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Gout Dugout.Issue #068. new purines tables | night time gout attacks | a gout free Christmas
December 21, 2014

Hello and Welcome to the Winter (December) 2014, edition of the Gout Dugout newsletter. The Gout Dugout is the 10 minutes' read from that gives you useful ideas that may help with your gout. Copy and print if you prefer to read a version on paper. If you are extra busy now because it's Christmas time, you could bookmark it for later.

A Merry Christmas and a gout free 2015!


Regular readers of this newsletter during the past years know that from time to time I have bemoaned the relative lack of good purines in foods numbers. In gout, we have one of the world’s fastest growing medical conditions and one where the average age of sufferers is falling. A recent news story of the top 10 Google What IS…..? questions in the American state of Arizona in 2014 had What IS Gout? at No.9.

And that’s not just the top 10 health questions but all questions. Purines in foods are at the heart of the dietary knowledge sufferers must employ if they are to control their gout.

And yet no serious government medical research funds – at least not in the English speaking world – have been allocated to help gout sufferers learn about the amount of purines in regularly eaten foods and especially about the four purines sub set viz adenine, guanine, hypoxanthine and xanthine. Neither how much uric acid each of these four produces. Nor how much of each purine is found in the foods and drinks we consume.

We have soldiered on with rather skimpy material, and up to a point, we still do.

So it was with pleasure that a few weeks ago I discovered a new purines list in English. It was in fact a study (1) compiled by a research team from two Japanese universities, who were funded by The Gout Foundation of Japan. And I am glad to say this is not one of those hugely expensive medical science studies, but has been made available free of charge.

So to them, many thanks. Here's your "gout Christmas present," courtesy of the Biological and Pharmaceutical Bulletin of the Pharmaceutical Society of Japan. You can download it free here..

When you arrive at this page, click on the blue tab (for html version) or the red tab (for the pdf version). Being a Japanese study there is a orientation towards Japanese foods but nevertheless there is a useful number of Western foods listed, in fact most listed are both Western and Asian.

More about this study in the next issue.


Gout attacks are more than twice as likely at night.

An old gout belief got closer to scientific confirmation recently when a study on the timing of gout attacks was published (2). It has been widely thought for a long time that you are more likely to get a gout attack during the early morning and at night (midnight to 8am), than during the day (8am to 4pm). This timing makes a gout attack even more unpleasant.

So why is gout worse at night ? Two proposed reasons are that the body is colder at night, and less hydrated. Another is that it is more acidic at night.

Between 4pm and midnight there would be a slightly greater chance than between 8am and 4pm, but again much less than at night.

The study examined the timing of over 1,400 gout attacks involving 724 gout sufferers over one year.

The results were irrespective of well known gout attack triggers such as pre-attack alcohol use, and the use of diuretics. And irrespective of factors such as obesity, and age and sex. Even irrespective of use of meds like allopurinol, colchicine and nsaids.

Seems the old belief, like so many in gout, is true.


I have nothing new to say this year about getting though a gastronomic Christmas unscathed. But if you're looking for tips and techniques, have a look at:

December 2008 Find out why you might want to be careful of mince pies and cranberry sauce.

December 2010 Say boo to a goose.

December 2011 This edition includes a write up about a Christmas low purine meal.

And the December 2011 issue has a good list of foods to avoid at Christmas. Keep up the water drinking if you are used to it !

You can access newsletter back issues here

This is the website's page about gout triggers.


Best fish for gout is proving to be a popular new page. It asks which are the best fish for gout, and it tries to answer the question as accurately as possible by comparing the amount of purines in fish (as measured by the amount of uric acid their purines would produce), with the amount of their omega-3 fatty acid content. Since omega -3 is good for gout, and purines are bad, the more omega -3 per purine in a fish, the better it is.

Although of course, high omega -3 fish tend to be high purine too so this is only true if you only eat high purine fish moderately, say about twice a week.

Also there isn't enough information on so many fish. So it's a rough guide. But to see the fish ranked in tables, best down to bottom… click to this page.

Other new pages.....

Uricase Peg-20 is a page about uricase, which is the heart of the two current gout biologics, and a lesser known biologic under development, uricase peg-20, for which there are huge plans. They might turn it into the most successful gout drug of all one day. Visit this page

Olives for gout Olive leaves are probably somewhat better for gout than olives. Read why here.


Astra Zeneca PLC of Great Britain announced that Lesinurad will be submitted for US and EU approval by the end of this year, that is anytime now. (Or I'd say early next year is more likely). Lesinurad lowers uric acid by stifling its return to blood by acting on a transporter in the kidneys.

It is proposed that it is used at a dose of 200 mg together with a gout med that works in a different way by inhibiting uric acid production, that is allopurinol. (It has also been trialed with febuxostat which also inhibits xantine oxidase and hence uric acid production).

Two new gout drugs are due to begin Phase 2 trials. These are the trials before the round of Phase 3 trials. Phase 3 preceeds an application for medical authority approval. I haven't mentioned the first of these here before in the newsletter.

TWi Biotechnology of Taipei, Taiwan, will trial its AC-201 controlled release (CR) tablet, which is designed to inhibit the creation and action of the important intermediary of the inflammation response to gout crystals, namely the cytokine Interleukin-1B (IL -1 Beta).

And Revive Therapeutics Ltd in Ontario, Canada says that the U.S. FDA has accepted its application to begin a Phase 2 clinical trial for REV-002 (Bucillamine), which it plans to do.

If you are not a subscriber to the Gout Dugout, this free gout newsletter, you can sign up at this page - click on the link below.

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2015 marks the eighth year of the Gout Dugout - the first issue was in January 2008. Next year the publication schedule will be the same as this – March, June , September and December, towards the end of these months. Look out for it in your Inbox!


Use's search box, located towards the bottom of the Home Page, to find site references to any word you enter into it. It is a good way to find out where and what the site has to say about any gout topic. For example, want to know more about Rasburicase? Type that in the site search box.

There are currently around 225 pages, including all the back issues of this newsletter. It works. Use it!

Thanks for reading, all the best of health.

John Mepham BA (Econ)
Makati City,

(1) Total Purine and Purine Base Content of Common Foodstuffs for Facilitating Nutritional Therapy for Gout and Hyperuricemia Kiyoko Kaneko, Yasuo Aoyagi, Tomoko Fukuuchi, Katsunori Inazawa, Noriko Yamaoka Laboratory of Biomedical and Analytical Sciences, Faculty of Pharma Sciences, Teikyo University, Tokyo and the Department of Health and Nutrition, Kagawa Nutrition University, Saitama. Biological and Pharmaceutical Bulletin Vol. 37 (2014) No. 5 p. 709-721

(2) Nocturnal risk of gout attacks. Choi H.K, Niu J, Neogi T, Chen C, Chaisson C, Hunter D, Zhang Y. Arthritis and Rheumatology. 2014 Dec 11. doi: 10.1002/art.38917. [Epub ahead of print]

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