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Gout Dugout.Issue #054 uric acid excretion | new purines research | Krystexxa news
June 29, 2012

Hello and Welcome to the June 2012 issue of the Gout Dugout newsletter. It's the ten minutes' read that gives you ideas that may help you with your gout. If you have difficulty reading it from the screen, by all means copy and print it.

Tip Use the website'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, and there are currently nearly 200 pages, including the back issues of this newsletter.


Last month

we looked at a Japanese study of young women who significantly increased their uric acid excretion by eating an alkaline diet. (1) Raising uric acid excretion in urine (remember, a little also goes out in sweat and about 30% is destroyed by bacteria in the intestines) is not measurably exactly the same thing as reducing uric acid in the blood. This study did not measure, or did not publish measurements, of blood (serum or plasma) uric acid. So we don't know whether blood uric acid fell or not, at the same time that there was a big rise in the amount excreted. As you know, falling blood uric acid is the main objective of all gout treatment, however it is achieved.

I wondered how the ingredients in the alkaline and acid diets used measured up by other dietary criteria, so I got out a blank spreadsheet and entered all the diets' data – the foods and quantities eaten, plus calories, carbohydrates and fructose per amount eaten, with nutrients data taken from the USDA National Nutrient database. I learnt that both diets contained about 2,000 calories per day. Not likely to be enough to put on weight in young women, nor lose it in an attempt to lower uric acid through weight loss. Indeed their measured body weight varied only 1% so loss of weight could not have affected uric acid levels.

The carbohydrate amount of these diets was probably the amount most people eat daily, although I would put on weight at this amount. It was not at a low or even restricted carb diet level (much higher than these). You would not lose weight, and maybe lower uric acid, for low carb diet reasons. The alkaline diet was about 276 carb grams a day; the acid diet was about 266 carb grams a day. Both these carb numbers are before net carbs and any data that couldn't be found. Net carbs (the real effective number, after fibre/fiber) would be about 5% less than these. Unfound data would not change the picture in any important way.

I also learnt that the fructose content was about 19 grams/day, alkaline diet, and about 5 grams/day, acid diet. These are nicely below the 25 fructose grams daily it has been thought is safe to eat without fructose eventually having an effect on uric acid levels. And if 21 grams of honey had not been eaten daily on the alkaline diet, the fructose amount would have been much less, about 11 grams/day.

The diets' purines had also been calculated by the researchers. On the alkaline diet, they ate just 306 mg a day, and on the acid diet 533 mg day.

This study took place in Japan. The prepared recipes were Japanese. However, most of the ingredients are common everywhere. So dishes from many countries could be made. Plus you could add/delete your own ingredients.

If anyone wants the spreadsheet I made to do these calculations, just email me - no charge - at:

The ingredients are in the Appendix to the study, which is a free download, courtesy of Nutrition Journal.

A follow up study to this study has been published very recently. Uric acid measurements were done and I'll look at this next month.

A better way to measure? Here is an interesting approach in this study you might like to consider. The ingredients and their quantities for a day were chosen first. Then the recipes were made. You probably think the other way round, I know I do – recipes first, then use the ingredients required with some adjustments. Their method is stricter and more disciplined.


If you suffer kidney disease to any degree, even badly, and gout, here is some good news. It's good news too if you have gout and think you might one day. If I remember correctly about 20% of gout patients will at some stage, suffer some degree and form of kidney disease. And news it is, because this is new information about Krystexxa and gout. This information was previously unknown in the wider gout world.

Kidney disease reduces the options available to doctors to treat gout with drug medications, but new research presented at the EULAR (European League Against Rheumatism) 2012 conference demonstrated that Krystexxa can be given to patients at any stage of kidney disease. Krystexxa is the biologic (infused) med that gets uric acid down considerably in many of its users.

However, Krystexxa's "side effects" are considerable. Remind yourself of them if you wish at the Krystexxa website.

The publication of this has been timed, I think, to boost the chances of Krystexxa getting EU approval. Currently Krystexxa (pegloticase) is only available in the United States. A decision about Krystexxa approval in the EU is due before the end of this year.


There are gout photos such as this one showing gout in a couple of the smaller toes on the website that were supplied by its

friends. I am appealing for more. Do you have any photos of your gout? Any part of the body - elbows, arms, hands, ankles, feet, wrists, fingers, toes and big toes, knees, ears wherever. I know many like to keep their gout confidential so if you don't wish to be identified, don't send me faces – not likely anyway since gout of the ear isn't common. Or, on request, I could always crop out, or blurr them.

Please email me at

Alternative Health Research/Flamasil™


New gout and purines research published online at the end of last month by the Annals of the Rheumatic Diseases journal, (2) confirmed again one of the oldest pieces of gout treatment advice. Monitor and if necessary cut down on your purines if you want to avoid attacks, which of course you do. It was a large study of gout patients, and their gout attacks, whose diets were monitored and analysed (analyzed) for a year.

Here is what was re-affirmed about purines and gout attacks:

• Vegetables and fruit are not as big a risk as meat and fish because they contain less purines. Of course you knew that already.

• If you eat too many purine rich foods you can trigger a gout attack in days. From the study's structure it seems two days of eating purine rich foods can trigger an attack, although we know from testimonials that people think one meal, or a night's binge drinking can do it. The conversion of purines to uric acid is a matter of hours. But you already know an attack can be triggered by a "rush" of purines.

• The risk of an attack at the highest level of purines intake was nearly five times greater than at the lowest level. i.e. simply put, eating more purines means a higher attack risk.

However, among factors not included in the analysis, and therefore not included in the "nearly five times greater" conclusion were other measures people take to prevent gout attacks such as water drinking, relevant vitamin intake, exercise, other dietary measures, and drugs other than allopurinol, colchicine, and NSAIDs. Also not included in the study: uric acid levels, the climate, absence of stress, wearing comfortable shoes, pH levels.

And of course you are not a median or an average.

One important finding in the study I think was that gout patients who were allopurinol users had a 5+ times increased risk if they were in the highest in-takers of purines group, (highest purine in-takers compared to lowest). So watch your purines! A low purine diet is more important that you might have realised (realized). You probably should not imagine you can binge on purines if you take allopurinol, and get away with it for very long.

You would have to buy the study but you can read the study's abstract (containing the main conclusions), free, here courtesy of the Annals of the Rheumatic Diseases Journal at the British Medical Journal (BMJ) website. Or, more details about it will be on the website soon, and its URL will be in next month's newsletter.

I had a three intense "reads" of this study and I suspect much more useful gout and purines data still has to be reported from it. When it happens, you'll read about it in this newsletter.

Go to's purines page.

Check food and some drinks purines amount at this purines table on the Internet.

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.

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

Go to the home page by clicking on the link below. Use its search box, to find gout information you are looking for.


Apart from another look at the acid/alkaline diet for hyperuricemia study, I'll return to the old question about fructose and gout. Does fructose cause gout and if so, how much fructose should you eat and drink? There's been an important new study about fructose and uric acid published recently. I had planned it for this issue, but now it's for the next one.

Thanks for reading and all the best of health.

John Mepham BA.(Econ).

799, Infantry Street,
Palar, Armor Vllage,
Makati City 1201,

(1) Aya Kanbara, Masayuki Hakoda, Issei Seyama. Urine alkalization facilitates uric acid excretion Nutrition Journal 2010. 9:45

(2) Yuqing Zhang, Clara Chen, Hyon Choi, Christine Chaisson, David Hunter, Jingbo Niu, Tuhina Neogi. Purine-rich foods intake and recurrent gout attacks Annals of the Rheumatic Diseases. Published online 30 May 2012 .

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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