Comments on: A variety of gout information.. http://www.goutdietblog.com/archives/244 Diet for gout Sat, 22 Nov 2008 04:32:27 +0000 http://wordpress.org/?v=2.1.3 By: Allie Belletto http://www.goutdietblog.com/archives/244#comment-617 Allie Belletto Tue, 26 Jun 2007 03:15:19 +0000 http://www.goutdietblog.com/archives/244#comment-617 There are some very interesting points in there. First thing I note is that allopurinol is a solid answer. I recently read that not only does it work for gout, it improves your arterial function (blood vessels that have been hardened are softened and made more flexible again by allopurinol - reducing heart and stroke risk). Second item, this is the first time I have seen the same scale used in this forum that my doc uses (even though the links to uric acid level appear to be tenuous in your note). Since I am not a math whiz, is there a table somewhere that equates the scales or a calculation that can be done to see equivalencies between the two (i.e. 7mg/dl = 450umol/L)? Third point, your skiing, your friend's weightlifting, my golf (carrying clubs) and others' exercises seem to be a common theme. Anecdotally, I know I was not a big water drinker before I began taking allopurinol, and I am thinking that dehydration may play a huge part in the triggering of crystallization - just a hypothesis. While the dehydration may have something to do with onset, allopurinol enables all these activities again, so I am a big believer in this remedy. There are some very interesting points in there. First thing I note is that allopurinol is a solid answer. I recently read that not only does it work for gout, it improves your arterial function (blood vessels that have been hardened are softened and made more flexible again by allopurinol - reducing heart and stroke risk). Second item, this is the first time I have seen the same scale used in this forum that my doc uses (even though the links to uric acid level appear to be tenuous in your note). Since I am not a math whiz, is there a table somewhere that equates the scales or a calculation that can be done to see equivalencies between the two (i.e. 7mg/dl = 450umol/L)? Third point, your skiing, your friend’s weightlifting, my golf (carrying clubs) and others’ exercises seem to be a common theme. Anecdotally, I know I was not a big water drinker before I began taking allopurinol, and I am thinking that dehydration may play a huge part in the triggering of crystallization - just a hypothesis. While the dehydration may have something to do with onset, allopurinol enables all these activities again, so I am a big believer in this remedy.

]]> By: Sabina Shamel http://www.goutdietblog.com/archives/244#comment-618 Sabina Shamel Wed, 27 Jun 2007 11:51:00 +0000 http://www.goutdietblog.com/archives/244#comment-618 The molecular weight of uric acid is 168. To convert grams tomolarity devide by the moluculer weight.7/168 = 416 plus or minus a few decimal places here and there toaccount for the units.7 correlates pretty well with the 450 listed and is probably withinthe accuracy of the measurements. A word about serum levels of sodium urate. I have posted on thisbefore. It is very important. I'll keep harping on it thoughbecause it is critical that we get our arms and brains around anunderstanding of what this means to each of us. Sodium urate in solution is in equillibrium with the crystals ofsodium urate in our foot and these crystals hurt. So far so good.Moreover, it is iimportant to bring down the level of sodium urate inthe blood and this is also true and important. However, you, andyour body must also account for the excess uric acid that is in yourbody that is stored there as uric acid, usually in your fatty tissue,but sometimes as trophi deposits near your joints. When your body dumps out some of the urate that was in your bloodthrough your kidneys, this stored uric acid can immediately go tosodium urate, replentishing the level in the blood therebymaintaining the balance. In order to lower your overall serum sodiumurate level, you must first deplete the uric acid level in yoursystem. If you take allopurinol long enough, your body will excretethe residual uric acid, it will fail to make more because theallopurinol will stop your body from making more and eventually, youruric acid level in your body will be low enough that the uric acidlevel in your blood will not be replentished after you excrete someof it in urine. Thus as long as your body has excess uric acid in it, usually storedin your fat tissue, you will have a hard time lowering the level ofurate in your blood because as that urate is excreted, more issupplied via the stored uric acid. Yes indeed, when you go onallopurinol, and are able to stop the production of new uric acid, itis only a matter of time until your overall level of sodium uratewill be reduced and this will happen as fast as you can excrete it. Earlier a poster suggested that since their urate level was low andthey still got gout, they must be excreting urate normally. This isnot necessarily true. Unless you have had your 24 hour urate level inurine tested, you do not know whether your excretion process isnormal or not. You could have a low blood level of urate, because theconcentration at which crystallization starts could be low for thatperson. That level, that is saturation, is an individual thing ineach of us and is affected strongly by what else is in the bloodaffecting solubility. The only thing you can say is that if allopurinol eventually allowsthat person to achieve an overall reduction in the urate in theblood, then the kidneys are functioning enough to allow that processto happen. It does not imply that their kidney activity is anywherenear normal and in most gout patients, they do have a measurablyreduced ability to excrete uric acid through renal activity. The lowlevel of urate in the blood is just an indicator that their systemmaintains a low level of urate for equillibrium and that the personwill in all likelyhood get a gout when their system gets to theirsaturation level, it could be 4 or it could be 9. The molecular weight of uric acid is 168. To convert grams tomolarity devide by the moluculer weight.7/168 = 416 plus or minus a few decimal places here and there toaccount for the units.7 correlates pretty well with the 450 listed and is probably withinthe accuracy of the measurements.

A word about serum levels of sodium urate. I have posted on thisbefore. It is very important. I’ll keep harping on it thoughbecause it is critical that we get our arms and brains around anunderstanding of what this means to each of us.

Sodium urate in solution is in equillibrium with the crystals ofsodium urate in our foot and these crystals hurt. So far so good.Moreover, it is iimportant to bring down the level of sodium urate inthe blood and this is also true and important. However, you, andyour body must also account for the excess uric acid that is in yourbody that is stored there as uric acid, usually in your fatty tissue,but sometimes as trophi deposits near your joints.

When your body dumps out some of the urate that was in your bloodthrough your kidneys, this stored uric acid can immediately go tosodium urate, replentishing the level in the blood therebymaintaining the balance. In order to lower your overall serum sodiumurate level, you must first deplete the uric acid level in yoursystem. If you take allopurinol long enough, your body will excretethe residual uric acid, it will fail to make more because theallopurinol will stop your body from making more and eventually, youruric acid level in your body will be low enough that the uric acidlevel in your blood will not be replentished after you excrete someof it in urine.

Thus as long as your body has excess uric acid in it, usually storedin your fat tissue, you will have a hard time lowering the level ofurate in your blood because as that urate is excreted, more issupplied via the stored uric acid. Yes indeed, when you go onallopurinol, and are able to stop the production of new uric acid, itis only a matter of time until your overall level of sodium uratewill be reduced and this will happen as fast as you can excrete it.

Earlier a poster suggested that since their urate level was low andthey still got gout, they must be excreting urate normally. This isnot necessarily true. Unless you have had your 24 hour urate level inurine tested, you do not know whether your excretion process isnormal or not. You could have a low blood level of urate, because theconcentration at which crystallization starts could be low for thatperson. That level, that is saturation, is an individual thing ineach of us and is affected strongly by what else is in the bloodaffecting solubility.

The only thing you can say is that if allopurinol eventually allowsthat person to achieve an overall reduction in the urate in theblood, then the kidneys are functioning enough to allow that processto happen. It does not imply that their kidney activity is anywherenear normal and in most gout patients, they do have a measurablyreduced ability to excrete uric acid through renal activity. The lowlevel of urate in the blood is just an indicator that their systemmaintains a low level of urate for equillibrium and that the personwill in all likelyhood get a gout when their system gets to theirsaturation level, it could be 4 or it could be 9.

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