Uric acid reduction – it's the trend that's your friend




This page about uric acid reduction – how the uric acid level changes  –  was last reviewed or updated on 30 April 2013.

You can use a uric acid meter or you can visit your doctor regularly for a uric acid test. (And if you use a meter see a doctor occasionally for a check on the results). However you do it, monitoring your uric acid level is a key to any gout treatment. Uric acid reduction is the name of the game. You must know your uric acid level. Most likely you won’t make progress with gout until serum (blood) uric acid has fallen to 6.0 mg/dL (0.357 mmol/L/357 µmol/L) or below. But too many gout patients ignore their uric acid level. They fly blind amidst a mountain range. And, it has to be said, some doctors don’t measure uric acid levels readily. You have to ask.

How does the amount of blood uric acid change as it falls? Is it a smooth parachute jump down to the ground, or a bumpy ride? Some medications alter uric acid levels considerably within 24 hours. So much so, that this in itself can cause a gout attack as the process encourages crystal formation. (It’s why you should NOT take uric acid lowering meds during a gout attack).

THE CASE STUDY

My focus in this article is mainly not how lower uric acid was achieved, but how serum (blood) uric acid fell. Note that the uric acid rises - seen in the number series below, and during the falling trend - may have been caused by dietary errors.

Uric acid measurements here are shown in the mg/dL format. To convert to µmol/L multiply the mg/dL number by 59.48. Thus for example 6.0 mg/dL x 59.48 = 357 µmol/L (rounded).

To convert µmol/L to mg/dL divide the µmol/L number by 59.48. Thus 357 divided by 59.48 = 6.0 mg/dL.

Consider the real uric acid readings below. It is a case of successful uric acid reduction. They show how serum (blood) uric acid behaves when subject to a diet reduced in purines, and the gout medicine Allopurinol, taken every evening (300 mg tablet). The subject is a 57 years old (2012) male with a mild case of gout. His start line uric acid was 11.7 mg/dL which is quite high.

He monitored his uric acid reduction with a uric acid meter he purchased. And he used his mobile phone to set up a daily reminder alarm for his Allopurinol. So the medicine was only very occasionally missed.

Dietary measures For his diet he decided to cut out beer, cut down on red meat and on fish, avoid green (runner) and broad (fava) beans. He thinks beans raise his uric acid. He ate more white meat. Wine was not given up but was limited to 2-3 bottles a week (about 2-3 glasses daily). He drank 2 litres (liters) (3.5 U.K. pints : 4.23 U.S. pints) of water daily, which is more or less the recommended amount.

This is not a difficult diet. It’s a relatively simple lower purine diet anyone could follow to reduce uric acid.

Now cast your eyes over how his uric acid reduction actually occurred. The overall fall in just three months was excellent: – 6.3 mg/dL. Most gout sufferers would be delighted with this.

3 May 2012 Before lunch 11.7 mg/dL; 4 May 2012 After lunch 10.7 mg/dL; 5 May 2012 After lunch 10.7 mg/dL; (note: not a duplicate reading of May 4th); 9 May 2012 After lunch 9.4 mg/dL;  12 May 2012 After lunch 9.8 mg/dL;  15 May 2012 After lunch 10.2 mg/dL; 23 May 2012 Before dinner 7.1 mg/dL;  3 June 2012 Before lunch 7.2 mg/dL;  4 June 2012 After dinner 7.9 mg/dL;  23 June 2012 Before lunch 9.2 mg/dL; 20 July 2012 After dinner 6.9 mg/dL; 3 August 2012 Before dinner 5.4 mg/dL.

In three months his blood (serum)  uric acid reduction went from 11.7 mg/dL down to 5.4 mg/dL.  A superb uric acid fall of 6.3 mg/dL. Or putting it another way, a 54% fall from the start line number.

Some conclusions – these might happen to you

(1)   Don’t get discouraged if uric acid rises after a fall. In this series of numbers, in one period it rose 0.8 mg/dL but in a subsequent eight days, plummeted 3.1 mg/dL. So keep ploughing on. Remember the old stock market adage - the trend is your friend.

(2)   Then it rose again 2.1 mg/dL. (May 23rd – June 23rd).  But this rise was a precursor to a subsequent large fall. Again the biggest fall came after a rise. In this case, down 2.3 mg/dL  to 6.9 mg/dL.

(3)   It could fall 1.0 mg/dL in just one day. And then not fall at all on the following day.

(4)   And it could rise 0.7 mg/dL in one day. Sudden rises in uric acid can of course trigger a gout attack. So can sudden reductions.

(5)   A few weeks could pass without uric acid falling.

(6)   The changes in uric acid did not trigger a gout attack. But they can.

And a warning....

If uric acid rises again, during a falling trend, it is possible you are being warned. Are you watching your purines? Taking your meds? With our article subject rising uric acid did not lead to gout symptoms. But it could, and worse, an attack.

After the uric acid reduction to below 6.0mg/dL

Since August 2012, our subject has taken readings monthly or so. You can see that maintaining uric acid below 6.0 mg/dL is not necessarily straightforward. It still requires commitment. Rises above it still occur. This happens in clinical studies too, when study participants are organised (organized) and monitored by medical professionals.

The results were as follows

7 August 2012 After dinner 5.7 mg/dL; 15 September 2012 After breakfast 7.9 mg/dL; 10 November 2012 Before lunch 5.6 mg/dL; 23 December 2012 Before lunch 7.2 mg/dL; 15 January 2013 Before lunch 7.3 mg/dL; 14 March 2013 Before lunch 6.5 mg/d; 25 April 2013 After breakfast 6.8 mg/dL.

Here, between August 7th and September 15th there was a jump up of 2.2 mg/dL. Again from November 10th to December 23rd – it was up by 1.6 mg/dL. But the diet and the medication still delivered reductions.

Note Our subject took his uric acid level just before Christmas 2012. In his case Christmas feasting didn’t do any harm.

TIP  Good days to take uric acid readings.  Before and after Christmas; on January 1st, if more rigorous gout treatment is a New Year’s resolution; before going on holiday (vacation) and on return – did you slip up whilst on holiday (vacation)?; during cold weather to check the weather is not causing a rise.


Related links

How to buy a uric acid meter to measure your blood uric acid level.

Visit our large list of purines in foods and drinks which categorises them into high, medium and low purine.

Read about a low purine gout diet and uric acid meters




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