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…

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. …

This increase of uric acid in your system will encourage the formation of tiny urate crystals. Then the crystals usually start to accumulate mainly around joints and eventually cause a reaction with our immune system. This reaction with the immune system triggers sudden attacks of pain and inflammation at the affected area. In patients at risk of developing gout, certain conditions can precipitate acute attacks of gout. These conditions include dehydration, excessive eating of food high in purines and heavy alcohol intake.

One way of boosting the effects of any gout treatment is to drink a lot of water. This helps in flushing out the excess uric acid from the body.
There are several advantages of drinking water along with taking your gout cure:
• Helps in flushing out uric acid and other toxins.
• Helps in prevention of kidney stones.
• Helps boost metabolism rate for weight loss (excess weight may be a factor for gout).
• Helps in preventing more gout attacks.

When you don’t drink enough water, your body gets dehydrated. Dehydration may lead to other ailments like improper kidney functioning. When kidneys do not function properly it might lead to formation of kidney stones, kidney infection and cause uric acid build-up. As you already know, excess uric acid is the main culprit behind gout.

Dehydration does not result just from not drinking enough water. Your body can get dehydrated if you consume drinks like coffee, alcohol or carbonated drinks very frequently. So for gout prevention and treatment, the first step you need to take is to reduce the intake of these drinks and increase the consumption of water. Sometimes it can be hard to motivate yourself to drink a lot of water every day. In such cases you can drink fruit or vegetable juices. But it is best to stay with water as much as possible.

PURIXA™ (www.purixa.com) is one gout cure that benefits from a good supply of water. It’s recommended that you drink 8 oz of water, six to eight times a day as well as your daily dosage of PURIXA. Try mixing PURIXA with orange or sour cherry juice. Also add a slice of lemon in water with PURIXA. Mixing PURIXA with milk is another great way to take PURIXA.

Leave this Gout Cure & Gout Remedy page to browse other Gout Remedy pages…

For now, we will focus on natural uricosuric agents as most gout sufferers are “under-excreters” of uric acid. There are several natural agents that have proven to be effective uricosuric agents.  Let’s examine some of the more common and potent agents available in natural gout remedies.

 

Casein, is a no-purine, protein found in milk.  Casein is proven to increase the amount of uric acid excreted in urine, the uricosuric effect. Researchers have tested these effects in several studies. These studies have demonstrated in clinical trials that, in addition to casein’s known uricosuric effect, increasing uric acid excretion, the protein acutely decreases serum uric acid concentration in the blood.

Vitamin C is also a uricosuric agent. Studies have shown that 200 mg to 500 mg/day vitamin C for 2 months reduces blood uric acid.  It is interesting to note that the one’s higher uric acid levels, the more effective vitamin C becomes in reducing uric acid.  In a prospective study, researchers found that higher vitamin C intake is independently associated with a lower risk of gout. Supplemental vitamin C intake was shown to be beneficial in the prevention of gout. The study included 46,996 subjects.

Both these agents, Casein and Vitamin C, are generally very safe and effective when taken in the right proportions.

It is important when considering natural agents to reduce uric acid, that one considers both uricosuric and xanthine oxidase inhibitors.  One natural gout product that contains this dual mechanism of natural products is PURIXA (www.PURIXA.com).

Leave Natural Uricosuric Agents to browse other gout cures…

Natural xanthine Oxidase inhibitors can be part of the gout treatment regimen. There are two very potent and safe agents that have XOI effects, green tea leaf extract and Resveratrol from Japanese Knotweed root.

Green tea contains high level of catechins, in which Epigallocatechin gallate (EGCG) is the most abundant compound among other types of catechins. Their antioxidant effect contributes to various potential health benefits of green tea. Several in-vitro studies have found that green tea inhibits xanthine oxidase activity and subsequently uric acid production. It is interesting to note that the FDA has approved human clinical trials in the United States that will study the effects of green tea leaf extract on gout.

Resveratrol from Japanese Knotweed root, an exceptionally potent polyphenol compound, has been shown in-vitro to be capable of directly inhibiting xanthine oxidase activity and thus block the over production of uric acid [1].

It is important when considering natural agents to reduce uric acid, that one considers both uricosuric and xanthine oxidase inhibitors. One natural gout product that contains this dual mechanism of natural products is PURIXA (www.PURIXA.com).

Leave Natural Xanthine Oxidase Inhibitors to browse other gout cures

Natural Gout Cures References

1. Resveratrol Xanthine Oxidase Inhibitor
…

In the first article, I explained how the correct treatment for gout is to reduce uric acid, but gout is not a disease that can be treated by a standard dose. Allopurinol is an extremely common and inexpensive way to lower uric acid. Unfortunately, there is a very common myth that 300mg allopurinol will bring gout under control.

Whilst 300mg may be effective in many cases, it is not effective for all gout patients, and in rare, but extreme, cases it may be dangerous.

What Is Gout Treatment?

Though pain relief is important, the only way to permanently fix gout is to lower uric acid until all uric acid deposits have been dissolved. There are many ways to lower uric acid, including several types of drug, alternative treatments, and diet. Combinations are often effective, so gout diet improvements with low dose gout medications might suit you. It is best to discuss your options with your doctor as soon as you are diagnosed with gout.

Uric acid monitoring is vital, and you must get this down to 5mg/dL (0.30mmol/L) as soon as you can. As uric acid crystals dissolve faster at lower uric acid concentration, it is a good idea to aim as low as possible for around six to twelve months. The length of time will vary according to how long you have had gout, and it’s severity. Once you have gone six months without a gout flare, you can slowly relax your uric acid lowering treatment until you maintain 5mg/dL (0.30mmol/L) for the rest of your life. In many cases, treatment can be relaxed completely for a few months, but you should always keep checking uric acid levels.

What Is Gout Treatment By Allopurinol?

As the most common gout treatment, allopurinol is surprisingly misunderstood – often by doctors who should know better. There is no such thing as a standard dose, yet many doctors simply prescribe 300mg allopurinol per day, and leave the patient to manage themselves.

For many gout patients, that dose is inadequate. The correct procedure is summarized nicely by the British Society of Rheumatology (edited slightly for clarity):

Recommendation
Initial long-term treatment of recurrent uncomplicated gout normally should be with allopurinol, starting in a dose of 50–100mg and increasing by 50–100mg increments every few weeks, adjusted if necessary for kidney function (see further), until the therapeutic target (uric acid in the blood less than 5mg/dL [0.30mmol/L]) is reached (maximum dose 900mg).

My preference is to refine this procedure to include an intensive uric acid dissolving period as I described above. Whether you do this or not, the dosage is clearly not a standard 300mg, and will vary from person to person. It may also vary from time to time, as your body ages, or if you change your lifestyle. Regular testing is vital at least once per year, and monthly whenever you change dose.

What Are Gout Dangers From Allopurinol?

Though allopurinol is generally well tolerated, there are a very small number of people who are allergic to it, and this might lead to Allopurinol Hypersensitivity Syndrome. This is a very dangerous condition that might be controlled through drastically lowering the dose then incrementing in very small steps. However, it can prove fatal, therefore it is wise to start with a 100mg dose to ensure that you can tolerate it.

In Fatal allopurinol hypersensitivity syndrome after treatment of asymptomatic hyperuricemia, Alfonso Gutiérrez-Macías and colleagues report the death of a gout patient taking 300mg allopurinol daily. There are many similar reports which I am currently researching to review dosages that are acceptable or potentially problematic.

Though the effects of Allopurinol Hypersensitivity Syndrome are severe, they are very rare. On a personal note, I am currently taking the maximum 900mg dose with absolutely no side-effects. I recommend that you focus on the benefits of lowering uric acid quickly and effectively, but discuss any fears about side-effects with your doctor.

What Is Gout: The Facts

300mg allopurinol might be the right dose for you, but you need to go through the right procedure to make sure you get the dose that is right for you.

1. Start with 100 mg and test after 4 weeks
2. Increment by 100mg every 4 weeks after testing to get uric acid down to 2 to 3 mg/dL (approximately 0.1 to 0.2 mmol/L)
3. Maintain low level until you go 6 months without a gout attack
4. Relax the dose by 100mg every 4 weeks after testing to maintain uric acid at 5mg/dL (0.30mmol/L)
5. Test at least once per year. If dose change is necessary, test every 4 weeks until uric acid level is stable.

Leave What Is Gout Myth #2 to browse the Gout Treatment Section…

Gout is really quite simple – an immune reaction to invading uric acid crystals. But many people fail to understand the immune system part of that definition. Also, many people build on the basic misunderstandings, and the Internet has fueled a host of myths about gout.

Today I will look at the pain measurement myth – gout patients (and some doctors) who measure the success of gout treatment solely by the reduction or absence of pain.

What Is Gout Pain?

Pain control is important. The intense pain of gout is hard to bear and seriously affects our mobility and enjoyment of life. It creates personal fears of returning pain that cause us to modify our behavior and to become anxious. We must control gout pain, but that is only a short term measure. To cure gout properly we must lower uric acid.

There are many more myths about uric acid levels, and I will cover these in later articles in this series. For now, I will simply say that for uric acid lowering treatment to be effective, it must reduce the concentration of uric acid in our blood low enough to cause all existing uric acid crystals to dissolve.

When I learned that allopurinol and other uric acid lowering treatments can cause gout attacks, I was shocked and confused. How can a treatment that is designed to help gout sufferers cause more pain? When you understand that, you understand what gout is, and you understand why you can never judge any gout treatment, including gout diet improvements, simply on the basis of gout pain.

What Is Gout Treatment?

In a comment on the gout forum today, Bob claims that blood donation as a gout cure does not work, because he is still getting gout attacks. But how does he know that if he does not know his uric acid levels?

Is the continuing gout pain from new uric acid crystals forming, or old ones dissolving? My best guess is that his uric acid level does drop after each blood donation, but the reduction is neither big enough nor frequent enough.

What Is Gout: The Facts

The only way to stop gout pain returning is to lower uric acid enough to dissolve uric acid crystals. The only way to measure the effectiveness of that treatment is to monitor uric acid levels. Pain will continue until all crystals are dissolved, and you should take pain relief as a preventative, or as required. For full details, please browse my Gout Treatment Section.

Leave What Is Gout Myth #1 to browse the Gout Treatment Section

If this has helped you understand what is gout, please vote for it in the What Is Gout discussion. You can also add your own ideas, or ask related questions.…

Last year, Tunisian scientists investigated benefits of crushed flax seeds. Though they were looking for glucose lowering and antioxidant effects, especially with reference to diabetes, they had the good sense to also measure uric acid. Their report, “Flax and Pumpkin seeds mixture ameliorates diabetic nephropathy in rats”, includes facts about uric acid lowering, especially where uric acid is raised as a result of kidney problems from diabetes.

Now, similar to my previous article, this investigation just gives us pointers that crushed flax seed may help lower uric acid. It is far from a reliable random-controlled investigation into human gout. The shortcomings include:

• Rats not humans
• Induced diabetes not natural gout
• Combined flax and pumpkin seeds – which is most effective?
• Very small improvement between healthy controls and treated animals

However, the investigation might give some useful pointers to gout sufferers, especially if you are trying to manage your gout using natural gout home remedies.

The essence of the experiment was to investigate 3 groups of rats: a control group; an untreated diabetic group; and a diabetic group treated with crushed pumpkin and flax seeds. Uric acid measurements show:

Though the changes are small, other uric acid lowering treatments have shown to be more effective as uric acid levels increase. If your uric acid level is 8mg/dL, the improvement might be significant, but you will need to find this out yourself.

Flax Seed: Next Steps

Though natural products should be safe for limited self experimentation, you should always check with your doctor first. This type of experimentation is better with your own home uric acid test kit, but you could also do it if you arrange lab tests every 2 to 4 weeks.
To test the effects of crushed flax seeds, you should start with a uric acid test, take flax seeds for 2 to 4 weeks, and test again. You need to repeat this for at least a year, testing periods with and without the flax seed supplement. You should avoid other changes to your diet. If you try this, please report your results in the gout forum.

Read more about flax seeds for gout.…

Before I begin, I must point out that this is a very early look at the potential for an existing asthma relief to assist gout pain relief. The investigation is based on induced gout in mice, and is far from the stages of being an accepted gout treatment. If trials on people are ever introduced, I will provide further information on my reference pages for new gout medicine. At the moment, this is only a potential for further research. Furthermore, it is only aimed at pain relief, and your treatment plan should focus on uric acid lowering treatment, with some provision for pain relief during the first few months. Once uric acid lowering has been successful, there is no further need for pain relief, so you will not need the potential benefits featured in this article.

Earlier this year, scientists in Venezuela investigated the effects of montelukast on gout [1]. They explained that indomethacin reduces inflammation as a COX inhibitor. However, there is another type of inflammation associated with gout, the lipoxygenase pathway, and indomethacin has no effect on that. Montelukast, which is commonly used to relieve asthma, inhibits lipoxygenase activity which blocks the synthesis of leukotrienes – molecules that trigger swelling and inflammation.

The investigation shows that montelukast appears to have a better anti-inflammatory effect in gouty arthritis compared to indomethacin. Moreover, the combination of both treatments is even more effective.

We must remember that this experiment uses mice that have gout induced by artificially depositing uric acid crystals. I am not aware of any human trials, but if they do start, I will monitor the progress and report back to you.

References

1. Title: The effect of montelukast in a model of gouty arthritis induced by sodium monourate crystals. Authors: Ponce L, Arjona M, Blanco G, Alvarez S, Arcila E, Ortega A, Nuñez D, Verzura J, Tovar R, Bethencourt S, Riera R, Mora-Orta S, Corado J. Published: Invest Clin. 2011 Mar;52(1):15-22. Gout And Montelukast
…

Allopurinol and alcohol is a popular topic for debate amongst gout sufferers.

Allopurinol is the leading medicine to lower uric acid, and gout patients who take it, at the right dose, are almost certain to take control of their gout. Yet, they remain concerned that alcohol consumption might affect allopurinol and reduce their chances of recovery.

In this article, I consider evidence relating to alcohol consumption and allopurinol.

Specific research on allopurinol and alcohol is hard to find. Allopurinol patient information advises limiting alcohol. However, no sources are cited that support this advice:

When taking allopurinol, keep your alcohol intake to a minimum i.e. 1-2 standard drinks, once or twice a week. Drinking more than 4 standard drinks on one occasion, even if infrequently, is strongly discouraged.

Alcohol And Response To Treatment Of Gout

In a letter to the British Medical Journal in 1988, Ralston and colleagues summarized their investigation into alcohol and allopurinol treatments.

Excessive consumption of alcohol has long been associated with gout in susceptible people. Although patients with gout are generally advised to stop drinking alcohol or cut down their intake, this advice may not always be followed. We looked at the relation between alcohol intake and the response to treatment of gout.

They considered alcohol intake of 30 units per week or more to indicate heavy drinking. They report that 95% of heavy drinkers usually continue to have gout attacks, compared with 29% of gout patients drinking less than 20 units per week.

However, the quality of data is poor. They note that stated alcohol intake is probably not the same as actual intake – i.e. patients did not tell the whole truth about alcohol intake. Worse than that, there is no indication that allopurinol treatment was managed properly – i.e. target uric acid levels are not quoted, only ridiculous normal ranges. They point out that failure to take allopurinol is the most likely cause of treatment failure.

Allopurinol And Alcohol: Next Steps

I can find no hard evidence to suggest that alcohol reduces the effectiveness of allopurinol. Clearly, if you drink so much that you cannot remember to take gout medications, then you have a serious problem that needs to be discussed with your doctor.

You have probably seen my frequent calls for “moderation in all things” for gout sufferers, and alcohol is no different. The biggest problem with allopurinol treatment continues to be inadequate dosage management. You must insist on frequent uric acid blood tests until you have achieved uric acid levels below 5mg/dL (0.30mmol/L), with allopurinol increased up to a maximum of 900mg per day. If you cannot achieve low enough uric acid levels, then factors such as alcohol intake must be considered.

As with most aspects of gout management, managing allopurinol and alcohol is a personal matter, and there is no ‘one size fits all.’

You must ensure that your allopurinol dose is managed properly and that you are taking the correct amount to control uric acid levels. Once your uric acid levels are stabilized, you can check if alcohol affects you by comparing results during periods of abstinence against results during periods of normal alcohol intake.

In my experience, there are many more problems associated with incorrect allopurinol dosage than problems associated with allopurinol and alcohol intake. If you are not clear about your own situation, please discuss your needs and uncertainties in the allopurinol and alcohol debate.…