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The Gout Dugout Issue #012.Febuxostat closer to FDA approval; Xmas foods to avoid;treating gout pain
December 03, 2008

A warm welcome to the December 2008 edition of the Gout Dugout newsletter, and to those new readers who have signed up since the November edition.


In last month’s edition I mentioned that there would be a special arthritis committee meeting, convened by the US FDA in late November to discuss whether febuxostat should be approved. There was. And the committee voted 12 – 0 with one abstention for its approval. However, this committee does not make the final decision, the FDA does. So we wait to see whether it will happen. Read more at

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One gout food to avoid at Christmas is cranberry sauce or jelly, popularly eaten with turkeys. I have never found a study about cranberry sauce/jelly and uric acid but I have found one about cranberry juice, details of which I put on a couple of months ago. The effect of cranberry juice in the study was to raise urine uric acid levels, and lower the pH of urine (both undesirable effects). The risk here is the formation of uric acid kidney stones, a risk that's quite high – I have seen numbers up to 20% in gout sufferers, and that may be higher as gout sufferers get older. Read more at this website page

Or visit

I am not sure why mincemeat is high purine and in fact I've only seen one purines list where it is mentioned at all, so perhaps what I'm going to say is irrelevant. But the source was a good one. You probably know what I am talking about but if you don't, this is the filling for mince pies, widely eaten in English speaking countries, and some on the European continent, at Christmas.

Mincemeat is after all really just a mixture of dried fruit, usually raisins, currants or sultanas all of which are, simply put, variations of different varieties of dried grapes. And apples may be added. Neither grapes nor apples, are known to be high purine but perhaps it's because the water has evaporated and the purines in the grapes become very concentrated. We call it mincemeat because originally, in 16th and 17th century English recipes, it was meat plus fruit, but now most are really mainly minced dried fruit. It is definitely not minced/ground beef.

Sometimes manufacturers add a little alcohol, often brandy (which might account for it, beef or vegetarian suet and spices. A variation includes venison (deer meat), minced sirloin and minced hearts which might account for it too. If you buy them, or make them from mincemeat in jars, look at the ingredients.

And just one more foodstuff to remember that is definitely high purine – gravies made from gravy powders or meat extracts.

If you need to be deadly serious about your gout diet foods at Christmas and usually eat turkey, note turkeys are medium purine. Four ounces is probably the maximum. Remember most vegetables are low purine. I hate dampening one of Christmas's major pleasures, but only you can determine whether these cautions apply to you personally.


I've spent a lot of time with the Barry Sears' Omega RX Zone book over the past month. (Non U.S. readers note that RX is a dual-initial-turned-into-a-word in the U.S. for what is called a prescription in most other English speaking countries). The result is an improved page about fish oils and new pages about omega -6 oils for gout, and the pros and cons of fish for gout.

Or visit For the omega -6 page

Or visit And for the fish for gout page

Or visit

Sears extols the virtues of fish oils (the Omega -3 oils EPA and DHA) and the omega -6 oil Linoleic acid in reducing pain and inflammation. Both these oils need to be used in tandem. The heart of the theory, and in detail it's complicated, is that pain and inflammation can be alleviated to some degree by changing the balance of "good" and "bad" eicosanoids in the body. (Good and bad are relative terms – in other contexts "bad" can be "good"). This is what he argues these oils do plus you need a reduction in insulin levels achieved by going onto his Zone diet.

He has packaged it all nicely into a book using studies that have been around for many years, plus his own experience and knowledge of these oils and his analysis of how they work. Barry Sears is a lipids (fats) chemist by training.

In Sears' theory, NSAIDS work by knocking out classes of the Cox enzyme which to him are eicosanoids and corticosteroids like prednisone work by knocking out more even more classes of eicosanoids than NSAIDs. The omega -3 and -6 oils do the same thing but more selectively, and they improve eicosanoid balance by producing more "good" eicosanoids. So you can see where Sears' ideas have their basis in the same science as that which lies behind why NSAIDs work for gout pain (when they do, which is often the case) and the corticosteroids, which are more reliable than NSAIDs in knocking pain out. However, these oils will not have the same side effects as the drug medications, and especially the corticosteroids like prednisone, which are too dangerous to be taken for very long.

The pages I put up, and especially the one about omega -6 oils are intensive reading since I tried to cover all the main points in a couple of pages. You'll need to read the page about gout and fish too, for the obvious reason that so many high omega -3 fish (otherwise very desirable) are unfortunately high purine. For gout pain relief, and its inflammation – naturally – I think these ideas are among the best one can find. Doing things like putting your feet in ice cold water for half an hour, or propping them up with gout stools or taking a hot bath with Epsom salts are all very medieval, fine up to a point if they work and a huge disappointment when they don't.

If you seriously want to try these oils I recommend reading these pages and then the Sears' book.

You really need to understand the science behind it and do it properly. There is both a short chapter and a long appendix on eicosanoids, so for a quicker understanding focus on the short one. You need to understand how arachidonic acid is created and why it must be reduced. And much else besides.

And you must work with a doctor who has an understanding of why eicosanoid balance affects pain and inflammation, and not all doctors will, but many rheumatologists may. The doses Barry Sears talks about are higher than typical medical authority recommendations for the omega -3 and omega -6 oils, although eating more omega -3 oils is official policy. High dose fish oils can have side effects which are explained. One for example, is you probably shouldn't take high dose fish oils with any blood thinning medicine.

Are there any testimonials for this, from gout sufferers? Yes there are. Read on.


That's the theory, what about the practice? In the Omega RX Zone book Sears mentions one example of someone who used his formula for gout pain and because this person had taken the dosage for a year, I think it worked for him. If it hadn't worked he would have given up in two or three months. So perhaps we are talking here about at least a year without gout attacks, or attacks of less severity.

And I found a testimonial from a gout sufferer who said gout went away with the Sears' formula, (although the person doesn't unfortunately say for how long). This person was in a very serious medical condition, not only the gout. It can be read here at the reader reviews of the Omega RX Zone book. Read the one entitled Dr. Sears reveals the health miracles of high dose Omega 3 from A Customer.

Or visit

Most reader reviews are positive. I suggest you ignore those who say that Barry Sears is just trying to sell his fish oils. He is trying to sell his fish oils of course, but in my opinion the greater truth is that Sears' is selling what he believes in, there's a lot of evidence, and many testimonials saying high dose and quality fish oils bring lots of health benefits. (I've only focused here on gout pain and inflammation). And in the book he also mentions another supplier of high quality fish oils, not just his own company.


In next month's edition, among other items, we'll look more at gout pain relief with Sears’ ideas. And I'll stare into a "gout crystal ball" and discuss some likely developments on the new gout drug scene in 2009. I promised last month there would be more about pegloticase, whose developers have now applied for FDA approval. This will now also be in the January issue because I think this letter is now long enough. You get so much to read in your inbox and people are always very busy in the weeks leading up to Christmas. There’s no hurry. Pegloticase will not be FDA approved, if it is, until mid 2009 at the earliest.

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

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Thanks for reading. A Merry Christmas.... and a gout attack free 2009 to all readers!

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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