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Posts to Ask Dr Stoll BB regarding Goute

There have been a few posts to the Ask Dr Stoll Bulletin Board (BB) regarding Goute. Many of them have been archived here. The archive is roughly chronological. I hope you find it useful.

First, allopurinal is one of those serendipidous discoveries that sometimes work so much like our own processes that they cannot really be considered a "drug" like much of the rest that we know of.

Gout is a congenital condition. One is born without the ability to make the enzyme that converts uric acid to urea. Since there is widely varying "penetrance" of this genetic lack, some people cannot do it at all (those get gout as infants.) and some just are not as good at it as the "normal" people are (those may not get gout till they are 90.)

Did you get a 24 hour urine for uric acid or did you have the diagnosis just by blood? About 90% of all diagnosed gout is NOT gout and most of the erroneous diagnoses were made by the simplistic tendency of a lazy doc to make the diagnosis superficially.

Allopurinal almost perfectly duplicates the enzyme your body should be making anyhow (IF you truly have goute--there are a lot of things that will elevate blood uric acid other than goute.) and replacing that enzyme with allopurinal for the rest of your life is exactly what you should do. It is a lot like taking insulin for diabetes. your body needs it.

Since the breakdown of protein in your body inevitably leads to uric acid and then (normally) to urea, reducing the protein in your diet would help (IF your blood results are due to gout.) Would it help enough? Only trying it would tell.

However, the accumulation of uric acid in your tissues is what causes gouty symptoms. If you truly have goute, the only way for you to stop the symptoms permanently is to reduce the storage in your tissues. That means you have to excrete it faster than you make it.

Uric acid is not nearly as soluble in water as urea. Since the pathway for this stuff to get out of your body is to be dissolved in urine (urea is why urine has its name), the more soluble the molecule can be the more successful it will be excreted. If you stop with uric acid, lots of it will be deposited in your tissues.

Read the package insert for allopurinal. It is a very safe substance. If you truly have gout, you need it.

These are things your own doc should have explained to you.


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