lower uric acid Tag

Some reprieve for gout patients who cannot tolerate allopurinol arrived in recent years in the form of febuxostat. Sold as Uloric, or Adenuric, this was hailed as the first new gout treatment in 40 years.

Now, those patients who, try as they might, cannot get uric acid low enough, have a further option, but it is far from an easy one.

FDA approves new drug for gout

In a press release yesterday, the U.S. Food and Drug Administration announced the approval of Krystexxa (pegloticase) for gout in adults who do not respond to, or who cannot tolerate, conventional therapy.

They explain how gouty arthritis occurs

due to an excess of the bodily waste uric acid, which is eventually deposited as needle-like crystals in the joints or in soft tissue. These crystals can cause intermittent swelling, redness, heat, pain and stiffness in the joints.

Gout is strongly associated with obesity, high blood pressure, high cholesterol and diabetes, and occurs more often in men, in women after menopause, and in people with kidney disease.

“About 3 percent of the three million adults who suffer from gout are not helped by conventional therapy. This new drug offers an important new option for them,” said Badrul Chowdhury, M.D., director of the Division of Pulmonary, Allergy, and Rheumatology Products in the FDA’s Center for Drug Evaluation and Research.

They then explain how, Krystexxa differs from allopurinol and febuxostat, which blocks the enzyme (xanthine oxidase) that produces uric acid. The new gout treatment is an enzyme that lowers uric acid levels by metabolizing it into a harmless chemical that is excreted in the urine. The drug is administered to patients every two weeks as an intravenous infusion.

I will summarize the research that supports the license application when I update the gout treatments reference section with this newly approved treatment. For now, you need to be aware of the cautionary conclusion to the FDA Krystexxa press release:

Since one out of every four patients in the clinical trials experienced a severe allergic reaction when receiving an infusion of Krystexxa, health care providers should dispense a corticosteroid and an antihistamine to their patients beforehand to minimize the risk of such a reaction. Other reactions during the clinical trials included gout flare, nausea, injection site bruising, irritation of the nasal passages, constipation, chest pain and vomiting.

Physicians are also being warned to be cautious about administering Krystexxa to patients with congestive heart failure because the drug was not studied in this patient population.

Krystexxa is being approved with a Risk Evaluation and Mitigation Strategy that includes a medication guide for patients and materials for healthcare providers to communicate the risk of severe infusion and allergic reactions.

Sounds serious doesn’t it?

Let that be a reminder just how serious excess uric acid really is. If yours is high, you must do all you can to lower uric acid in your blood. If you do not know your uric acid number, please get it sorted. Today.

Milk Diet For Gout: Contents

Uric Acid Percent Change After Milk

Milk Diet For Gout: Introduction

The 1991 investigation claiming milk is beneficial for gout appears to be somewhat ignored by the medical profession. Now, almost 10 years later, a similar investigation reports similar findings. I have not done a full comparison of the two milk and uric acid studies. For one thing, I do not have full access to the latest study. However, you should find plenty of useful information in this summary taken from the American College of Rheumatology (ACR) press release.

Please note that I’ve paraphrased the original press release to make it more readable and relevant to us non-medical people. The full gout and milk report has subsequently been published in the British Medical Journal [1].

Milk Diet For Gout: Overview

The ACR’s press release, ‘Got Gout? Get Milk’, promotes the research presented at their Annual Scientific Meeting in Philadelphia, Pa.

It describes gout as a painful and potentially disabling form of arthritis with symptoms usually consisting of intense episodes of painful swelling in single joints, most often in the feet (especially the big toe).

They note that treatments are already available to prevent or control the arthritis associated with gout, but managing this disorder can be difficult, and treatment plans often have to be tailored for each person. I believe it is vital that treatment is planned individually, which is a key point in the Gout Freedom campaign.

They note that previous studies indicate that individuals who drink a lot of milk have a lower risk of developing gout. Though not specifically referenced, this is almost certainly Choi’s statistical analysis linking high dairy consumption with lower gout incidence.

Milk Diet For Gout: Research Report

The presentation is titled: “The Acute Effect of Skim Milk On Serum Urate Concentrations: A Randomized Controlled Cross-Over Trial” and it’s authors are listed as:

• Nicola Dalbeth, FRACP , Department of Medicine, University of Auckland, Auckland, New Zealand
• Sumwai Wong, Department of Medicine, University of Auckland, Auckland, New Zealand
• Greg Gamble, Department of Medicine, University of Auckland, Auckland, New Zealand
• Anne Horne, Department of Medicine, University of Auckland, Auckland, New Zealand
• Barbara Mason, Department of Medicine, University of Auckland, Auckland, New Zealand
• Lynette Fairbanks, Guy’s Hospital, London, United Kingdom
• Fiona M. McQueen, Department of Medicine, University of Auckland, Auckland, New Zealand
• Jillian Cornish, Department of Medicine, University of Auckland, Auckland, New Zealand
• Ian R. Reid, University of Auckland, Auckland, New Zealand
• Kate Palmano, Fonterra Research Centre, Palmerston North, New Zealand

Uric Acid Research Purpose

Recent observational studies have highlighted the beneficial role of skim milk in prevention of gout. The aims of this study were to determine the acute effects of intact skim milk on serum urate concentrations, and to examine the mechanisms of the urate-lowering effects of skim milk.

Uric Acid Research Method

This was a short-term randomized controlled cross-over trial of skim milk in 16 healthy male volunteers. The following products were tested (each 80g protein):

1. soy control
2. early season skim milk
3. late season skim milk (containing high concentrations of orotic acid, a naturally occurring uricosuric agent)
4. MPC 85 skim milk (an ultra-filtrated skim milk containing very low concentrations of orotic acid, purines and lactose)

Each participant received a single dose of each product (each containing 80 grams of protein) in random order. Researchers collected samples of blood and urine immediately before each participant drank one of the beverages and then hourly over a three-hour period. They completed this with each participant for each of the four beverages with a week in between each session.

Uric Acid Research Results

After drinking the soy milk, uric acid in the blood increased by about 10 percent. In contrast, all skim milks led to a decrease in serum uric acid by approximately 10 percent. All products (including the soy milk) rapidly increased the ability of the kidneys to remove uric acid from the body.

Additionally, researchers found that late season skim milk led to a greater increase in the removal of uric acid by the kidneys when compared to the other skim milks. Late season skim milk is primarily available from countries where milking is seasonal and cows are grass-fed, such as New Zealand and Australia, and is known to contain higher levels of orotic acid, a substance that promotes uric acid removal by the kidneys.

There were no significant differences over time or between groups in changes in serum oxypurines (xanthine and hypoxanthine) or purines (guanosine and inosine). However, all products led to an increased excretion of xanthine.

Uric Acid Research Conclusion

The press release concludes that the study showed that skim milk has a specific acute uric acid-lowering effect. The authors suggest long term studies for further proof that it might be a good dietary way to assist in the prevention and treatment of gout.

“This study has shown that skim milk can significantly reduce the serum uric acid concentration in the short term,” explains Nicola Dalbeth, MD, FRACP; senior lecturer, clinical medicine, University of Auckland, Auckland, New Zealand, and lead investigator in the study. “The results suggest that increasing the amount of skim milk in the diet may help with preventing the development of gout, and also assist with treatment for those with the disease. We are now continuing this work by studying the longer term effects of milk in people with gout.”

Milk Diet For Gout: Next Steps

Now is a good time to seriously consider improving your diet with skim milk. Do not forget that even the lowest fat skim milk still has some energy, so if you are counting the calories make sure you plan this diet change properly.

More importantly, you must realize that the uric acid lowering effects of skim milk, though significant, may not be enough to reduce you uric acid to a safe level. You must continue to check uric acid levels regularly to ensure that you remain safe.

If you are used to drinking full-fat whole milk, I found that by gradually reducing the fat content, I was soon happy with the taste of skim milk. In fact, I now find full fat milk far too creamy for my palate.

There are more natural gout cures to lower uric acid in the Gout Treatment Section.

Milk Diet For Gout: References

1. Dalbeth N, Wong S, Gamble GD, et al. Acute effect of milk on serum urate concentrations: a randomised controlled crossover trial. Ann. Rheum. Dis. 2010;69(9):1677-1682.

Leave this Milk & Gout page to browse other Gout Cures

Uric acid crystals must be dissolved to permanently get rid of gout pain, but how long does it take to get rid of them?

Like all gouty issues, the answer is never simple. However, we can see some factors that affect the time it takes for crystals to dissolve, and see that the time to start dissolving is now.

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