Simple Gout Treatment

I know gout can be complicated, but let’s try the simple approach to gout treatment before we look for difficulties.

Gout treatment is the heart of finding gout freedom.

Gout treatment must be preceded by a proper medical diagnosis of your gout symptoms.

Gout treatment might  be followed by adjustment to your gout diet.

So for all of you making life difficult for yourselves by worrying about food and drink – stop now. Do not even think about diet until you have a good gout management plan.

1. Starting A Gout Treatment Plan

The best gout treatment plan starts with good diagnosis from your doctor(s). If you have a confirmed gout diagnosis then move to step 2.

Gout diagnosis can be difficult for a small minority of gout patients. For most people, it is very simple.

If your gout symptoms are not confirmed, see your doctor or rheumatologist today. If they are confirmed, a more complete analysis of possible causes is useful, but not essential. If you have it, it may give you more options for gout treatment.

I will announce a personal gout symptoms assessment tool soon. In the meantime read the Gout Symptoms section, which is first in the list of sections near the top and bottom of every page. If you still have questions, ask in the Gout Symptoms forum.

Continue to read your simple 3 step gout treatment plan

Find more (see gouty search hints for guidance).


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Bismuth Subsalicylate and Gout

Bismuth subsalicylate is the active ingredient of many anti-diarrhea products. You should avoid it if you have gout.

Most products that contain bismuth subsalicylate carry warnings about gout. Salicylates are found in many plants, where they give beneficial protection against pests. Most famously, salicylates from willow was used to develop aspirin, though it is produced artificially now.

I mentioned salicylates in Beware Gout Cures You Do Not Need. That article lists many medicines that can cause gout, or make it worse.

Brands that use bismuth subsalicylate include:

  • Bismusal®
  • Kaopectate®
  • Peptic Relief®
  • Pepto-Bismol®
  • Pink Bismuth®
  • Stomach Relief®

Other brands may be available. Maalox is complicated, as some formulations include bismuth subsalicylate, but others do not. You must check the label. FDA warnings about certain Maalox formulations include:

Bismuth subsalicylate could interact with anticoagulants, hypoglycemic agents, nonsteroidal anti-inflammatory drugs (NSAIDs), and other anti-inflammatory medica­tions. Medical conditions such as gout, stomach ulcer, kidney disease, and bleeding problems could become more problematic with the use of a salicylate-containing product.

Got Gout? Stop Pepto

In Canada, the Department of National Health and Welfare has warned against Pepto-Bismol and similar products for gout sufferers:

Products containing bismuth subsalicylate are sold in Canada under the following brand names: Pepto-Bismol liquid and tablets, Rawleigh Pleasant Relief and Watkins Settelz. A product called Stress Liquid may soon appear on the market. These products should be avoided by patients undergoing oral therapy with anticoagulants, sulfinpyrazone, probenecid, methotrexate or medications with high levels of salicylate

Pepto-Bismol is one of the most popular, so I have had a quick look at alternative anti-diarrheal agents. Most other popular choices use Loperamide HCl as the active ingredient. I have not found any studies to indicate that Loperamide HCl adversely affects gout.

Any gout sufferer needing anti-diarrhea products should always buy from a reputable pharmacist. You should ask for confirmation that the product does not contain bismuth subsalicylate.

What’s the best anti-diarrhea product you have found? Ask about bismuth subsalicylate in the gout forum. Share your thoughts about bismuth subsalicylate in the gout network. Chat about bismuth subsalicylate in the gout chatroom.

Avoid Excess Calories for Gout

If you want gout foods to avoid, calories are just as bad as purines.

Purines don’t just come from meat on your plate. They also come from meat on your bones. So more weight = more flesh = more uric acid.

Just like other animals, humans eat for energy, and to build new tissues. New tissue replaces old, but if we overeat, our bodies create extra tissue, and we get fat. Tissue replacement is an essential part of life, but the meat in our own bodies is just as much a source of uric acid as the food that we eat.

Eating excess purines will increase our uric acid levels from diet. Excess calories will do the same from body weight.

Gout is not simply about food, but where food is a contributory factor then calories are just as important as purines. In fact they may play a bigger part in gout diet management as calories are contained in almost all foods, whereas purines that affect gout are only found in animal products and some fungal products, like mushrooms and yeast. Purines in vegetables can be ignored.

Continue reading Avoid Excess Calories for Gout

What is gout to you?

I can answer “What is gout?” but the more important question is “What is gout to you?”

This is a heads up for a new gout support service called Keith’s Learners. I will launch it officially in a few days, but for those of you with a burning desire to learn what gout is, here is a pre-launch introduction.

Over the years, I have used many different methods to explain what gout is. I believe it is important for all gout sufferers to have that knowledge. It helps you ask the right questions when you discuss gout with your doctor. It helps you discuss gout in support forums and with friends. Your gout knowledge is something that tells you when people are not giving you the right answers.

That is why I often try to explain What Is Gout? by explaining what it is NOT! Exposing myths about gout is a good way to tell if your advisers truly understand gout. Do they know gout, or are they merely spouting something they read in an old book, or outdated website? On that page, I also point out that what really matters is: What gout is to you?.

Continue reading What is gout to you?

Worried about High Uric Acid?

I’ve reviewed my survey about high uric acid levels. I’ve added the results about what concerns you most, below.

I have a lot of information about high uric acid (hyperuricemia), and I wanted to reorganize it so it helps you more. In May, I created a short survey, to help me know the best information to help your gout.

From discussions and responses to existing pages, I identified several things about high uric acid that gout sufferers worry about:

  • I cannot eat my favorite food
  • I want to be told what to eat
  • I don’t understand high and normal uric acid
  • I don’t know how to reduce uric acid
  • I’m worried about another gout flare
  • I’m worried about tophi
  • Heart disease and high uric acid
  • Kidney disease and high uric acid

They are not in any particular order. I also included an option to add other topics about uric acid that worried gout sufferers.

Continue to the High Uric Acid Survey

Foods High in Uric Acid – a Surprising Myth

As a gout sufferer, you must know the foods high in uric acid. I’ve listed them all for you below, but first, some explanations about food and uric acid.

Actually, food never contains uric acid, it contains something called purines, and your body converts purines to uric acid.

This is important, because excess uric acid is what causes gout.

I have a surprise for you about purines, but first I must explain my foods high in uric acid list, which is shown in full below.

You can see that my purines table shows actual numbers. Please don’t waste your time with other food lists that only show labels such as high uric acid in food, or moderate uric acid in food. My table takes all the foods from the biggest purine database, and lists real purine values in an easy-to-read format. That helps you plan your gout diet properly. If you are unsure about purines and foods high in uric acid, please read How Purines Affect Gout.

Continue to browse the Foods High in Uric Acid table

Facebook Likes Gout – Hates GoutPal

Facebook likes gout so much, it does not want you to learn how to beat it. It hides most of what GoutPal tells you!
Make sure you get all GoutPal notifications.
1. Check ✔ Get Notifications
2. Interact more
   ☑ Like regularly
   ☑ Comment regularly
   ☑ Share regularly
   ☑ Post your gout status regularly

The band of gout sufferers in GoutPal’s Gout Chatroom is growing, but are you missing out? Sometimes Facebook can be frustrating, but, just like gout, there are simple ways to make it better.

When you Like my GoutPal page on Facebook, you get notifications when I post something. But Facebook only notifies you about some of them. Facebook watchers have different views, but a common statistic is that, you only see about 25% of GoutPal posts, unless you tell Facebook you want more. There are 2 ways to do this:

  1. Make sure Get Notifications is checked
  2. Interact regularly with Likes, Comments, and Shares

See how to tell Facebook You Hate Gout

Is 80mg Uloric always enough?

Uloric is prescribed as either 40mg or 80mg per day according to the latest Uloric Prescribing Label.

Standard procedure is to start with a 40mg dose, then test after two weeks to see if 5mg/dL has been reached. If not, then increase to 80mg per day. Note that there is little room for half measures here. The label says “below 6mg/dL,” and this should normally be interpreted as 5. Anything between 5 and 6 might be acceptable in certain patients with other health issues, but the target for safe uric acid levels is 5mg/dL or lower.

Unfortunately, a GoutPal follower in the gout chatroom is struggling to achieve anywhere near this:

Uloric Safety

Uloric is generally safe, though some isolated concerns about liver problems prompt me to recommend that every gout patient on Uloric should have liver function and kidney function tests whenever they have uric acid tests. This should be at least once per year. I also recommend this for allopurinol.

As a new drug, Uloric has been subjected to extensive tests during its trial period. As part of these trials, it was determined:

ULORIC was studied in healthy subjects in doses up to 300 mg daily for seven days without evidence of dose-limiting toxicities.

Is 80mg Uloric always enough?

If allopurinol or Uloric is not achieving target uric acid levels, a rheumatologist should be consulted. This is a specialist case, beyond most doctors, and definitely beyond the scope of an Internet support service such as GoutPal.

A rheumatologist would normally consider either increasing the dose or supporting with other gout medicines to achieve a reasonable target. There are no general guidelines for this, as each case has to be considered on a personal basis, with complete medical history.

In an ideal world, gout patients would have liver function, kidney function, and 24-hour uric acid excretion rate tests before starting treatment to lower uric acid. As Uloric and allopurinol are generally safe and effective, these tests might not always be done. In most cases, they are not required.

In edge cases, such as this one where 80mg Uloric is not enough, the test results might be useful. Only a rheumatologist who has good gout knowledge can judge this. Your rheumatologist might take you off uric acid lowering medication to take the tests so that he has the full facts.

What happens next is really beyond GoutPal. This website cannot provide medical help, and you must see your own rheumatologist. I can however help you ask the right questions. In this case, the questions are:

  • Uricosuric Support: can Uloric be supported with a uricosuric, such as probenecid, to assist with uric acid excretion?
  • Off-label Dose Increase: can Uloric dose be increased beyond 80mg in view of the reported safety up to 300mg per day.

Please note that Uloric is a brand name for febuxostat, which is also sold under other names, including Adenuric. As a new drug, it is not available under it’s generic name of febuxostat. It is also sold as Atenurix in and around the Philippines. Interestingly, from the limited prescribing information I have seen, maximum dose of febuxostat sold as Atenurix is set at 120mg per day.

Have you been in a situation where standard uric acid lowering treatment has failed to achieve safe uric acid levels? Please share your experiences, and your rheumatologist’s advice in my gout forum my gout network, or in the gout chatroom.

Leave Is 80mg Uloric always enough, to browse Uloric (febuxostat) guidelines