Gout and alcohol
My situation is this: I am aged 38 and have suffered with gout for about 6-7 years, gradually getting worse and more prolonged. The doctor I had at the time did not want to put me on the Allo as he thought I was too young (Something I now wish I had argued!!)After going through about 5 doctors and when I was now getting the attacks in my knees and eventually my elbow, I was reffered to a specialist in the rhemeotology department at the hospital, who Immediatly gave me an injection (Dont know what it was but it worked!) and put me on the allo 100mg a day rising to 300mgs over the next few weeks.I started taking the Allo in September this year and since then I would say that I have had more attacks than before I started on it, Although they do not seem to be as acute or prolonged than I have had in the past, they also always seem to be in places where I have had bad attacks in the past.Now this is where Arnolds posts have got me wondering, The day before the post on the old deposits I went back to my regular doctor and told him that Im getting attacks at least as frequently as before I started on the allo. His diagnosis was: I drink too much, thats why the tablets arnt working!!! He then pulled out a book and started searching through it and came up with……….”The maximum dose of allopurinal allowed per day is 900mgs so I am increasing your dose to 600mgs a day”This is not what I wanted to hear and have not yet started taking 2×300mgs a day it seems completely over the top.The question is as I have only been on the allo for about 3 months is it likely that its these old deposits are causing me the grief and am I better to stay on the 300mgs a day and give them more time??I think I would rather take you guys advice than trust these doctors who all tell you something different each time!!Incidentally If I do stick to the 300mgs Im going to have an awful lot of spare tablets as hes now prescribed me 112×300mg at a time!!!!
Sabina Shamel on July 30th, 2007
I have read the posts about alcohol with borderline amusementbecause I have felt that if you indulge and get side effects, that’sjust the price of indulging.
That bit of sermonizing-from one who has gone through too many threeday hang overs in his younger life.
If you search in the literature on alcohol, uric acid and kidneyfunction, you will find that the kidney is almost completely unableto remove uric acid when there is alcohol in the system. I don’t knowwhere I found it but there are several references to it andrumatologists know this and will tell it to you. The reason alcoholhurts gout, beer wine, etc, is not because of purene content. Thereis virtually no purene content in beer or wine to speak of, it isbecause while that alcohol is in your system, your kidneys are simplynot able to remove urate effectively. Therefore, if you have, let’ssay, four drinks in a four hour evening, not an unreasonable orunusual amount either, you will have alcohol in your system for about10 hours. Therefore, in a 24 hour day you inhibited your bodiesability to remove uric acie by 10/24ths of the total day. So lets sayyou make a habit of this four drinks a day, if you do then I believeyou have more problem than just gout but lets move on, if you do itfor say three times a week, that amounts to a reduction in uric acidremoval of 10/24 x 3 all devided by 7. That amounts to a reduction ofurate removal of about 20%. Thats more urate than you get from yourdiet and thus you are forcing your system to tolerate more than twicethe load it would normally have to deal with.
Look, we are not talking about kidney failure here with gout. It is aslow process in which your system fails to remove enough uric acid byonly a very small amount every day. If you insist on drinking on aregular basis, you will be forcing an already overloaded urateremoval system to do the required job with less total hours worked.
It’s like a waste management company that is slightly over loadedletting its employees off for 20% of the time they should be working.What would happen?
The waste would build up…..
Sabina Shamel on July 30th, 2007
Stop your alsohol consumption till you get clear of gout.
You may not be able to walk because of alcohol and you can stopdrinking and regain the ability to walk. If you continue to push thelimits with gout it may make is so you won’t be able to walk whetheryou drink or not. Put this in perspective, that pain hurts and thelonger it hurts the more damage you are doing to yourself.
Stop the alcohol completely, replace it with water, stay onallopurinol and hang in there.
It will get better.
I might be tempted to increase the dosage to 600 mg but only for amonth. Keep in mind that if you are suffereing from an old uric aciddeposit dumping urate ion into your system, allopurinol will doabsolutely nothing for that problem. The only thing that will help iswater and perhaps indomethecin. Indo will increase the rate of urateremoval but watch out for it because it will turn your stomacheinside out if you are not careful.
You didn’t mention colchicine, you should be on it when you have anattack and you should have a NSAID of some kind to get your throughthe attacks. After you start the allo you should be able to feel theattacks coming and take prophelactic amounts of colchicine and yourNSAID of choice, mine is Celebrex, and you should be able to stopthose attacks within 8 hours.
Final thought here. Gout is viewed in the medical community as anaffliction that involves, to some extent, a malfunction if the liver,and alcohol is known to destroy the liver over time.
How much does two plus two equal?
Albina Bonow on July 30th, 2007
My wife works in a 5 star restaurant. Up until 6 mos ago, I was drinkingsome of the best red wine in washington state (US). Only 2-3 glassesa night but it was still complicating my gout. It impairs your kidneys andit dehyrates your system.
If you have gout and can’t stop drinking booze, then you have anotherdisease called alcoholism. Get help. You’ll be glad you did.
Terrance Molock on August 1st, 2007
Gout is basically dealt with by REDUCING your average blood uricacid levels by 20 to 30% AND into the low average range.You takeenough allopurinol to do this and keep this up.You may at first needmore allo..as fairly fresh deposits enter your bloodstream andarticially/temporarily raise the blood uric acid level.If 100mgdoesn’t produce the requisite NUMBERS you take more..up to900mg.FORGET any silly talk of more allo reducing attacks ordeposits..THIS is ONLY! true if you are NOT taking enough of thestuff in the first place.Dr’sand people who deal with gout otherwiseare simply CONFUSING the issue..AND the numbers. You get your blood uric acid levels down that amount..and adjustthe allo according to DO THIS. This is not rocket science or complicated.
ONCE you have the blood uric acid level in the required zone..YOUWAIT..for the years when you DIDN’T take allo AND allowed thedeposits to build up to leave.
The deposits will leave on average in 1 to 3 years..up to 10years.NOTHING can affect this much.WHEN they cause trouble..bybasically breaking up..exposing their nastiness to the white bloodcells..you get attacks.If the attacks are stubborn,frequent..you takecolchicine every day for a while.
Alcohol..Does anybody here KNOW why alcohol was first blamed forgout? I am not going to go through that again..I have postedextensively about that.
Around the time when such things as “purine’s” in food wasdiscoverred..(again) we get back to the original reasons for alcoholand food)alcohol was labelled as LOADED with purines.There isPLENTY!! of old school medical information..yes from medicaltextbooks right here on the net..PLUS a virtual PLETHORA ofanecdotal/heresy evidence to support this.The medical community wentright along with this.I don’t know..20/30 years ago it wasdiscoverred that alcohol had NO purines in it..next tonone.HMMMmm..UNFORTUATELY NOW alcohol and meat eating could no longerreally be blamed any more.Little problem developedhere..allopurinol.was NOW in use..and this put the hammer to gout andthe researchers began looking at ALL the factors.Pretty muchEVERYTHUNG got thrown out.IF you had gout..you either reduced yourblood uric acid level..or you were beat.Allo worked..nothing else did(probenicid).
MORE AND MORE people in the medical community now see alcohol asnot a factor.It is growing.As I have said..here in Toronto..I haveNEVER met even ONE that said that alcohol per se was a factor atall.Ok before anyone gets their shorts in a big knot..let’s look atthe “alcohol per se” factor.Alcohol is a diuretic..again..this is notrocket science..you drink the stuff..it dehydratesyou..THEREFORE.again..not too hard to figger out..you drink 1drink..1 coffee you replace it with 1 water.Grade 4 math should showthat you can’t keep taking basically water out of yoursystem..WITHOUT putting it back in.ARE THERE??? ANY studies wherepeople have drank AND consumed water to offset the diuretic effect ofalcohol..OF COURSE NOT! Does anyone do this..OR evev/ever knownanyone that drinks a large glass of water with every drink?? OFCOURSE NOT..
Blah blah yes it was discoverred years ago that alcohol doesinterfere with the disposal of urate..to such a negligible extentthat it can barely be measured.Unfortunately it was ALSOdiscoverred..that some uric acid is “reclaimed” and added back to thesoup.
Sorry to say folks that we END UP right back at the blood uricacid levels..If there is too much uric acid in your blood (for you)THEN it ends up in your joints.If the blood uric acid level isok..then so are you.As Walter stated..if you are TEETERING on theblood uric acid level where the excess heads into the joint area(either from not enough or no allo)then getting dehydrated fromdrinking..OR EATING/DRINKING/DOING ANYTHING that ADDS to your ALREADYborderline blood uric acid level..is just DUMB.And he isright..CLEARLY for me..at a blood uric acid level of about 4.4..thisis simply WAY too high for me..my kidneys are simply unable todispose of enough MORE of it to reduce my blood uric acid level tothe point at which it doesn’t end up in my joints.I take allo..thistakes the level from the 4.4 to about 3..and I am safe..havea “cushion” to work with in my levels..I am NOWHERE in danger ofreaching that 4.4 mark..NOR can I get anywhere even close.I stay at 3now.
Myself..having been a drinker..still drink..not much though.Hasthis EVER affected my blood uric acid levels? Having been literallyCRIPPLED with gout..and having basically a FREE rein/access to anactual accreddited medical lab for blood uric acid level tests.YES! Idid get to do a LOT! of “testing”.AND I got to talk to a LOT! ofpeople who took the blood tests..did the testing.Sure..there weretimes when I had a few beers..a hamburger etc..at the point where itshould have affected my blood uric acid levels.Mine stayed in theaverage range..around 4.4 etc.I COULD NOT move them!..
Ever take a look at WHO gets gout attacks AFTER drinking.Worth alook.Those NOT on allopurinol.C’mon we are NOT talking about peoplewho are NOT on allo..OR those who are not on enough..OR those whodrink NO water..eat NO fruits..NO vegetables..SWEAT..getDEHYDRATED..OR have compromised kidneys/liver etc from excessivedrinking..OR those that consume MASSIVE quantities of alcohol..ORthose who have ilness’s.”Those not on allopurinol”.OF COURSE if youhave chronic gout and JUST START allo and for you the chemicals(which are NOW blamed for setting off attacks)in the alcohol TRIGGERattacks with existing deposits..then don’t be blaming the alcohol.
Take enough allo..AS IT IS PRESCRIBED with ENOUGHWATER!!..eat/drink/exercise fairly sensiblly..don’t worry what youeat and drink.ONCE the allo has done it’s job..and the deposits areleaving..or have left..
FUNNY! how NOW we BEGIN to see MORE AND MORE people coming forwardand saying..HEY wait a minute..I quit drinking and the attacks kept acoming..I continued drinking and taking allo and..hey..that’sright..no more/less attacks..
When I was first hospitalized and diagnosed with gout..I KNEW thatI would be told it was caused by drinking..and would get lectured.ANDof course I got the SAME response from EVERYONE at the hospital.AND Iasked..pointedlly..does drinking affect it..THEN I got the standardquestions about drinking..I guess to see if I was an alcoholic/hadalcohol problems.I also got BAITED..try this on from am EXPERIENCEDe’gy Dr..verbatim conversation.
“Arnold..do you..say..like a nice roast beef dinner?” I KNEW that he would then say no more..or less..or neveragain..we are ALL tempted to lie to these people.
I answerred yes..KNOWING what he would say
“Arnold..do you like a few beers”
AGAIN I KNEW what he would say..I said yes.
As I lay there on a bed in the emrgency ward..with many otherpatients nearby and within earshot..this Dr ..clipboard inhand..writing..talking loudly..he turns..
“Arnold..you have severe..very severe and chronic gout..it hasFULLY attacked BOTH your feet.You will have to take a drug calledallopurinol..it is cheap and harmless..EVERY day for the rest of yourlife.People USED to say it was caused by eating excessive amounts ofmeat and drinking.IF you enjoy a nice roast beef dinner..THEN HAVEONE! IF you enjoy a few beers then DRINK UP!”..
Terrance Molock on August 3rd, 2007
The MAIN reason that I get a “BIT” “unravelled” over thealcohol/gout thing is that for EVER it has beenblamed.COINCIDENTALLY..the person will drink less/quit..whatever.ANDthe ATTACK is gone.With bad anecdotal advice..bad medical advice..andghe feeling that the evil alcohol is to blame.OFF said gout sufferergoes to heaven..without his bubba.Mr. gout simply goes back to doinghis EVIL work..so one trigger..alcohol is gone..he goes back LOADINGup the joints..maybe other joints with deposits.As a rule of thumbthe longer the deposits are allowed to be made..the moresudden/explosive/harder to control the next attack will be.SOOooowithout bubba..ONE FINE morning he gets ANOTHER vist from themonster..BIGGER than ever.How can this be? I’ve been a goodboy.HOPEFULLY this time he gets and stays on the allo.People go onthe allo..THEN quit drinking..thinking that they don’t/no longer needtthe allo.WRONG move.
The rhuematologist I have seen for years…He asks if I enjoy theodd nice steak and a couple cold beers.I said ya..sure.Hesays..”Good..stay on allopurinol..keep on enjoying them!..THE ONLYthing you will accomplish by giving them up..as far as gout goes..isgiving up that enjoyment.You give up allopurinol and ALL that youdo/accomplish is handing your life back in a couple empty bottles andan empty steak plate..TO: the forces of evil.They WILL come again foryou They will NEVER leave you alone.I assure you..they WON’T becoming back with another steak and a couple more beer”
I have seen some GRIM results in terms of gout in a few peoplethat blamed alcohol/quit/DID NOT get proper treatment(allo) and theyagain faced the LARGER than life now gout monster.