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The Gout Dugout Newsletter, Issue #008. A new gout drug, the Atkins diet for gout, gout attacks
August 02, 2008

Welcome to the August 2008 Gout-Dugout


The European League Against Rheumatism (EULAR) held its annual meeting recently in Paris.This is a big conference where presenting study papers and trial results are large items on the agenda.

There were a number of gout presentations, but I think the most interesting was one of a new anti gout compound that shows much promise. Currently it's named RDEA808/RDEA594, although this will change to a generic name if it continues to make progress. And it will be developed as RDEA594, a metabolite of RDEA806.

The curiosity about this compound is that began its trial life as an anti HIV compound, which it still is. But in the course of its trials its developers learnt that it's also a potent reductor of uric acid.

How it does it work? The developers are not yet completely sure but they think it encourages the excretion of uric acid. i.e. as with probenecid, sulfinpyrazone, benzbromarone, and pegloticase. It does not work, they think, like allopurinol or febuxostat.

The best figures presented at the EULAR meeting for RDEA 806 were a mean (average) serum (blood) uric acid change from a baseline (i.e. starting level) of greater than 7.0 mg/dL of about 45% in ten days to two weeks. i.e. an average of UA 7.23 mg/dL down to 3.96 mg/dL. Reductions were largest in two patients who had higher initial starting levels of uric acid which is nice to learn.

Rapid falls in uric acid levels often bring on gout attacks. So far the developing company has not reported this effect, but these are early days.

These figures are encouraging but it remains to be seen whether results would be as good if UA levels in a large group of patients, who started at much higher UA levels, were tested. That is, beginning at serum uric acid of 9.0 or 10.0 mg/dL or greater.

Don't get excited. This new gout drug, is still years away from any possibility of approval, but clearly it's worth watching. There will be more news about its progress later in 2008. Phase 1 trials for RDEA 594 begin in the second half of 2008.


One omission at present on is that there is nothing about whether the Atkins diet is a helpful diet for gout. A lot of people wonder about this. Not surprising because I have read the Atkins diet outsells all other diet books combined by 4 to 1.

Actually I have been researching the Atkins diet for gout and my determination to get this finished, written and online on the site was given a boost in mid July when a study of three diets, including the Atkins diet, was published in the New England Journal of Medicine, and picked up by the media, no doubt world wide.

The study was conducted over two years in Israel. Curiously it was actually conducted at the Dimona nuclear weapons facility in the Negev desert, the place where Israel developed nuclear weapons, it's said in the 1960's. Participants were drawn it seems from the base's workforce.

The Atkins diet, which for many years was not supported by studies, was compared with a low fat restricted calories diet and a restricted calories Mediterranean diet. One headline result was that the Atkins diet, with non restricted calories, did best in reducing weight.

Whether the Atkins diet is good for gout is another matter. What a shame that this study in Israel did not measure baseline, interval and finishing uric acid levels. A huge opportunity not taken, or if they were measured, the figures have not been published. The Atkins diet has not unfortunately been studied for gout treatment.

The Atkins diet and gout is a big subject that requires careful research. From my personal experience of the Atkins diet, it has been very successful for me. Successful that is, in reducing weight and lowering blood pressure (I didn't have HDL cholesterol, LDL cholesterol, triglycerides, insulin and blood glucose levels checked before I went on it, so I don't know about its effects on those as far as I'm concerned).

And I got much better results in weight loss (about 90 lbs in 18 months) than those found in the (now) many studies of the Atkins diet. Others too have reported better results than in the studies. I have my witnesses!

I also continued to lose weight after twelve months, albeit at a reduced rate. Some criticisms of Atkins say this doesn't happen. It did for me. And I wasn't quite as strict with myself as Atkins requires. If I had been, I am certain I would have lost more weight more quickly.

I hope to get my research onto the website soon, as will let you know in this newsletter when it's viewable.

A caution. If these comments should prompt you into trying the Atkins diet for gout, make sure you discuss it with a doctor first. You need to know baseline levels of uric acid and the other markers mentioned above. Plus insulin and glucose levels. And you need to discuss your complete medical condition. This is VERY important.

You should also have a very thorough understanding of what the Atkins diet is all about. (Latest version: Dr.Atkins New Diet Revolution, M. Evans and Company Inc, New York 2002. Other publishers in other countries).

In this study, the Atkins diet performed about 20% better than a Mediterranean diet and 67% better than the low fat diet for weight loss. These percentages were among all participants who completed the study, 272 in all. Most participants were males.

Among the smaller number of women… they lost more weight on a Mediterranean diet than on the other two diets but only 45 women took part in the study and possibly fewer finished it. Participants were on weight loss amounts for 6 months, and maintenance amounts for 18 months.

The low fat diet is the one so beloved by government nutrition authorities, food manufacturers, much of the media and many researchers. But those on the Atkins diet ate the most fat. As far as blood pressure, cholesterol levels and triglycerides are concerned, Atkins was generally the best for most.

The New England Journal of Medicine is one of the most generous of online medical publishers. You can download the study free When you arrive at the Journal's home page, enter "Atkins diet" into the search box and the study will arrive on screen. It's called "Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet"

Any problems downloading?. Email me and I'll send it by email attachment.


The detailed information released by the European Medicines Agency about febuxostat contain a wealth of statistics about febuxostat's and allopurinol's performance in (amongst others) the large APEX and FACT trials conducted on these two gout medications. The EMEA has approved febuxostat for EU nations.

These trial results were so useful because these were very large studies of gout patients. From these I was able to draw some very interesting, even if generalized across the whole group of patients, conclusions about the likelihood of suffering gout attacks whilst on these medications prior to their end. And how long, after uric acid levels have been lowered to the 6 mg/dL target, it will then be before someone can expect attacks to cease.

More details at and There are also links on these pages to the EMEA's febuxostat (Adenuric) reports if you want to read them in full.

Remember febuxostat has not yet been approved in the U.S. and many other countries. I don't think it has yet been approved in Canada and Australia but please check with your doctor if you wish to know.

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All the best,

John Mepham

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 remedies with your doctor or other health care professional before implementing any treatment.

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