Tagged: Beer and Gout
August 28, 2015 at 1:35 am #21895
Thanks Ron and Keith for input.
I keep getting told about “old” crystals causing flare-ups and once these have dissolved (once uric acid levels are in safe zone for a while) then these flare-ups should stop. What I cannot get to grips with is where do this old crystals lurk before they decide to cause a problem? Logc tells me that a flare up is caused by a crystal being formed (due to indulgence,temperature etc) and that these crystals form in joints – hence the problems.
IF there are “old” crystals in my blood stream or wherever anyway, why aren’t they causing me problems – can crystals exist without causing problems? Is it these combining factors that cause the old crystals to decide they are going to go for a joint? – whereas before the factors kick in they lurk elsewhere and don’t cause problems?
I know it is a combination of things but surely bottom line is: crystals at joints cause the gout problem.
I took a chance last night – went for a curry with a mate I hadn’t seen for ages and had 2 ciders and 2 glasses of wine and touch wood – so far OK.
Thanks again.August 28, 2015 at 10:20 am #21897TimParticipant
I think it’s a good question that you’re asking.
I had a toe that was swollen and odd looking for a couple of years. It caused no pain unless i squeezed it, which of course I avoided. I didn’t know it was gout because even when i had the odd gout attack every year or more, it wasn’t the toe that was painful but somewhere else. Then, this year, i got an attack and the toe erupted with tophi. 3 months on it still hasn’t healed though is much better as my levels (on 200mg Allpurinol) have dropped below 5.
And here is my idea as to what the “old” crystals are.
Correct me anybody if it seems wrong, please.
There is some kind of tipping point and uric acid builds up, you have an attack or “acute gouty arthritis” that goes away as you have expelled some uric acid. The crystals are still in your joints waiting to build to the tipping point. When the next stage hits – the “chronic tophaceous gout”, the tipping point has been reached in several joints and it’s a big blast that is hard to shake. As the Allopurinol starts reducing the uric acid, the tipping point is reduced and so the flares occur.
Why the tipping point might be reduced by Alo, I don’t know. You would think if it lowered the level that the “old” crystals would just hang around waiting like they were before – I think that is the gist of your question, Barry.
So, my question out there is, if Alopurinol lowers production of uric acid, why don’t the crystals hang around until it is raised again?
Because if the lowering of the level creates flares, does that mean before an attack (pre- Alo) our levels were dropping, sparking an attack?
Seems a mystery, the whole damn thing.
TimAugust 29, 2015 at 5:24 am #21899
“Seems a mystery, the whole damn thing.”
Absolutely spot on Tim. Every day the experts are finding new explanations for different aspects of gout. The only truth that bears out is my last response to Barry:
“The only thing that is certain is that, with uric acid safely below 5, attacks will get less frequent, less widespread, and less intense. The lower you go, the faster that happens, but gout attacks remain a risk until most existing uric acid crystals dissolve.”
But Barry’s new question is fascinating (at least to me):
“where do this old crystals lurk before they decide to cause a problem?”
When we experience a gout attack, it’s our immune system telling us there’s a problem. We’re not supposed to have non-human matter floating round our bodies. Our white blood cells hide the crystals by engulfing them. They die in the process, but the invader is hidden.
Now, that stops our immune system sending out inflammation signals. The pain goes away, but the problem doesn’t. Without stopping the uric acid excess, we just get more of the same. In advanced gout, we can see this as tophi start to burst through our skin. But we don’t see the smaller deposits, or the deposits hidden deep within our bodies. I don’t fully understand the next part of the process, but as deposits grow, they harden. Tophi become solid lumps, so it seems like there’s some sort of calcification process. Anyway, there’s more to the lumps than pure uric acid crystals. Crystals are engulfed in white blood cells, and this hardens into something more.
If you did not treat the excess uric acid, or didn’t treat it well enough, uric acid crystals would continue to form, and at random, these cause gout attacks. I say “at random” because the theme of this thread is beer causing gout attacks, but not other alcoholic drinks. I don’t believe that to be the case. I do believe that alcohol can play a part in the gout problem, but it is one of many factors, so attacks will never correspond directly to alcohol drinking.
If you do get uric acid below 6, through allopurinol or any other means, then uric acid crystals start to dissolve. This is based on the equilibrium laws of inorganic chemistry, but there are confounding factors:
1. As uric acid crystals dissolve into the blood, they raise blood uric acid until it is excreted by the kidneys. In some cases, this might trigger new crystals to form. Adequate hydration is vital, but some gout patients with low excretion rates are best advised to support allopurinol with an uricosuric. If you’re reluctant to add more meds, then there are dietary ways to encourage this.
2. Some of the crystals will be isolated from the bloodstream by the aforementioned coating of white blood cells that have built up and hardened. We’ve had a few reports from long term allopurinol users who have experienced flares after years of no gout symptoms. My best guess in this situation is that a long-hidden cluster of uric acid crystals has suddenly started to dissolve. In any event, this explains why gout attacks appear at random for a few months after you start uric acid treatment.
I hope that answers Barry’s question. As for Tim’s ‘tipping point,’ I don’t think it’s that straightforward. There is certainly a tipping point as far as our immune system is concerned. I don’t think anyone knows what it is, but a single uric acid crystal is unlikely to trigger the massive inflammatory response that we experience as a gout attack. So, how many uric acid crystals does it take trigger the attack? I’ve never seen any research that explains this, but I’d love to hear from anyone that knows. One important thing to bear in mind about the ‘tipping point’ is that it only relates to uric acid crystals that the immune system can identify. That means new crystals forming when uric acid is high. It also means old crystals that are partially dissolved to the point where the dead cells that hid them fall away.
There are a few mysterious unknowns that can make gout management very complicated. However, basic understanding of the immune system makes it a little bit less of a mystery.August 29, 2015 at 2:22 pm #21901Ron AveryParticipant
What a detailed and in depth answer. I’m always learning something new about gout on this site.
One thing you didn’t mention that you have before is how FFA’s (Free Fatty Acids) may actually cause the gout flare up while high purine foods and beverages increase uric acid which is the fuel.
Perhaps this is one more piece in the puzzle as to why Barry experienced another attack ?August 31, 2015 at 5:50 am #21902
Beer and gout discussion continues after this update notice…
Beer and Gout Update
This is an old discussion about beer and gout. But it still contains many relevant and interesting points. But, for the latest gout discussions, you should read:
However, before you join those discussions, it is wise to read the facts about gout and beer:
I’m reviewing all my beer and gout articles. So, please share your questions, opinions, and experiences at Beer and Gout review.
I think you are right in saying “one more piece of the puzzle”
There are so many things that can trigger an attack, and I believe they are often very individual. For instance, @susan-lewis-suselew wrote recently about lack of common redness with and only minor swelling with her gout. Her immune response might be different from most, but I’ve no idea how we can measure that.
It seems that, as soon as we learn something new about gout, we uncover more mysteries.
Many doctors are still stuck with “one size fits all” gout treatment plans. But leading rheumatologists emphasize individual treatment plans for each gout patient.September 3, 2015 at 1:24 am #21906
Thanks gents for comments – I have been away for a few days and ignored e-mails etc! I will read your input carefully a bit later and comment – thanksSeptember 29, 2015 at 12:40 am #21931
Thought I’d give an update. I can’t say whether it is down to the allopurinol or not but I haven’t had an attack for 5 weeks (touch wood!) despite having 2 cans (sometimes pints if I am at the pub) of cider a night. Before I started taking allopurinol I could go for months without an attack even with drinnking much more so I cannot rule out anything really. But – just thought I’d let you all know that perhaps cider is the way to go? I miss my Stella but did get convinced that strong lagers were blamed for high purines. My rationalisation that cider could be OK was down to the old wives tale that cider vinegar was good – and surely cider can’t be too different from cider vinegar! Well, I believe it anyway!September 30, 2015 at 3:21 am #21932
Great update Barry. I was going to take you to task for not supplying latest uric acid test results. But, who cares – an update is an update 🙂
You are a fine example of a good gout patient. Find your own way to deal with the gout pain. And never take your eye off safe uric acid numbers.
It’s 3 and a half months since you started here, and we’ve had some great discussions. Is that over six months on the allopurinol now? I always see six months as a milestone in gout. In my opinion, once you’ve gone six months with uric acid under 300 μmol/L, and not had a gout flare, you’re pretty much ‘cured’. You say 5 weeks without an attack, and I’m hoping it’s the first 5 weeks of your Gout Freedom!
Anyway, Wednesday is my weekend, so it’s off to the pub to meet my Mum for lunch. I’ll be raising a glass to your continuing improvement, Barry. I’ll also be toasting all the other gout sufferers who make my GoutPal project so fulfilling for me.
Cheers!September 30, 2015 at 10:50 pm #21933Ron AveryParticipant
That’s an interesting comment you make about being on Allopurinol for 6 months and no gout flare means your pretty well cured. I’ve been on Allo for almost 8 months and no flare ups so that makes me feel real good !
I’m back to exercising and playing sports like I used to and I’m still enjoying my beer & wine and occasional scotch. My next visit with the doctor is the beginning of December so I’ll post my uric acid acid levels once I get them.
If I am indeed “cured” I owe a wealth of gratitude to you and this site for steering me in the right direction and giving me support I needed to get on the right track to beating gout.
Barry, I hope that your flare ups are behind you and you can start enjoying your Stella’s again !
RonOctober 1, 2015 at 1:11 am #21934
Hi Ron and Keith
yes – been on the allopurinol now for 30 weeks (firstly at 100mg a day and latterly at 200mg). I do sincerely hope and want to believe it is the fact that my acid levels have gone down (287 micromols at last test in August) that is to be attributed and not just how it has worked in the past – ie I could go months without an attack before I started on allopurinol – very random. I am due for another blood test on 13th Oct and will let you know the results.
Thank you for your interest and comments and I wish you well!October 2, 2015 at 4:17 am #21935
Ron, I’m blown away by your comments. It’s great of you to take time to let us all know about your progress.
It’s a wonderful feeling for all gout sufferers to know that our gout is improving. It’s a wonderful feeling for me to be part of that.
Barry, the apparent randomness of gout attacks can be confusing and confounding. I can’t tell you the number of bad days I’ve had in the past, wondering what I’ve done to deserve another gout flare. I’m certain you’ll soon be looking back on recent months as the time you found Gout Freedom. I know that’s an optimistic hope at the moment. But, I can’t wait for your test results to confirm that you’re continuing to control uric acid.
Thanks guys for a really optimistic start to October 🙂October 4, 2015 at 11:40 am #21939PhilParticipant
Thanks for all the replies,as mentioned previously I am ok drinking a couple of lite beers preferably German and pilsners also a couple of original ciders .The minute I touch any draught beer that’s when the gout flare up starts so I permanently avoid my much loved draught bitters now completely. Cheers PhilOctober 5, 2015 at 5:57 am #21944PaulParticipant
Give it up Phil!
No alcohol is the way forward.October 5, 2015 at 7:52 am #21947
Well, Paul, that’s one point of view. Another point of view is to control uric acid, so you can make choices about your lifestyle rather than being dictated to by gout.
Phil, it seems to me that you have similar reactions to Barry, so the best way is to go with what works for you. That’s the main thing about managing gout. We are all different, so finding what works best for each individual is always the best way to manage gout. Whether it’s diagnosis, treatment, or diet, I hate the “one size fits all” approach.October 5, 2015 at 9:29 am #21950PaulParticipant
Giving up alcohol in order to get onto the allopurinol is my suggestion. Hopefully this means that once the gout is under control you (I) can go back to drinking alcohol in moderation.October 5, 2015 at 9:42 pm #21952
I agree, Paul, that getting on allopurinol is the priority. I just don’t understand why Phil isn’t taking it anyway.October 16, 2015 at 3:11 am #21986
As promised – had blood test on Tuesday and results of serum urate are 281 micromols/L – a small drop from August but good news? Should I expect it to go even lower or is that value is what it should really be? Are old crystals going to dissolve at this marginal value (ie just below “safe”)?
I have stopped drinking my beloved Stella and drink cider – 2 cans a night.October 16, 2015 at 3:34 am #22077
As the gout forum explodes, is that Michael Caine we hear?
“Barry, you were only supposed to blow the bloody uric acid down!”
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