Allopurinol is a xanthine oxidase inhibitor, which slows metabolic degradation of 6-mercaptopurine, which is an analogue to hypoxanthine. This is done by the deamination of adenine, which forms a nitrogen group (which will eventually form urea; and precipitate urate) and the hypoxanthine. Allopurinol decreases this synthesis of uric acid through those mechanisms, which of course increases xanthine. Normally, when first beginning allopurinol in high urate serum patients, xanthine stones may build up in the kidneys. However, it is an effective treatment of gout and kidney stones especially if you neutralize the pH of the urine (ie by drinking lots of water).

An excess in vitamin C while taking allopurinol can predispose a patient to kidney stones. Ascorbic acid is weakly acidic and decreases the pH of the urine. In addition, it has uric acid elimination properties (so-called uricosuric effect).

Thus, if you know anything from pharmacology lectures on three-model pharmacokinetics and general knowledge of acid-base equilibria, you can see that there is a direct increase in uric acid output and a further decrease in pH from taking high amounts of ascorbic acid. Acidification of the urine is a phenomenon that then can cause the uric acid calculi.

I am therefore suggesting that only taking high doses of ascorbic acid with allopurinol (without enough water or sodium bicarbonate solution) there is a chance of nephrolithiasis.

Thanks for the reply.

I am aware of the fact that:

1) Purines are degraded to hypoxanthine, xanthine, and then to uric acid, with the help from xanthine oxidase (XO) and xanthine oxidoreductase. And, Allopurinol inhibits XO to reduce the production of uric acid, thus raises xanthine (and hypoxanthine) level in the urine to cause possible xanthine kidney stones .

2) Taking mega doses of ascorbic acid (vitamin C) can acidify urine; uric acid and xanthine precipitate easier in acidic urine.

But I am confused as the following:

1) The posts say "...The only problem might be kidney stone formation if you're taking Allopurinol..." and "...when first beginning allopurinol ...xanthine stones may build up in the kidneys. However, it is an effective treatment of gout and kidney stones..." -- My confusion: How can Allopurinol cause "kidney stone formation" and, at the same time, "is an effective treatment of ... kidney stones" ?

2) The 2nd post says " ... taking high doses of ascorbic acid with allopurinol ... there is a chance of nephrolithiasis" [kidney stones]. -- My confusion: If a person has a high urine uric acid level, two things can happen. One, do not take Allopurinol and face a higher chance to have uric acid kidney stones. Two, take Allopurinol to cut down the chance of uric acid stones and raises the chance of having xanthine stones. Either way, the patient is faced with the chance of having kidney stones. So, what does it matter if one takes Allopurinol or not?

3) The 2nd post states: " An excess in vitamin C while taking allopurinol can predispose a patient to kidney stones. Ascorbic acid is weakly acidic and decreases the pH of the urine..." -- My confusion: Doesn't low pH urine prevent and dissolve certain stones such as calcium phosphate kidney stones?

It is fortunate that we have one or more med students on board. However, their input would be appreciated more if it is made clear to those of us who aren't medical professionals.

1) Allopurinol can decrease uric acid excretion and thereby prevent those types of kidney stone formation, but at the same time can cause xanthine stones if the pH is low

2) As long as one alkalises their urine (by taking sodium bicarbonate or other alkalising agents) to increase pH, this may prevent xanthine stones. This is relatively rare, but it is still a possibility especially if taking megadoses of vitamin C

3) Specific stones must form in acidic or basic pH. Thus a low pH would dissolve something like a calcium phosphate stone but may cause a cystine stone. pH must be balanced carefully

Gracious.

It has been awhile. I ceased the 8000 mg of esther C maybe a month ago. I saw an improvment but the truth is I got far better mileage with baking soda. A friend created some gelatin capsule for me. Each contains about 1/3 teaspoon of baking soda and I take 3 in the AM, 3 in the PM. This allows me to avoid the nasty taste and be a bit better in maintaining consistency. So far so good and am I grateful not the put up with the taste. I still take 1000 mg C a day as part of my vitamins.

In answer to the query I have noticed tophi decrease. Now, I was on vacation and enjoyed myself greatly. Maybe to the tune of 750 ml rum a day. I did note and increase. I don't know what the 'sweet spot' is on consuming alcohol, taking BS and expecting to see a net loss. I think maybe I had best just give it up entirely.

Now, I do KNOW that if I abstain of just keep it down to a Friday night I don't suffer pain. And I do notice things get better over time. Perhaps over a year I'd notice big changes.

I do test my pH (spot check) and I tend to stay at 7.1/7.2. I do check BEFORE I take BS and I am at 7.0. No kidney stones and I do drink water/tea to the tune of 6 18 ounce glasses a day. My thought is if I pee quite a bit I give my body more opportunities to clean up. I also have a Subway for lunch and a rather light snack when I get home. I tend to allow myself to eat more on the weekend.

I'm glad JYY2 and I found a receptive audience. I do think pH is the trick and probably aids in other parts of health. A friend tested his urine and he was 5.7.

ggoede1,

I've just been diagnosed with gout and read this thread shortly thereafter. i've been in a deep depression since i got the news three days ago even as i pull myself out of a "subacute" attack to use my dr's words. what depresses me most is the fear that i will not be able to enjoy food or spirits any longer. just wondering how you do with the restricted/forbidden foods list. a perfect friday night for me is 6-8 beers, a cheeseburger, steak, or chicken wings. i know i can't eat like this often, but once every couple of weeks gives me hope that i can still enjoy myself some. thoughts on this, anyone?

Also, do you think the GoutCure's claims of ridding your body's stored UA are accurate? You were using the supplement for a limited time but, could your limited gout attacks be attributed to the decrease in your UA level? i'm considering buying the product. like you said, it makes sense to me. as for now, the BS approach at morning and night are helping to clear up my minor pain.

Tested my new methods yesterday with my own experiment. I drank 2 tblespoons of ACV in the am. after work i lifted and did cardio pretty hard for about and hour. upon arrival at home i drank a protein shake and another tblespoon of ACV. I then met a friend for dinner and had four budweisers, prime rib and garlic mash potatoes. before bed i drank a teaspoon of baking soda and woke up this am completely gout free with plans to work out again today. i might even eat some wings and have a beer or two. i believe in the value of keeping my ph in the 7plus range.

I've got to say thanks to you folks for your chronicles posted here. Your posts give me hope. I've spent almost 5 of the last 12 months on crutches or a cane from gout.

I'm now 52 years old. My attacks started about 9 years ago, were infrequent (maybe once per year), and almost always in the left knee (which had been operated on previously). At first I didn't know what was causing the pain and gross swelling, but I knew it felt different than any other pain I'd ever felt (absolutely debilitating and excruciating) and that it came on without any precipitating event like a twisted joint during exercise. In March and April 08 gout hit me in the 2nd toe of the right foot, which I knew hadn't been injured so I went to the emergency room and was diagnosed with gout. October and November 08 it struck the left knee again. This month (Feb 09) it's in the arch and tuberosity area of the right foot. The pain got so bad I contemplated amputation of the foot. Can anyone relate?

I started the Baking Soda treatment last w/e and have been monitoring my pH. Within 3 days the pain subsided greatly. I've been taking 1/2 tsp in the AM and PM. and have moved the pH to the high 7's, low 8's. Sometimes I take it in the afternoon also.

I have to admit that it feels weird to have to relearn how to eat properly at my age. I always thought I knew what a balanced diet was, NOT!! I never considered pH a factor but you have convinced me that it is the key and I have been learning some of the alkalizing and acidifying foods (what a pain). Who'd have thought lemon juice was alkalizing?

There were two excesses in my life: intense exercise and 88 oz of diet cola per day. I'm working hard to moderate both and hoping those changes and the addition of Baking Soda and alkalizing foods will turn this nightmare around. I prefer not to take Allopurinol if I can turn it around through other means. We'll see.

Thank you for your valuable information, it has given me hope.

In regards to "I prefer not to take Allopurinol..."

Please remember that baking soda will help get rid of the crystals which cause the flare ups and ease the pain, but it will not lower the uric acid levels in your blood. Higher PH means more solubility for the acid which may help, but again you need to have your blood checked regularly to see what level you are at. The goal is to get below 6 which is the point that the crystals will form.

A book I recently read (Beating Gout, A Sufferer's Guide to Living Pain Free by Victor Konshin) said that even with a modified diet, you are only able to lower your uric acid level by 1 or 2 points. The other home type remedies help with the symptoms but not necessarily the cause.

The main point here is that having a uric acid level above six can lead to other health risks such as heart disease and can be a factor in promoting high blood pressure, obesity, etc.

I totally understand where you are coming from in hoping to avoid taking medications (especially 'for life), but I would strongly recommend that you check your levels before deciding not to take allopurinol.

Good luck!

The missing link in this discussion is sleep apnea, which medical literature has reported to both increase serum uric acid and lower its pH. Furthermore, ALL the serious medical problems currently being found to be associated with high levels of serum uric acid have already been shown to be strongly associated with sleep apnea.

Victor Konshin's book mentions the connection with sleep apnea only briefly. I expect that his upcoming second edition will focus more on this connection.

I had been having mild gout attacks in my right big toe joint without knowing it for over a year. Like others here, I went on a diet and boom, my foot was over twice its normal size.
What did I do?
Well, I searched and searched.
I found someone saying that tart concentrated cherry juice had worked for them, and sure enough it worked for me too. Then I found a product (check spelling) called Goutezol, which is made of a number of natural herbs like turmeric, quercetin, celery seed extract, rutin, nettle and burdock root (maybe more). This was to help dissipate the tophi, which it is doing now. My attack was acute, but this remedy worked within hours of drinking the cherry juice concentrate, which I am still drinking after 10 days, and there is steady improvement on a daily basis.
Sounds quirky, but for me it worked, and I am still on my diet.

All, I suffered a TIA stroke back in February. I think the cause was baking soda. If you choose to use baking soda do so with the use of a BP monitor. I am on Allopurinol and it is better. Seriously, monitor your BP while using baking soda. Baking soda is sodium bicarbonate Operative word is 'sodium'.

Be cautious.

I have been thru the colchicine, allopurinol route and started the baking soda routine about 2 years ago. No gout attack during that time. Quit the BS about 3 months ago...ate shrimp last weekend - all weekend and by Monday, couldn't walk. Panic ensued and I resorted to Colchicine which reduced the pain within 4 days. So back to researching alternatives. Came across the Buffer PH by VAXA and planned on starting that today. Was pleased to read that some have already found relief from that. Looking forward to the experiment.