 with it. I don't drink alcohol or fizzy drinks so that was no issue for me. As I said I get blood tests done with allopurinol, drop it for 2 weeks and see - never goes to below 6. I just have to accept my kidneys or something isn't working A1. I drink loads of water. My idea couple of years ago was to take allopurinol for a time. I now think that having low cholesterol caused by the allopurinol and low blood urate is healthy.

      As for the allopurinol- after a month on it, it hurt my stomach. I now allow it to dissolve in my mouth before swollowing and it's never a problem.

      If I were you I'd wait to see if you have another attack and have your blood tested to see if the high urate isn't just a minor blip. As for all the cherry extracts and things - read the research literature- there's little to no support for it, but loads of people swear it works...but there's loads who say cooper bracelets work too.

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  • Posted

    Hi there,

    Answers to your questions:

    1. I am living proof it can be done. Cut out wheat of any kind, except sour dough bread, cut out HFC's, Offal, spinach and definitely lose weight.

    2. Kidney issues is the biggest one.

    3. I don't take pills, I exercise or walk at least 20-30 minutes a day. I keep away from those foods I mentioned. I do drink cherry juice, for me any kind works fine, but they say Tart or Black Cherry works best, when I can find Black Cherry that seems to work for me. I also drink water with lemon or just eat lemons as this neutralizes your blood and internal organs. I drink lots of liquids, coffee, herbal or fruit tea, homemade fruit juices, and water. Drinking liquids is the best thing for you since it flushes out parts of the crystals, as well as exercise. Exercise recirculates the blood and generates new blood which is good for keeping your organs from deterioration.  Btw, when I exercise, avoid the treadmill and avoid running. Walk or use the elliptical or bike. Hope this helps.

     

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    • Posted

      Well, aren't we luck! I've had 3 full blown attacks but I've also had tingling sensations of gout pain starting to increase until I drink cherry juice to neutralize the effects of a full blown attack.

      The other 2 attacks came without warning which woke me up with severe pain in the morning. So something must have happened overnight.

      I just had my blood work done and my urate levels came in at 4.8, and everything else was just fine. Doctor didn't find anything wrong with me but felt compelled to give me pills so he wrote an rx for Vitamin D pills.

      I was stressing because of this thinking that since I've had kidney issues in the past that my kidney's were suffering because of my gout. But they're not thank goodness. I was also in fear of my cholesterol being out of control but that was due to a pill I was taking for anxiety but since my other doctor lowered the dosage my cholesterol went down almost 400 pts, this was a huge relief since that almost gave me a heart attack due to the stress which is why I requested to have a complete panel done to see what was off. 

      I agree I'm not the best model for gout, since I also believe I have both types of gout. But all in all drinking liquids keep you from forming gout and it flushes out the crystals. And exercise keeps the blood moving which in turn helps keep synovial fluid flowing to the joints.

       

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    • Posted

      Gout is a symptom of hyperuricemia. At 4.8 your blood urate is not only good it is low. With low uric acid you will not be getting gout attacks.

      We're your gout attacks in your youth?

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    • Posted

      Truly I don't understand. I sometimes feel as if I'm having gout pain. Cherry juice or turmeric or bromelaine seem to remove the feeling. Maybe it's my pseudo gout. I got it once in my 30's and once in my 40's. And though I didn't get an attack once in my 50's it felt like a gout flare up.

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    • Posted

      If you have low uric acid and you have been diagnosed with pseudogout its extremely likely any symptoms are from pseudogout. I believe there's no treatment for pseudogout as yet; just take anti inflamatories and pain killers?

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