At least one patient, or rather his wife, has reported good initial results in the gout forum, and has promised to keep us updated with progress. Any new treatment is always interesting, and people want to know more about it.

The scientists get to have their say in the professional publications, but much more important, is the way treatments affect gout sufferers. Now, gout patients have a chance to tell their story.

A leading health magazine is looking for Krystexxa patients to interview. Please see the details at that link, and share your story.

Of course, I would be delighted if you could also share your experiences about Krystexxa, or any other gout treatment in the gout treatment forum.

Leave this Krystxxa article to browse more Gout Medications To Lower Uric Acid…

Potential Renal Acid Load (PRAL) is a calculated value that estimates how foods might change acidity or alkalinity of the body.

PRAL is a precise calculation from 5 nutrient values in food, but it is not an exact measure. It is a shortcut measure to assess the affect of foods on the pH of the body.

PRAL For Gout Sufferers

PRAL is a widely used tool for estimating the acid load on your kidneys. This is the general pH level derived from many different compounds, not uric acid.

PRAL is not a measure of uric acid, but a higher pH makes uric acid more soluble. This means that crystals are less likely to form.

It is important to realize that pH of blood is tightly regulated by our body, and so following an alkalizing diet is not likely to have a dramatic effect on gout. However, an alkalizing diet is widely recognized as promoting good general health. For gout sufferers at risk of kidney stones, an alkalizing diet is very effective in preventing or dissolving uric acid kidney stones.

What Is Potential Renal Acid Load?

Potential renal acid load experiments show that PRAL is a reliable approximation of the pH effect of foods. It is calculated from:

PRAL =

0.49 Protein + 0.037 Phosphorus - 0.021 Potassium – 0.026 Magnesium – 0.013 Calcium

Acid forming foods have a positive range, alkaline forming foods have a negative range. For adequate nutrition it is important to chose a combination of foods with positive and negative PRAL values. You need some acid forming foods, but you must balance these with sufficient alkaline forming foods to give an overall negative total. As far as I know, there is no target value to aim at.

Your target is really to increase the pH of urine, so frequent testing will show if you need to improve your PRAL score.

As PRAL is more about nutrition than gout, I have moved my tables of individual food items to my Food Diary website. There you can analyze your total diet, and then see which food items you should change to improve your gout diet.

Leave the Potential Renal Acid Load page to read other aspects of an Alkalizing Gout Diet Menu…

A recent discussion about uric acid and heart disease prompted me to take a look at current research. This also tied in with a little bit of reorganizing I am doing. An old post about lowering uric acid levels did not appear to have any relevance to heart disease, but one link led to another, and before I knew it, a whole host of other diseases seemed to connect with gout.

Interestingly, the link between many of these diseases is via new research into allopurinol. I will come back to that at a later date, but for a hint of what is involved, please see Do you have gout with another disease?

Lower Uric Acid

In an earlier post, I mentioned that Hershfield believed that lowering uric acid below 2mg/dL (0.12 mmol/L) would probably be safe ^[1]. On reviewing that report in more detail, I noticed that much of his evidence was based on other diseases. There are conditions where people have the opposite conditions to gout sufferers. I.e., they either cannot produce uric acid or they over-excrete it. The first case is because they do not produce xanthine oxidase, the second because they have genetic kidney defects that stop the kidney from reclaiming uric acid. In both these conditions, people have no known ill-effects with uric acid levels below 1mg/dL (0.6mmol/L)

When I followed this through to other investigations of lowering uric acid, I hit on a report that also looked at other benefits of lowering uric acid outside the world of gout.

Allopurinol For Other Diseases

Wei and colleagues investigation, Impact of allopurinol use on urate concentration and cardiovascular outcome ^[2], attracted me for several reasons. The investigation highlights the poor level of treatment generally, with only a small percentage of gout patients achieving safe uric acid levels. This is one of my pet topics that I will keep returning to, but the investigation also ties together the issue of lowering uric acid for gout sufferers with the advantages of such a regime for patients with other health problems.

This has set me on a path to investigate and summarize several other diseases. Mainly, I am hoping that the outcomes from helping other diseases through lowering uric acid, will bring a better understanding of how uric acid affects us beyond the obvious gout problems. But, that is for another day. For today, let me leave you with the conclusion:

In conclusion, more than half of the patients taking allopurinol did not reach the recommended target urate levels. High-dose allopurinol use was associated with a lower risk of cardiovascular events and all-cause mortality than low-dose allopurinol use, suggesting that higher doses of allopurinol may be of benefit by reducing cardiovascular disease or death.

If you are interested in the links between gout and other diseases, please join the gout forum discussion I mentioned above.

Leave Gout And Heart Disease to browse the gout disease pages

Gout And Heart Disease References

1. Title: Reassessing serum urate targets in the management of refractory gout: can you go too low? Author: Hershfield MS. Published: Curr Opin Rheumatol. 2009 Mar;21(2):138-42. Can Uric Acid Go Too Low?
2. Title: Impact of allopurinol use on urate concentration and cardiovascular outcome. Authors: Wei L, Mackenzie IS, Chen Y, Struthers AD, MacDonald TM. Published: Br J Clin Pharmacol. 2011 Apr;71(4):600-7. doi: 10.1111/j.1365-2125.2010.03887.x. Allopurinol Uric Acid And Cardiovascular Health
…

Gout is often associated with other disease, though often the links are unclear. We have situations where gout causes another disease, another disease causes gout, or there appears to be a statistical link, but nobody understands how the health problems affect each other. We know that excess uric acid causes gout, but other properties of uric acid are less certain.

There are many investigations that show statistical links, but these often raise more questions than answers. In many cases, a statistical association leads to specific investigations, but it can take several years of detailed research before scientists understand these complex relationships.

I have covered many diseases associated with gout, but if you think I have missed one, please share your views and experiences in the gout disease forum. I would also appreciate your comments there if you want me to give priority into researching or summarizing a particular disease and it’s association with gout.

There are lots of discussions in the gout forum about different disease associations. Use the search box near the top of every page to find current discussions. This will also include relevant articles from the gout disease blog.

Gout And Heart Disease

Heart disease, or cardiovascular disease, which includes related conditions such as stroke and angina, is currently being investigated widely. Various associations are being considered, in particular the role of uric acid. Some recent investigations into allopurinol in heart patients reveals strong links between uric acid and heart disease, though the relationship is not yet fully understood.

Search for heart or cardiovascular for articles and discussions related to heart and gout disease.

Gout And Kidney Disease

As uric acid is excreted or reclaimed through the kidneys, there are many associations between gout and kidney disease. Kidney stones are a common risk for gout sufferers.

Search for kidney or renal for articles and discussions related to kidney and gout disease.

Gout And Liver Disease

As the liver plays a big part in producing uric acid, there are many associations between gout and liver disease. Some gout treatments create concerns about liver damage, but this requires individual case investigation and analysis, because gout patients can also get liver improvements.

Search for liver or hepatic for articles and discussions related to liver and gout disease.

Gout And Osteoarthritis

As uric acid is deposited around joints as crystals, there are many associations between gout and osteoarthritis. Joint damage is a common risk for gout sufferers.

Search for osteoarthritis, bone erosion, or joint damage for related articles and discussions.

Gout Disease: Next Steps

In the Gout Disease Blog, I often report associations between gout or uric acid and other diseases. As these associations become better understood, I review and summarize the relationship here. You can keep up-to-date with developments in the field of gout associated with other diseases by subscribing to my free update service:

Leave this Gout Disease page to browse other gout-related topics.…

This page will explain how an alkalizing menu can help gout sufferers.

The most important thing to realize is that this has nothing to do with neutralizing uric acid, a common misunderstanding. Adopting an alkalizing diet creates an environment in your body where uric acid is more soluble. This has a noticeable effect on urate kidney stones.

The second-most important thing is to realize that you must analyze the whole of your menu to estimate the acidic load of your total diet. Individual foods are meaningless in isolation, though once you have a view on your entire menu, you can look at individual foods to see where you must make changes.

Pending the summary information, you should read the following articles for more information:

Alkaline Foods: More Myths Exposed

Avoid the myths about alkaline foods for gout and see what benefits the gout sufferer can expect.

Alkaline foods are said to give massive health benefits. But what are the hidden dangers for gout sufferers?

Diet For Gout Sufferers: Food Tables

Introduction to the food tables that help plan a diet for gout sufferers.

You cannot plan a diet for gout sufferers without food tables. These gout diet tables are the best, and will get even better.

Alkaline Foods For Gout

Using PRAL to plan your gout diet menu to avoid gout kidney stones.

Alkaline foods for gout are hard to understand. This explanation makes sure you avoid the pitfalls of bad gout diet planning

Is Alkaline Diet uricosuric?

Will this gout PDF file help lower uric acid using an alkaline gout diet menu?

Planning a gout diet menu often includes an alkaline diet. Tasty, healthy, but can it really lower uric acid as a uricosuric?

Leave Alkalizing Gout Diet Menu to browse the Gout Diet section…

Why limited appeal? As I noted in the original article, baking soda tends to raise blood pressure. There is a high occurrence of high blood pressure amongst gout sufferers, so many simply cannot contemplate it.

Baking soda for gout sufferers is most useful as a method for dissolving or preventing kidney stones, but you must consult your doctor about this.

To understand why this works you need to consider the causes of gout.
In the first place, uric acid levels build up to a level that cannot be held in the blood.
Crystallization occurs and uric acid salts are deposited in the joints.
There is no specific level when this happens and some people can have high levels of uric acid (hyperuricemia) without developing gout.
Therefore, you should not simply focus on uric acid levels, but also on other factors.

Body fluids are a combination of many different compounds. Some are acidic and some alkaline.
Acidity or alkalinity is generally measured using a pH scale with values between 0 and 14.
On this scale 7 is neutral, anything below 7 is acidic and anything above 7 is alkaline.
As the overall pH of body fluids fall, uric acid becomes less soluble, increasing the risk of gout attacks.
Conversely, increasing alkalinity lowers the risk of uric acid crystallizing and helps dissolve existing crystals.

Due to the effects of acidity, many people find that treating gout with baking soda dramatically improves their condition. The maximum dose, unless advised otherwise by your doctor, is 4 teaspoons per day. This can be either one teaspoon dissolved in water taken 4 times a day, or 1/2 teaspoon more frequently.

Do not exceed this maximum, and always dissolve it in water – undissolved baking soda can rupture the stomach.
Disadvantages
Although I do not class baking soda as a drug, it can have side effects and interactions with drugs you may be taking. You must not start taking baking soda without consulting your doctor. Significantly, as a salt of sodium (baking soda is also called bicarbonate of soda or sodium bicarbonate) it can raise blood pressure. Possible side effects include:

• Appetite loss
• Breathing slow
• Continuing headache
• Feet or lower legs swollen
• Mood changes
• Restlessness or nervousness
• Twitching or painful muscles
• Unpleasant taste
• Urge to urinate frequently
• Vomiting or nausea
• Weakness or tiredness

If you have tried this, or have any questions or opinions on it, please discuss baking soda in the gout cures forum.

Alternatives To Baking Soda For Gout

There are alternative ways of increasing alkalinity of body fluids as a gout treatment. The main alternative is food. The standard text for checking pH values is the US FDA’s “Approximate pH of Foods and Food products” list.

I have reformatted this list elsewhere, but since doing this I have realized that the pH value of food is not especially important. The significant effect of food is how it affects the alkalinity of the body after it has been digested. To learn more about how food affects body pH, see treating gout with an alkalizing diet. …

With a growing amount of information about gout and uric acid, indexing becomes more important to help you find the information that is most relevant to you.

Gout And Uric Acid Indexing

There are several indexes available now, and I am building more through 2012.

Subject Section Gout And Uric Acid Indexing

The main index pages are divided by subject, and are accessed via the Gout Index in the main menu.
Other categories are listed on the following pages:

Alphabetic Gout And Uric Acid Indexing

I am working on alphabetic indexing now.

Personal Relevance Gout And Uric Acid Indexing

This is the main indexing project for 2012.

I am looking at why people visit GoutPal with a view to standardizing the various aspirations of my visitors. This allows pages to be flagged with their suitability for a particular aspiration. For example, if you are looking to lower uric acid, then previous visitors who have the same aspiration can recommend the most suitable information that has helped them.

Progress of this indexing project now rests with you. I have recently introduced the Gout And Uric Acid Status project. Please vote for the statements about gout and uric acid that most match your aspirations. If you have other gout-related aspirations, please add them as answers. and if you can think of better wording for any of the statements, please add your comments. Also, remember to vote up the question if you think this project is a good idea.

Other Gout And Uric Acid Navigation Tools

In addition to the indexes, there are several existing ways to find information, with more planned for 2012.

Gout And Uric Acid Menus

The box menu near the top of most pages gives lists of Top Level Sections, Best Gout And Uric Acid Pages, Similar/Related Topics, and pages within the Same Section.

During 2012, these will move to a menubar that will stay at the top of the screen. This is an extended version of the menubar at GoutPal Interactive. I will also add menus for Favorite pages and Recommended pages.

Searching Gout And Uric Acid Information

I have saved the best (in my opinion) until last. The final way to find information is to use the search box at the top of every screen.

You can also use it here:

Please note that, whilst this search box is specifically to search GoutPal pages, you can use the Full Search to find any pages on the Internet. Please bookmark that link and use it to replace your current search tool.

Gout And Uric Acid Navigation: Next Steps

I am always interested in improving the methods for finding gout and uric acid. If you have a favorite way, please vote for it on the gout and uric acid navigation poll. If you know of better ways, please add your suggestions as answers to that poll. If you have suggestions for improving current indexes or other navigation methods, please add your comments to the appropriate answers.

Leave this Gout And Uric Acid Navigation page to browse other gouty arthritis related pages.…

The biggest problem for new gouty arthritis patients is to know where to start to make sense of all the gout and uric acid information. There are over 500 reference pages on this website, and over 1200 gout and uric acid discussion pages on GoutPal Interactive.

I am working on an alphabetic index, requested by a regular visitor. Once that is completed, I am introducing a new feature where visitors can recommend pages that are particularly useful. In order to make them as relevant as possible, I will incorporate a gout status indicator. Visitors will be able to recommend pages that are particularly suitable for someone seeking a clear diagnosis, or a gout sufferer seeking natural cures etc.

For this to work, I need a list of statements that visitors can mark as being particularly relevant. I have started such a list, but this would mean much more to me, if the statements mean something to you. Obviously, not all statements will apply to everyone, and some will change. For example, a gout patient looking to stop gout pain now, might be more interested in ending future gout pain, once the crisis is over. Some people will find more than one statement relevant.

The statements are currently:

• I want to stop current gout pain.
• I want to end future gout pain.
• I want to lower the uric acid level in my blood.
• I want to avoid gout medicines to fix my gout.
• I want to understand more about how gout works.
• I want to improve my gout diet.

I would like you to think about this list. If any of these apply, please can you vote for your most suitable gout and uric acid statements. Whilst you are voting, if you think of any other statements, please add them as answers. If you can improve the wording, please add appropriate comments.

Thank you for helping me make access to the gout and uric acid pages easier.

Leave this Gout And Uric Acid Page to see how to find gout and uric acid information…

Before I look at at exercise, you must remember what gout is – a uric acid imbalance where excess uric acid forms crystals in joints and other body tissues. Of itself, and contrary to popular belief, it is not a dietary problem, though bad diet can make gout worse, and occasionally it is the only source of excess uric acid.

There is an important test, when first diagnosed with gout, but before uric acid lowering treatment starts. That test involves collecting urine over a 24 hour period, which is then analyzed for uric acid output. This tells you if you are an over-producer, or under-excreter. With this knowledge, managing exercise & gout together becomes easier. Whether you get this test or not, uric acid blood tests are vital. Exercise can affect gout in different ways, and if you do not know your precise uric acid level (a number, not a label), you will not be able to judge the benefits or pitfalls from your exercise program.

Now, this article is concerned with athletic endurance and strenuous exercise. We know that gentle exercise is good for gout, as it improves mobility without the added complication of raised uric acid from exercise stress^[1]. So does this mean that strenuous exercise is bad for gout?

Like many aspects of gout management, managing gout & exercise is not about good and bad, or right and wrong, it is about balance. It is about balancing your physical and psychological need for exercise against inherent risks. We have seen, from the first study, that there is a risk of increased uric acid from strenuous exercise. However, that report also indicates that these effects can be avoided. Individuals who know that their uric acid excretion is not impaired will also benefit from staying hydrated during, or immediately after, strenuous exercise.

In a later article, I will look at specific benefits of exercise reported for gout sufferers. A statistical study offers some insight into the benefits of exercise^[2]. In that report, men running 5 miles per day had 50% less incidence of gout than least active men.

Though statistical studies need careful interpretation, this is supported by other specific studies that i will summarize later. There seems little doubt that exercise will benefit most gout sufferers, but it is pointless in isolation. If you have ever had a gout attack, the maximum safe level for uric acid in your blood is 5mg/dL (0.30mmol/L). Exercise might help you achieve this, but you must take uric acid lowering treatment if necessary to maintain that safe level. If you do not, the crystals will build up and erode bone, cartilage, and tendon.

Exercise your mind and control your uric acid, before the deposits cripple you and permanently deprive you of physical exercise.

Leave this Gout & Exercise page to browse the Gout Diet Section.

Gout & Exercise References

1. Treating Raised Uric Acid From Exercise Stress
2. Gout And Athletic Endurance
…

(function(d, s, id) { var js, fjs = d.getElementsByTagName(s)[0]; if (d.getElementById(id)) return; js = d.createElement(s); js.id = id; js.src = "//connect.facebook.net/en_GB/all.js#xfbml=1"; fjs.parentNode.insertBefore(js, fjs); }(document, 'script', 'facebook-jssdk'));At this time of year, I’m often in reflective mood.

Looking back at the past year’s achievements. Looking forward to next year’s challenges.

Today, I am mindful of the social aspects of gout. Who amongst us has avoided the laughter and derision when we share our goutful state within our social circle? We have even had gout forum contributors complain of their doctor’s diagnosis accompanied by gleeful laughter.

It’s not funny! Gout hurts.

But it also hurts and saddens me to see the attitudes to this most painful of health conditions. People perceive gout as some form of amusing self-harming. So we hang our heads in shame, complaining of age and arthritis, scared to mention the G word.

But this is wrong. We have to take charge, and tell the world about gout as a genetic metabolic problem. We need to play down the food aspects. Yes, food is an important consideration in gout treatment, but only as part of a proper gout management plan. Worrying about certain foods as gout triggers is pointless, and only confuses the important issues.

Worst of all is the appalling lack of understanding and valid treatment programs in the health industry. But I digress – let me get back to social issues.

I have come to realize that the only way to make significant changes is to share. So 2012 will be my year for broadening horizons, and pushing gout awareness to everyone who needs to understand it better. Now this is no gout awareness campaign pushed by huge pharmaceutical companies. Nor is it a network of snake oil salesmen striving to create misinformation so they can benefit with “secret reports” and “miracle cures.”

My gout support network will push the values of openness and honest helpfulness that have brought GoutPal to the forefront of gout support. And it all comes down to you.

I wrote earlier about the importance of you in improving gout support services for everyone. To get more people involved, I have pushed forward with two of the biggest social networks.

GoutPal On Facebook

I set up a GoutPal Facebook page some time ago, but never really got round to learning how to develop it properly. I have revamped it, and I want to improve it during 2012, but I heed your help.

Not only do I need you to Like my page, I also need your input about what to include on the page. At the moment, it is mainly a series of automatic posts from the GoutPal websites, but I am sure it can be a lot more than that. I do not want to detract from the gout forums on GoutPal Interactive, so I am not keen on using it for questions and answers. What would you like to see there?

Also, Facebook has a blog following service. Is that useful, or would you prefer my regular email/RSS update service?

Follow this blog

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GoutPal On Google Plus

Google have been keen to ride on the success of Facebook, and introduced a Google Plus service, where I have recently added a GoutPal page.

This service is very new to me, and I have yet to explore it’s potential. Have you used it? Like Facebook, what do you think is the best way to promote gout awareness through Google Plus pages? I have added PlusOne badges to the top and bottom of all pages here – have you shared your favorite pages with the rest of the world yet?

Reclaim Social Space For Good Gout Support

I’m unsure how successful my network expansion plans will be, but I am certain of one worrying fact. The online world of gout continues to be manipulated by self-serving pharmaceutical companies masquerading as information sources and self-serving snake-oil salesmen masquerading as reliable product sources. They have taken over Facebook, and I see that Google Plus will be the next target. With your help, we can stop this abuse of social networks by sharing the good stuff.

If you have ideas or questions about expanding the gout support network, please share them in the GoutPal Improvements Forum.…