advice with gout

[John Mcgovern]

Hi a few bits of infomation about me I AM 55 year old I have had problem with my gut for a few years so I have been on 20mg omeprazole
for 4 years the reason I was put on these seemed to be connected with eating and drinking to much when on holiday or christmas and new year I developed Goat 18 months ago when I had a bad attack as I couldnt walk for 3 week i was put on allopurinol 100mg I have since had another 2 attacks the last being went i return from holiday 2 months ago this time I have had trouble getting pain free this time.
I am now on 400mg allopurinol per day. which i would prefer not to take at all, I was think of going on a alkali diet and trying detox
to try to cleanze the blood

[Keith Taylor]

The research on omeprazole is inconclusive. One report was unable to establish a link between omeprazole and gout, yet another claims that in a few rare cases, it does raise uric acid.

What concerns me most is that several of the common causes of acid reflux are also associated with increased risk of gout. These are:

• Obesity
• High intake of table salt
• Low dietary fibre
• Low physical exercise

Of course, what I don’t know, John, is if any of these apply to you. A good starting point, if you don’t mind sharing the information, is your height and weight. I’m guessing, because you seem to be focusing on diet, that you might feel that your diet is not good. I like your idea of adopting an alkaline diet. That is certainly good for gout, and should also help the acid reflux problem.

Diet changes take many months before you get the benefits. It is best to start as soon as possible, but introduce changes gradually. Rather than a specific eating plan, it is best to start thinking about food differently. To start an alkaline diet, just start replacing meat with vegetables, and snack on fruit. Once your body adjusts to eating less meat and more plants, you can put more effort into specific recipes and meal plans to optimise your diet. This isn’t a temporary ‘detox’ – it is a lifelong improvement to eating habits. I can help with specific problems that you might face, so just ask.

In the long run, you might reduce your dependency on allopurinol. For now, you need to make sure your dose is right to bring uric acid down to 0.30 mmol/L or lower. Regular testing is important, so as dietary changes take effect, you can reduce the dose to maintain safe uric acid. It might be possible to reduce allopurinol to zero, but your main concern, to prevent serious joint damage and other health problems caused by gout, is to keep uric acid at a safe level.

[John Mcgovern]

Hi KEITH,

I am 5FT 10 inches tall I weigh around 182 lbs, one other thing i forgot to mention was,I have allergies that i take antihistamines
for nothing to serious grass, dust cig smoke and a few others, I;M still confused what to eat and not to eat web sites are so conflicting, My normal diet consists of beef and pork 2 or 3 times a week one of those times sausages white fish such haddock or cod
I also drink alcohol glass of white wine Monday to Friday is red any better? I used to drink lager but havent any for maybe 8 weeks.
During my last attack which lasted 3 weeks ones i had recovered I went out for a meal and had a chicken dish with a rich sauce and 2 beers next day I had a really bad attack I dont think my uric acid level was high at the time so confused, in fact I had a blood test done that day I was 272 u.m.o.l

[Keith Taylor]

It is great news that your uric acid is below 300 ?mol/L. That means your blood uric acid is in the safe zone, but it might take several months for existing uric acid crystals to dissolve.

One way to reduce that timescales is to increase allopurinol, and aim even lower. You should discuss this with your doctor. Some doctors are receptive to this idea, others will advise you to be patient. Whichever you do, you should maintain adequate hydration to allow dissolving uric acid to pass through your kidneys. Skimmed milk and coffee are particularly good for reducing uric acid. Also, try to keep joints wrapped to maintain temperature, as uric acid dissolves better at warmer temperatures. Don’t overdo this however, as direct heat is not good for inflammation.

It is important to realise that diet is only one factor that can affect gout. Ideally, a 5’10” person should maintain weight below 173 pounds http://www.goutpal.com/2269/losing-weight-with-gout-foods-to-avoid/
This is only a guide, but generally speaking, excess tissue is a source of uric acid. Meat and fish is the other source. Your diet is not very bad, and your uric acid is safe, but if you want to try and remove reliance on allopurinol, there are improvements you can make. If you choose to do that, I recommend you stay on allopurinol for at least a year. You should also wait until you have not had a gout flare for 6 months. I can help you with an alkaline diet at http://www.goutpal.com/gout-diet/gout-diet-menu/. By it’s nature, an alkaline diet is very good for gout.

Gout flares during early months of allopurinol are common. They happen as partially dissolving crystals get attacked by the immune system. Usually this has nothing to do with food, but as humans, we always try to make connections. If it is food-related, the gout attack is not related to immediate purine intake. Latest research shows that is actually Free Fatty Acids in food that trigger immune cells to respond to uric acid crystals. It is just coincidence that most high purine meals tend to be high in saturated fats.

Usually, doctors prescribe colchicine or other pain prevention during the first few weeks of allopurinol. Has your doctor ever discussed this?

I hope this helps, John. If what I say conflicts with other advice you have had, please let me know the specifics, and I’ll try to explain the confusion, or improve my explanation.

[John Mcgovern]

Hi for the last 10 days I have been trying to eat a mainly veggie diet I had a slip up 2 days ago when i had chicken curry which had a processed sauce, I had a flare up today which I thought was the result of eating that this was my normal diet until I started read information about diet 10 days ago I had beef mince tonight,because that what was made for me and did worry about it, After reading your post i now know that is not so important

MY gout treatment is 400mg of allopurinol per day so that’s the starting point my last uric acid test was low.

[Keith Taylor]

I wouldn’t describe 272 as low. 300 is the top limit, so you’re safe, but not low. I have to go from memory, as I’ve lost my test result history. I think I got down to around 220. It’s time there was more research in this area, though I doubt there will be any funding for it. At the moment, all we know is that lower is better. The lower you get uric acid, the faster old crystals will dissolve. That means less risk of gout attacks during uric acid lowering treatment.

If only the powers that be could grasp this idea, we would have much better gout treatment success rates. At the moment, patients often give up on allopurinol because they feel it is either making gout worse, or is no help. I know that doesn’t apply to you, John, so I’m sorry for using your thread for a personal rant.

I’m not sure what to do next.

What is concerning you about gout right now? I’d love to help more, if I can.

Continue here if you like, or start new topic(s) with your most important questions, opinions, or experiences.

[Keith Taylor]

Hi @john-mcgovern-543,

Anything new to report about your gout?

[John Mcgovern]

Hi KEITH,

As I told you previously I was on 600mg of allopurinol, my doctor told me I should’nt be taken so much and to reduce it to 300 about 4 weeks ago even though I have not had a attack since January, there has been some days where my feet are sore,I have noticed that the bone in my foot is fine when I get up in the morning but by evening is swollen but not red so i worry its ready to flare up at anytime, I have changed my diet I eat chicken at least 3 time a week I eat cabbage and drink the water I have beef maybe once every 2 weeks, I had my blood checked 2 weeks ago it had went from 180 to 248, I was wondering if I should increase my dose of allo again to try to ensure I dont get a other attack, 1 more thing I have cut out drinking beer which i miss but i drink wine instead this doesnt seem to spark anything off or could it.

[Keith Taylor]

As I told you previously I was on 600mg of allopurinol

I can’t see that fact anywhere, so I’m worrying that I might be missing important information that will allow me to respond better. Best to keep this type of important gout information in your profile. Your profile is displayed every time you log in. The best advice I can give about controlling gout is to get into the habit of logging into this forum a few times a week. When anything significant happens, record the facts in your profile. Your profile has 2 powerful properties to help control gout:

1. It prompts you to focus on gout issues that are important to you
2. It helps other people who are responding to you. We can make sure our responses are relevant

I can’t get a proper handle on how many years your uric acid crystals have been building up, or how long you have been actively dissolving them. These are the crucial facts to assess if you should increase your allopurinol or not.

It’s very frustrating. Your doctor has the facts about your gout history, blood test results and allopurinol dose. Unfortunately, it looks like your doctor does not have sufficient gout knowledge to advise you properly. I have the knowledge, but insufficient facts to advise properly.

In my opinion, diet is not very important until the allopurinol dosage issue is sorted out. Diet changes have different effects depending on your uric acid levels. I like discussing these effects, but without the context of a uric acid plan, such discussions tend to be too random.

My worst fear is that I am making this too difficult, but nobody is telling me. Lots of people do complete their profiles here, then never start discussions. Others discuss general aspects of gout, without sufficient personal gout facts in their profiles to help make responses relevant.

Please somebody! Tell me what I’m doing wrong.

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