Gout Diet Blog

Here goes another lecture about what happens in, either a test tubeor your body.

Take a pile of solid uric acid and put it in a flask. Next, pour 1000ml of water on that pile and in that water put a little salt, youknow, your blood is actually pretty much like the salt water of theocean. Sheke the flask and after a few hours, the water in the flaskwill be saturated with monosodium urate.

Now, go and get a very fancy osmosis machine, mmm your kidneys, andhave it remove all the monosodium urate in the water. While it isremoving that monosodium urate the concentration of urate in thewater will go down. However, if you let the flask stand for a while.more uric acid will dissolve and form more monosodium urate andvoila, you will be back to saturated again.

Uric acid is only slightly soluble in water and at any time it onlytakes a very small amount of monosodium urate to saturate your blood.

Now, I have left out the issue of the acidity of the water and thisis one of the most important factors in the behavior of monosodiumurate. So far, our flask has just been allowed to dissolve pure uricacid and then have it removed with the fancy osmosis machine. Butthose of you who took high school chemistry will say, aaa ha, whenyou remove sodium urate you will leave hydrochloric acid behind. Yesbut I neglected to tell you that we added a fancy acid nutralizationsystem to our flask-a buffering system- that keeps the pH, that isthe overall acidity, constant. But we can in fact modify the overallacidity of the system and that is in fact what most of the snake oilremedies do.

As the acidity of the flask goes up, the tendancy of uric acid is tostay as uric acid and the overall level of monosodium urate in theblood will be surpressed. Thus, tissue soluble organic acids willtend to surpress the blood level of mono sodium urate and thereforeretard and even stop the crystallization process. Water solubleorganic acids like acetic acid-vinegar, ascorbic acid-vitamin C,citric acid-lemmon juice.

Uric acid, in its acidic form, that is as the organic acid, isrelatively harmless to you. It stays as the acid form and it canaccumulate as trophi which can be painful in their own right but nowhere near as painful as deposits of mono sodium urate, the sodiumsalt of uric acid. The point of this discussion is that even if youcould magically remove all the monosodium urate in your blood withina few seconds, your blood would rapidly return to the saturated stateas long as your have the large excess of uric acid to feed theequillibrium.

There is no convenient or economically practical way to measure, ormonitor, how much uric acid you actually have in your body but it isbelieved that you have been accumulating it for at least 10 yearsbefore anyone has an attack.

When you measure your blood urate you will be measuring how far belowthe saturation point you are at any time but if you stop the urateremoval process, your system will quickly come back to saturated. Ifyou are on allopurinol, for example, you will be surpressing theformation of new uric acid and your kidneys will continue to removeold uric acid but don’t forget that you have years and years ofstored uric acid it it will take time to redissolve all that old uricacid and remove it. When I say time I mean that it will take at least3 years and although each person will be different, the few studies Ihave found that track it, show that your permanent uric acid levelwill not actually fall to below saturated until you are in yourfourth year of taking allopurinol.

So, in summary, tracking your blood urate is important but don’texpect that you are going to permanently reduce that level in a shorttime. When the level actually falls to below 4 and stays therewithout allopurinol, then I suggest you discuss with your Doc, thatit is time to reduce the allopurinol dosage.

My mom, who has been on allopurinol for 15 years. She reduced herdosage from 300 to 100 about a year and a half ago and1. her sodium urate level has held at well below saturated,2. she has nothad new gout attacks, and3. the muscle cramping and muscle pain that she was complaining aboutwent away when the dosage was reduced.