Gout and MS

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Gout and MS

Postby 1hunter » Thu Jul 22, 2010 6:23 am

I have read that people that get gout dont get MS and people that have MS do not get gout... Is this true? have there been any studies to confirm this?
thanks
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#%#*

Postby jackD » Thu Jul 22, 2010 6:43 am

That is pure #%#* I had a VERY BIG- SORE -RED BIG TOE to prove it.

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Postby jimmylegs » Thu Jul 22, 2010 7:44 am

short answer yes ms and gout are virtually never found in the same person, it's all about uric acid levels, ms is low, gout is high, in ms it's correlated with low zinc, and if you fix low zinc your uric acid will bounce back to the same level as healthy controls.

long answer, yes indeed there are studies to prove it. the overlap between gout and ms is almost negligible and i guess jack is one of the unfortunate ones who get to enjoy both. one study's n-value is incredible, in the order of a MILLION patient records studied if memory serves. [note: it did not serve, i found the reference when i got a bit further into my reply below, and it's 20 million records actually]

the central thing is uric acid. the normal range for this nutrient according to my lab is 140-360. my first uric acid test came back 194. oh that's well inside the normal range i thought.

then i started to read about comparisons between uric acid in ms patients compared to healthy controls. i updated wikipedia with my findings relating uric acid and ms - http://en.wikipedia.org/wiki/Uric_acid

folks have gone in since and made a series of additions to this page, some of which need work but these are my contributions:
***
Low uric acid
Multiple sclerosis
Lower serum values of uric acid have been associated with Multiple Sclerosis. Multiple sclerosis (MS) patients have been found to have serum levels ~194µmol/L, with patients in relapse averaging ~160µmol/L and patients in remission averaging ~230µmol/L. Serum uric acid in healthy controls was ~290µmol/L.[26] Conversion factor: 1 mg/dL=59.48 µmol/L[17]

A 1998 study completed a statistical analysis of 20 million patient records, comparing serum uric acid values in patients with gout and patients with multiple sclerosis. Almost no overlap between the groups was found.[27]

Uric acid has been successfully used in the treatment and prevention of the animal (murine) model of MS. A 2006 study found that elevation of serum uric acid values in multiple sclerosis patients, by oral supplementation with inosine, resulted in lower relapse rates, and no adverse effects.[28]

Causes of low uric acid

Low dietary zinc intakes cause lower uric acid levels. This effect can be even more pronounced in women taking oral contraceptive medication.[29]

Normalizing low uric acid
Correcting low or deficient zinc levels can help elevate serum uric acid.[31]

Inosine can be used to elevate uric acid levels.[26]
***

So, uric acid low in MS averaging 194, healthy controls 290 or so.

You start to see gout up around the 360 mark for uric acid. It's not just about uric acid and zinc though, there are other ratios for other nutrients and based on that 20 million record study, I suspect it's an extremely unusual health scenario that would result in gout and ms for one person.

i tested between 188 and 194 for uric acid for years. my first zinc test came back 8.6. zinc in healthy controls averages around 18.2 umol/L.

i worked on zinc for a while before figuring out the zinc - uric acid connection.

last test that i had of those two things together was zinc up to around 16.1 i believe, and uric acid had popped up to 278. booyah! :D :D :D

jimmylegs

ps my zinc level was the worst ever but now it's included at my lab and shows up at the bottom end of the normal range. the low end was 10.5 when i got my result now when i get tested the bottom end is 8.6. ridiculous.
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Interferon Beta + Uric Acid

Postby jackD » Thu Jul 22, 2010 9:42 am

So much for that idea.

jackD


Mult Scler. 2010 Apr;16(4):455-62. Epub 2010 Mar 3.

Boosting endogenous neuroprotection in multiple sclerosis: the ASsociation of Inosine and Interferon beta in relapsing- remitting Multiple Sclerosis (ASIIMS) trial.

Gonsette RE, Sindic C, D'hooghe MB, De Deyn PP, Medaer R, Michotte A, Seeldrayers P, Guillaume D; ASIIMS study group.

Collaborators (47)Gonsette RE, Sindic C, Goffette S, van Pesch V, Duprez T, Demaerel P, D'hooghe MB, Nagels G, Descamps M, Van Remoortel A, Deville MC, van Nunen A, Medaer R, Vanroose E, Bogaerts A, Michotte A, Bissay V, De Boeck M, De Deyn P, Sheorajpanday R, Braxel E, Seeldrayers P, Jacquy J, Piette T, De Cock C, Guillaume D, Reznik R, Metz R, Maertens de Noordhout A, Delvaux V, Dupuis M, Cras P, Willekens B, Timperman H, Decoo D, De Sutter M, Van Zandijcke M, Dehaene I, Verhoeven K, Deryck O, Casselman J, Criel A, Schotte V, Verhaeghe R, Dusautoir C, Hermoye L, Maes F.
National Centre for Multiple Sclerosis, Vanheylenstraat 16, Melsbroek, Belgium. r.gonsette@skynet.be

Abstract
Anti-inflammatory drugs are effective on relapses, but neuroprotective agents to prevent disability are still unavailable. Uric acid has neuroprotective effects in experimental models including encephalomyelitis and appears to be involved in multiple sclerosis. Oral administration of inosine, a precursor of uric acid, increases serum uric acid levels and is well tolerated.

Our objective was to test the possibility that a combination therapy associating an anti-inflammatory drug (interferon beta) and an endogenous neuroprotective molecule (uric acid) would be more effective than interferon beta alone on the accumulation of disability.

Patients with relapsing-remitting multiple sclerosis on interferon beta for at least 6 months were randomized to interferon beta + inosine or interferon beta + placebo for 2 years.

The dose of inosine was adjusted to maintain serum uric acid levels in the range of asymptomatic hyperuricaemia (<or=10 mg/dl).

The primary end points were percentage of patients with progression of disability and time to sustained progression (Kaplan-Meier analysis).

The combination of interferon beta and inosine was safe and well tolerated but did not provide any additional benefit on accumulation of disability compared with interferon beta alone.

We conclude that endogenous neuroprotective mechanisms recently identified in multiple sclerosis are complex and uric acid does not reflect the entire story.

PMID: 20200198 [PubMed - indexed for MEDLINE]
Last edited by jackD on Thu Jul 22, 2010 9:48 am, edited 1 time in total.
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Postby 1hunter » Thu Jul 22, 2010 9:43 am

Thanks JimmyL

that is helpful and hopeful for me... I am in CIS land, My nero said there is a 60% chance i will develop MS at some point. I went to the Dr. after i had a slight numbness in my right hand and right leg. MRI showed brain lesions but all blood tests, envokment potentions, and LP were all normal.
After doing some research i went to a lyme disease Dr. ( i do have a high exposure to ticks and have been bit numerous times) he said no way this is MS and is most likely lyme or somthing else.
I have had gout attacks a couple time a year since i was 18 years old (41 now) My Dad, Grandpa, Uncles all had gout problems and were/are on medication for it. Most of my numbness has returned to normal and no new symptoms for over a year now.
I would say that based on what you said it is more likely i had/have a Lyme disease or somthing else and not MS.
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Postby jimmylegs » Thu Jul 22, 2010 10:25 am

We conclude that endogenous neuroprotective mechanisms recently identified in multiple sclerosis are complex and uric acid does not reflect the entire story.


you and this article are correct, jack - fixing uric acid is not the whole story.

uric acid status is an indicator of the body's antioxidant status, and also whether the body's urea cycle is functioning properly.

yes you can use a precursor such as inosine to drive it up artificially. however, correcting uric acid by essentially artificial means will NOT fix ms.

holding a lighter under the thermostat is not going to warm up the room. it is a signal that something more fundamental is wrong, and that is where we can start to see the rest of the story.

i tried for years to elevate my uric acid by eating purine rich foods, all the stuff that is supposed to lead to gout, without success.

i was investigating uric acid and zinc separately long before i connected the two together. when i finally put it together and tested them at the same time, a clear correlation became obvious.

unlike inosine, zinc is a basic fundamental nutrient. it is a foundational component of hundreds of widely diverse biochemical interactions in the human body. one facet of zinc is its critical importance to proper functioning of the urea cycle in the human body.

unlike inosine, zinc is linked to a variety of functional issues in ms. THAT is the kind of thing that can really warm up the room.
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Postby jimmylegs » Thu Jul 22, 2010 10:37 am

glad that's making things better, hunter. still can't hurt to be vigilant about MS when you have neurological symptoms.

from what i see after a quick browse, peripheral neuropathy can be seen, rarely in gout - due to nerve compression apparently. the occasional case of carpal tunnel syndrome etc, but due to a site specific buildup of crystals.

since you are at risk for developing gout you could consider increasing your potassium intake. reduce sodium intake, eat black cherries, bananas, potatoes with skins on, and so on, approach the pharmacists and ask for a high potency potassium pill, eg 600mg.

you need about 3500-4000 mg potassium per day and around 2000mg sodium intake.

if it's lyme that's another thing altogether but for now, i can offer the gout info. my friend recently was suffering with it so i have looked into it before.

anyway HTH!

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Postby jimmylegs » Thu Jul 22, 2010 10:58 am

oh and i meant to post you these article links:

The association between gout and nephrolithiasis in men: The Health Professionals' Follow-Up Study
http://www.nature.com/ki/journal/v64/n3 ... 3979a.html
*(basically, gout increases risk for uric acid kidney stones)

Successful management of uric acid nephrolithiasis with potassium citrate
http://www.nature.com/ki/journal/v30/n3 ... 6201a.html
*(basically, potassium helps)

so, why not use the potassium early :)

if you go to a health food store and ask for a gout remedy they're likely to give you something with black cherry - guess what that's full of ;D

good luck with all your health investigations :)
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Gout and MS

Postby lovebug » Thu Jul 22, 2010 1:40 pm

I too have gout and MS. So it can happen together. I have had gout for about 3 years and RRMS for 16 months..........
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Postby jimmylegs » Thu Jul 22, 2010 3:22 pm

for THREE YEARS??? that must be horribly painful.

my friend (who does not have MS) got gout and then got rid of it by and large over the last few months.

i just called him to ask about it and he says he has to stay on top of things nutritionally or he starts to get a sense that all is not well.

he first had a bad spell over the winter, took colchicin for a couple weeks, and also cut down on the high protein diet and alcohol.

it went away, then came back, then he took another break from high protein diet and alcohol. this time no colchicin, but added high potency (600mg) potassium pills to the mix (he's not a fan of fresh fruits and veggies AT ALL).

at any rate, he runs a lot so he's pretty aware of how his feet are doing, and he thinks by and large his foot feels best when he stays on top of his potassium intake. just one person's report.

sorry to hear you are one of the ones in that sucky MS + gout boat :(
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Postby CureOrBust » Fri Jul 23, 2010 5:55 am

There was a study in Serbia I think, that found supplementing with Inosine was beneficial. I can not remember the full details right now. I would not put much into the above study, as they also used interferons. I don't think I even read if they were monitoring patient Uric Acid levels?

I use Inosine, and previously had below standard levels, now I am pushing the upper range. Its nowhere near the whole answer (as lovebug sadly has found), but the statistics and the Serbian study means I will continue to use it; in addition to my other regime items.
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Postby 1hunter » Sun Jul 25, 2010 9:24 am

Jack and Lovebug,

because do have gout and MS...Can i ask if your MS is mild?
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Re:

Postby Amir » Mon Jul 22, 2013 9:08 am

jimmylegs wrote:for THREE YEARS??? that must be horribly painful.

my friend (who does not have MS) got gout and then got rid of it by and large over the last few months.

i just called him to ask about it and he says he has to stay on top of things nutritionally or he starts to get a sense that all is not well.

he first had a bad spell over the winter, took colchicin for a couple weeks, and also cut down on the high protein diet and alcohol.

it went away, then came back, then he took another break from high protein diet and alcohol. this time no colchicin, but added high potency (600mg) potassium pills to the mix (he's not a fan of fresh fruits and veggies AT ALL).

at any rate, he runs a lot so he's pretty aware of how his feet are doing, and he thinks by and large his foot feels best when he stays on top of his potassium intake. just one person's report.

sorry to hear you are one of the ones in that sucky MS + gout boat :(


I have just read your 3 year old posts on Gout and MS. Very interesting.

I have come across a 24 year old who has Relapsing Remitting Gout for 6 years and in horrendous pain every 2 months which lasts for about 3 weeks. He cannot touch the affected area even with a feather when this happens.

Do you have any updates on your knowledge of this subject. I have read a lot on the internet but from what I am observing in this patient things do not quite fit in with conventional explanations.
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Re: Gout and MS

Postby jimmylegs » Mon Jul 22, 2013 9:39 am

heya, do you mean rrms + gout for 6yrs? at age 24??! not. fun. :(

to tease out what is going on w your 24 y o friend, I would be looking for food/fluid intake over 3 days, a journal record of all meds, all supplements, all symptoms related and unrelated, all other diagnoses and familial tendencies to illness.

then I would head for the science. bloodwork would be a strong recommendation. we can characterize quite a few levels in the average ms patient, but I doubt we could safely make any assumptions when gout and ms are seen together (if that is indeed the case). a potassium level could be useful, for example, but it is not a test i'm in the habit of suggesting for ms patients. not that it would be hard to find a target level, it's just not really red flagged in the ms research I've seen to date.

here's one bit of reading that could make a useful starting point.

Effect of gradual accumulation of iron, molybdenum and sulfur, slow depletion of zinc and copper, ethanol or fructose ingestion and phlebotomy in gout
http://www.medical-hypotheses.com/artic ... 8/abstract

the author has a similar and very useful article on ms. the nutritional parallels and differences are interesting.

fundamental and likely in large part permanent dietary revisions would likely be key for your friend. if it comes down to choosing a therapeutic course of supplements for a quick initial boost to the biochemistry, 'revital' health looks like a good place to shop - I noticed one across from Victoria stn, but it was closed so I checked out their web site.

hopefully that's a little bit useful!
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Re: Gout and MS

Postby Amir » Mon Jul 22, 2013 11:01 am

jimmylegs wrote:heya, do you mean rrms + gout for 6yrs? at age 24??! not. fun. :(

to tease out what is going on w your 24 y o friend, I would be looking for food/fluid intake over 3 days, a journal record of all meds, all supplements, all symptoms related and unrelated, all other diagnoses and familial tendencies to illness.

then I would head for the science. bloodwork would be a strong recommendation. we can characterize quite a few levels in the average ms patient, but I doubt we could safely make any assumptions when gout and ms are seen together (if that is indeed the case). a potassium level could be useful, for example, but it is not a test i'm in the habit of suggesting for ms patients. not that it would be hard to find a target level, it's just not really red flagged in the ms research I've seen to date.

here's one bit of reading that could make a useful starting point.

Effect of gradual accumulation of iron, molybdenum and sulfur, slow depletion of zinc and copper, ethanol or fructose ingestion and phlebotomy in gout
http://www.medical-hypotheses.com/article/S0306-9877(99)90925-8/abstract

the author has a similar and very useful article on ms. the nutritional parallels and differences are interesting.

fundamental and likely in large part permanent dietary revisions would likely be key for your friend. if it comes down to choosing a therapeutic course of supplements for a quick initial boost to the biochemistry, 'revital' health looks like a good place to shop - I noticed one across from Victoria stn, but it was closed so I checked out their web site.

hopefully that's a little bit useful!


Many thanks for your excellent input as usual. This patient has not been diagnosed with MS.
It was me renaming Gout as "RR" Gout because that is how it presents itself.

My work is with the TMJ/teeth and body symmetry. I found him to be one of the worst cases of asymmetry. I am treating him for that but do not want to miss out on any other important tests etc. like you suggest.

It would be interesting if symmetry treatment helps. It will be three months before we can definitively make any further comments of any relationship of gout to asymmetry.
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