Posts Tagged uric acid lowering diet
An article that will appear in the September Issue of the Journal of the American Dietetic Association calls into question the long held belief that those with gout need to maintain a “purine-restricted” diet. This article points out that some foods, such as some vegetables are very high in purines, yet research has consistently shown that consumption of these vegetables is strongly correlated with a reduction in uric acid levels and in gout attacks. Research has also shown that beer is strongly correlated with higher instances of gout even though modern beers often have very low levels of purines.
Although diet has long been assumed to be associated with hyperuricemia, this association remains to be verified. Studies that have reviewed the relationship of diet and hyperuricemia have found it to be a difficult and complex issue.
Gout is a disease that medical science obsessed over for, well, since medical science came into being. Only in the last fifty years has gout become a “forgotten” disease. Through this long and amazing history, gout has had a more or less faithful companion: the autumn crocus flower. It’s from the bulb of this flower that colchicine comes.
Some reports say that colchicine has been in use for over 6000 years while other reports say its a much newer drug that has only been in use for 2000 years. Regardless, it is still considered to be a first line drug by many doctors. Unfortunately, those doctors are grossly out-of-date. Not only in using colchicine first, but also in how they use it…
If you have gout, it is important to get your uric acid levels tested regularly. This is important for a couple of reasons. First, if you are taking medication, or even natural remedies to lower uric acid levels, you want to make sure that they are actually working. You also want to make sure that you are maintaining a healthy uric acid level – too much uric acid and gout can occur (bad) – too little uric acid and neurological issues can occur (rare, but worse).
Second, uric acid levels can fluctuate wildly, from day to day, even hour to hour. A blood test gives you a snapshot of what your uric acid level is at that moment. You could be having a good day and your uric acid level is low. This might make you feel as though you do not need to take so much medication and scale back. Unfortunately, this will likely result in a gout attack.
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I have been sitting in my office this morning with the television on, watching the coverage of the swine flu outbreak. I am always impress at how much panic an infections disease can generate. Personally, if the swine flu does become pandemic, I hope I am one of the first to come down with the disease. Why? With a disease as virulent as the flu, the odds are very good that I will develop the disease eventually and if that happens, I want to get it before the medical system is overloaded and drugs like Tamiflu run out. Beside, I am a healthy 38 year old and the risk of serious complications, let alone death, are small. This way, I would get the best care, medications, will get it over with quickly, and be healthy (and immune to the disease) when the disease hits it’s peak so I can help care for others. So you won’t find me walking around with a mask on – which really doesn’t provide much protection anyway.
What does swine flu have to do with gout?
Not much really, however some medications used to treat gout can suppress the immune system which can make you more susceptible to disease including the flu and can make the flu worse if you should get it. If you are unlucky enough to develop the flu just as you are being treated with corticosteroids or colchicine for a gout attack, it could make it much worse - particularly if you are elderly. Note that NSAIDs and medications to lower uric acid levels do not suppress the immune system.
Of course, if you manage gout properly by lowering uric acid levels, there is no need to ever treat a gout attack because you will not get them.
Update: NYC Assistant Principal in Critical Condition
In New York City an Assistant Principal has come down with the N1H1 flu and is now in critical condition. It has been reported in the media that the only preexisting health condition he had was gout. As a result I have seen a lot of interest in any possible connection between gout and swine flu. It has been reported in the media that this Assistant Principal is suffering from kidney failure. As I have written previously (see,Is Gout Dangerous) that gout is strongly associated with kidney failure. If fact, nearly all people suffering from gout have significant kidney damage at the time of death.
So, did gout combine with swine flu contribute to this man’s kidney failure? That remains to be seen, but I would not be surprised if this turns out to be the case. The flu could have found a comfortable home in the already damaged kidneys. As the disease spreads, we will see if more people suffering from gout develop serious kidney complications.
Update 2: NYC Assistant Principal Passes Away
Unfortunately, NYC Assistant Principal Matthew Wiener passed away Sunday, May 17th. Our sympathies go out to his family.
As for the connection between gout and swine flu… Its unlikely that gout played a role, but it is possible. I hope that the CDC takes a close look to see if there was a connection. If they can find a connection, then I hope that they will at least advise the public of the risk and advise the medical community to treat those that have gout and develop swine flu more aggressively.
If you have gout, you understand that gout has a definite impact on your quality-of-life during an attack — life sucks. The pain can be unbearable. Researchers have looked at this question more quantitatively though and come up with some interesting findings.
As we know, gout is caused by uric acid crystalizing in our joints, which causes an immune response (if you don’t know this, see, Gout Basics). Even when you are not in the middle of a gout attack, if you have high uric acid levels, crystals are always forming and dissolving and not just in your joints, but all over your body. These crystals are seen as invaders by your immune system which causes it to respond. This causes your immune system to alway be in a heightened state of alert and it causes inflammation in your body which can cause many deadly diseases (see, Is Gout Dangerous). But the problems do not stop there…
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Diet is the most common method dragged out as a means of controlling gout but as I have written in previous posts, diet alone can almost never eliminate gout. Research has shown that diet, even tightly controlled diets can reduce uric acid levels by at most 1-2mg/dL (55-110µmols/L). This can ‘cure’ gout only if your uric acid levels are just over the level where gout becomes possible. For example, gout is only possible in people with uric acid levels above 6.8mg/dL (380µmols/L). If your uric acid level is normally 8mg/dL(440µmols/L), then with a very tightly restricted diet, you might be about to pull it off, but if you slip up — you’re in trouble. If your uric acid level is normally 9mg/dL(500µmols/L) then the best you can manage is 7mg/dL(390µmols/L) which would definitely reduce the number of attacks, but can never eliminate them entirely.
What’s more interesting is that the most commonly referred to diet for people with gout is a “low purine diet” but few people, even medical professionals, really understand what this means. Yes, they may pull out some old chart that tells you to stay away from shellfish, beer and asparagus — among others, but you need to know these lists are only just guesses.
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