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Dietary Considerations
The Purine Content of Foods
Cherries

In the News
- Cherry Consumption Reduces Risk of Gout Attacks
- Milk Supplements Might Prevent Gout Flares (January 2012)
- Vitamin C, a good Gout Preventer.
- Coffee Can Lower the Risk for Gout
- Meat and Seafood Raise Risk of Gout; Dairy Foods Lower It
- Alcohol and Gout

Alternative Therapies
Herbal medicinal plants with reported folkloric use in the treatment of gout
Phytotherapy
Herbal medicinal plants with reported folkloric use in the treatment of gout

PURINE CONTENT OF FOODS
Purine from food accounts for only 15% of uric acid; 85% is endogenous, formed from purine metabolism in the body independent of diet. Certain dietary restrictions are still helpful. Alcohol, especially binge drinking, increases production and decreases excretion of uric acid. During acute bouts of gout, most of the protein in the diet shoud come from cheese, milk, eggs, and low purine vegetables.


PURINE-RICH FOODS
Anchovies
Beer and other alcoholic beverages
Bouillon
Broth
Consomme
Goose
Gravy
Herring
Legumes
Meat extracts
Mince meat
Organ meats (brain, kidney, liver, sweetbreads)
Patridge
Roe (fish eggs)
Sardines
Scallops
Yeast (as supplement) and yeast extracts

MODERATE-PURINE FOODS
Asparagus
Beans (dried)
Fish
Lentils
Meat
Mushrooms
Peas (dried)
Shellfish
Spinach

LOW-PURINE FOODS
Bread
Butter, polyunsaturated margarine, & other fats
Cereals
Cheese
Chocolate
Coffee
Cream soups made of low purine vegetables
Eggs
Fruit and fruit juices
Milk, milk products and eggs
Noodles
Nuts
Olives
Peanut butter
Rice
Salt
Sugars, sweets and gelatin
 
Cherries contain an enzyme that helps to break down and cause the excretion of uric acid. Eat one cup cherries every day to relieve the pain and cup daily to prevent future attacks. Look for fresh raw cherries first. Frozen or canned unsweetened cherries or 100% pure cherry juice may work too. A half pound (225 g) of fresh or canned cherries per day is claimed to be effective in lowering serum uric acid and preventing recurrences of gout. (Other alternative therapies to lowering uric acid are: milk, vitamin C, and coffee.) See Below


IN THE NEWS
CHERRIES DECREASE RISK OF GOUT ATTACKS
In a study of 633 patients with gout cherry consumption over a 2-day period was associated with a 35% lower risk of gout attacks compared to no intake. A similar inverse association was seen with cherry extract. When combined with allopurinol use, the risk of gout attacks decreased to 75%. (Abstract)
MILK SUPPLEMENTS MIGHT PREVENT GOUT FLARES
A New Zeland clinical trial results suggest the skim milk powder (SMP) enriched with 2 dairy fractions may prevent gout flares. Previous studies have identified two dairy fractions: glycomacropeptide (GMP) and G600 milk fat extract (G600), with anti-inflammatory effects in acute gout models. In a 3-month randomized trial evaluating milk products for the prevention of gout flares, results showed a significant reduction in gout flares in the SMP/GMP/G600 group. Following treatment, greater improvements were noted in pain and excretion of uric acid, with improvement in tender joint count. Results suggest SMP enriched with GMP and G600 may reduce the frequency of gout flares.
VITAMIN C INTAKE AND THE LOWER RISK OF GOUT IN MEN
In a 20-year study of nearly 47,000 men, daily supplements of vitamin C found in sprouts, peppers, and oranges appeared to decrease the risk for gout. A study concludes higher vitamin C intake is independently associated with a lower risk of gout. Supplemental vitamin C may be beneficial in the prevention of gout. The benefit appears to be dose-dependent. Compared to men who did not take vitamin C supplements, those who took 1000 mg to 1,499 mg daily had a 34% lower risk of gout; those who took 1,500 mg daily had a 45% lower risk. Usually 1000 mg a day or less is unlikely to cause harm. Diarrhea has been reported with doses doses greater than 1000 mg a day.
COFFEE AND LOWER RISK OF GOUT
Research in Canada sorting through data on more than 14,000 men and women in a 6-year survey found that coffee drinking of four or more cups a day lowered the risk of gout by 40-60%. Coffee-and, to a lesser extent, decaffeinated coffee- significantly lowered the amount of uric acid in the blood. Tea and other caffeinated drinks had little effect on uric acid, suggesting some other constituent in coffee, like the antioxidant chlorogenic acid, may be responsible for the uric acid lowering.

MEAT AND SEAFOOD RAISE RISK OF GOUT; DAIRY FOODS LOWER IT
A 12-year study confirmed the conventional wisdom on the dietary causes of gout. Purine-rich foods­beef, pork, lamb and seafood­increase the risk of gout while diets high in casein and lactalbumin reduce the risk. Every additional daily serving of these meats raised the risk of gout by 21%. while each additional serving of seafood raised it by 7%. An expected finding was that the intake of purine-rich vegetables did not increase the risk of gout. therefore, suggesting that there should be no restriction of purine-rich vegetable sources.

In contrast, increasing the intake of dairy foods, especially low-fat fairy foods (skim milk and low-fat yogurt), decreased the risk of gout.

These risks are independent of other risk factors for gout: hypertension, high BMI, alcohol use, diuretic use and chronic renal disease.

ALCOHOL AND GOUT
The study also confirmed the association of gout with alcohol use. However, the risk varies with the type of alcohol consumed, with beer more likely to cause gout than spirits. And the good news for oenophiles, moderate wine consumption does not appear to raise the risk of gout AT ALL. (Lancet 363[9417]:1277-81,2004).


PHYTOTHERAPY
A list of herbal medicinal plants with reported folkloric use for gout

Alfalfa Medicago sativa
Ash Fraxinus excelsior
Autumn crocus Colchicum autumnale
Birch Betula alba
Bistort Polygonum bistorta
Black currant Ribus nigrum
Boxwood Buxus sempervirens
Celery Apium graveolens
Cherry tree Prunus avium
Cowslip Primula officinalis
Dandelion Taraxacum officinale
Devil's claw Harpagophytum procumbens
Elm Populus nigra
Garlic Allium sativum
Goldenrod Solidago virgo-aurea
Grapevine Vitis vinifera
Heather Calluna vulgaris
Horsetail Equisetum arvense
Juniper Juniperus communis
Lemon tree Citrus limonum
Linden Tilia cordata
Meadowsweet Filipendula ulmaria
Mossy whitlow-wort Paronychia kapela
Nettle Urtica dioica
Oats Avena sativa
Onion Allium sepa
Pellitory Parietaria officinalis
Pine Pinus sylvestris
Potato Solanum tuberosum
Red vine Vitis vinifera
Sarsaparilla Similax aspera
Spiny restharrow Ononis spinosa
Strawberry Fragaria vesca
Soapwort Saponaria officinalis
Vervain Verbena officinalis
Willow Salix purpurea
Yucca Yucca filamentosa


Last update: October 6, 2012
IMAGE SOURCE: The Gout by James Gillray. Published May 14th 1799. / File:The gout james gillray.jpg/ James Gillray / May 14, 1799 / Public Domain / Wikipedia
Additional Sources and Suggested Readings
(1)
Asymptomatic Hyperuricemia: To Treat or Not to Treat / CLEVELAND CLINIC JOURNAL OF MEDICINE. AUG 2002
(2)
Intricacies in the Diagnosis and Treatment of Gout / Patient Care . July 15, 2001
(3)
Donna Tinnerello MS,RD,CDN. August 1999
(4)
MEAT AND SEAFOOD RAISE RISK OF GOUT; DAIRY FOODS LOWER IT / Internal Medicine News. June 1, 2004. Mary Ann Moon
(5)
Alcohol and Gout /
Lancet 363[9417]:1277-81,2004
(6)
Natural Treatment of Gout / Phytotherapy / Herbal Teas / Botanical OnLine
(7)
Arthritis / Gout / Holistic OnLine
(8)
Effects of skim milk powder enriched with glycomacropeptide and G600 milk fat extract on frequency of gout flares: a proof-of-concept randomised controlled trial / Nicola Dalbeth, Ruth Ames, Greg D Gamble, Anne Horne, Sumwai Wong, Barbara Kuhn-Sherlock, Alastair MacGibbon, Fiona M McQueen, Ian R Reid, Kate Palmano / Ann Rheum Dis doi:10.1136/annrheumdis-2011-200156
(9)
Vitamin C Intake and the Risk of Gout in Men / A Prospective Study / Hyon K. Choi, MD, DrPH; Xiang Gao, MD, PhD; Gary Curhan, MD, ScD / Arch Intern Med. 2009;169(5):502-507.
(10)
Can Coffee Prevent Gout? / Johns Hopkins Health Alert
(11)
Cherry consumption and the risk of recurrent gout attacks / Yuqing Zhang, Tuhina Neogi, Clara Chen, Christine Chaisson, David Hunter, Hyon K. Choi / DOI: 10.1002/art.34677
 
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