[Keith Taylor]

I include vegetables in my list of foods high in uric acid. But, as I explain on that page, vegetables have no significant impact on uric acid.

I strongly recommend you post about your gout, and what specific help you need, in a separate topic. You can ask any questions about your gout, right now. Please add enough information about your gout, so that I can answer you properly. Especially, tell me what you want to do that you can’t do because of gout. Then, I can help you beat gout.

[Keith Taylor]

I don’t understand? 😕

“minimal relief” ❓ Allopurinol is for uric acid control, not pain relief.

Medically, there is absolutely no difference between any brand of allopurinol, unless it is one of the combination drugs. Zyloprim is allopurinol. Zyloprim is a Sabela brand, and the one that Walgreens promotes on it’s website. Unfortunately, I’m leaving the USA today, so I won’t have time to check pricing.

Norkin, it sounds like you’re being misled by some poor advice. Why not start a new topic with more details of your experience to date?

[Keith Taylor]

It’s very easy to measure urine pH. And, it’s pointless trying to alkalize without testing.

Personally, I’d prefer some type of digital device, but I couldn’t find anything suitable. So, in the UK, I buy pH Health Medical pH Test Strips for Urine , which is cheap, and simple to use. That product is currently unavailable in the USA. But, there are lots of products for testing urine pH.

Your target urine pH is always higher than 6.

The target pH for urine in healthy individuals is 6.5 to 7 in the morning, rising to 7.5 through the day.

So, make sure the product you choose is suitable for the right pH range. It must include the 5 to 8 range. It’s probably best to avoid any that include an Alkaline Foods Chart. In my experience, they are always wrong. But, you can ignore such false charts, and consult someone who knows what healthy alkaline diet means.

[Keith Taylor]

Malcolm, the problem with GPs is, they dish out the pills, then send you on your way. The best people for pain control are hospital nurses. They don’t want to be disturbed all night by old men like me shrieking in agony, and sobbing in my pillow.

A wise man of old used to describe how he trained his doctor to prescribe the right treatments. It sounds like we must do that for you.

Colchicine is brilliant at stopping gout pain before it starts. But, for existing gout pain, it does nothing. Of course, our natural anti-inflammatories will deal with existing pain within a week. But, I believe anti-inflammatories should be used to give earlier relief. For relief within hours, anti-inflammatories can be supported with compatible pain blockers.

I understand gout. I don’t understand doctors.

Perhaps other gout sufferers can share their experiences of how they got effective pain control from a GP? ❓

[Keith Taylor]

KK D, I think you need to step back, and understand the gout problem.

Fundamentally, gout is excess uric acid. The only way to stop gout permanently is to control uric acid. Every uric acid therapy is different. But, I have a rule of thumb that says:
“Once you get uric acid safe, it takes about a month for gout recovery for every year that uric acid was not safe.”

Again, generalizing, most gout sufferers have unsafe uric acid for many years before they realize they have gout. And, once you start uric acid control therapy, it can take up to six months to get uric acid safe, depending on how aggressively you manage your uric acid lowering treatment.

So, you must be able to control gout pain, during the time it takes to successfully control uric acid. And, you only know if you are controlling uric acid from blood test results.

So far in this discussion, there is not one mention of uric acid test results. And, without uric acid test results it is impossible to assess the value of any of the products you mention. It’s also impossible, without accurate uric acid test results, to measure the effectiveness of any gout treatment.

The other side of gout management is pain control. That should be a 3-part combination that:
1) Inhibits the spread of inflammation.
2) Reduces existing inflammation, which relieves most gout pain.
3) Blocks residual gout pain.

In conclusion, that gives us 4 aspects of gout control that need different treatments. You need to judge each treatment on how it tackles one of those aspects of gout.

Just stopping gout symptoms is pointless – our own bodies do that naturally within a few days. But, our bodies need help to stop the next gout attack. 4 different types of help.

So, before I can advise on any of the products that you mention, I need to know:

How can I help you control uric acid?

How can I help you control pain until you get uric acid safe?

You can decide which is most important. As you started by asking about non-stop gout attacks, I suggest pain control is most important for now. But, it only makes sense to control gout pain if you are also starting to control uric acid.

[Keith Taylor]

That’s great, Johnson.

I like your main paragraph. It’s a good way of saying what I’ve tried to emphasize at certain times. If you have a healthy diet, gout has less of a chance. In my view, the ultimate measurement of a healthy diet is urine pH. But, only if it’s achieved by good quality food. Fruit and veg are the gout sufferers friends.

[Keith Taylor]

Hey James, that was well worth waiting for! 😀

First, a massive thank you for inspiring me to write Don’t be a Gout Statistic. Please note, that is not a personal response to you. It is some general thoughts I have about the value of gout statistics. Ie, gout statistics are very important in the context of general gout guidelines. But, they are mere pointers for investigation and action, when it comes to personal gout management plans.

So, for point (1), I can’t agree with your rheumatologist. That does not make him wrong. But, we have different reference points. I don’t want, or need, to discuss the statistics with your rheumy. What matters to me is, are you happy with allopurinol for life?

You might see I’ve flagged my allopurinol vacation article for review. I need to clarify general principles. But, beyond general principles, you need to be happy with your personal treatment plan. Of course, the idea of a break from allopurinol is a future concern. First, you must demonstrate that you have tight control over uric acid. And, your uric acid burden needs to be considerably reduced before you can contemplate an allopurinol vacation.

It’s up to you if you want to discuss it now, or in a few months time.

2) Thank you for those links. I’m short of time to investigate them fully at the moment. If you, or anyone else wants to prioritize this, I suggest a separate topic.

3) “take Allopurinol and you should be able to enjoy most foods in moderation without having to count life by the minute and avoiding all sorts.”

I don’t think avoiding certain foods is ever the answer. But, we all (gout sufferers) do it. What I learned most from controlling uric acid is that diet is very important for general health. No point in controlling gout, only to die of a heart attack.

I remember reading that allopurinol stops all uric acid production from food intake. And, it stops about half of uric acid production from our own flesh. So, for gout diet, there is no purine consideration when taking the right dose of allopurinol. And, the gout risks from being overweight are halved.

But, there’s more to life than gout control. Which is why I should spend more of my time adopting and promoting EFSEP. But, that’s a different topic.

Gout Pain Control
If “as required” gout pain control works for you, I think that’s best. Personally, I also preferred this to preventative gout pain medication.

The most important thing for all gout sufferers is to feel comfortable with their personal gout pain control therapy. Then, gout attacks are much less fearful. And, your last question about gout attack risks on allopurinol become less important.

In principle, I answered that in the article you inspired. But, on a personal level, I’d need much more precise information, James. Risk of gout flare depends entirely on individual uric acid levels. Both current, and historic. Historic uric acid levels determine the size of your uric acid burden. That, in turn, determines part of the risk factor for gout attacks. But, the risk is in 2 parts: risk from new crystals forming. And, risk from old crystals dissolving.

The risk from the uric acid lowering part of the equation only comes into effect when uric acid crystals start to dissolve. At core body temperature, this is 400 μmol/L (6.8 mg/dL). Lower at the joints due to temperature, so certainly not a consideration at this stage in your gout recovery.

[skip next 2 paragraphs if this is getting boring]

Once you lower uric acid to therapeutic levels, you might be able to titrate allopurinol treatment to slow down the rate at which old crystals dissolve. In theory, that would reduce the risk of gout flares from allopurinol. But, you also have to consider the lifetime risk. This is an exercise in improbable uric acid lowering measurement, and incredibly complex gout flare risk assessment. My mind boggles at the complexity of risk assessment at each joint with the range of differential temperatures; uric acid burden; and localized uric acid blood concentration.

Academically, it might be an interesting project. In practical terms, the way to reduce the risk of gout flares is to aim as low as possible for uric acid. And, if you’ve tested positive for low uric acid excretion rates, supplement allopurinol with uricosuric gout medicine.

Sorry, my last few paragraphs got outrageously technical. In short:
A. Be confident with gout pain control.
B. Get uric acid as low as possible.
C. Stop worrying about gout flare risks.

Thanks again, James, for your continuing support of GoutPal. I look forward to your next inspiring contributions.

[Keith Taylor]

Keith Calling Johnson! ( @johnson-ater )

Please can you guide me how you want your forum to be run. This is new territory for me. I’m not even sure if I’ve given you enough privileges to moderate it the way you want.

Johnson, how do you feel about off-topic discussions in your personal gout forum?

Love ’em and encourage ’em?

Hate ’em and move ’em?

Or, something else?

Thank you for your patience during the early stages of Personal Gout Diaries. I’m sure that good etiquette will evolve. Most of all, I want you to be happy that your forum is helping you understand and control your gout.

[Keith Taylor]

“I’m going to be testing it every saturday for the remainder of the year and reporting my results here.”

That’s great, Johnson. Like @nobody hinted, I believe trends are more important than individual results.

When I used my uric acid meter, I ignored unusually high or low results. And, I plotted moving averages on a spreadsheet.

It’s good to aim for consistent conditions. So, try to test at the same time each Saturday. Also decide if you test before or after breakfast. And, try to eat your final Friday meal at the same time each week.

[Keith Taylor]

“I hope I’m not intruding my commenting here by the way. Apologies if I mis-stepped.”

No, it’s great to comment on other people’s topics. I wish more people would do it!

I like to think I’ve got pharmaceutical gout treatment nailed. But, I’m still a learner concerning gout diet. And my interest in herbal gout medicine is purely academic. So other gout sufferers experiences are very important.

On the topic of home uric acid tests, I’m far from being an expert. I see the high level of detail in Blood UA Results, and other efforts by people like Mark. Then, I know I’ll never be able to offer the same quality of advice on home uric acid testing that other people can.

[Keith Taylor]

That’s a fantastic way to look at your diet. In itself, it might not be an effective gout diet. But, if it prepares you to make better food choices for the rest of the year, it is very valuable. And, it’s unlikely to do any harm.

Most importantly, there may be aspects of your 30-day diet that you can incorporate into the rest of the year. I’d need to know more about it. Best to focus on parts of the diet that you enjoy most. Think about your favorite fruity flavors. Then, we can look for gout-friendly recipes that incorporate those flavors. I believe gout diets only work when you enjoy them.

If your elbow isn’t bothering you, it’s best to leave it alone. It happens when uric acid crystals inflame the bursa in your elbow (medically called olecranon bursitis). In most cases,it resolves naturally. You can encourage the natural healing process with rest. There is a chance that it is unrelated to gout. It’s commonly called “Student’s Elbow” caused by pressure on the elbows from extended studying. I’ve only had it once, and I’m fairy certain it was caused by uric acid crystals. But, that’s not a scientific diagnosis. The only way to be certain, is to get fluid analyzed by a competent rheumatologist. You should consider that, if it gets painful, or lasts beyond 2 weeks.

Compression probably helps. Ice might reduce pain. But, as you have no pain, what’s the point? I have my own theories about avoiding low temperatures near gouty joints. But, there’s no medical consensus, so you have to make up your own mind.

[Keith Taylor]

I’ll reserve judgment on the 30 day fast, until I know more about it. Generally speaking, you are right on both those counts.

But, every 30 day diet I’ve seen suffers from one huge problem. When fasting, the body first breaks down lean tissue. That’s because it is easier to get energy from lean tissue than from fatty tissue. You will lose some fatty tissue, but that is much better as a consistent, slow weight loss over many months. And, if you revert to over-eating after the fast, you will add back mainly fatty tissue. The net effect is that you end up with a higher proportion of body fat.

Please don’t take this as a lecture. I’m terrible at weight control. But, the most effective way to lose weight is through gradual weight loss over many months. It’s more about longterm eating habits than shortterm weight change.

So it is with alkaline diets. They need to be a permanent fixture to add real value. An occasional month won’t make much difference. Also, you have to confirm alkaline diets with urine pH tests. I started that last year, and realized it’s harder than I thought.

I’m not trying to put you off, Johnson. Maybe we can help and encourage each other to adopt healthier diets over several months.

[Keith Taylor]

Hi Johnson, I moved your first post into your forum. I hope that helps you keep all your important gout facts in one place.

On your juice fast question, there’s no real relevance to uric acid. Uric acid control is a longterm program. 30 days is neither here nor there. And, it’s also not relevant if it goes up or down. Only the exact numbers are relevant. I doubt it will make significant change. And, I don’t want to confuse matters by listing a bunch of “what ifs”.

If you’ve got some accurate uric acid test result data, I can explain things better. If you haven’t, then it’s time to start!

Never stop taking allopurinol without good reason. Getting a baseline might be good reason. That’s what a good rheumatologist will do. But, you need 2 weeks off allopurinol before the blood test for uric acid is accurate. And, I would get a lab test, rather than rely on a home test kit (unless you’ve already done this to assess the consistency of your home testing procedure).

That might well raise more questions than answers. If so, ask the questions. If you can get into the habit of asking gout questions, you will overcome your doubts about sticking with it. If you can’t think of your own questions, join in with other topics.

I want 2017 to be the last year you ever need worry about gout. I can’t force you to keep posting here. But, I can promise you that, if you do, you will control your gout. And if, in the process, I can gently nudge you from fad diets to healthy eating, I’ll be a very happy man. 🙂

[Keith Taylor]

Thanks for the update about your gout symptoms, Chand.

You need to be aware that gout pain and swelling will subside naturally in a few days. But, you must not ignore excess uric acid that causes gout. If you fail to control uric acid, gout will get worse. Eventually, it spreads to all joints. Gout prevents natural joint repair, so you will get damage to cartilage, tendons, and bone.

After that, gout spreads to soft tissues. You will get damaged skin, kidneys, and heart. All organs are at risk, except the brain.

I urge you to start treatment for uric acid control. If you want me to help you with this, please post your latest uric acid blood test results. Also post as much history as you can about symptoms, test results, and any gout treatments you have tried.

[Keith Taylor]

Sounds encouraging, Malcolm.

On colchicine, it’s good to know how it works. Our immune system fights uric acid crystals. When overwhelmed, immune system cells send out signals for reinforcements. Essentially, white blood cells grow and divide, so our army is bigger. And, this is what produces painful inflammation. Colchicine slows the cell division process. But, it does nothing for existing inflammation.

It’s best as a preventative. Or, at the first hint of a gout flare. It is useful after that, to slow spreading inflammation. But, once a gout attack has started, you should support colchicine with an NSAID. Ibuprofen and naproxen are the most common these days. But, your doctor or pharmacist can advise on different anti-inflammatories to suit your medical history. In extreme cases, you also need a painblocker such as paracetamol/acetaminophen. Again, medical professionals will advise on safe, compatible combinations.

[Keith Taylor]

By unbelievable coincidence, I’m right on track for this. As you can see from my vacation post, I’m travelling the Southern States. I’m using Airbnb, so experiencing real life in American homes. Maybe I’ll write about why American food stores are gout-producing hell sometime. But, my point is (eventually!), my temporary New Orleans home has a large bottle of Sriracha Hot Sauce. Yummy 🙂

[Keith Taylor]

Thank you very much for your gout diary request. Because of time constraints, I haven’t pushed this service as much as I might. But, I feel every gout sufferer should keep a diary like this. Even if they want to create it privately. You are very brave to do this in public. Other gout sufferers will learn from your diary. You’re paying back before you even started! What a great thing to do.

Before I explain my gout diary service, I should say that, from your description, you are at a similar stage to me, several years ago. I understand every word you wrote at a personal level. Now’s a great time to take control. And, I believe a gout diary is a great starting point.

How you use it is up to you. I’ll explain that shortly. But first, I should explain the context from my point of view. When we are learning to control gout, there is lots of information. Some of that is personal. Some is general information about gout. Many gout sufferers have important experiences and opinions that determine how they want to approach gout management.

Ideally, you read lots of information. And, you start discussions about aspects of gout that interest you. You also join in topics started by other gout sufferers. That’s a lot of information, so your gout diary is where you summarize what is important to you. It should contain:
– Personal facts
– Gout symptoms
– Gout medications
– Test results
– Important unresolved questions
– Important opinions about gout treatment
– Important gout experiences

It’s a reference section for Johnson’s gout. You use it to track your gout recovery. I use it to focus my responses to you in a way that minimizes irrelevant details.

Your Gout Diary
I will help you as much as you want. I want your gout diary to be meaningful and helpful to you. My style might not be what you want. So, you are free to maintain your diary as you think fit. I will help whenever you ask.

If you don’t know where to start, just tell me. I’ll ask some questions, and summarize the answers in your name. You can edit that whenever you like.

If you have no experience of editing, I can do it for you, or teach you. That will make more sense once you make a start.

You can start posting in your gout diary now. Or ask for help making a start.

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