Back to Back Issues Page
The Gout Dugout.Issue #040.Make coffee work for you; Thai fish spas for gout;febuxostat availability
April 28, 2011

Hello and Welcome to the April 2011 edition of the Gout Dugout newsletter, the free gout newsletter that takes 10 minutes to read and gives you ideas about gout you might find usable.


There have now been five studies I know of, that indicate coffee is a good drink for gout sufferers. One shows it lowering uric acid (UA); two very large population studies show it reducing the risk of gout; and two show it both lowering UA and reducing gout risk.

In these studies, coffee is described as just coffee - it would be hard and expensive to distinguish it much. Regular is better than decaff, but we don't know, for lowering uric acid, if roasted or ground beans are better than instant; if Robusta is better than Arabica; or whether Brand A is better than Brand B, which is better than Brand C. I suspect the better the quality, the more it lowers uric acid, but that's just a guess that better ingredients do you more service.

It seems that there is something in coffee that inhibits uric acid production, or encourages its excretion, but precisely what is still speculation. A favourite (favorite) is a substance called chlorogenic acid which is also found in apples, bell peppers, plums and prunes.

Is there anything in these studies you can actually use? None of the drinks that lower uric acid, lower it by much, including coffee. They aren't Krystexxa, or febuxostat or even allopurinol. Milk was found to lower it by 0.25 mg/dL, and orange juice by 0.71 mg/dL in men and 0.24 mg/dL in women. Coffee is similar. It seems you have to drink a minimum of four cups a day, and perhaps five or six, before you'd get a uric acid reduction of maybe 0.40 mg/dL, and less if you're a woman.

Or let's say the latest coffee and gout study was true for you. In which case you might be talking about a 0.37 mg/dL reduction from seven cups a day, or 0.20 mg/dL from four to six cups which is what the coffee addicts achieved compared to those who didn't drink it.

This might not seem much to you and it doesn't seem much to me. However in at least one study the investigators thought reductions of around these amounts were clinically relevant across a large population, and lowered the risk of gout by a decent amount, even if UA was reduced much.(1)

Some of this sounds practicable, and there must be a useful message from all this clever research.


I think the first message is this. Given that the most someone can drink a day is probably about 15 eight ounce glasses (unless they are on a drinking binge, which is an exception, not a run-of-the-mill-event) without spending inordinate amounts of time getting rid of what they've drunk, and given you need to drink let's say eight glasses of water to dilute uric acid, plus two glasses of cherry juice, (which I rate with water, above coffee, milk and orange juice for gout) you might have a few glasses left in your daily allowance. In which case, for the remaining glasses, take your pick from coffee, milk or orange juice, because the research has told us they can't do any harm by raising uric acid and might do a bit of good.

And the second message is that if you have to drink 5 or 6 plus cups to get a small uric acid reduction of 0.40 mg/dL, and the reduction is probably less if you are female, then the research has told us that coffee is definitely behind water and cherry juice in effectiveness. Both for dealing with gout and the prevention of gout. Unlike water and cherry juice, no one has ever said coffee relieves gout attacks. And coffee is possibly behind milk and orange juice.

What about tea, black or green? Although both colours (colors) haven't been shown to lower uric acid, they both contain other healthy substances. Personally I'd want to use other methods to lower uric acid, and carry on drinking tea (black). If coffee could perform like febuxostat, or even allopurinol, I would think differently, but it doesn't.

So how can you use all this? Start by asking yourself "what is the maximum number of glasses or cups (assume they are both 8 fl.ozs) you can drink a day."

One formula: 16 glasses - 8 (water) + 2 (cherry juice) = six for the remainder.

Or another formula: 12 glasses - ten (8+2) = 2 for the remainder.

The remainder might include, for the sake of living a life for many of us, one glass of wine a day.

Just remember the caveat about espresso coffee and niacin. Niacin competes with uric acid for excretion and the amount of niacin in about six daily espressos might be significant.

(1) Coffee, Tea, and Caffeine Consumption and Serum Uric Acid Level: The Third National Health and Nutrition Examination Survey. Hyon K. Choi and Gary Curhan. Arthritis & Rheumatism (Arthritis Care & Research)Vol. 57, No. 5, June 15, 2007, pp 816–821.

Alternative Health Research/Flamasilâ„¢


When I used to visit Thailand regularly in the mid 1970's, I don't remember anyone telling me about the country's health fish "spas." So I'm pretty sure they have developed since then, after first making their appearance in Turkey in the 1960's. These places made news last month when a freelance writer in Bangkok reported on a controversy about the hygiene of the water they use. Unlike swimming pools, the owners can't add chlorine because it would kill the fish in the tanks.

What happens in these places and what does it have to do with gout?

You sit on a bench and dangle your feet into lukewarm water in an aquarium. As if you'd put your feet into a bowl of warm water with added Epsom salts. But the water at these "spas," (these places aren't Baden Baden, Saratoga Springs, Bath or Vichy) has had hundreds of Garra Rufa (or similar) fish added. They suck at your skin to eat dead skin, thus removing skin and leaving the rest with a smooth finish. It's supposed to be good for some diseases, especially skin diseases. These fish aren't piranas, they are toothless you'll be relieved to know.

You can see it at this YouTube video.

And, what-do-ya-know, this fish activity was described by a gout sufferer as a gout cure.

When I read that, my curiosity was immediately aroused. How could a skin suck get rid of gout? I read the fish somehow "suck proteins out of formed uric acid crystals" to end gout attacks, at least in the feet somewhere. Could they do the same out of formed tophi. It seems highly unlikely, whether crystals or tophi.

We all know that when uric acid has crystallized, the immune system is provoked into action and that certain proteins are involved. But I've always thought that gout attacks end when the naked MSU crystals are re-coated by proteins, the action which calls off the neutrophils attack on the uncoated crystals. Not because proteins are removed, if that's what these fish do. Quite why proteins detach from the urate crystals and later re-attach themselves is still a big gout mystery, but that's the scientific explanation.

So I won't be going back to Thailand this time to find out more. And I think I'd prefer the Epsom salts.

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 from Britain.


Three years have gone by since febuxostat (TMX-67) won its first marketing approval for EU countries and to date it has been approved in 11 countries. In the next three years it's expected to gain approval in Hong Kong (2011), Taiwan (2012) and China (2014).

A few days ago its ultimate owner, Teijin Pharma Ltd of Japan, announced agreements with three regional distributors which will also see it available in Turkey, the Middle East, North Africa, Caribbean countries and Mexico, probably within the next 2 years. Now that febuxostat has been accepted in North America, Europe and Japan it's hard to see any government elsewhere coming up with an objection on medical grounds.

This is excellent news for thousands of gout patients in these regions, especially if they suffer from mild to moderate kidney disease, since febuxostat can be prescribed for this with a dose that can be given to those without kidney disease.


If you can order from the U.S. (wherever you are) have a good offer, valid to the end of this month - to be precise at 11.59 pm on April 30, Pacific Standard Time. Buy one alkaline booster drops and get one free. These are the pH drops I discussed in last month's issue.

I think you have to be on their mailing list to be eligible and you can join it by clicking on the link below to visit the pHionbalance website.

If you miss out this time, there will be future useful offers from them coming into your inbox. And you get the free alkalising recipe book.

pHionbalance products

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.


Next month, among other items, there'll be some more comparisons of coffee's effect on the uric acid level with the effects on it of other drinks, including beer, the drink thought to be highest in purines. And we'll see if caffeine is the mystery ingredient in coffee that lowers uric acid.

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.

Back to Back Issues Page