Understanding Purines for Gout

If you suffer from Gout, chances are you have done some research on it. If you have done any research, you have probably read about purines. There seems to be an unlimited supply of websites attempting to define what is safe to eat and what should be avoided.

Purines are found naturally in the cells of our body and in the food we eat. As much as 85-90% of the purines (Adenine and Guanine) in our body come naturally from our DNA. The remaining 10-15% of purines (Hypoxanthine and Xanthine) come from the food and beverages we consume. Either way, the purines make their way to the liver where it is metabolized in to Uric Acid. The uric acid then travels to the kidneys where most is removed from the body as waste in urine. Some of the uric acid is deposited in the bloodstream. When too much Uric Acid enters the kidney's more is deposited into the bloodstream. It is the excess uric acid in the bloodstream that crystallizes in joints to create what we all know as Gout.

Low Purine Diet Guide

Since up to 85% of the purines come from DNA, that means the remaining 15% can be controlled by what we eat. There seems to be unlimited supply of websites telling us what we should eat and what we should avoid. Generally, you want to maintain a low purine diet and limit consumption of high purine foods. I found this chart at Primary Care Specialists. This chart is a good guide on what to eat and what not to eat. High purines eats, red meats, seafood and alcoholic beverages among many other things. I have listed a few sites I like to reference when I need to find out about a particular food or food group.

Please share with me your favorite website for looking up the purines list.

Purines Food Lists
http://www.dietaryfiberfood.com/purine-and-uric-acid/purines-food-and-gout.php
http://www.webmd.com/arthritis/tc/diet-and-gout-topic-overview
http://goutcuresandremedies.blogspot.com/2012/05/comprehensive-list-of-purine-containing.html
http://www.goutpal.com/gout-diet/purine-rich-foods/

Information Sources
http://library.med.utah.edu/NetBiochem/pupyr/pp.htm
http://www.ehow.com/about_5047849_purines-pyrimidines.html

Uric Acid Meter Accuracy

Easy Touch GU Log

I bought my Easy Touch GU, Uric Acid Meter several years ago. Although, I do not believe it is as accurate and reliable as a test performed at the doctor’s office, I still believe it is a reliable guide that helps in planning menus and activities. 

I purchased my meter from a vendor in Florida a few years ago before they were available on Amazon. Read my previous post on my Uric Acid Monitor. When it first arrived, I used it several times a day. I tested my blood when I woke up, before going to bed, before / after meals, before / after known trigger foods, and randomly during the day. I noticed that my uric acid levels varied through-out the day. It changed depending on, not just what I ate, but what I was doing such as relaxed vs doing sometime of strenuous activity. 

During gout attacks, I observed variances in my levels as well. Although, my levels were higher than normal, they still varied through-out the day. What I found most interesting was that as my gout attack wore on, my uric acid levels went back to the normal range, but I was still in pain. This helped me realize once the uric acid crystals developed in my toe, I had to maintain a low uric acid level for days sometimes weeks for the uric acid crystal to dissolve. If I ate any moderate / high purine foods, it didn't allow the crystals to dissolve as quickly.

I use my meter as a guide. If I think I might be at risk of having gout, I check my blood. If the meter reads that my uric acid is greater than 7mg, I avoid the steak and beer, and have chicken and water instead. If it is within range, particularly below 5mg, I might have a couple of shrimp or a steak but I do not over-indulge. Since Allopurinol does not work for me, I watch my diet and monitor my blood levels. You can read my post on my experience with Allopurinol at Is Allopurinol Good . 

Male : 3 ~ 7.2 mg/dL (179 ~ 428 umol/L)

Female : 2 ~ 6 mg/dL (119 ~ 357 umol/L)

I believe the uric acid meter is worth the investment. I learned a lot about how uric acid works in my blood. My doctor confirmed that uric acid levels can fluctuate. When I compared the results from the meter to the result from the lab, they were not exact but close enough. I purchase my refills through Amazon and find them a bit expensive so I do not test as much as I did in the beginning. There is a bit of a wait to receive the refills so I hopefully that will improve in the future. 

I would enjoy hearing experiences with your Uric Acid Meter. 

Gout Medication

When someone is suffering from a gout attack, the only thing they want is for the pain to stop. Many gout sufferer turn to medication for relief. There are three types of medication to considering for gout sufferers: Steroid drugs, Non-steroidal anti-inflammatory Drugs (NSAID) and Gout Prevention Medication.

When someone goes to the doctor for a gout attack, many times the doctor will prescribe a steroidal prednisone dose pack to help eliminate the pain. This can be an effective method of helping with a gout attack. However, it is common for the need for longer dose and sometimes this may not help. Prednisone can also be addictive and should be tapered off with the help of a doctor.

Gout attacks can be accompanied with tremendous pain that can be controlled using the proper NSAID medication. Powerful NSAID medications can be prescribed by the doctor like Voltarol, Arcoxia, Indomethacin, and Zipsor. Over-the-counter medications like Naproxen, Ibuprofen, or Aspirin. These medications can be used to control the pain associated with a gout attack however they do not remove the uric acid causing the gout attack. As with any medication, one medication may work better for different people. Side effects can also be associated with any medication.

Gout Preventive medication are used to reduce the uric acid in the blood stream. Medicines like Allopurinol, Uloric, Colcrys, and Colchicine are very popular for gout sufferers attempting to control their gout. They reduce or limit the amount of uric acid that enters the blood stream.

There are also natural alternatives to fighting gout on my Fight Gout Naturally blog post.

Gout Preventive Medicine

• Allopurinol
• Uloric
• Colcrys
• Colchicine

Non-Prescription Gout Pain NSAID

• Naproxen
• Ibuprofen

Prescription Gout Pain NSAID

• Voltarol
• Arcoxia
• Indomethacin
• Zipsor
• Piroxicam

Prescription Steroid for Gout Pain

• Prednisone Dosage Pack

If I have overlooked any medication for helping gout, please add yours to the comments link below this post

Alkaline Water for Gout

Increasing the alkalinity of the body is a good way to reduce your risk of gout. When you add sugary carbonated sodas, candy, beers, sugars, meats, and other acidic foods and beverages the your diet the body as a whole becomes more acidic. This is not good for the body as viruses and bacteria can survive. It is even worse for gout sufferers, it makes it harder for the kidneys to remove the excess uric acid which contribute to more gout.

The human body is naturally alkaline with a pH of around 7.4.

pH < 7 is Acid
pH = 7 is Neutral
pH > 7 is Alkaline



Pool Chemical Test Kit

 There are many different ways to get alkaline water depending on your taste buds and budget. Each method has it's pros and cons. To test the pH of the water, you can get a swimming pool chemical test kit or test strips. There are also test strips used for urinalysis to check the acidity of your urine to track your progress.

Lemon Water - The cheapest way to get alkaline water at home is squeezing lemon juice into regular tap water. Although the lemon water is acid, it is believed to have an alkaline effect on the body.

Baking Soda - Baking Soda (sodium bicarbonate), which has a pH of around 8.0, will alkaline your water also and is very inexpensive. Due to the high sodium content, baking soda can increase your blood pressure. Ask your doctor before trying this remedy. Personally, I did not like the flavor or texture of the baking soda water.

Baking Soda Remedy
- A half teaspoon to 6 to 8 ozs of water.



Alkazone

 Alkaline drops - Alkaline drops can be added to any beverage to increase it's alkalinity. Although, not as inexpensive as lemons or  baking soda, a single bottle is not too expensive and can last for weeks or months. The bottles are small so they travel well and are convenient when out for dinner. There are several brands available through your local health food store or favorite online retailer. Each brand of Alkaline drops I tried each used different minerals to change the pH of the water. This created an after taste in some brand that I did not like. I prefer AlkaZone, but I recommend trying several brands to find the one you like.

Water Alkalizer Machines - Water Alkalizer use electric charges, or electrolysis, to adjust the pH of the water in its tank. Alkalizers can be purchases in small portable bottles, counter-top versions, or systems for an entire house. Some of these systems are very expensive so that are not for everyone.

Gout with Wide Shoes



My Gout Shoes - EEE

 Anyone who has experienced a gout attack in their toes knows that it can be very difficult to walk. This is particular true for those who travel for business or pleasure. Back when I was having frequent gout attack, I would have to travel for work. Although, I didn't travel much, Gout seemed to find me before or during the trip. As with most business travel, you get bigger meals, fast food, and lots of walking.

On one particular gout experience, I had been preparing a presentation that I was to give at this conference for months.  As luck would have it, gout found it's way to my right toe about 4 weeks before I was supposed to attend the conference. I immediately cut my on my trigger foods, limited all red meats, seafood, alcohol, etc. I drank lots of water, cherry juice, and chicken in hopes that I could shake this attack myself. With one week before I left and the gout attack didn't seem to be subsiding. I broke down and went to see my doctor. I was desperate to get this gout attack eliminated before my travel. It was just not to happen. I was in lots of pain with no end in sight and business travel on my mind. I knew there would be lots of walking and my food was not going to be up to it.

With that in mind, I decided to find a larger pair of shoes. I needed shoes that I could walk in that looked professional and would cause the me least about of pain when I walked. So I went out and found me a pair of EEE width dress shoes. They were huge to walk in but as long as I tied them tight, I was able to walk around. It was not the perfect solutions but it helped me get through that week.

pH Balance for Gout Control

One way you can help control your gout attack is by controlling the pH balance of your body. The pH, or Power of Hydrogen, in the body is measured on a scale from 0 to 14. A pH of 0 is extremely acidic, a pH of 14 is extremely alkaline, and a pH of 7 is neutral. The body is naturally alkaline but only slightly around 7.5. A person can become extremely sick if the body is too acidic or too alkaline so it is important to try to keep it balanced. Most of the food and drinks we consume are acidic making our bodies more acidic. Consider all the alcohol, sodas, and caffeinated beverage we have in a day. They are all acidic. Even fruits which are healthy to eat are high acidic. Then on those hot days when you are drinking lots of water to stay hydrated. The water we drink (from the tap or bottled) is generally acidic. This makes our job as gout sufferers even harder because the more acid is in our bodies the harder it will be to stop a gout attack.
During one of my longest gout attacks, I decided to find out about the acidity of my body. I purchased some pH balance strips that you would use to test the chemical in a pool. So when I would go to the restroom, I could check the acidity of my body. It was eye opening to see how acidic my body was. You can find Urinalysis Strips online designed to inform you about the chemicals in your body beyond just your pH balance. I highly recommend testing your pH balance but either test strip should to the trick for gout issues.
Since our bodies and food are so acidic, what does a gout suffered do? We need to consume more food and drinks that are more alkaline than acidic. When I looked at a list of alkaline foods I noticed that some of the vegetables on that list are high in purines, like cauliflower and asparagus, which I once enjoyed. As I mentioned before, bottled water is generally acidic. I decided to use the pH strips in samples of the water I was drinking. I tested water from the kitchen and bottled water. Water from my tap was very acidic probably due to the metal pipes. Bottled water depends on the brands. Most of the bottled water that you find in the stores are neutral or slightly acidic depending on the brand. A few were more acidic than others. I then discovered that there are some brands that sell alkaline water. Most are only slightly alkaline around 8.0. If you look in the health food stores some can be found to be as high as 9.5. Unfortunately, purchasing bottled alkaline water can be expensive. Then someone introduced me to Alkaline drops. These are drops that you add to any drinks to make them more alkaline. There are many brands of alkaline drops available. I have tried several brands in tea and water. Some brand leave a bad taste so I suggest you try a few brands and see what you like. There are home remedies around that use baking soda to help balance the pH but I did not enjoy the taste of it but alkaline drops are not bad.

Food I Avoid or Limit

This is a list of food I completely avoid, (A Growing List)
- Regular hot dogs (beef or skinless are good)
- Peanuts
- Shellfish (crab, lobster, CLAMS, OYSTERS, scallops, etc)
- Asparagus
- Kelp Noodles
- Powdered Eggs
- Diet Pills

Food I limit (might have one or two)
- Sushi (Tuna, white fish)
- Mushrooms, cauliflower, Tomatoes
- Steak, Pork
- Beef Jerky
- Beer, Wine, Spirits
- Beans

Food safe to eat during a gout attack.
- Chicken
- Cherries, strawberries, raspberries
- Grapes, Watermelon

What food do you avoid

My Second Gout Attack with Oysters

In July 2005, I had to take business trip where I was able to bring the whole family. We made a mini-vacation out of it. The pain in my left foot was feeling much better and I was walking without a limp for the first time in weeks. On the second night, we went to a seafood restaurant with a few coworkers. This place served some fantastic smoked oysters. I only ordered one dozen for myself. My son ordered two dozen of his own. It did not take long before he realized his eyes were bigger than his stomach. So like the great father I am, I offered to finish the last dozen. After consuming two dozen smoked oysters, we were ready to go back to our vacation rental, 30 minutes away. From the time we left the restaurant to the time we arrived to our rental, I had gone from walking normal to a full blown massive Gout Attack. Walking from the car to the bedroom was very difficult. My wife had to help me walk since putting any pressure on my foot was painful. That night, I learned the pressure from the soft flat sheet from the bed lying on my toe caused excruciating pain. As I mentioned before, I don’t generally go to the doctor, but the pain I felt from this attack forced me to find a local doctor to provide me with some much needed relief. The doctor gave me another NSAID but real relief from this attack was weeks away. From this experience, I learned that I need to do a lot more research in to the cause of Gout. Obviously, oysters were now off the menu, as well as beef and beer. It was frustrating to discover I was slowly eliminating my favorite foods from the list of items I was able to eat. I read that poultry was better than beef, pork and seafood, so I ate lots and lots of chicken.

My First Gout Attack

My first Gout attack was in May 2005. My foot had been hurting for a few weeks but I overlooked it as just stumped my toe. The joint below my big toe had become swollen, bright red and HOT to the touch. My ability to walk had become such a chore and the pain was getting worse. I don’t usually go the doctor but my wife finally told me she thought I should go. So after 3 weeks of growing pain in my foot, I finally went to the doctor following the Memorial Day weekend. The first thing he asked was if I had a “Big Weekend”. He wondered if I "drank a lot of beer and ate steak or burgers” over the holiday weekend. Ironically, I hadn’t had any steak or beer this weekend. He diagnosed me with “Gout” or the “Rich Man’s Disease”.

I had never heard of gout prior to this visitor to the doctor. My doctor gave me two medicines that I had never heard of until now: “Colchicine” and “Allopurinol”. Colchicine was supposed dissolve the uric acid crystal causing my gout. I was to take the Colchicine once every two hours until the pain went away or until the side effects started to occur. It only took 3 dosage of Colchicine before the side effects began. I would spend much of the next 3 days in the restroom and the gout pain had not subsided. The “Allopurinol” was a preventive medicine that I was to start when the attack was over. That would not happen for monthly. The following week I was still in pain so I went back to see my doctor. This time he only gave me more education. He told me to watch what I ate and to take “Aleve” or other NSAID for the pain and to drink more water. The pain continued for a few more weeks and was about gone. Then in July, was to go on a summer business trip where I was able to take the family. I wish I had done more research about Gout Triggers. This would become a trip I would never forget.

What is Gout?

Gout is a type of arthritis that causes excruciating pain to the joints it affects. With typical arthritis, cartilage erodes over time. With Gout, needle like uric acid crystals accumulate on the joints causing the joint to become red, swollen, and inflamed  The most commonly affected joint is the one below the big toe but it can occur to most any joint in the body.

Uric Acid is naturally removed through the kidneys, but when there are high levels of uric acid, called Hyperuricemia, the kidneys are not able to extract it all from the body allowing it to collect on the joints.

Uric Acid is created when the body breaks down purines found naturally in the body as well as the plants and animals consumed as food. Some foods like organ meats, legumes, and seafood have a higher consideration of purines than others.