Cherry-Bombing an Old Foe: Gout

Once considered a “disease of kings” that only affected the affluent, gout is now affecting ordinary everyday citizens of the United States at increasing rates.

The current estimate is that 8.3 million Americans—roughly 4% of the adult population—is suffering from gout. It’s a major shift from 40 years ago, when the disease was rare. And this is not just an American phenomenon; gout is on the rise throughout Europe and in most other developed countries, as clearly shown in a 2015 study by Kuo and colleagues published in Nature Reviews Rheumatology

nrrheum.2015.91 f1Many factors are at play in the resurgence of this debilitating condition. Longer lifespan is one contributor. Risk of developing gout increases with age, especially for post-menopausal women. Higher rates of meat consumption and alcohol intake, and widespread use of thiazide diuretics and immunosuppressive drugs also contribute to the surge.

Constellation of Comorbidities

But in the US, we cannot ignore the fact that the rising prevalence in gout correlates with increasing prevalence of metabolic syndrome, diabetes, obesity and heart disease. These conditions are inter-related

Conventional medical treatments for gout include corticosteroids, NSAIDs, colchicine, and uric acid-lowering medications such as allopurinol. These drugs are variably effective, and seldom provide full relief on their own. Further, drug therapies may not always be appropriate for some patients and may cause bothersome side effects for others.

Lifestyle modifications are also needed. Dietary changes can improve quality of life for patients with gout—provided that they stick with it. Ideally, gout patients should limit alcohol consumption, and avoid foods rich in purines, such as red meats, anchovies, yeast, and organ meats. Heavy consumption of purine-rich foods raise levels of uric acid, which is the main culprit in development of gout.

It’s also a good idea for people with gout to reduce fructose intake. Uric acid is a byproduct of fructose metabolism and overconsumption can lead to uric acid. Most Americans consume the bulk of their fructose as high fructose corn syrup in beverages and packaged foods. So it’s a good idea to put a tight limit on soft drinks, candy, baked goods, and most processed foods.

Risk of gout does correlate somewhat with body mass index. The higher the BMI, the greater the risk. Maintaining a healthy BMI has been shown to reduce gout symptoms and uric acid levels. This is especially important for patients with diabetes, obesity, or metabolic syndrome in addition to gout.

Proper hydration is also crucial; dehydration can trigger acute gout attacks by raising uric acid levels and stressing the renal capacity to properly excrete it.

Since gout is an inflammatory disease, it’s a good idea to increase intake of foods rich in antioxidants and Omega-3 fatty acids to help lower inflammation in the body.

Cherries Offer Sweet Relief

Despite the best medical efforts, there is no definitive “cure” for gout and it’s painful flare-ups. This is prompting patients and researchers alike to seek out new ways tobing cherry manage the disorder.

Fructose issues aside, cherries are at the forefront of this new wave of gout research. Several studies show promise for consumption of cherries, either as the whole fruit or freeze-dried in supplement form, as a potential treatment of gout.

Cherries have been shown to reduce the risk of recurrent gout attacks.

In a case-crossover study by researchers at Boston University and involving more than 600 people with chronic gout, those who ate three servings of cherries or cherry extract (equivalent to half a cup or 10-12 cherries per serving) over a 48 hour period reduced acute gout attacks by 35% (Zhang Y, et al. Arthritis Rheum. 2012: 64(12): 4004-11).

When cherries or cherry supplements were combined with allopurinol treatment, the risk of severe attacks was 75% lower than it was during periods when the patients took neither the fruit nor the drug. The authors note that the gout-quelling effects of cherries were persistent across all subgroups stratified by gender, obesity status, purine intake, alcohol consumption, and pharmaceutical use.

This synergistic effect of cherries with gout medications has positive implications for patients with co-morbid kidney disease. Regular consumption of cherries might provide a dose-sparing effect easing the burden of toxic medications on the kidneys.

Back in 2003, US Department of Agriculture researchers showed that in healthy women, consumption of two servings of sweet Bing cherries (equivalent to 280 grams) following an overnight fast resulted in a marked decrease in plasma uric acid levels. The mean plasma urate fell from a pre-cherry baseline of 214 micromol/L to 183 micromol/L, a reduction of approximately 15%.

This was matched by a concomitant 42% increase in urinary urate excretion three hours after cherry consumption. The finding, say the authors, “supports the reputed anti-gout efficacy of cherries” (Jacob RA, et al. J Nutr. 2003; 133(6): 1826-9).

Cherries are high in vitamin C, which has an inverse relationship to uric acid: as ascorbic acid increases, uric acid decreases. They also contain high levels of antioxidants and anti-inflammatory anthocyanins that have been shown to lower inflammatory markers such as C-reactive protein. Anthocyanins 1 and 2 actively block the COX-1 and COX-2 pathways that promote inflammation.

Several nutraceutical companies are trying to translate the positive data on cherries into new supplement formulas for gout patients. One such product, called N2Gout and made by Vinco, contains 600 mg sweet cherry powder per capsule, along with 30 mg turmeric extract, and 3 mg pantothenic acid (Vitamin B5).

The company claims that N2Gout is most effective when taken daily for prevention, but also may be used during flare-ups. The dosage is 2-4 capsules, in divided doses, for “mild discomfort” and up to 6 capsules, in divided doses, for an acute gout attack.

Vinco acknowledges that there are no product-specific clinical studies of N2Gout, but they did use available clinical research to guide their choice of ingredients and dose levels.

We clearly need more science on cherries, and other food-based options for management of gout. That said, there’s little harm in adding a daily serving of cherries—fresh, frozen, or in supplement form—to one’s daily food routine. The tasty fruits certainly can’t hurt, and very well might help.

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Sarah Arvelo holds a Master’s degree in Clinical Nutrition and Integrative Health from Maryland University of Integrative Health and also teaches yoga classes in Washington, DC.