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Gout Dugout.Issue #051 low purine diets | krystexxa EU availability | encouraging gout therapy study
March 21, 2012
Hello and Welcome to the March 2012 issue of the Gout Dugout newsletter. The 10 minutes' read that can give you good ideas for dealing with gout. If you find it hard to read from a computer screen by all means copy and print.
LOW PURINE DIETS FOR GOUT: THEY DON'T HAVE TO BE SO EXACT
When I first started digging around for information on purines, after a few days I was surprised at how little there was. Here we have a major disease that's growing, but there is not enough information related to one of its causes. Yes….. you can put together a reasonably decent list of the purines in foods (but not in drinks), but there aren't that many sources out there and all the information doesn't exactly agree, although much does.
If you wanted to answer a serious question such as which of the four purines most leads to raised uric acid, and in which foods and drinks is it most found (and least found), frankly that isn't easy. Maybe this information is locked away in a few laboratories somewhere, or in a bank vault.
And of course I used to think it mattered a lot. But now I think it matters less. Why?
Because people can put together a low purine gout diet based on rough-and-ready information which will lower their uric acid somewhat, and in some cases by enough to control gout.
I was reminded of this a few days ago when checking some uric acid (UA) reduction figures for the low purine gout diet study that's described on this best-gout-remedies.com page. The low purine (LP) diet used in this study was not especially scientific. Some low purine diets say "eat no more than 200 mg of purines daily." I am not sure I would know how to do this exactly (as I indicated above), but roughly and basically it would mean living on milk, bread, butter, fruit, many vegetables (maybe not asparagus and tomatoes but including potatoes), nuts, tea/coffee (very limited or no alcohol), rice, pasta. And a small amount of meat (say 3 ounces) daily, but not offal(organ meat), medium/high purine fish, and other foods that are low or medium purine.
In this low purine diet study the instructions were not very scientific. The participants were told to restrict high purine food intake (defined as 100 – 1000 mg of purines per 100 grams of food) or restrict foods classified as high on purine tables, plus alcohol and foods in which yeast (and curiously eggs, which are low purine) had been used. (But bread, although usually yeasty, is low purine). Meat, except some game and offal (organ meat), was not considered high purine so they could eat that.
Or, if they were already avoiding high purine food, they were simply told to decrease, not avoid, medium purine foods such as meat, fish and veg. (Since this study it has been learnt the purines in most veg don’t raise uric acid). The dieters didn't try to lose weight, nor did they.
Did this somewhat rough-and-ready regimen produce the desired effect? Apparently it did. In 36 weeks (say 8 months) the average UA level (men and women) fell by – 2.09 mg/dL and in just the first 6 weeks by – 1.56 mg/dL. Both are excellent reductions. The reduction came solely from the purines restriction, not from lost weight.
In this study in fact, the LP diet reduced UA almost as much as 150/300 mg of allopurinol (-2.39), and when allourinol was added to the diet (– 2.48) i.e. only 0.39 more than the low purine diet alone. And to repeat, this success came from a fairly generalised, non specific, LP diet.
But I still hanker after more detailed purines figures. Maybe some day a government body somewhere will pay for them.
If you want to read this study you can download it here. It's free.
It's not red wine, it's elderberry juice and it's very high in flavonoids, especially one anthocyanidin called cyanidin. Ten times more cyanidin than in cherries. Good for a gout diet. See Useful Databases below.
KRYSTEXXA EU AVAILABILITY
Krystexxa (pegloticase) is the super gun of uric acid reduction, if it can be taken, and if it works. It's been approved in the U.S. now for about 2 ½ years. In one study it got uric down to 2.9 mg/dL from 9.8 mg/dL.(1) Although those numbers are statistical, that's a lot.
Its developers, Savient Pharmaceuticals Inc, recently announced that it is now available for "named patients" in EU countries. Although it still awaits EU approval, it can be made legally available through a programme (program) run by a company called Idis Ltd.
Krystexxa (pegloticase) is the treatment for difficult to treat, when all else has failed, gout. Savient calls this RFG, or refractory (that's stubborn to you and me), chronic gout. If this is you, and if you live in an EU country (this is a list of EU countries - doesn't show Gibraltar but Gibraltar is in the EU too),), ask your professional health care provider to contact Idis Ltd.
Telephone: (UK) + 44 (0)1932 – 824123. Don't dial (0) if you call from outside the United Kingdom. Fax: (UK) + 44 (0)1932 – 824323. Don't dial (0) if you call from outside the United Kingdom.
Read more about Krystexxa at its website
THE "DIRTY DISH HYPOTHESIS" STUDY
In last month's issue of this gout newsletter, I mentioned the recently published study in the December 2011 edition of Arthritis & Rheumatism which advocated a two stage approach to controlling gout.
First, get your uric acid down to the crystal dissolving level of 6.0 mg/dL or below.
Second, once crystals and tophi have gone from tissues, and blood uric acid has fallen, and attacks have ended, maintain your uric acid below 7.0 mg/dL. It was good to read that what is widely believed in the gout world was again found to be the case. i.e. that crystals dissolve below 6.0 and reappear to trigger gout attacks above 7.0.
I had an interesting correspondence this month with a gout sufferer who reduced his uric acid (UA) from 14.0 mg/dL (very high) down to 5.9 mg/dL (i.e. - 8.1 mg/dL) in only a little over 2 months he said. That was a very good reduction in a short space of time. He did it with a combination of 40, later 80 mg of febuxostat daily plus weight loss of 70 lbs (32 kilos). How much each contributed isn't known but if I had to guess I'd say – 5.0 from febuxostat and – 3.1 from the 70 lbs of lost weight and avoiding purines.
He is a classic example of someone who can learn something useful from this study because his UA is now at a crucial level.
At 5.9 (and he wants UA to go further down because gout is clearing up and tophi are reducing but he isn't gout free) he is now just below 6.0 mg/dL. If he does clear up his gout within the next 12 months, this gout therapy study says he needs to keep his uric acid subsequently below 7.0.
The 1.0 mg/dL zone between is either the red light danger zone (if UA levels have been rising), or the get-ready-for-a-new-life, green and amber zone, if UA levels have been falling. If you are in the zone, this is where you make the right, or wrong, decisions that subsequently have a great effect on how your gout therapy goes.
There were 211 gout patients in the "Dirty Dish" study and 27 of them succeeded in getting UA down to 6.0 – 6.99 mg/dL. Note although there were 211 gout patients only 9 were women. I guess it's harder to find women with gout. So the numbers I'm quoting really apply to men. Women should read them at about 0.5 mg/dL lower, although strictly speaking what’s said here might not apply to women, because of the small number (and maybe there were no women in the fortunate 27). But I guess it does. None of the 27 had a recurrent attack in the subsequent 2 ¾ years after ending uric acid lowering treatment. But those who didn't succeed, because their uric acid stayed above 7, (the other 184) had recurrent attacks. The flare frequency was most correlated with the uric acid level. The higher the level, the more the attacks.
Oh…..and it also confirmed another old truth. Don't take diuretics for high blood pressure if you have
hyperuricaemia and gout.
The UASure is a DIY home uric acid test kit. It measures the level of uric acid in the blood. Click on the link below to visit a company who can ship it world-wide, including the United States and Canada, from Britain.
I say this because it cannot be bought in many countries.
USEFUL DATABASES UPDATED
There are those who think that food and drinks restriction don't really play a part in gout therapy but I am not one of them. Why? Because if a low purine diet can get uric acid down by just over - 2.0 mg/dL, as it did in one study, and if the Zone diet can get it down by up to - 1.7 mg/dL in another, then clearly diet is something you should pay attention to.
And the cost per - 1.0 mg/dL reduction might be cheaper than drugs or endlessly paying for expensive foods like high quality fresh cherries.
Most gout sufferers are with me on this one because everyone thinks there is (or ought to be) a way of dealing with gout by diet alone. And sometimes such treatment works. So I am definitely in the school of you-can-never-know-enough about food, to avoid mistakes with what you consume. Such mistakes are very easy to make if you don't know what’s in your food.
The very best free nutrition database I know has been recently updated. Now version 24. You can use it free online or download it free to use on your own computer. Published by the U.S. Dept. of Agriculture, I estimate it would cost about $40 if you had to buy it.
You can download it free here. Of course it doesn't show purines.
Another nutrition database of the U.S. Dept of Agriculture is its Flavonoid Content of Selected Foods. This was last updated in 2011. So why should this be of interest to gout sufferers? Because during gout attacks more damaging free radicals are released. These are the free radicals that antioxidants scavenge. Some flavonoids in foods are antioxidants, and this database is the best public source of information about the flavonoids in foods. Use it to make your gout diet healthier. This one is in a PDF format. Called the Flavonoid Content of Selected Foods release 3.0 (2011),
you can download it free here.
Thanks for reading... and all the best of health.
799, Infantry Street,
P.S. You may distribute this newsletter freely and free-of-charge, providing any links in it remain unchanged and it remains intact. Partial copying is not allowed.
NB. The contents of this newsletter contain medical information, not medical advice. Please always discuss gout remedies with a doctor, or other health care professional, before implementing any treatment.
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