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Gout Dugout.Issue #062. Latest Vitamin C and gout study | uric acid reduction case study
June 28, 2013
Hello and Welcome to the Summer (June) 2013 edition of the Gout Dugout newsletter. The Gout Dugout is the 10 minutes' read that gives you ideas that may help with your gout. Copy and print if you prefer to read a version on paper.
I'll begin with a new study about Vitamin C and gout.
NEW STUDY SAYS VITAMIN C DOES NOT REALLY LOWER URIC ACID.....BUT IT IS OUTNUMBERED BY THOSE THAT SAY IT DOES
A few weeks ago, the Journal Arthritis & Rheumatism published a new study about Vitamin C and uric acid. It's widely believed in the world of gout treatment that Vitamin C lowers uric acid by a useful amount, and it does it by encouraging its excretion, although one study concluded it could inhibit its production.
But this new study (1) did not have good news about Vitamin C and uric acid. Over 8 weeks a 500 mg daily dose of Vitamin C (taken alone) lowered uric acid by a quite small amount, deemed insignificant, although it had risen in blood plasma. Moreover, when Vitamin C at 500 mg was taken together with allopurinol, it didn't help either, although allopurinol did lower uric acid. And unlike any previous Vitamin C and uric acid study, the patients were gout sufferers, with an average start-line uric acid level of 8.4 mg/dL, which is high. Not surprising since they had gout.
Of course I wondered whether I should rewrite the gout and vitamin C page, and the free Vitamin C for gout pdf that new subscribers to this newsletter receive. But I don't think so. We already know Vitamin C does not always lower uric acid, although it might always do so at very high doses.
For a start, this study only tested fewer than 20 participants on only Vitamin C at 500 mg. Secondly, the lead researcher, a professor in New Zealand, thought there was a case for testing it at a higher dose.
Thirdly, I think the most conclusive evidence for Vitamin C was a meta-analysis (a study of studies) of 13 Vitamin C and uric acid studies between 1990 and 2009. (2) Combined together, the results were based on 556 participants, also at a median dose of 500 mg, this time over a median of 30 days. None suffered from gout but not all were healthy; some were in long term care, and had other ailments. All this data from 13 studies was "married" although the data merging was not perfect because the 13 studies had many different rules. But the meta-analysis found that uric acid fell in 8 studies, rose in 4, and there was no change in 1. When Vitamin C was the only substance taken (9 studies) the uric acid fall was a useful – 0.54 mg/dL.
Fourthly, there was also Robert Atkins' (the Atkins diet) gout protocol as explained in his book Robert Atkins' Vita Nutrient Solution. That began at 5 grams each day. This is important because Atkins must have used this dose on people with gout so he clearly thought it was useful in gout treatment, although Vitamin C was not his only gout protocol nutrient. (Remember all the studies in the meta-analysis were not on gout patients).
Fifthly, there have been more studies about this topic than those covered by the meta-analysis, which stopped at 2 grams a day. These studies – at higher than 2 grams' doses - have also found a positive connection.
So the new study's findings were out of whack with a majority of Vitamin C and uric acid studies. But I was pleased with the interest taken in a natural remedy for gout. Of course you can't be sure Vitamin C at 500 mg (and higher) will lower your uric acid, but that conclusion has been reached before. But we do need more Vitamin C studies on gout patients.
Don't take a high dose of Vitamin C without discussing it with your doc. Just as drugs have side and adverse effects, so might Vitamin C at high doses.
Your opinion Does anyone have anything to say about their personal experience of Vitamin C and uric acid? Has anyone
used a uric acid meter to see whether a Vit C dose lowered uric acid? If it's going to work you would probably know after about 30 days.
Please use a contact form such as this one to let me know
THE DOWNS AND THE UPS OF URIC ACID REDUCTIONSince the last issue of this newsletter in March, there's been one new page loaded on the website that I particularly want to draw your attention to. If you are taking regular blood uric acid measurements, and if you get frustrated by its seeming failure to fall, or if you have a gout attack whilst on medication and think that it has not worked, you may get some consolation and encouragement from reading the case study on this new page.
The page is about how uric acid actually falls – how the numbers change. In this case, it was a very successful uric acid reduction, using allopurinol and a lower purine diet, in a mild case of gout in a 57 years old male. He took the readings himself with his uric acid meter. He kindly sent me the readings, and his diet, then corresponded about some details.
The reduction was 6.3 mg/dL over three months last year. There were also later monthly readings when he switched to controlling his blood uric acid at a lower level.
The uric acid reduction here was not all plain sailing. Rises interrupted falls, periods passed without any falls, there were
spikes up and then spikes down. Reminds me about what actually happens when one is losing weight. One steps on the scales
after a 2 weeks absence thinking there "must have been a fall," and there hasn’t! But two weeks later one is down 4lbs.
A number of useful conclusions can be made from what happened, so if you are interested in his experience – and it was
click here to go to the uric acid reduction page.
By reading this newsletter you show you are more interested in gout than someone who simply swallows allopurinol daily. The
more you know the better you can judge the quality of advice you get. Note this. A study found that at a doctor's practice 61%
of 125 gout patients had NOT had their uric acid checked and only 6 of 125 had it checked once a year. Clearly the targeting
of uric acid was not much of a priority.
Click on the Flamasil ad to go to the Flamasil website
Gout in the big toe might not be as bad news as you think.
Within a few months of entering the world of gout, which for most people happens after that surprising first attack, most sufferers have learnt that the big toe is the usual first attack spot. And most also learn that gout is progressive – untreated and uncontrolled and it will get worse. But here’s something that might soften the blow.
A newly presented study from a Mayo clinic in the U.S. - actually it took 13 years on average in 46 gout patients - says if you get a big toe attack first, which 72% did, there is less risk of a repeated attack, compared to say the knee, elbow or another joint. If true, seems your big toe attacks might not be as bad as you think. But I’m not sure just 46 patients, despite statistical scoring, is sufficient to draw firm conclusions. And if your first attack was in a big toe, don't relax your efforts.
Gout in New Zealand
Some of the most interesting recent research work into natural gout remedies has been done in New Zealand. The latest milk for gout studies, and the latest gout and vitamin C study, discussed above, were both done there. Now I read that a very welcome fish oil for gout study is to be undertaken there too.
Could it be something to do with the fact that Auckland, the city on New Zealand's North Island, is thought to have the highest density of gout sufferers in the world?
Cherries in season
To all gout sufferers, whatever your stage..... note that cherries are now in season in North America and Europe. Buy them to freeze, juice, cook, eat raw. Sweet or sour, both types have been shown to lower uric acid and fight inflammation. If you are new to gout and are reading about cherries for the first time,
visit this page for a starter about cherries and gout.
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.
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.
Go to the www.best-gout-remedies.com home page by clicking on the link below.
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!
Thanks for reading, and all the best of health.
(1) Lisa K Stamp, John L O'Donnell, Christopher Frampton, Jill Drake, Mei Zhang, Peter T Chapman. Clinically insignificant effect of supplemental vitamin C on serum urate in patients with gout; a pilot randomised controlled trial. Arthritis & Rheumatism, 2013; DOI: 10.1002/art.37925. Note urate is uric acid.
(2) Stephen P. Juraschek, BA, Edgar R. Miller, III, MD, PhD, and Allan C. Gelber, MD, MPH, PhD Effect of Oral Vitamin C Supplementation on Serum Uric Acid: A Meta-analysis of Randomized Controlled Trials. Arthritis Care & Research. 2011 September; 63(9): 1295–1306. doi: 10.1002/acr.20519
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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