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You haven’t given me much information to go on really. For instance:
– Who told you to try Apple Cider Vinegar (ACV) for gout?
– Do you think it might help with gout pain relief, or with uric acid control?
Anyway my short answer to How much apple cider vinegar should I drink for gout is:
“Less than one tablespoon per day.”
I feel for you Malik. But you should know that there is a simple answer – adequate pain control. Which is why I recommend that people don’t start uric acid treatment until they have confidence in effective pain management.
Professional guidelines take on this is to prescribe colchicine as a preventative for at least the first six months of allopurinol treatment. Now, I don’t necessarily agree with that in all cases. But it’s better than nothing.
Key to getting free from this gout pain hell is to understand you have a mix of 3 tools:
1. Colchicine to stop inflammation getting worse. But it does nothing to reduce existing inflammation. Though that inflammation will subside naturally, it is usually better to use one or both of the other tools in support.
2. Anti-Inflammatory drug to reduce inflammation. Due to the way our pain signaling works, this usually stops pain as well. Everyone is different but some people might still have levels of discomfort that they cannot tolerate. So …
3. Pain blocking analgesics that are compatible with whichever anti-inflammatory you take.
Every gout sufferer needs to work out a plan with their doctor for their own pain management routines. Because you can vary the approach to match the intensity of pain and swelling. But this is something you must discuss with a qualified health professional.
I’ve commented several times before about my personal choice of health professional – hospital ward nurses. Because they are practicing pain management every day with a wide range of patients. Depending on the experience of your doctor, my next choice would be a pharmacist or doctor. Note that gout needs prescription strength pain relief. So your doctor has to get involved at some point. Therefore, your best first option is to discuss a proper gout pain strategy with your doctor. There are lots of options. Especially because some drugs will act as more than one tool. But your plan must include strategies for inflammation control, inflammation reduction, and residual pain blocking.
Getting back on to the topic of allopurinol side effects. There are standard medical procedures for dealing with elevated liver enzymes during allopurinol treatment. So you should discuss these with your doctor at the same time.
If your doctor seems clueless about how to manage uric acid treatment properly, then your rheumatologist should have the answers. In any case, it’s much easier to have those discussions when you are confident in gout pain management.
but it’s my choice. We’re all different
I think that neatly sums up my opinions on both allopurinol and Atorvastatin.
I remember an interesting discussion about statins in my 50s. It was with the one doctor who understood gout. Now that’s not relevant to the statin discussion but it made me listen to him more than other doctors who didn’t even understand what statistical normal distribution is (don’t get me started!).
His explanation was that during his time in practice he’d seen a substantial drop in heart disease. He put that down to decrease in smoking and increase in statins. Though he readily admitted this as a belief rather than a scientific study result. I interpreted his advice as part of the risk-reward balance that all doctors have to make decisions on every day. And as I could see no risks to taking statins, I take them.
Similarly, with allopurinol which I’ve studied in more detail. I’m aware that some moronic doctors will start with a very risky 300 mg dose. Fortunately, that’s never happened to me. Anyway, I cannot find any studies showing adverse effects when allopurinol is prescribed according to modern protocols. Also, I’m more aware than most people of the terrible damage that excess uric acid causes. So daily allopurinol is a no-brainer for me.
But if you look back on old forum discussions, you’ll see that it took me many years to realize that.
It’s worth repeating pb’s comment:
but it’s my choice. We’re all different
1) Your opening sentences tell me that your primary care doctor knows nothing about gout and how to manage it. But we can educate him. I’m unsure about your rheumatologist because you haven’t described any discussions about treating uric acid. So your first decision is:
Which doctor do you want to work with to develop a proper plan for your gout recovery?
2) Then you describe a series of random pain meds that work well for gout when they are taken in a sensible way. But might or might not be useful when taken randomly. So your second choice is:
Carry on randomly or start to learn how gout pain works and how to stop your immune system going into meltdown.
3) You’re beginning to approach a solution when you mention one uric acid test that is 6.8 mg/dL. But gout control needs, at the very least, a series of uric acid test results with dates. And a commitment to change things to get those results down to a safe level. So your final decisions (for now) are:
a) What do you consider to be a safe level for uric acid?
b) How to get uric acid safe? Drugs, herbs, diet, or a combination of whatever appeals to you most.
For all those decisions, it’s OK to not know the answer right now – we can discuss them in more detail if you need to.
In my opinion, the reason you are feeling “at your wits end” is because everything you described is reactions to events that seems to have very little logic attached. But if you control that situation with a logical plan, recovery is quite easy. Now, I’m happy to share my experiences to help you achieve gout recovery. But I need to know more about what you want. We can start with the three decisions I mentioned. Or we can address other concerns if they are more important to you.
I must say have been drinking lots of water, even when not thirsty, and it has made a difference.
I’m glad you’re feeling better.
Thanks for making me think deeper about water intake and allopurinol. I made a passing reference to it years ago:
The kidneys play a vital role in gout management. Drinking plenty of water helps the kidneys flush uric acid from the body. Even if you take allopurinol to inhibit uric acid production, you still need water. It helps the kidneys get rid of the by-products of allopurinol. All medical or home remedies for gout that reduce uric acid will work better if you drink plenty of water.
But speaking of references, there are 5 sentences of my opinions. Without a single scientific reference to back them up. So I’ll remedy that.
In the meantime, I took a quick look at my allopurinol supply:
- The doctor’s instruction label says “Take with a full glass of water”. No indication of how much. Also, one glass of water a day will not avoid dehydration.
- Instructions in one of my packs says “Take with a little water after meals“. But it goes on to say “Drink plenty of fluids while you are on this medicine”. The manufacturer’s bold, so they must recognize the importance of hydration when taking allopurinol.
- The other pack makes no reference to water or hydration.
I wonder if discomfort eased by hydration is a general thing. Or if it’s gout-specific?
Hey pb ( @p-mb )I’m sorry that I missed your post and hope you are still reading this forum.
Triggers for gout flares are very complicated. But absolutely impossible to guess without knowing your blood uric acid level at the time of the flare. Because flares can be caused by new crystals forming (bad). Or by old crystals dissolving (good). Search ‘Allopurinol Medication: Why It Hurts To Get Rid Of Gout’ using the search box near the top of each page.
Anyway, the important thing is to get uric acid safe. Because then you can never have a gout flare once old uric acid deposits have dissolved.
Importantly, I started checking for links between statins and gout. Now I haven’t yet found links between statins and uric acid. But the revelation that statins improve mortality for gout sufferers is great news.
If anyone wants me to summarize more research on statins and gout (and/or uric acid), please let me know.
Welcome, and let’s hope we can get this sorted fairly soon.
Firstly, I second everything nobody has written.
My first thought when I read your message was a feeling of concern about your uric acid test results. Because without reliable results, you will never get a straight answer. Anyway I hope some of my experiences are relevant to you.
- Home uric acid test kits. The real problem here is accurate blood sampling. Because a finger prick is drawing blood from capillaries. And that’s notoriously unreliable. I believe they have a place if you are very meticulous. So please don’t take this the wrong way. But “I take my UA levels daily at home, I’m usually in the 3.5-6 area.” is a sure sign to me that you are not meticulous enough. If you’ve kept a daily log, please post it. More importantly, do you have any lab tests to corroborate home test data?
- Gout recovery starts when you have gone six months without a gout flare with uric acid never higher than your safe target. Safe targets are controversial among gout doctors. Some aim for below 5 mg/dL. Others aim for below 6 mg/dL. But most primary care physicians don’t know what a safe uric acid target is – or what to do with it.
From your description, I can’t tell if you have started gout recovery and relapsed for some reason. Or if you are still in the early stages of dose adjustment to reach target.
As far as what to do next is concerned, I can’t really offer an opinion at this stage. Because analyzing data on your uric acid levels matched with allopurinol dose changes would be my first step. Generally speaking, it’s a bad thing to stress joints that are weakened by uric acid crystals. So I would consult a professional trainer in your situation. Then when your recovery starts (as per my point 2 above) you can gradually increase exercise intensity. The good news on that point is that studies I have seen indicated that joints damaged by uric acid crystals tend to recover once uric acid is made safe. Sorry that’s a bit vague – I’ll research deeper if you wish.
On reviewing my article about honey and gout, I see that I missed the study mentioned above.
Another recent study complicates matters. Because it refers to a controversial component of honey known as 5-hydroxymethylfurfural (HMF). Now this compound is limited to processed or aged honey, not fresh. But it does have the capacity to lower uric acid, as a Xanthine Oxidase Inhibitor.
Shapla, Ummay Mahfuza, Md Solayman, Nadia Alam, Md Ibrahim Khalil, and Siew Hua Gan. “5-Hydroxymethylfurfural (HMF) levels in honey and other food products: effects on bees and human health.” Chemistry Central Journal 12, no. 1 (2018): 35.
So there are mixed reports on the benefits or drawbacks of honey for gout. That might be due to different types of honey. Or due to mismatches between its effects on animals and people with different starting levels of uric acid.
Until there are studies of honey for gout sufferers, I guess we will never know.
When my gout spread from my ankle to my knee, I knew it was gout. Because I’d already started researching gout symptoms. Mainly due to my first gout doctor who subjected me to a four-day hospital diagnosis. When he doubted I had gout because it started in my ankle not my toe.
Subsequently, I learned that gout is a progressive disease. Which can affect all joints and spread into all organs except the brain. Left untreated, gout is a serious joint-destroying, life-threatening disease. However, it’s really easy to cure with uric acid lowering medicines – if they’re managed properly.
Interestingly, Ancient Greeks had different names for gout depending on the joint affected. So foot gout was podagra and knee gout was gonagra. See Another Name For Gout for more gout names.
I hope you got my help desk message. If not, please check your spam and also whitelist [email protected]. Or maybe this is your answer to my question about stopping allopurinol. If it was just a temporary stop, then that’s OK. But I will remain worried if you’ve been advised to stop allopurinol permanently without good reason.
Anyway, apologies to other readers for that private exchange. I’ll get back to the issue.
Doctors often stop treatments before blood tests if they are reviewing how the case is being managed. The idea is to get a fresh start by removing any complications caused by existing treatments before creating a new management plan. When I’ve spoken to people about this before, they’ve mentioned one or two weeks treatment-free before retesting blood. But that might depend on the drugs involved.
Allopurinol is soon eliminated from our bodies. But before elimination most of it changes to oxypurinol. Now oxypurinol lasts longer. But any remaining effects should be gone after three days. Since half of it is eliminated in 30 hours.
Allopurinol has relatively short half-life in plasma (2–3 h), whereas the half-life of oxypurinol is much longer (14–30 h) due to renal reabsorption (Pea,. 2005).
As nobody says, this is something that your doctor needs to explain. Because we are all in the dark about any potential change in your treatment. Also, I agree with his remarks about regular testing while taking allopurinol as normal. Otherwise, you cannot tell if your allopurinol dose is right.
I always worry when doctors start talking about withdrawing allopurinol without good reason. I’m oversensitive on this issue. Because I’ve seen too many friends have their later years ruined by illogical ill-informed allopurinol cessation.
I’m very interested in your experience and would love to update my articles to reflect the use of Celebrex for gout patients. I had hoped I would have finished that by now. But everything seems to take longer these days. Anyway, If anyone has any questions, experiences, or opinions about Celebrex please share your thoughts.
Gamebronc, I hope you will start to care for your uric acid. Because gout is a progressive disease. So the occasional attack that you can cope with in your 60s becomes joint damage that stops you enjoying your 70s and 80s. If I can do anything to help you with that, please let me know. Because I have had several friends older than you and I who have wished they started allopurinol earlier. I’m 62 and I started a few years back. But I’m feeling the damage in my knees now so I wish I hadn’t delayed.
I refer you to the reply I gave Sandeep – https://goutpal.net/forums/topic/alternate-protein-sources-and-getting-rid-of-side-effects-of-feburic/#post-3097
Because my attitude to gout diet is:
1. First establish healthy eating patterns. So there’s a link to Indian government advice in my first reply.
2. Consider improvements to a basic healthy diet for better uric acid control. Now that means reviewing the weekly list of food you eat. So there’s not much more I can say without a list of what you eat now.
As for exercise, there are no specific gout exercises. Except to avoid stressing joints. Because your joints will be weakened by years of uric acid crystals.
Finally, for now, you need to get your doctor to review your febuxostat dose. Because 7.2 mg/dL is still too high – get under 5 unless there are medical reasons why you can’t.May 15, 2020 at 8:51 am in reply to: Best Gout Treatment – get results within just seven days #9729
You just need a little bit of Enhanced Google…
In less than seven days Keith’s search results…
Surprising what you can find with a crucial search engine. Even though it filters obvious spam there’s still enough to see that the only way this will lighten the burden of your gout is to lighten your pockets.
Thank you for joining this forum.
I would like to discuss a few points you have raised. But the main one for now is:
But today I had a terrible pain again. And again, I don’t know why.
Because I believe this is the most important issue. Then once we’ve discussed this I might ask more about some of your other points.
I wonder if you know why gout pain happens. Because I can see that you are frustrated to see gout pain returning. So I have to ask you about your understanding of what gout pain is.
I want to explain it in terms that mean something to you. So perhaps you could explain to me how you deal with other types of pain in your life? Say toothache, headache, or any other type of pain that has happened more than once.
I also stopped allopurinol for a few years. It took about 5 years until uric acid built up enough to start gout attacks again. Anyway I restarted allopurinol and the attacks stopped again after a few weeks. But I’m very annoyed with myself. Because I got more joint damage when I stopped allopurinol.
One things certain – I’ll never stop allopurinol again!
So if I were in your shoes Dave I’d get uric acid tested. Because if uric acid is high those tweeks will get serious.April 23, 2020 at 7:00 pm in reply to: Stopped drinking beer, good gout diet, but foot swollen #9407
Hi Rob (@yahoouser)
I echo everything nobody said. Also, I’d strongly recommend seeing your doctor as soon as you can get there to get uric acid tested. With lockdown, that might be delayed. But once you are able, it’s your best start.
Once you do get the test results please let us know what your uric acid level is and what your doctor advises.
Very interesting – thanks 068694
Personally, I think I found the offender at sentence 4. But that’s only based on what I’ve read in this post. I probably don’t have all the relevant information.
The reason I say this is that your first 3 sentences explain about gout and allopurinol. So I was expecting some insight into your uric acid levels. But not a number in sight!
The whole point of taking allopurinol is to reduce uric acid to safe levels. Then it takes a few months for old uric acid crystals to dissolve. But after that, there’s no need to worry about gin, lager, or any other individual drinks or food. Except you want to maintain a reasonable diet to prevent other diseases.