I'm still trying to figure out my gout issues, going on a year now. They rarely hit my joints badly, instead being out the ligaments and tendons. Achilles tendon, medial knee, patella, medial ankle, hamstring tendon, lateral thumb (pip) joint, lateral big toe, and ligament of my middle finger. Last year i had an upper extremity DVT, no trauma or other cause identified, till later found i had 2 genetic predispositions for clotting, Factor V Leiden and Marburg I. Doctors were surprised I'd had no prior events till now(43). Started Apixaban, and had 2 gout flares, but didnt know what it was, later thumb and medial ankle within a week. Then it hit my big toe and i knew. Uric acid was measured to be 8.9 and i started Allopurinol. Not sure via what mechanism the Apixaban is causing gout flares, but I'd rater not have a stroke, heart attack, or another DVT.. so won't be eliminating that. No flares for 9 months, but some minor(1/10) on the pain scale from time to time in my toe. One time my patella hurt for over a month, now pretty sure it was a flare in the patellar tendon. I eat fairly well, generally avoid processed foods, and anything with seed/vegetable oils due to their metabolic effects long term, as well as some toxic metabolites(OXLAMs, HODEs, etc). I often fast 16-22 hours a day, only having coffee or water. Doctor thought i was prediabetic, as my 20 hours faated blood sugar was 105, but upon checking my A1C is 5.1. I anticipate my blood sugar is high enough to activate the polyol pathway though. My next step is to try increasing glycine and arganine via diet(connective tissues, skin, and broths) while reducing branched chain amino acids. Data I've seen shows this should drop my fasting blood sugar by 20 points or more, which i would hope for reduced polyol activity lowering UA. Before this i want to get a home UA meter though. Other factors that may play a role: - heterozygous MTHFR - Heterozygous for a gene causing hemochromatosis. Currently asymptomatic and I donate blood refularly, but know my liver iron is about 10% above reference range a couple years ago. - sleep apnea controlled by prior diet changes which fixed my allergies, sinus inflammation, chronic pain, and joint inflammation. This even put my lifelong asthma into remission 3 years into the changes. Any other ideas of pathways to read into would be appreciated.
You mentioned you measured uric acid when you are having a gout flare. It's known gout flares lower uric acid in the blood. Did you have data prior to that measurement showing its level?
I am not aware that UA is lowered in a gout flare. In fact, there is published data that shows UA is elevated in the flared joint than in circulating UA. This suggests that perhaps a production issue is happening in the joint. We also know that the highest risk of flaring is when UA is fluctuating up or down acutely. The gout flare happens in two steps: a unique inflammatory stage and the stage involving MSU crystals. UA is required for both steps or stages but crystalline UA is step two, soluble UA with seed crystals is step one. Knowing circulating UA is just one piece of information and tells us nothing about the dynamic of step 1 which requires other factors besides UA.
Very helpfull info.I went on keto last year Oct.Fantastic results.No single gout attack till end of February this year.I switch to carnivore and done few prolonged fastings for general health.Now I struggle for 2 months with constant gout attacks.Will lower my protein and took some Alluporinol ,but this is horrible drug,so will stop it after 1 week and hope everything will go back to normal
What you are describing is relatively common with carnivores. I think its because UA production is increased due to elevated glyconeogenesis and glutamine metabolism in carnivores. While circulating glucose is mainly modulated in keto and carnivore because of the carb restriction, reliance on gluconeogenesis and glutamine in carnivores is more extreme so there are greater fluctuations in UA. Some people get relief by going back to keto so as to have some incoming carbs. Also, IF definitely causes wide swings in UA.
@@DrPetesKetoKlub Thx Doc.Do you think best option for me is to switch back to Keto?I have to say I love Carnivore ,its so easy and tasty:)but this gout is crazy.I have to say that since I take regulary Allopurinol it all calmed down.Another very interesting observation I found is that if i take sample of UA from left hand is always higher than from right about 50 ummol/L
@@lesg5260 I am more kind of ketovore and on 100mg Allopurinol daily.Want to go back to carnivore and waiting for latest blood tests and liver test if can increase Allopurinol dose to 200mg
Hi, I have been battling this on and off for a few years now and trying not to go on lifetime meds. Iim type 2 diabetic and changed my diet a few years ago to keto and I still have it. When I feel a flare I do all I can to do natural remedies because I don’t want to go on lifetime meds. I have a question can plant oxalates cause those crystal to form when sugar is raised naturally like the dawn effect? Also now that I’m hardly on any carb and veg does that mean that the oxalates in the fat gets released and hence the crystals from the oxalates are released and cause gout crystals to form? Remember plant crystal oxalates are made of sharp crystals that can cause harm in our bodies?
Is there am objection to taking citric acid ... to avoid the potential K+ health hazard? Would not K-citrate be protonated in the high pH of the stomach anyway?
I'm here. You are right, I haven't published in a while. That's because I'm writing which takes a lot of time away from the other things that I do like videos. Sorry! I'll be back soon!
Also I thought that when the oxalates release into the body…it causes inflammation. Is that when the body sends out Uris acid to bind with it and causes it to store in our joints? I’m not a dr but it’s something I was thinking that can be the root cause? Is there anything I can take to break down those oxalates crystals?
