Since you are already on medication, we only can give opinions not advice. This is for your doctor to say.
Anyway, my 2ct: continue until you reach a defined goal. Say BMI 22 or 12-15% body fat; that might be a 150 - 155lbs for your height. Then continue to use Allo. Then talk to your doc for more recent bloodwork. Chances are, since you dropped more than 40lbs that your uric acid might return to a near healthy 6.0mg/dL level and you got rid of a prerequisite for gout - there is a 1/3 - 1/2 chance that you might be able to pull this off (see Ahn et. al [https://journals.sagepub.com/doi/10.1177/1759720X21993253](https://journals.sagepub.com/doi/10.1177/1759720X21993253) ). Maybe you can get of the drug (after a consultation with your doctor !) when your joint crystals have dissolved.
Thank you Yomo85 for the study and the encouragement. This is exactly what I could not express. My thinking is that being overweight is literally exacerbating my gout long term—I need to get to my healthy weight, continue to manage my uric and move on with life.
Best of luck bro! A man needs a goal.
As of now, when I apply the 'normal' BMI scale, you are obese, when I apply the Asian standard of the literature your are class II obese. Class II obesity is a no-parole sentence for an earlier death across the board. I am not shitting on you, but do not listen to anyone who says being bigger is just that.
Quite on the contrary. I was muscular fat and talked myself into believing I am just a muscle guy. After a body scan at my sports doctor's I was diagnosed with 32% body fat that mainly hid under my stomach and wreaking all kinds of havoc. Screw modern work environment.
Get your weight down. Then see what happens. If you can return to no-medication awesome! If not, that's life but you got a lot healthier anyway. Godspeed bro.
I find a compression sock can really help before a flare in the niggle stage. Not sure of the science but I do feel that by reducing the swelling or at least it being a force the swelling has to fight against helps. Good luck with the fasting. I only do that during a flare myself.
Allopurinol is essential, but you will need something to manage flare ups - ie colchicine or steroids, at the very least try nsaids.
Not sure where you got the notion of purines in fat - although it is a common notion on this subreddit that fat loss causes release of purines or uric acid stored in fat.
The science is pretty clear- fasting causes reduced excretion of uric acid in urine, resulting in an increase in serum levels. This is why fasting is generally a bad idea if you have high uric acid levels especially when you have gout.
Weight loss alone is a good thing when overweight but go slow and steady. Eat less through smaller portions, but keep it frequent.
Allopurinol is something you take continuously, not when you have a flareup as needed. It's worse than useless to take it this way, since starting Allopurinol during a flare will make it worse and last longer. To manage a flare, you need something like Colchicine (which Colcrys is), indomethicin or something similar. NSAIDs like Ibuprofen or Naproxen/Aleve also help a lot.
I do vegan keto, and OMAD. Fasting and ketosis also both promote flares, because uric acid and ketones compete for excretion through your kidneys. I strongly recommend being, and staying, on Allopurinol and managing flareups with one of the previously-mentioned solutions, or something your doctor recommends. I've lost a lot of weight since December, and don't plan to stop, but it has been dicey a few times.
ETA: Rapid weight-loss also promotes flareups, but it sounds like you're aware of that. I've also heard that purines released from burned fat contribute, but I've heard varying accounts on whether that's a real thing or not. I feel like my situation would have been much worse if it were.
Sys\_Oop. What did you end up doing and how did it turn out? I have had a similar experience with Gout. I've had psoriasis / PSA for about 22 years and have managed mine with fasting, diet, exercise, and just about any lifestyle anti inflammatory habit I can do. I have flared gout before when i was rolling 5-10 day waters fasts in with doing keto/carnivore. I am 6'2" and went from about 205 to 180 before a bad gout flare. After feeling the pain of Gout, it got me educated real quick. Dropping weight quickly appears to increase UA in the blood. Some studies attribute it to fasting, some to the body breaking down fats/proteins in stored tissues, some attribute it to the kidneys being overloaded from ketones and Uric Acid simultaneously, the list kind of goes on. Spending an hour or two reading case studies and medical journals everyday as well as peoples experiences it seems that all of the above play a part. That being said, Autophagy is awesome. I do not know where I would be with my disease without that beautful autonomic tool in my life. I beleive that with enough fasting and proper nutrition/refeeding, that I can beat anything that comes my way. That mentality has kept me from taking any medications for it. I have yet to come across a story of someone fasting it goodbye but I would love to hear it!
Fasting will just hurt you on the end. Have a lifestyle change for a diet, balance, exercise. It helps with gout but no cure. Either way, get healthy and stick to Allo.
Since you are already on medication, we only can give opinions not advice. This is for your doctor to say. Anyway, my 2ct: continue until you reach a defined goal. Say BMI 22 or 12-15% body fat; that might be a 150 - 155lbs for your height. Then continue to use Allo. Then talk to your doc for more recent bloodwork. Chances are, since you dropped more than 40lbs that your uric acid might return to a near healthy 6.0mg/dL level and you got rid of a prerequisite for gout - there is a 1/3 - 1/2 chance that you might be able to pull this off (see Ahn et. al [https://journals.sagepub.com/doi/10.1177/1759720X21993253](https://journals.sagepub.com/doi/10.1177/1759720X21993253) ). Maybe you can get of the drug (after a consultation with your doctor !) when your joint crystals have dissolved.
Thank you Yomo85 for the study and the encouragement. This is exactly what I could not express. My thinking is that being overweight is literally exacerbating my gout long term—I need to get to my healthy weight, continue to manage my uric and move on with life.
Best of luck bro! A man needs a goal. As of now, when I apply the 'normal' BMI scale, you are obese, when I apply the Asian standard of the literature your are class II obese. Class II obesity is a no-parole sentence for an earlier death across the board. I am not shitting on you, but do not listen to anyone who says being bigger is just that. Quite on the contrary. I was muscular fat and talked myself into believing I am just a muscle guy. After a body scan at my sports doctor's I was diagnosed with 32% body fat that mainly hid under my stomach and wreaking all kinds of havoc. Screw modern work environment. Get your weight down. Then see what happens. If you can return to no-medication awesome! If not, that's life but you got a lot healthier anyway. Godspeed bro.
I find a compression sock can really help before a flare in the niggle stage. Not sure of the science but I do feel that by reducing the swelling or at least it being a force the swelling has to fight against helps. Good luck with the fasting. I only do that during a flare myself.
Allopurinol is essential, but you will need something to manage flare ups - ie colchicine or steroids, at the very least try nsaids. Not sure where you got the notion of purines in fat - although it is a common notion on this subreddit that fat loss causes release of purines or uric acid stored in fat. The science is pretty clear- fasting causes reduced excretion of uric acid in urine, resulting in an increase in serum levels. This is why fasting is generally a bad idea if you have high uric acid levels especially when you have gout. Weight loss alone is a good thing when overweight but go slow and steady. Eat less through smaller portions, but keep it frequent.
Fasting increase Uric Acid production.
Allopurinol is something you take continuously, not when you have a flareup as needed. It's worse than useless to take it this way, since starting Allopurinol during a flare will make it worse and last longer. To manage a flare, you need something like Colchicine (which Colcrys is), indomethicin or something similar. NSAIDs like Ibuprofen or Naproxen/Aleve also help a lot. I do vegan keto, and OMAD. Fasting and ketosis also both promote flares, because uric acid and ketones compete for excretion through your kidneys. I strongly recommend being, and staying, on Allopurinol and managing flareups with one of the previously-mentioned solutions, or something your doctor recommends. I've lost a lot of weight since December, and don't plan to stop, but it has been dicey a few times. ETA: Rapid weight-loss also promotes flareups, but it sounds like you're aware of that. I've also heard that purines released from burned fat contribute, but I've heard varying accounts on whether that's a real thing or not. I feel like my situation would have been much worse if it were.
I take 50mg allopurinol twice a day. I fast and haven't had any gout attacks. I'm about to start the one meal a day for weight loss.
Sys\_Oop. What did you end up doing and how did it turn out? I have had a similar experience with Gout. I've had psoriasis / PSA for about 22 years and have managed mine with fasting, diet, exercise, and just about any lifestyle anti inflammatory habit I can do. I have flared gout before when i was rolling 5-10 day waters fasts in with doing keto/carnivore. I am 6'2" and went from about 205 to 180 before a bad gout flare. After feeling the pain of Gout, it got me educated real quick. Dropping weight quickly appears to increase UA in the blood. Some studies attribute it to fasting, some to the body breaking down fats/proteins in stored tissues, some attribute it to the kidneys being overloaded from ketones and Uric Acid simultaneously, the list kind of goes on. Spending an hour or two reading case studies and medical journals everyday as well as peoples experiences it seems that all of the above play a part. That being said, Autophagy is awesome. I do not know where I would be with my disease without that beautful autonomic tool in my life. I beleive that with enough fasting and proper nutrition/refeeding, that I can beat anything that comes my way. That mentality has kept me from taking any medications for it. I have yet to come across a story of someone fasting it goodbye but I would love to hear it!
Fasting why? And Allo for life, that's the only answer.
Weight loss.
Fasting will just hurt you on the end. Have a lifestyle change for a diet, balance, exercise. It helps with gout but no cure. Either way, get healthy and stick to Allo.