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Gout Dugout.Issue #060.2012-good year for natural gout remedies | Christmas gout gifts | febuxostat
December 21, 2012

Hello and Welcome to the December 2012 issue of the Gout Dugout newsletter. A very Merry Christmas to all readers. The Gout Dugout is 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.

This is the 60th issue of the Gout Dugout, at the end of 5 years. As mentioned last month, in 2013 the frequency will go from monthly to quarterly because I need to release time for website upgrading. The frequency next year will be March, June, September and December. So expect the next in your Inbox in March and to compensate I'll try to increase the content from its current 1,500 – 2,000 words per issue. I hope you continue reading.


Early in the year we learnt of the new New Zealand study about milk for gout, covered in the February 2012 issue, and the prospect in the not too distant future there will be the first ever custom -designed natural gout remedy product – a milk drink probably made from skimmed milk powder plus GMP (a derivative of a milk protein), and a milk fat extract. You can also read about this on the milk for gout page

There were three cherry trials I covered in the September 2012 issue which demonstrated reduced inflammation and pain (and in some lucky cases no pain) from daily consumption of cherry juice concentrate. And this year we also learnt of the second alkaline diet study which showed again that healthy young women - who were not gout sufferers - increased their uric acid excretion when they ate a more alkaline diet.

Low fat milk, cherries, and an alkaline diet, they all did something in scientific studies to lower uric acid, or inflammation, or raise uric acid excretion.

The research work on all these is continuing. But what we also badly need are studies on baking soda (bicarbonate of soda), apple cider vinegar, strawberries, celery and fish oil for gout. The questions that need to be answered are precisely when and why, and among which types of gout patients, can these substances be useful. A study of orange juice (OJ) among gout folk would also be a good idea. The OJ study that said it does lower uric acid wasn’t on gout patients. However, it's probably the vitamin C in it that lowers uric acid, and one study of Vitamin C in gouty folk was positive.

The cherries study, by Professors Naomi and Michael Schlesinger, (which reported on three trials in all), came up with something else that's significant. Some participants actually lowered inflammation and ended pain at a lowered uric acid level that was much higher than 6.0 mg/dL. Whatever you read in the world of gout literature, you will be told that uric acid must be reduced to 6.0 mg/dL (in men, bit lower in women). Below this level it's said most gout people can start to expect benefits. And to control gout you'll need to stay below it.

But maybe not. At least if you are taking two tablespoons of cherry juice concentrate every day. Because in this study some trialists became flare free at an average uric acid level of 7.8 mg/dL. (This is an average, not everyone).

But, as they say, I think it's best to keep on going down to 6.0 and below. YOU are NOT those trialists; they did all do it by any means; they were small trials. If you're doing the right things in your gout treatment, you ought to be able to keep to below 6.0 and stay there. Very few gout sufferers could achieve permanent success at around 7.8 mg/dL.

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The very last event you want over the Christmas period is a gout flare. Whether there are more at Christmas, or after, I don't know but it's likely. Many new gout sufferers have still much to learn. For example they need to acquire a thorough knowledge of purines in foods.

I covered the subject of avoiding gout causing foods and drinks (those that are high purine) extensively in past December issues so I won't re-write what I have said. The most comprehensive was in December 2008, also December 2010, and December 2011.Just click on the links below. These tell you what to avoid, and typical Christmas foods you can eat, but you have to bring discipline to the table.

December 2008

December 2010

December 2011


Best Christmas present for gout sufferers? If you're asked what you want by anyone who intends to give you a present, or fancy buying one for yourself, what's the best gout gift? I’d say a uric acid meter by far. Get to learn how your uric acid level really behaves, and how it responds to your diet, exercise, medications, special foods etc. And it saves visits to doctors to check your level. (But occasionally you should to confirm the readings the meter gives you).

Another clever purchase is a bulk purchase of cherry juice concentrate. It pays to think big. You save time by ordering once a year instead of monthly; and you save money in the long run. Lots of cherries go into producing it. In the cherries study mentioned above the researchers said 1 tablespoon contained the equivalent of 45-60 cherries, which is a lot.

The best deals available are in the U.S. It might even be worth while having it shipped from there. Do your homework – add shipping costs, maybe some duty (not so likely, or not much, the world is closer to totally free trade than it has ever been, apart from a few very protectionist places). Some countries do have import regulations for these products. Ask the supplier.

And it really does not take long to get to most countries. I guess you are not in Tristan Da Cunha, one of the world's most remote islands. You know how fast a week goes. You might easily wait a week before you can get to the shop where you normally buy, and pay more.

Here are three U.S. producers/online retailers, all in the cherries state of Michigan.

Traverse Bay Farms. Free shipping in the U.S. Also sell The Gout Haters' cookbooks. You can email them about any import regulations in your country.

Brownswood Acre foods This is the company that produced the cherry juice concentrate used in the cherries study mentioned above. If you live in the U.S. there's a store locator, on the site. Click on the link to see the countries they deliver to. You can pay with Paypal as well as cards. Orders should arrive in up to a week. That's really not much.

Leelanau Fruit Co. Keen prices but the site is less elaborate than the two above.

Travers Bay Farms

Brownswood Acre foods

Leelanau Fruit Co.

Here below are a few links I found to buy cherry juice concentrate in six other English speaking countries. I selected them as soon as found. No homework done on their sites.



Canada (This is a Canadian price comparison site)


New Zealand

South Africa

Apologies if your country isn't here. Search BUY (NAME OF COUNTRY) cherry juice concentrate.

Click on the Flamasil ad to go to the Flamasil website

Alternative Health Research/Flamasil™


If you live in a country where febuxostat is not available (and it's still not in most), the febuxostat page on the website has been updated and explains which countries are going to see it launched in 2013 and after (mainly after). But at least you'll know it is scheduled.

Scroll down to Febuxostat News on this page.


The American College of Rheumatology (ACR) published its new gout management guidelines in October. About 33 big hitters from the world of academic gout research contributed to the 30 pages plus tome in two parts that focused mainly (not entirely) on drug medications. Little was said about natural gout remedies, little was said about natural remedy pain relief, but ice is recommended as an adjunct (not the main one) therapy for acute gout. Various foods and herbs including strawberries and cherries were mentioned but it was just said that they were not recommended for acute gout. Most gout sufferers and I would agree with that, which is O.K. as far as it goes.

Any roles for them as adjunct therapies along with medications was not described. And nothing was said about baking soda (bicarbonate of soda) or apple cider vinegar, or pH theory (including alkaline diets). Alkalies once dominated gout treatment in the 19th century days of Sir Alfred Garrod (he discovered the true cause of gout) and earlier, and about which he was often positive. Water drinking and urine alkalization with potassium citrate were recommended.

Low fat/ non fat dairy products were recommended, but I don’t think research has been done on regular, full fat (whole, pure, 100%) milk.

The dietary advice would be well known to those who have read up about gout, but one ACR recommendation did strike me as possibly new. Not sure. Avoid high fructose corn syrup in drinks sweetened with it, and in foods. If you haven't read that before you have now.

The guidelines can be downloaded here, free, courtesy of the Journal Arthritis Care & Research and the American College of Rheumatology.

Vitamin C was not mentioned in the ACR guidelines. But recent (November) gout guidelines from the British Society for Rheumatology (BSR) and the Primary Care Rheumatology Society in Britain, recommended Vitamin C at 500 mg.

Download the BSR guidelines here courtesy of these two organisations and the U.K.'s University of Keele.

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 to the United States and Canada, from Britain.


Last month I wrote about Uloric/Adenuric (febuxostat) and liver tests saying that new Uloric prescription information (for the U.S.), now requires gout patients who are on an ongoing course of febuxostat, to report symptoms that may mean liver injury before they can get a liver test.

In the EU (European Union), febuxostat is called Adenuric. I visited the European Medicine Agency's website and found that Adenuric's product information was updated in November. I don’t know if the following statement is an update, but it reads "Liver function test is recommended prior to the initiation of therapy, (as in the U.S.), and periodically thereafter based on clinical judgement." Because whether a test is required is based on clinical judgement, your doctor should have this in mind and not wait for you to report symptoms that may mean liver abnormalities.

Symptoms that may mean liver injury include: fatigue, anorexia, right side upper abdominal discomfort, dark urine, jaundice.

Take care Of course this advice is the sort of thing that comes from "above." I doubt every doctor that deals with gout has followed this. So if you are taking febuxostat make sure you report symptoms to your doctor and be aware of the need for liver tests. What has been said about febuxostat and liver abnormalities could apply to about 1 in 20 of newsletter readers who are taking febuxostat.

Febuxostat can be taken by people with mild/moderate liver disease. But the U.S. FDA reports fatal and non fatal liver failure in patients taking uloric although the reports do not have enough information to establish the likely cause. So testing could be vital.

Febuxostat leaflet information is on the last few pages of this febuxostat product information at the European Medicines Agency website - click the Product Information tab.

Febuxostat information at the U.S. FDA. Enter

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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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. There are currently around 200 pages, including all the back issues of this newsletter. It works. Use it!

That's it for this month. Have a great Christmas. And Happy New Year. "See you" in March.

Thanks for reading, and all the best of health.

John Mepham BA.(Econ).

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

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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