Let’s get organized and systematic
First of all, your physician. If he does not have gout he willprobably treat you from his text book and he probably has 10 to 100patients that suffer from time to time with it. His main objective isto get your pain relieved, with as little real effort as possible andalthough he may be genuinely sympathetic, he cannot understand thedetails of your symptom or for that matter really, what it was thatled to your last attack.
The cause of gout is well documented and clearly the people on thisforum understand that the culprit is Uric Acid. A metabolic endproduct that our bodies are not able to excrete as fast as we make.Specifically we are having uric acid percipitation, usually in ourbig toe area and it causes severe pain and discomforture when ithappens.
The clinical difficulty with gout and what causes it, is that theconcentration of uric acid in your serum blood level that exists whencrystals start to form for person A is often very different than itis for person B. Moreover, it can also be different for youpersonally in attack #1 and attack #2. I have good clinical data onme on this one. In other words, when you have an attack your level ofuric acid may or may not be the same as it was the last time. It isnot the concentration alone of uric acid in your system that causesthe crystals to form. By the way, if anyone disagrees with thepremises I intend to lay down, please correct me because it isimportant for all of us to really understand what is going on. Thisis not vodo and it is not even mysterious.
IT IS RELATIVELY SIMPLE CHEMISTRY BUT THAT CHEMISTRY IS TERRIBLYCOMPLICATED BY THE WAY EACH OF US LIVE OUR LIVES AND BY THE UNIQUEWAY EACH OF OUR BODIES REACTS TO AND WORKS ON AND EXCRETES THEMETABOLIC END PRODUCT, URIC ACID.
So far, all this is known stuff and not too important. I want to makea statement that you all need to think about relative to your diet,exercize and hydration levels.
The solubility of any substance in water, which is what our bodiesuse as a solvent, is dramatically affected by whatever else is therein solution with that substance. Gout attacks are, in allprobability, caused by something that affects the local solubility ofuric acid and probably not by total uric acid concentration alone. Inother words, if your contration of uric acid is at a fixed high leveland you eat something that, or do an activity that, makes the overallsolubility less, you can get an attack with out having an increase inuric acid level.
So I ask the following question which I do not know the answer to. Inthe middle of an attack is it better to drink lots of plane water orshould you have water and gatoraid. I can argue it both ways and I donot know which is right. With gator aid, you will be taking in moresalt. That increased salt will increase the ability of your tissue tohold water. You can prove this to yourself with your scales. Drinkexcessive pure tap water and then let your system come back tonormal, usually 4 to 6 trips to the bathroom, and then weighyourself. Then drink the same amount of gatoraid and let yourselfequilibrate. Weigh yourself again. You will find that you gained moreweight after the gatoraid because the increased salt will increasethe tissues ability to hold water. Perhaps more water in your systemwill allow uric acid to go back into solution, a good result, or, theincreased salt in your system may cause the uric acid to percipitateout, clearly a bad result…. That is a simple question that we canget a difinitive answer to and then when we have an attack we willknow what to do. I personally option for the gatoraid rout but I maybe completely wrong on this one.
A related thread I have picked up on here and something I am certainis very important to me, is that when I get dehydrated, I get twingesand sometimes little attacks in my toes. When you get dehydrated,there is less water and with less water the relative concentration ofuric acid will go up and percipitation will happen. When uric acidpercipitates, it does so because the concentration in the system isgreater than the water in your system can hold. But, you say, itdoesn’t always percipitate. Dehydration doesn’t always cause it.There is a complicating fact about dehydration which is that althoughyour system will have more uric acid concentration, it will also havea higher concentration of other things like salt.
I don’t know the answer but I think it is important for us to knowthat we should or should not add salt to the water we drink, i.e.gatoraid, when we drink water to help a gout attack.
Lets go back to pure uric acid in water and look at it from thatperspective. You may not have uric acid to do it with, but you cantake water and sugar or water and salt to understand it. You can putsugar into solution in hot water and then cool that sugar watersolution till the solution is a thick syrrup. No crystals will formif you just cool it. But, when you add one single tiny crystal tothat supersaturated solution, bingo, the whold area will formcrystals of sugar and they will form around that single crystal.Moreover, when that happens, the crystals will end up being large andit will be difficult to get them to go back into solution. Try it,you can pour out any water, or even add more water and you will seethat sugar crystals that have formed in a super saturated solutionare very difficult to redissolve. I think my three really bigattacks, like no sleep for two to three days, even a sheet over myleg was too painful to stand, I’m sure you real sufferers know what Iam talking about, all three of my bad attacks were when I had verylittle warning that it was coming from the twinges.
IT IS POSSIBLE THAT WHEN WE ARE HAVING THE LITTLE TWINGES, WE AREOPERATING AT SATURATION BUT WE DON’T GET TO SUPERSATURATION BECAUSETHE CRYSTALS KEEP US WARNED AND THEREFORE CAREFUL OF WHAT WE AREEATING. ONCE TRAINED BY THIS AFFLICTION TO NOT PIG OUT ON A LOBSTERMEAL, WE ABSOLUTELY RESPECT THOSE TWINGES AND EAT CAREFULLY.
So, I’ll end this too long post, with anobservation and theory that I have developed from what data I thinkis real data. The issue is fat and oil. Fact– when your weight ishigher than normal, you are more succeptible to gout attacks. Themost effective treatment for gout is loose weight. Why? There is nouric acid in fat at all. None, absolutely no uric acid is in fat andyour body cannot make uric acid from it. But, your body can maketriglycerides from fat, and it does, and triglycerides can affect theoverall solubility of uric acid. So the statement in one of the listabout fats and oils being OK may be completely wrong. I personallybelieve that it is. I think that fats and oils in our diet are aperscrption for an attack for us. It’s not my idea here either but Ibelieve it because it best fits the facts I have seen. Low body fatand low fat in the diet will keep the gout attacks away.I think ithas to do with overall solubility of uric acid in the system that ishigh in triglycerieds.
At least in the regulation of my own life I intend to lower my weightby about 25 lbs out of 205. I went gout free, twinge free, for abouttwo years when my weight was down to about 190-195. As my weeightdrifts up, so do my attacks. I’m just recovering from one that lasted6 weeks and it has given me the impetus to get rteally serious aboutits treatment. I don’t now about the rest of you but I am nearlyuseless when the pain is really bad.
So, I say we have to track both the total purene intake but also thefrequency and quantity of some ofhte things that we consume, likefats and oils, salt intake, etc. etc.More later on things likeMuscle fatigue aroung gouty area.Muscle fatigue may be part of pre-gout symptomDissolving crystalsAllopurinolCulcicine(great at spelling)One last observation-With each of my bad attacks, the end of the attacks were at the sametime as pretty heavy dihrreah. I think the gut may be a good uricacid extractor and I want to explore that concept more in the future.
Terrance Molock on May 23rd, 2007
First..and foremost..the uric acid concentration/level.This isthe one area where the very latest research..the fact that bafflesall the experts..nothing whatsoever is known about this. Why do most..almost all people with high..maybe very high u/alevels..not have/never get/never will get gout.It seems like such asimple question.There is just no answer as to why people getgout..and for some..almost no cure.Test after test..study afterstudy..still clearly shows that a very,very small percentage of thosewith high u/a levels get gout.Of those that get gout..it is not theraging high u/a levels that now set off alarm bells..the thresholdfor u/a levels has been lowerred in blood tests.This now kicks backan automatic “attention required” by the computer doing the bloodwork.ANY u’a level over the average..in a gout sufferer..and I amindeed taking about a well established/documented average level forthe individual.An individual sufferring from gout will clearly beable to provide a history..the longer the better..the more frequentthe better..at the most no longer than 6 month intervals.We can anddo establish a u/a level for that individual that will probablly leadto attacks.It is the this average/mean level for that individual thatmust be reduced.Diet can have a range of 5-15% in overall u/alevels.And this may very well be enough to curb minor attacks.Causedby spikes in the u/a levels.Secondary u/a level attacks..caused bythe crystalization of u/a deposits..some deeper/much lessaccessible..can seldom be dealt with by diet.The u/a deposits have togo..about the only way is allopurinol..a sudden..dramatic decrease inthe body’s overall u’a level makes the chemical affinity for thedeposits inhospitable..and they eventually leave. Dealing with gout “attacks” is seldom successful in the longrun.The latest stats/are not encouraging..that old notion that somepeople only have 1 attack..or a few or they get less..if you have agout attack..within about 10 years there is like a 97% chance youwill have another one. One thing about gout..the attacks almost always get worse.I wouldsay that after your first minor attack..get a good grip on your u/alevels..try the diet thing..after your next attack..you are now veryseriously risking the kind of attacks from deposits..that were goingon without your knowledge. I have heard/known simply far,far too many people that thinkthey have a handle on this monster..only to again and again have itrear it’s ugly head..who wants to live on the threshold of a goutattack?.To be so ultra careful of every single activity/every morselof food..every bit of activity..we can talk about this and that anddehydration..for too long.I have seen people..my Dr’s see thesepeople all the time..brutally broken..some sufferring permanentdamage..and wracking their brains..as to how this could/did happenwhen they were so careful.
Next we have to quickly touch on what is gout?Again the expertssimply do not know..is it the crystalization of u/a in the blood? Yes and no..not that uncommon(discoverred by accident)u/acrystals in the aspiriated sample from the joint..AFTER the attack isover..AFTER?HUHH what??..hey wait a minute the wbc count is NOW waydown?WHAT? this test was done to prove that the u/a crystals weregone..indeed the attack is over..what’s this? Highly complex stuff..if the wbc’s do not see the foreign body asa threat..=..no wbc attack..the terrible attacks are caused simply bythe wbc surrounding the crystal..and trying to shove it out throughthe joint.I have felt wbc activity..WEIRD,WEIRD feeling at the siteof ferocious attacks..long after the attacks were gone.I asked myrheumatologist what this was..”They are returning to the scene of thecrime..rooting around..looking for crystals..and you know whathappens if they find any”.Anti inflams.NSAIDs work by reducing theinflammation.trying to get some circulation goin’ on..reduceswelling..colchicine..the age old..2500 years documented goutfighter..the autumn colchicum..POISON..kills wbc cells..not only thatthis nasty drug is used to create cell mutations..there is still sometricky debate as to it’s actual working mechansim.Never mind it isALL that ever worked for me.NOTHING else ever did ANYTHING..
Add to this..a million other theories and cures..
Oh yeah..quickly on the pottassium/salt/sport drink thing..1banana has the chemically reactive pottassium potential to make anAWFUL lot of sports drinks in your body..these sports drinks havebeen loaded with sugar..it sure is an interesting point because theysure do work by blocking dehydration..whether this is good ornot..Idno..I have 1 now and again
True..u/a is also eliminated in the bile..
Be well..
Sabina Shamel on May 23rd, 2007
First of all, thank you very mucu for the reply and for addressing myquestions and statements. My purpose in writing was to find you, andothers like you, who have taken as scientific an approach as wepossibly can. I know that there is a lot less known about this thingthan any of us would like to believe but the fact is that it is aterrible affliction that you and I must deal with as best as we can.I hope to acquire information, either anecdotal or documented dataand do my own research on understanding what is going on. Clearlynecessity is the mother of invention and this is one necessary beastto pay attention to.
You mention skiing, I was a tennis player. Tournaments every weekend,ranked as high as 3 in doubles in mens 35, 40, 45, in California andthen gout before I got to play in the 50’s. I am now convinced thatmy knees, that keep me from playing tennis are also affected by goutand that’s what really happened to me.Your statement that”It is the this average/mean level for that individual thatmust be reduced.Diet can have a range of 5-15% in overall u/alevels.”This I believe is the starting poing each of us must deal with. It iscritical information. I completely agree with you that it should beobtained and tracked by each of us on a six month interval at aminimum I agree but I think it would be more prudent to track it on a3 month interval. To be done properly I assume it should be doneabout once a month.
I also believe that you should add to that list every single thingyour HMO will approve of, to track. If we have 100 gout sufferers’blood chemistry for two years and 100 non sufferers’ blood chemistrywho have higher than u-n-me uric acid, also for a few years, we mightbe able to start to understand something. Has anything like that beendone, published?If so where?
I’d like to start to process the data. I came from an industry wherewe tracked every little detail, and I mean every one like time ofday, temperature of the room, who did the work, which brand ofequipment was used. Literally nothing is left out of the datacollection and then extensive retro analysis is used on the data tosolve the problem of why the yield went down or up. The fact is, manythings simply correlate and you have to know that they correlate tostart to understand why. Short retro history: we found that asubstrate had to be air dried for 12 hours or there was a direct fallof in yield equal to the square root of the time it did not get theair dry. We ended up calling it air bake because it was there in thebeginning because as we started the process, we had a long time to doeverything. As production picked up we ended up moving faster andfaster and each substrate had less and less time in air at roomtemperature. After 6 weeks of the very expensive production ramp theyield was down to zero. -Slowed us up looking and of course the yieldwent back up. We found it by systematically comparing the correlationof every step in the 4500 step procedure. Literally that many stepsand one graph showed it clearly and absolutely.We can figure this thing out and I am well past thinking that myRhumatologist is going to figure it out. They do know a lot more thana general physician but they do not have the proper motivation.
OK moving along.
What is that level for each individual?How much is it affected by diet, total relative body weight,hydration/dehydration?I also believe that exercize level will posatively affect goutaffliction. My theory, again relative only to each individual onthis, is that when you exercize enough to cause your body to sweat,what you are doing is raising your internal temperature. The sweat isthe bodies mechanism to reduce the temperature and if, lets say, yousweat for an hour on a treadmill, you have done two very importantthings.
First, you have kept your body temperature elevated for an hour whichwill have the effect of dissolving some of the residual christals. Ican’t imagine exercizing when I have a real attack but I find thatwhen I’m only having what you call “minor attacks” exercize is veryvery helpful after you get past the first 10 to 15 minutes.
Second, and this may be just as important, you will have raised yourblood pressure and pumped your blood through your syystem a lotfaster while you were exercizing. Osmotic pumps of all kind workbetter under pressure. I am certain that when I have a severe attack,if I stop my blood pressure medication for a few days, discoveredthis by accident, the gout gets better much more quickly.
And this may very well be enough to curb minor attacks.Ca”usedI’ll use your terminology here because in my experience, there aretwo very well defined kinds of pain associated withthis “mmm” “opportunity in life” Smile please…
I alluded to them in my first post, “Minor” and “Secondary” attacks.I don’t like the term secondary because it one context of the wordsecondary it implies that the “secondary attack” is less severe but Iunderstand the words use and will not quibble.
I think we need to put these charistics out, front, and center themas primary indicators that we will use to determine overallsensitivity. I categorize a “minor attack” as one in which I feel thejoint when I walk or even when I sit but I am able to put full weighton that joint. There is usually some swelling but not much and thereis usually a red and inflamed color in the area but again not toobad. Usually there is very little swelling with my “minor attacks”.
I categorize “secondary attacks” as those that keep me from puttingweight on the joing, that is that affect my gait when Iwalk. “Secondary attacks” are always accompanied with swelling,redness and in most cases I can’t even think about walking but to befair and honest, there have been weeks and almost months where I havehobbled around on 1 and 1/4 foot, even developed a callous on theoutside of one foot.
I do not agree with you that…”secondary attacks can …seldom bedealt with by diet.”
“a sudden..dramatic decrease in
My grandfather had gout, as I said, and when I was 5 to 16 I wouldvisit with him at least twice a year. I was very curious about hisproblem. He used to complain to me that he was having a very hardtime in life bvecause there were so very few things that he was ableto eat. He did not take colchicine and allopurinol was not aroundthen. His only tool was diet and although he spent a large part ofhis lfe crippled, he did regulate it with diet. I am not suggestingthat we do that, only making the point that you need to dramaticallyalter your diet when you have a secondary attack.
Let me give you my formula. Very complex and difficult to get… WHITE RICE, VITAMENS AND GATORAIDTHE WHITE RICE WILL ADD NOTHING TO THE URIC ACID CONTENT OF ME,ANDYET WILL SUPPLY ME WITH ENERGY TO EXIST, THE VITAMINS WILL ALLOWWHAT IS LEFT OF ME TO USE THE RICE AS FUEL AND THE GATORAID WILL KEEPMY HYDRATION AT A GOOD LEVEL.
When I know I am having an “secondary attack” I immediately stop allconsumption of anything but white rice. I think mashed potatoeswithout butter or the skin would work just as well but I like ricebetter. This last attack I did go to some boiled, peeled potatoes.
The white rice formula was my grand fathers and I added the vitaminsto his regine when I was 16. He said that it made the attacks go awaymuch faster and I have now been able to confirm that finding in myown body. My theory is that you probably need something in thevitamin load to do what you can about the uric acid. The gatoraid wasadded because I am afraid of overall electrolyte imbalence from toomuch water intake. That can be a problem without the issue of gout ifyou dri8nk too much water.
within about 10 years there is like a 97% chance you
“One thing about gout..the attacks almost always get worse.I wouldsay that after your first minor attack..get a good grip on your u/alevels..try the diet thing..after your next attack..you are now veryseriously risking the kind of attacks from deposits..that were goingon without your knowledge.”
“from deposits..that were going on without your knowledge.”I don’t understand what you mean by this statement. Are yousuggesting that we get uric acid deposition but do not feel pain fromthis deposition? I seriously doubt it. In fact I flat out don’tbelieve it.I think that what ends up happening is that however necessary, thebody finally gets rid of the crystals and then you go into a state ofno crystals. Over time your uric acid level builds and builds andthen s mething triggers the crystallization. Go back to the sugar inwater. Heat it up again and then let is sit. You can keep supersaturated anything in water for almost indefinite amounts of time andwithout a seed crystal, you will not get any crystals. This is trueof any solute in any solvent. Supersaturated solutions are the normin nature and as a chemist, you often have to work very hard to get acrystal to form.I think that what is happening is that you go on in life with moreand more Uric acid and finally a crystal forms in a secondary attackand you get massive crystallization.
Further I don’t agree with your statement “by the wbc surroundingthe crystal..and trying to shove it out through the joint.”
Trying to shove it out through the joint…?Do you have any documentation for this statement.It does not make good chemical sense. Rather I think that the joint,the coolest place in your body, usually, on average, your big toe,has a calcium location available as a crystal initiation site. Ibelieve that the data fit the model that uric acid complexes withCalcuim, this is a verifiable chemical fact, and is thereforeattracted to your bones, joints have much more contact with theblood, and that it is this initiation of the first uric acid crystalthat initiates the poercipitation of the rest of the uric acid inthat point. Do you know of any data to say that there are uric acidcrystals anywhere in your body when you are not having an attack?
I also challenged my Rhumatologist about the same point and he had toback down from his positon. It has been assumed that uric acid iswaiting as deposits that will then get bad. I don’t think so. I thinkthere is no deposit till you get an attack, in other words, untillthe initiation of crystallization. When it initiates you get aSecondary attack because your sustem has been so super saturated andthen what happens?
BAck to the pure sugar and water. If you measure the concentration ofsugar in super saturated water, you will find it can be very high.Then initiate crystallization and measure the concentration of sugarin the supernatent, the water phase, of the liquid. It will be atwhatever the concentratikon of soluability, the Ksp of sugar inwater. The sugar concentration of water will fall to the equillibriumlevel of sugar. The same thing happens in our bodies. We live in asupersaturated level of Uric acid and then it crystallizes. When ithas crystallized, and we feel somewhat recovered, like we can walkagain, and we are getting minor attacks, the system is justequillibrating the Uric acid level by crystallizing a little,keeping equilibrium and we feel it and let up on the diet and usuallyhit it with the medication and NSAI’s.
Tired now, again thanks for the reply and i am sure we willcorrespond more. As you said your gout is not going away and neitheris mine.
By the WAY, MY GRANDPA LIVED TO BE 98, SO DID HIS GRANDFATHER AND MYMOM IS A VERY STRONG, CONSTANTLY COMPLAINING ABOUT HER GOUT AND HERSIDE EFFECTS FROM WHAT SHE THINKS IS CULCCINE INDUCED PERIPHERALNEUROPOTHY, LIVELY OLD GAL OF 84, ON ALLOPURINOL FOR 4 YEARS NOW, 300MG IN A 125 LB BODY and no attacks since starting allopurinol.
My grand Pa used to tell me that gout is terrible but that itprobably made him live much longer because it made him stop eatingall those things that were bad for him. I think he was correct onthat one.
One more, sorry—”is it the crystalization of u/a in the blood?”Do you have any documentation for this. It does not make sense to me.I can see crystals getting into the blood as a secondary path buteven that I doubt. Do you know of crystals in the blood. I know theyget them from the fluid in and around the joingt. I do not know ofcrystals in the blood. If it were in the blood you would get crystalsin the capuillaries of the brain and that just does not happen as faras I know.
True..u/a is also eliminated in the bile..I assume you are talking about my sugestion that the gut can removeuric acid.
I plan to get proactive next time and take elax to induce diharreah.It may in fact depelete the Uric acid by another mechanism than kidnydialasys and if so, although not pleasant, we might get relief romanal dialysis. It is used in some kidney failure treatment andalthough I’m not willing to get my vein opened to get dialysis, thegut thing might not be that bad. Maybe we can get our Urid acidfushed from time to time.
Terrance Molock on May 24th, 2007
Hi again..”secondary uric acid”..attacks/deposits..these aren’tmy words but the words/terms of researchers.It is now pretty welldocumented/understood/accepted that there are 2 kinds of u/a..and 2kinds of attacks.The primary u/a..well we have to callthis “secondary” for a second.This is the u/a in the average personsbody..average over a long term.This is 85-95% pretty muchunchangeable..this has to do with the complexities of natural cellbreakdown/death..regeneration.In short ALL the factors that produceu/a.There are MANY and a multitude of othercomplexitites/factors.This is the real MONSTER.This u/a level goes onit’s merry way..starting in puberty something goeswrong..dna/chromosome/enzyme production.Usually in a males mid 40’sand later the u/a level has risen to the point where there are nowstores of it in the body..usually the big toe..first.These people arenow on the threshold of gout attacks.The deposits never goaway.Note..they are deposits..not yet crystalized.The deposits arealmost always added to..or go to other spots in the body.NOW we getinto the diet/exercise/dehydration factor..5-15%..all this does ispush the threshold over it’s limit.Diet/exercise/dehydration all havethe same 5-15% affect..going over this line..then back.It is nowknown that additional deposits are left behind after theattacks..these become tophi..they have pretty much lost theircapability to crystalize..and now become almost acidic..eating awayat pretty much everything there..blocking/plugging everything up.
So what we have in the typical gout sufferer is a person withu/a deposits..sometimes these are crystalized..sometimes the attackis a crystalization caused by what you did//diet/exercise..theadditional u/a that you are responsible for..then again sometimes aminor attack can precipitata a “sceondary uric acid attack”..theattacks can become so ferocious that they can become selfenergizing..the u/a acid level in the area constantly rising by thedeath of wbc’s in the area..colchicine can somtimes even aggravatethe condtion temporarily by killing even more wbc’s. The secondary uric acid deposits that have not yet crystalizedcan only be removed by lowerring the overall u/a levelsuddenlly..enough to shake them loose..and keeping the u/a level downto a point where the deposits simply cannot stick to anything..thinkof these deposits as “glop”..muck..This is pretty much impossiblewith anything we can do..diet/exercise..all we can do is keep the u/alevel below the threshold..this threshold does drop..and the sufferersimply cannot avoid the attacks..at this point..allopurinol..which isan oxidase xanithane inhibitor restricts/controls the bodies abilityto make u/a..almost always lowerring the overall u/a level so that wenow have a “cushion”..where we can temporarily raise ouru/a..diey/exercise/BUT we are still well within the threshold forattacks..hence no attacks.. U/A deposits..ABSOLUTELY!..it is just excess u/a that getsdeposited..enough of it/concentrate it..build it up..hit thetrigger..it will not show up on x-rays untill it becomes tophi..by-product.Some gout attacks..especially when starting allopurinol arecaused by “migrating” u/a..deposits..other gout attacks can be causedby something as simple as bumping a joint. We can’t keep thinking of u/a as crystals..this is u/a’s “midpoint”..u/a very soluble..then NOT..as in it is nowgloppy/mucky..THEN the crystalization..THEN the breakdown of it intotophi deposits..
There are many pictures of aspirated joint fluid..clearly showingthe types of crystals in cdd..crystal depositiondiseases..gout/pseudo-gout(different crystal shape)Clearly visableare u/a crystals..some free..no gout..some surrounded by wbc..withvarious wbc counts in the individuals.In more detailed photos thecrystals are shown imbedded in the synovial area..with the wbcforcing the crystals deeper into the area..gout attacks have even nowbeen found in flesh..deeper flesh.Not uncommon is for someone to havejoints tapped..”oh yeah..there are crystals..there IS gout..”BUT theproblem is that it is VERY hard to actually get a sample WITH thewbc’s in activity highly visable..as in colchicine..turn off the wbcattack..turn off the gout attack Crystals in the body..as oppossed to attacks..sure..a goutsufferrer with kidney stones..this will be a u/a stone..goutsufferers who have not dealt with their u/a problem..nowarning..renal failure..then renal tubes plugged up with gloppy u/a
Crystals in the blood..sorry this was a careless statement..I didmean the synovial fluid..but on this point this gets SERIOUSLLYcomplicated..obviouslly if the u/a is in the blood..AND it doesindeed get into the synovial fluid..obviouslly in the form ofcrystals..there has to be some crossover point..I don’t think the u/ain the blood that can/does plug up renal tubes..crystalizes..morejust thickens.
I have been almost 100%..no painkillers..no pain..since Nov.Someswelling..some wbc activity..BUT no pain/no activity restriction..Itoo am on 300 allopurinol..
COOL!..now we’re at the point that ALWAYS,ALWAYS comes withgout/gout discussions..ALWAYS!!!!..differences inrheumatoligists/research..
I NOW really,REALLY respect medical people when they say they DONOT KNO what causes gout
GREAT TALKING! Talk later/soon.. Arnold(THE skier)
P.S..I tend to base a lot of what I know about gout..on thesuccess of those now on allopurinol..especially those who have beendown every other road..what is a REAL shame is that some who havesufferred so much..hit the allopurinol..and that is their end to talkof gout..they have suffered enough and now just want to have somesort of a normal life..I can relate..8/20 months..in bed..20 hrs aday..30 Dr. vists..30 prescriptions in 6 months..(1 1/2 yrs ago)..ANdI am..always have been seriously fit/diet/healthy..
Hey did you know that they found u/a deposits in the crippledhands of T.Rex.. How about how one of the most pessimistic pieces of literatureever written got written?”Heart Of Darkness”..Conrad..trapped on aship for 6 weeks..he came off that ship with that thing printready.GOUT ATTACK.
Sabina Shamel on May 24th, 2007
“secondary uric acid”..attacks/deposits..these aren’t
No problems with the terminology
It is now pretty well documented/understood/accepted that there are 2kinds of u/a..and 2 kinds of attacks.The primary u/a..well we have tocall this “secondary” for a second.This is the u/a in the averagepersons body..average over a long term.This is 85-95% pretty muchunchangeable..this has to do with the complexities of natural cellbreakdown/death..regeneration.In short ALL the factors that produceu/a.There are MANY and a multitude of othercomplexitites/factors.This is the real MONSTER.This u/a level goes onit’s merry way..starting in puberty something goes wrong..dna/chromosome/enzyme production. Usually in a males mid 40’sand later the u/a level has risen to the point where there are nowstores of it in the body..usually the big toe..first.These people arenow on the threshold of gout attacks.The deposits never goaway.Note..they are deposits..not yet crystalized.The deposits arealmost always added to..or go to other spots in the body.”
I am not challenging you but I want to see the literature on this.I have been reading quite a bit on it recently and I think we need toget very clear what we are talking about.First Uric acid is just that, an acid, it is normally discociated atnormal PH and the crystals, at least in the last five articles I havefound on it, ate not uric acid. They are sodium ureate. Moreprecisely monosodium ureate. This much has been carefullycharaCTERIZED BY SEVERAL GROUPS AND CONFIRMED BY X-RAYCRYSTALLOGRAPHY. iT IS THE MONOSODIUM UREATE THAT CAUSES US OURPROBLEM AND, AS FAR AS i KNOW, AGAIN PLEASE REFERENCE IF YOU DISAGREEA reference, and there are others, ishttp://www.peerlesshospital.com/arogya.htm.
By the way, please bear with my approach to solving problems. I oftenget into trouble, not real trouble, but get sidtracked, when I attackthe data position of the other person. Believe me I want to get atthe answer and I don’t care who is right, I want to know what isgoing on.
Moreover, I have found several articles that state they believe-notebelieve- and they can’t prove it, that the real cause of the pain isthat the ureate crystals are very sharp and irritate the tissuemechanically which brings in the inflammation reaction.
Also, there are several places where they state that uric acid doesnot come from a breakdown of protein per-se, it comes from thebreakdown of nucleotides. The source is not important except thatknowing that it comes from nucleotides and not protein can make adifference in ones diet.Uric acid deposits are described and they fit your description of anamorphous semi solid from which sodium mono ureate probablycrystallizes.The reason thisis so important is that the solubility and therelative concentration of sodium mono ureate in solution is going tobe highly dependent on, among other things, the overall PH of thesolution from which it is dissolved. If this is a PH drivenphenomenon, then things like how many times you breath an hour couldaffect the tendancy to crystallize. A PH induced crystallization is alot different than a concentration induced crystallization. The PHinduced one would be more sudden. More likely it is both actingtogether to cause the actual Secondary Gout.
NOW we gethave
Do you have a reference to tophi. I have run across it but cannotfind it now. It may be actual uric acid sitting interstitially in thebody. Non crystallized, probably hydrated or tissue coated, layers ofraw acid. Which, by the way, is pretty harmless unless you go on thewrong side of the PH for it and make it start to add to the serumsodium ureate concentration which will cause deposition of thecrystals and an attack.
downanything..thinku/a
Can you please supply me with a reference for these statements.
suffererisabilitywecausedintoI don’t think you have the progression of events right with thechemistry of the compound yet and I want to make sure of this areabefore going on so I will be reading a lot in this area over the nextfew days.
showing
Pseudo gout, while certainly painful, is from a calcium deposion andcompletely unrelated to gout. The two do not go together.
Clearly visablenowhavethewbcAgain, can you give references for this?didu/aBy the way, I did find a reference that claims brain lesions andsenile dementia resulting from uric acid crystals aggregating in thebrain.More later, lunch time
Terrance Molock on May 26th, 2007
Let me say these few things..I have had gout for 15 years.In thewords of a rheumatologist..” the worst case of gout I have everseen”.Similar remarks from others in the medical community.When Italk about disabilty from gout.I mean literally..8 out of 20months..in bed 20 hrs a day.1 1/2 yrs on colchicne andindomethicine..every day..when I stopped for more than 12 hrs..backto the gout.I tried 30 prescriptions in 6 months.NOTHINGworked..except colchicine.My diet/fitness..this is not to brag ofcourse..but very,very few people would even come remotelyclose.Pretty much all the bad gout foods..I have never eaten.I havenever had my uric acid level above the normal range.Never.I have beenon allopurinol for 2 years now.Off pain killers for 8 months.I ampretty much 100%..very fit/healthy/gout free.Well..pain free.I amnot restricted in any way.Yes I have had gout to the point where thedeposits/tophi came right through my skin.NASTY!I have had peopleclose to me fiddle around with diet/foods..NOT dealing with theseverity of this monster.One had an attack where the u/a plugged uphis renal tubes.Kidney failure.Stroke.Partial paralysis,blindness.Theother had to have part of the foot removed..due to deposits/tophi.Ihave emailed countless people back and forth.Posted gout informationog numerous sites/groups.Taken part in surveys,interviews,research. I have 4 family members in the medical field,7 close friends inthe medical field,2 friends in medical research.I see arheumatolgist,a chiropodist/podiatrist,a dermatologist,and a g/p.PlusI have seen countless other people in the medical field.On top ofthis I haveread,read,read,researched..libraries,medical,internet.Received abouta zillion emails..and sent out almost as many.
I had,HAD..SOoo much information about gout.I have NONE now.NONE!What I have left is in my head.That is WAY more than enough for me.IfI am able to offer advice/assistance..I am more than happy to do so.Ialmost NEVER read any more about gout..I can say that with absolutecertainty..what I have said..often has come from others..experts inthe field.I used to have the articles/research/links..references andhave posted an awful lot of them..my conversations with experts inthe field..have become redundant..sadly to say.We all agree oneverything..SUBSTANTIALLY REDUCE URIC ACIDLEVELS..permanently.Overall.And about the only way to do this is withallopurinol.(ok probenicid too)It is next to impossible to have agout attack without the crystals forming in the first place.AND ifthe overall uric acid level is lowerred enough over a long enoughperiod..voila! no gout.True it is absolutely baffling as to why somehave gout..and some don’t.But the bottom line is..at the end of theday..person x has gout..he has lowerred his uric acid levelsubstantially with drugs..= succes..gout is gone.I am a livingtestament to that..and a damn good one.Would I ever try anything else?Like I replied to that question the other day from myrheumatologist..”SURE..HOWZABOUT WHEN I’M DEAD!!..THEN I’ll TRYIT..OR ANYTHING ELSE”
This repeat gout attack thing without resorting to drugs.Is justplaying with fire.And believe you me people not one person hatedgiving up their independance..and being on drugs every day for theirlives..as much as me.
I gotta admit I pretty much gave up on gout research when I cameacross an article..(I think? I posted it..or a link out here)andthen I passed this amongst others I communicated with..epxertstoo.The article was some research on how(No..I don’t remember who didit/said it..)but about how changes in uric acid levels..I think localuric acid levels..in the area..either raising or lowerring themcaused the protein to be stripped from one of the facets of the goutcrystal..THEN this crystal..with a bare spot..was recognized as ahostile foreign body..and attacked by wbc’s.I tore into thisone..asking EVERYONE,EVERYONE..I knew and EVERYTHING I had everread.Is this just b.s..?s this person an idiot..?can I just dismissthis as nonsense..everyone I talked to said they simply did notknow.It was certainlly possible..definitely not impossible.Some saidsure..a bare spot on a gout crystal could cause a chemical reaction. Judging from a few others..that have researched gout..the onlydefinitive answer is..lower overall uric acid levels.Usually..almostalways with drugs
My rheumatologist is a learned man..with a wall of medicaldegrees.Specializing in gout.He only wants to deal with gout bylowerring uric acid levels.Fair enough..I only don’t want gout.Hisquestion..”I want to study gout untill I know why it attacks the bigtoe..I have read every study..every bit of research..the latest..withdata links etc. there hasn’t been even one single shred of evidencethat can’t be completley dismissed almost immediately..do you want totalk about cooling,deposits,blood flow..why?why? no-one really knows”
Personally I do not care why it attacks the big toe(maybe becauseit attacked my feet)
See..gout is really a very simple problem..
You are very interested in the chemical aspect.I see nothing atall wrong with calling them “uric acid crystals’..and they are theresult of uric acid crystalizing.Plenty of people use this term..itis easy to follow/understand.It isn’t neccessary to split hairs andsay that they are not this is not true..that they are actuallyMSU..how many people understand or care..with all due respect.I knewthat they are MSU Reaction,irritation,inflammation..it all ends up as a wbc attackdoesn’t it..of course. Gout has been approached as a ph problem..hit the net with asearch on gout/lime/ph/testing/changing Tophi..deposits..again this can become semantics..whether thesedeposits actually contain any crystals or not..I think that anyonethinks that these are BAD..and we certainlly have the proof of that. There are LOTS of articles/research on gout deposits..and lots ofallopurinol “reducing deposits”..again this can quicklydegenerate/waste time on hair splitting/semanatics.NO..technically Ido stand corrected.There is NO KNOWN WAY..(this is very wellknown/documented)((other than surgerey))((( I belive that I have goneinto this at length before))) to “..quote..” remove deposits”..and Ido stand technically corrected..yes allopurinol willnot/cannot “remove” deposits..BUT WHAT ALLOPURINOL CAN DO..is toconsistentally..maybe drastically..maybe too much..or toolittle..lower the overall uric acid levels..so that the deposits willleave on their own..sheesh. Ok Ok Ok..whatever..uric acid..whatever happens..but let’s talkso others will understand this.I have had the deposits.I have hadthem come through my skin.The uric acid..or whatever..crystalizes..Iknow I know..we end up with MSU..and deposits..whether there arecrystals or not.At some point there are crystals..and PAIN..and againat some other point in time..there is no pain..but deposits..but nocrystals..and no pain..and the experts call this “tophi”..and thistakes “3-42 years to develop..averaging 10″
Sabina Shamel on May 27th, 2007
“Hi again..I guess I won’t be much help to you in your research.”
On the contrary, you, and your comments are invaluable. Your symptomsare a lot worse than mine and mine were, are, so bad that I can’tbelieve you managed your way through it.
I am more confused than when I started but I believe am gettingsomewhere and your writing has been a tremendous help. I have goneback and read everything you have posted on here and I reallyappreciate your posts and your surprisingly good attitude you haveheld over time.
First a few words on diagnosing and perscribing. I stand by mysuggestions. If everyone who has a pain in the foot runs off to thedoctor, well, if it goes away with IBprofin then it ain’t gout, histoe is better and its like telling a friend to take one for aheadache. If he has gout, he, or she, is not likely to get well soonand will have to go to a physician.
I will leave in what I consider your words of true wisdom learnedfrom experience because I think it makes a great summary of what canbe done for us. .
“the worst case of gout I have ever
“One had an attack where the u/a plugged up his renal tubes.Kidneyfailure.Stroke.Partial paralysis,blindness.”
This is a real threat to us gout sufferers, it can and has killedpeople with gout and things like aspirin exacerbate it.
“The other had to have part of the foot removed..due todeposits/tophi.”
“SUBSTANTIALLY REDUCE URIC ACID LEVELS..permanently.Overall.” AMEN”And about the only way to do this is with allopurinol.(ok probenicidtoo)
It is next to impossible to have a gout attack without the crystalsforming in the first place.AND if the overall uric acid level islowerred enough over a long enough period..voila! no gout. >testament to that..and a damn good one.”
“This repeat gout attack thing without resorting to drugs.Is justplaying with fire, (and literally your life).And believe you mepeople not one person hated giving up their independance..and beingon drugs every day for their lives..as much as me.
“I gotta admit I pretty much gave up on gout research when I camedidlocalgout
This one is very interesting indeed.
I tore into thissaid
I think that the more likely scenario is that crystals of MSU form onthe Uric Acid that is laying around in small deposits. Clearly theissue we have is that our bodies are having a severe inflammatoryreaction to the crystals.
OK so far everything you have posted can, as far as I know and as faras I believe, be put down in a bible of how to survive and live wellwith gout. From here I must disagree.
“You are very interested in the chemical aspect.I see nothing atknew that they are MSU
This is not the case at all and I’d like to show by some examples youknow about in your own life. The salt of an organic acid is not likethe organic acid at all. Lets start with the simplest of all, AceticAcid. Vinegar. You can drink it, it is acidic but you can also get itas Sodium Acetate. Sodium acetate is a white powder, with a highmelting point, it is freely soluable in water and it is actuallyslightly basic when dissolved in water. Another common acid isBenzoic acid. A kinda nasty acid if it gets on your skin, a solid atroom temperature and very slightly soluable in water. On the otherhand, sodium benzoate is again a white solid, completely soluable inwater and also slightly basic in water. In other words the sodiumsalt of an organic acid has entirely different properties from theacid form and there in is, I believe, the key to what is going on.MSU is formed from UA and it is the MSU that is measured in tests onyour overall Uric acid level. If you test the trophi, I will bet theyare not crystalline uric acid but probably amorphous pure uric acidthat the body has made a cyst around. It is a nusiance to the bodybut I am guessing, with a fair amount of data behind me now, that thedeposits of uric acid, in the acid form in your body, are there, theyare gout waiting to happen but as long as you don’t tgrigger thecrystal formation, that is the formation of Mono Sodium Uratecrystals, you remain gout free. Maybe full of uric acid and a mess interms of Trophi, but pain free. Well, at least gout pain free. Iimagine that the Trophi hurt although I don’t know having never hadone.
From a simple chemistry point of view, if a gout attack starts, oneshould acidify the system, perhaps with ascorbic acid, and thatshould hold the formation of MSU from UA to a minimum.
As you carefully point out, it does nothing to solve the fundamentalproblem which is too much uric acid. You have to get rid of it fasterthan you can make it and since, as a gout sufferer, you have alreadylost the race in that equation, you better shut down the formation inthe first place and that will allow whatever uric eliminationcapability you have left, to work and clean you out.
I do worry, and so far, have not reasearched at all about, what thenhappens to the material that would have ended up as uric acid if youhad not taken allopurinol and kept in in some other form.What does it stay as, is it toxic etc. I don’t know but I will belooking this up soon.
“Gout has been approached as a ph problem..hit the net with aI have done that and am about 1/3 of the way through the list. That’swhere I found the articles warning of aspirin and gout, with aspirinpushing uric acid out of the receptor in the kidney, in other words,the salycilate ion will selectively remove the urate ion in thekidney and this sometimes causes percipitation, in the kidneys, ofMSU.
So arnold, what I get from your writing, besides that your not alover of being the proud posessor of a case of the gout-history says,that famous people in history with gout, are not fun to be aroundwhen they have an attack….mmmmm
What i get is that there are two very different forms of solid uricthat accumulate in your body. Trophi which is, in allprobability,uric acid in its protonated form and MSU crystals.The stuff in your blood and serum is dissolved MSU. I know you don’tthink it makes a differenence but I know it does. Would you bewilling to send me, in e-mail form, the address of yourrhumatoligist. I would like to communicate with him. Not about youbut about the subject of gout.
Sabina Shamel on May 28th, 2007
Preliminary chemistry theory to fit the information you havesupplied.Uric acis deposits, slude deposits that are not gouty, not causing aproblem.Periodic gout attacks , way out of proportion to the amount of serumureate that is in the blood.Other people may have many times your Ureate level and do not getgout.
OK Consider the following, the nice thing about my theories here isthat they are pure chemistry and I have read nothing about this yet.I will but it’s fun and I think instructive to think it throughbefore reading someone elses opinion
Uric acid -> Na+ureate-dissolved-> solid Na Ureate as gout crystalsAcid form, <– <–Sludge
at peace, or in equilibrium. The position of the equiliibrium isstrongly affected by blood acidity. If the acidity of the water goesup, the tendancy of the acid is to take on a H+ ion and turn a ureateion into a neurtal uric acid molecule pulling the whole thing over tothe sludge mode. Similarly if acidity goes down, the acidity getsless, then the tendancy will be for the acid to discociate, to makethe dissolved ureate and that will drive the equillibrium to theright. Making more ureate will increase the saturation of the waterwhich will make the sodium ureate want to come out of solution, thatis to crystallize and give us -ouch-pain.
Now as to your question about why some people can have high ureatelevels and not ever get gout. Perhaps and probvably they do not havehigh levels of uric acid sludge in their system and are just high inthe ureate but not so high that it has triggered the formation ofeven the benign form of it, the acid form.
In other words, if we don’t know our intrinsic total uric acid loadon the total system, the blood serum ureate levels and the urineserum ureate levels will have no, or little meaning. My speculationis that us gourt sufferers must have much more uric acid in oursystems and when things change, most likely acidity by the way, thebalance is shifted . During that shift we may end up creating sodiumureate crystals from the uric acid sludge that was alreadyaccumulating in our joints. It is this tendancy of an organic acid toact this way that leads me to believe that the secondary attacks areprobably a result of pHification, of making more sodium ureatecrystals from the raw uric acid that was in all probability alreadyin and around the area being attacked.