March 13, 2018 at 10:32 pm #6639
Blood test done. Results expected on Thursday with rheumatologist on Friday and will update you in a separate post.
I was wondering if you could help with a few questions.
1. As you know I started Febuxostat last November and was around 58 kilos then. During the recent appointment I was down to 54 kilos and raised this with my haematologist. A few possible reasons were discussed one being diet. I told her I had cut down my sugars a lot which was a possible reason. From my own research afterwards I’ve come to know that drinking lots of water can also cause you to lose weight. What I wanted to know buddy is when you started Febuxostat did you lose any weight or were you always a large quantity water drinker therefore your weight remained the same?
2. Now I know we discussed the vegetable purine content vs the meats content and you have substantial belief that vegetable purines create the same effect as meat purines however do you know of any actual articles that prove this? The reason I am asking is because I have heavily increased my vegetable intake whilst mildly increasing my meat intake and wanted to know if it really makes a difference purine wise (I know this is healthier but I wanted to know purine wise).
3. In light of the increase in UA levels despite increasing the dose, maybe I am overthinking this but do you think it may be a simple case of ‘Febuxostat’ placement in the tablet? For e.g. where the actual drug composition resides in the pill. Maybe the distribution is biased to a given side or just a random concentration on either side or even the most concentrated parts being the edges of the pill as the largest UA drop was during 20mgs (approx 100ummol with hardly any further drops when going to 40mgs which if cut in half takes an empty or very low concentration middle? Maybe attempting to take the edge of the pills will result in a far greater drop?
There are a few more questions but I’ll ask them a little later.
March 14, 2018 at 9:57 am #6645
Keith TaylorKeymasterŦallars: Ŧ 1012.34Rank: Scholar
I can only comment competently on (2) as my febuxostat experience is limited to what I’ve written on GoutPal.com and these questions seem to go well beyond that.
The purine source (animal or plant) debate is interesting yet complex and largely misses the point.
Scientists have shown that different types of purines are digested differently. But most of the research is aimed at understanding purine metabolism. So very little useful purine research on gout sufferers is available. More importantly, I cannot recall anything like the type of investigation that is done when clinical research compares treatment options. Because the only research that matters is where gout sufferers are in controlled environments. Then we can compare different meal groups. But importantly, we must measure the purine type as well as its animal or plant origins. Also, we must account for temporary animal purine inputs from weight loss in the humans being studied.
With that level of research, we could gain more insight than current research. Which basically tells us that diets based on plant purines are more gout-friendly than diets based on animal purines.
But the real point is that we also need to consider non-purine issues that are related to this. Not least is Kanbara’s findings that alkalizing foods (mainly plants) are better than acidifying foods (mainly animals) at pissing away the purines.
In short, you need to consider what goes out as well as what goes in.
Finally, to bring this back to the topic title, I have a question I should have asked before I wrote the above. Why on earth does this matter when febuxostat effectively makes all food purine-free?
March 14, 2018 at 11:33 am #6646
1. When I started Febuxostat, doctors insisted I take too much. I had pretty bad blood tests, little appetite and obviously lost some weight (not a lot).
2. I have no beliefs about purines but I believe already asked you: what is there to prove? Purines are molecules, not life forms. Like Keith says, the amount of febuxostat you’re taking is supposed to dramatically lower the amount of uric acid made from the purines in your body anyway.
3. I wouldn’t worry about where the stuff is in the pill. But surely you haven’t thrown away pill fragments. Taxpayers are paying for them even if you’re not.
March 14, 2018 at 1:34 pm #6650
1. Ah right, maybe its the mass increase in the water intake as my appetite hasn’t really changed much outside of the decrease in sugar.
2. The reason I was asking was because I wanted to increase my educational curve on the subject (are purines the same across the entire food spectrum or do they differ between fruits, vegetables, meats, in their real contribution to UA etc) and I vaguely remembered you said you think they all contribute regardless from the food they come from.
3. Oh! these tablets are paid by taxpayers like myself? I guess my cat is not going to be too happy without it’s daily nibble any more.
March 14, 2018 at 1:55 pm #6651
@keith – Agreed on the Febuxostat side of the questions. I guess over time these answers will probably come to me naturally through experience.
I love the ‘Why does this all matter if Febuxostat is floating around your system’. Truth be told, there are so many sites out there that say fruit and veg count and sites that say they don’t so just eat more without giving thought to purine content and this site is my primary reference point for answers. Since the situation was a little up-and-down with haematological problems whilst on Allopurinol I was trying to take pre-emptive action should Febuxostat fail because of my haematological condition. I guess pre-paring for the worst. Call it a bad habit 🙂
I should really try this Alkalising approach to see how it impacts my levels. I’ll have a look at your document repository to see if there is anything there on UA creation via cell turnover and if Alkalising actually helps or increases potentially increases turn over.
Maybe I should go back to university and study bio-science and research as at this rate my brain capacity for my regular job (which requires tons of research) is fast depleting 🙂
March 14, 2018 at 2:44 pm #6652
I don’t know a better way to learn about purines and uric acid than to read the litterature.
Briefly: purines vary between particular foods rather than between convenient categories like animals and plants. Purines are no different from anything else that’s found in food in this regard. But unlike proteins for instance, I’m not aware of a comprehensive database with quality information about the amounts of purines in foods. So it can get complicated quickly… arguably more complicated than it’s worth.
Some plants have next to no purines so they’re safe. And we know replacing meat with dairy and eggs (also next to no purines) works. We also know soy is quite nutritous relative to its purine content and soy eaters seem to have good SUA numbers as well. Other plants though are nowhere as nutritous yet pack a non-negligible amounts of the most potent purines. So you don’t want to rely on any plant for nutrition. It’s always going to come down to the amount you eat so you only have to worry about plants you’re eating in large amounts.
Most people would I think eat rather small amounts of vegetables even if you told them to “just eat more” so that would be good advice for them.
My suggestion: don’t worry about this yet. Diet isn’t as effective as drugs.
March 16, 2018 at 11:04 am #6657
Correct – all this diet stuff isn’t going to reduce levels from 585ummol to 360ummol and vice versa, I’ve always known dieting at that UA level is a waste of time (rheumatologist said no matter how hard you diet you’ll never get more then 10% benefit in reduction). The ultimate direction in which I was trying to head was to see if vegetables purines count or are these non contributing purines [in the sense that if they get excreted or broken down before metabolising into UA]. For what its worth, I believe all purines are purines whether be from animals, fruits or vegetables. I’ve introduced many new colours to my diet namely Kale and this link seems to say its fine https://goutpal.net/forums/topic/kale-information/ (a little reading on this little green veg shows enormous health benefits).
March 16, 2018 at 12:50 pm #6658
Rheuma would be wrong if they put it that categorically. You can get a lot more than 10% out of diet. I did, no thanks to any doctor’s dietary advice. That was still not enough for me in the long run but it would be enough for some people.
March 16, 2018 at 12:57 pm #6659
I found numbers for “Vegetable drink powder from Kale”. That contains mostly guanine which is a harmless purine. I don’t know if the same can be said about what you’re eating but the plant doesn’t seem to contain a whole lot of purines in the first place.
March 16, 2018 at 1:41 pm #6660
Maybe he just being a little pessimistic and wanted to give me the easiest solution at the time which was a cheap box of Allopurinol and get me on the once a year visit patient list. In any case 10% in the lower quartile actually does make sense. Consider a patient with 400ummol – 10% = 360ummol which actually just about takes you into the safe zone. So 10% is all some people need I guess.
That contains mostly guanine which is a harmless purine.
I was trying to obtain this answer all along. So there are harmless purines and hurtful purines? [different types of purine that metabolise into insignificant UA values regardless of their start purine content value].
Rheu appointment today, this will be interesting.
March 16, 2018 at 2:46 pm #6661
Yeah, eating guanine seems to have very little effect on people’s SUA for some reason. But adenine does have an effect and you find that everywhere you find purines. It’s just that the relative amounts vary a bit between foods.
Hypoxanthine seems to be a good bit worse than adenine and you don’t find that purine everywhere. But some plants have significant amounts so avoiding the stuff is unfortunately not quite as simple as avoiding animal flesh.
I doubt doctors would recognize gout symptoms in patients with 400 but yeah, even 10% might be enough in some cases.
In practice though, the pill is almost always going to be a better solution whenever people have recognizable symptoms because you ideally want uric acid lower than 360 during the initial phase of ULT.
Thank you for visiting GoutPal's Gout Network
Did you find the personal help you need with your gout?
I will help you understand and manage your gout.
If you did not find the personal gout help that you need, please tell me:
Information on GoutPal is provided by a gout patient to help you understand gout and related issues. Gout information is provided by a layman, with no medical training or qualifications. It should not be used for diagnosing or treating any health problem or disease. The information is given to help you understand your doctor's advice and know what questions to ask. It is not a substitute for professional care. If you have an actual or suspected health problem, you should consult your doctor.