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Gout Dugout.Issue #027.Uric acid clobbered in a recent trial; women and gout.
March 04, 2010
Welcome to the March 2010 issue of the Gout Dugout newsletter. A ten minute read that could give you a couple, or more, useful gout ideas.
GOUT IN WOMEN - A NEW FINDING
Kidney disease, the metabolic syndrome and hospital drugs for transplant patients were not around in the 18th century when the popular, if that's the word, cause of gout was overindulgence in food and drink. Port wine got, and still sometimes gets, the blame but wine is well behind beer and spirits in purines. And in those days it was men, only men, who ate and drank themselves into gouty oblivion, although the famous 18th century sufferer Benjamin Franklin gave gout a female persona when writing his "Dialogue with Gout." He had an imagined conversation with Madam Gout.
These unfortunate men were all supposed to be wealthy, or maybe ex-wealthy if their gout meant they couldn't work much. The author of Robinson Crusoe, Daniel Defoe - himself a gout sufferer - wrote Crusoe's father into an early chapter of the Robinson Crusoe story as both a gout sufferer AND a poor man. So at least one 18th century writer depicted it correctly. Just about everyone could get gout, but only the wealthy and famous had starring roles in the disease, and gout in women was almost never described.
One exception was Britain's Queen Anne. If she had been able to munch on Royal Anne cherries every day she may not have died at only 49, a death that at the time was said to be related to her gout.
In that gout conscious century - gout was the diabetes, cancer and heart disease of the time - when it was, above all others, the disease which conferred status (as one suspects it still does, along sadly with mirth). And everyone thought it was over indulgence which caused it, nothing else.
But it isn't the only cause now and perhaps this is the reason why gout in women seems to be growing. However, a photo of a woman with gout is very rare.
When I started to write this monthly missive in January 2008 I thought virtually all subscribers would be men. After a few months I noticed it wasn't so. The subscriber list included a large percentage of women. So they read this to inform husbands, fathers, fiances, brothers and boyfriends I thought. But maybe a lot of the ladies are reading it for themselves.
It used to be thought that only post menopause women got gout. The hormone estrogen is reckoned to make women better excretors of uric acid than men.
The latest issue of the medical research journal The Annals of the Rheumatic Diseases carries a report from researchers at the University of British Columbia, Canada, who regularly churn out interesting gout reports based on statistical analysis of a huge medical database.
Among elderly gout sufferers in British Columbia, men and women, who were more likely to have a heart attack in this study - the men or the women? I won't pore over all the data, just give you the conclusion, which was a bit of a bombshell. It's been known for some time that gout in men increases the risk of a heart attack. But elderly women? Now we know that the risk of a heart attack in gouty and elderly women (65 years and above) is much greater than in gouty and elderly men.
So lady readers of the Gout Dugout, with all your info on gout -start talking about gout to your fellow fair sex. You might just warn them in time.
A NEW GOUT DRUG CLOBBERS URIC ACID LEVELS
RDEA594 (this new gout drug still has its cypher name) is one of 6 or 7 new gout drugs currently in various stages of development. It's a uricosuric (urosuric) medication, meaning that like probenecid it improves uric acid excretion. Its developers recently announced some trial results where it's been tested in combination with Allopurinol and Febuxostat (Uloric;Adenuric) which both work the other way - to reduce uric acid production.
RDEA594 is a new gout drug that can get uric acid levels down significantly on its own, but what happens when it's taken with Allopurinol and Febuxostat? Is there a double whammy?
When taken together with Febuxostat the uric acid reductions were better than when taken with Allopurinol. No surprise there.
What did surprise and interest me was that at the higher RDEA594 dosage (400 mg) and 40 mg of Febuxostat (Febuxostat can also be taken solo at 80 mg) when taken by healthy participants (not gout sufferers) average serum uric acid (urate) levels fell to just 1.2 mg/dL(0.72 mmol/L). The lowest uric acid level I've heard of up to now is 2.0 mg/dL, so this is low.
The RDEA 594/Febuxostat trial was an early one, and the participants were not gout sufferers. So we shall have to see what happens when they test this combination dosage on gout patients, which the developers will almost certainly do. What effect would a 1.2 mg/dL serum uric acid level have on attack frequency, tophi (especially), length of attack and attack intensity? We might find out when it gets to its phase 3 trials, or perhaps earlier. Watch this space.
Tested solo among people with mild/moderate kidney problems RDEA594 has also produced good uric acid reductions.
High uric acid levels are increasingly coming into focus as an
independent risk factor for heart disease and high blood pressure. Maybe one of the new gout drugs like RDEA594, that can really get uric acid levels down, down, down it seems, will make it as a medication for these conditions too.
I said last month I'd do a self test to see if Pantothenic Acid (Vitamin B5) can reduce my uric acid level over 3 months. The test has begun and I hope to announce the results in June.
FREE pH FOODS CHART
Paying attention to body alkalinity for treating gout is a big, under researched subject, although it has been a known gout treatment since at least the middle of the 19th century. I'll write more about it this year.
If you take the pH foods route to help lower uric acid levels, you have to know which foods have an alkaline effect and which have an acidic effect. The free pH foods chart and alkalizing recipes at www.phionbalance.com is worth using.Click on the following link and when the home page arrives, the download link for the chart is on the right. pHionbalance products
This site sells pH boosting products such as alkalizing water and minerals, antioxidant fruit supplements and pH test strips. All can play a role in lowering uric acid levels or improving body function, which you'll know if you've read BGR.com's pages on these topics. Become a member - it's free - and there are much better prices.
25% reduction Currently phionbalance have a generous offer - from now until 11.59pm on March 15th (Pacific Standard Time). They have a 25% off sitewide products promotion. But you have to be on their email list to know the coupon code, so you'll have to sign up first I think. There is a very small amount of small print stuff.
John Mepham BA (Hons)
165,Union Street, Maidstone, Kent, United Kingdom ME14 1EY
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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