5 ms·

I do not want to squash your hopes but with dietary changes alone it is not possible to stop progression of gout. In a few years you will probably start having

by chewz 6y ago

I do not want to squash your hopes but with dietary changes alone it is not possible to stop progression of gout. In a few years you will probably start having more frequent attacks. Lossing weight is little more effective. Keeping your uric acid well below 6.0 mg/dL is when the process starts very very slowly reversing. Fortunately there is a better understanding of the dissease and more new therapies in the pipeline. > Dedicated gout research, going on quietly in the background of other breathtaking advances in rheumatology, is now paying off. This comes at a time when the number of patients affected by gout continues to rise, mainly due to an epidemic of obesity. An effort to improve lifestyle choices as a society and better management of the disease by clinicians should have a positive impact on gout incidence and outcome in our lifetimes. > Importantly, prophylaxis may prevent the acute inflammatory response to crystals, but will not alter crystal deposition and ongoing joint damage, so the patient may well be unaware of progressive tophi formation and destruction of cartilage and bone. Therefore, prophylaxis should only be employed with effective ULT. > Treatment is lifelong with a dose sufficient to maintain the serum urate below 6.8 mg/dl (404 μmol/l), preferably below 6.0 mg/dl (357 μmol/l). Anything short of this does not reverse the process, but merely slows the rate at which crystal deposition continues. The lower the serum urate achieved, the faster tophaceous deposits will resolve [1] Latest evidence on gout management: what the clinician needs to know - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539261/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539261/

cannaceo 6y ago
Thank you for sharing this. I'll definitely be more aggressive managing my gout.
Taniwha 6y ago
Allopurinol works for most people (but sadly not everyone), my gout kept me in bed for a month of agony, but once I was able to start allopurinol my uric acid levels have dropped and been managed for over a decade without issue, or gross dietary changes.
jjav 6y ago
> I do not want to squash your hopes but with dietary changes alone it is not possible to stop progression of gout. We all might get gout for different reasons but the generalization of "with dietary changes alone it is not possible to stop progression of gout" is not true. I have completely stopped my gout attacks by cutting way back on fructose.
- deleted 6y ago
  [deleted]
krageon 6y ago
Given the frankly enormous variances in medicine, saying that it is entirely impossible that their situation has improved in the way described just because you can't see it seems a little small-minded. Such strong claims are something that might have been acceptable and expected thirty years ago, but not now.
abstractbarista 6y ago
That doesn't seem quite right. If your diet consists only of things that do not metabolize into uric acid, how can you experience gout? It might require a very strict diet, but surely this is possible?
- phobosanomaly 6y ago
  It's not just direct metabolism of stuff in the diet. Your body indirectly makes stuff that is then metabolized into uric acid (e.g. your DNA). Could be making too much, could not be excreting enough. "Many factors contribute to hyperuricemia, including genetics, insulin resistance, iron overload, hypertension, hypothyroidism, chronic kidney disease, obesity, diet, use of diuretics (e.g. thiazides, loop diuretics), and excessive consumption of alcoholic beverages. Of these, alcohol consumption is the most important." "Causes of hyperuricemia can be classified into three functional types: increased production of uric acid, decreased excretion of uric acid, and mixed type. Causes of increased production include high levels of purine in the diet and increased purine metabolism. Causes of decreased excretion include kidney disease, certain drugs, and competition for excretion between uric acid and other molecules. Mixed causes include high levels of alcohol and/or fructose in the diet, and starvation." https://en.wikipedia.org/wiki/Hyperuricemia#Increased_production_of_uric_acid https://en.wikipedia.org/wiki/Hyperuricemia#Increased_produc... Purines and pyrimidines make up the two groups of nitrogenous bases, including the two groups of nucleotide bases. Two of the four deoxyribonucleotides (deoxyadenosine and deoxyguanosine) and two of the four ribonucleotides (adenosine, or AMP, and guanosine, or GMP), the respective building blocks of DNA and RNA, are purines. https://en.wikipedia.org/wiki/Purine https://en.wikipedia.org/wiki/Purine Could just be a bad roll of the genetic dice with a dash of lifestyle.

by chewz 6y ago

cannaceo 6y ago

Thank you for sharing this. I'll definitely be more aggressive managing my gout.

Taniwha 6y ago

Allopurinol works for most people (but sadly not everyone), my gout kept me in bed for a month of agony, but once I was able to start allopurinol my uric acid levels have dropped and been managed for over a decade without issue, or gross dietary changes.

jjav 6y ago

> I do not want to squash your hopes but with dietary changes alone it is not possible to stop progression of gout. We all might get gout for different reasons but the generalization of "with dietary changes alone it is not possible to stop progression of gout" is not true. I have completely stopped my gout attacks by cutting way back on fructose.

deleted 6y ago
[deleted]

krageon 6y ago

Given the frankly enormous variances in medicine, saying that it is entirely impossible that their situation has improved in the way described just because you can't see it seems a little small-minded. Such strong claims are something that might have been acceptable and expected thirty years ago, but not now.

abstractbarista 6y ago

That doesn't seem quite right. If your diet consists only of things that do not metabolize into uric acid, how can you experience gout? It might require a very strict diet, but surely this is possible?

phobosanomaly 6y ago
It's not just direct metabolism of stuff in the diet. Your body indirectly makes stuff that is then metabolized into uric acid (e.g. your DNA). Could be making too much, could not be excreting enough. "Many factors contribute to hyperuricemia, including genetics, insulin resistance, iron overload, hypertension, hypothyroidism, chronic kidney disease, obesity, diet, use of diuretics (e.g. thiazides, loop diuretics), and excessive consumption of alcoholic beverages. Of these, alcohol consumption is the most important." "Causes of hyperuricemia can be classified into three functional types: increased production of uric acid, decreased excretion of uric acid, and mixed type. Causes of increased production include high levels of purine in the diet and increased purine metabolism. Causes of decreased excretion include kidney disease, certain drugs, and competition for excretion between uric acid and other molecules. Mixed causes include high levels of alcohol and/or fructose in the diet, and starvation." https://en.wikipedia.org/wiki/Hyperuricemia#Increased_production_of_uric_acid https://en.wikipedia.org/wiki/Hyperuricemia#Increased_produc... Purines and pyrimidines make up the two groups of nitrogenous bases, including the two groups of nucleotide bases. Two of the four deoxyribonucleotides (deoxyadenosine and deoxyguanosine) and two of the four ribonucleotides (adenosine, or AMP, and guanosine, or GMP), the respective building blocks of DNA and RNA, are purines. https://en.wikipedia.org/wiki/Purine https://en.wikipedia.org/wiki/Purine Could just be a bad roll of the genetic dice with a dash of lifestyle.