Introduction: Gout Attack Prevention
Gout attack prevention is an important series of lifestyle behaviors which can be done to reduce the chances of an attack occurring. Let’s take a brief look at how a gout attack occurs. In the simplest terms, gout (acute inflammatory arthritis) occurs when the levels of uric acid in the blood rise until the level becomes excessive, causing urate crystals to build up around the joints which cause inflammation and severe pain.
Once a gout attack sets in, there is little that can be done other than use pain medication and anti-inflammatories, then wait for the attack to run it’s course. It is important to follow your healthcare provider’s advice for the gout attack. The key however, is to work toward gout attack prevention to avoid the attacks from happening in the first place.
Dietary Factors Related to Gout:
Avoiding different types of foods may reduce the amount of uric acid production and therefore lower the amount of crystal formation in the joints to help with gout attack prevention. Choi HK, et al compared the lowest amount of meat and seafood intakes with the highest intakes of these foods. It was found that the highest quintile of meat and seafood consumption were associated with a 41% and 51% higher risk of gout attacks respectively. The author also found that an increased intake of dairy products, (especially low fat) resulted in a 44% lower risk of gout attacks. Interestingly, patients are traditionally taught by physicians to avoid purine rich vegetables, but an intake of vegetables rich in purines was not found to be associated with gout attacks in this study. When comparing intakes of different types of protein including animal, vegetable, and dairy proteins, it was found that vegetable proteins had a reduced risk of gout attacks by 27%, dairy had a 48% lower risk of gout, but animal protein did not affect gout risk. Also it was determined by the authors that alcohol use and body mass index greater than or equal to 25% each increased the risk of gout beyond any current dietary habits. (1)
Gout Related to Fructose and Purine intake:
Richette P and Bardin T. expressed that uric acid levels increase from the intake of fructose and purines. The authors discussed that the incidence of gout increases as purine intake from animal sources increases and high purine intake also may result in an acute gout attack. The risk of developing a gout attack was found to be significantly lower from vegetable source purines compared to animal source purines according to the authors. (2)
Gout Attacks Lowered by Eating this Fruit
Zhang Y, et al performed a case-crossover study of 633 gout patients. They were followed online for one year. The patients with gout who consumed cherries over a two-day period had a 35% lower risk of gout attacks when compared to those who did not eat the fruit. This shows promise when used as a supplement for gout attack prevention. Participants were asked about the date of gout onset, symptoms, medications and risk factors, including cherry and cherry extract intake in the two days prior to the gout attack. The lowest risk of gout attack occurred when patients consumed about 3 servings of cherries within the previous 2 days OR=0.39 (range 0.20–0.77 with 95% CI), but any range of intake from 1 to 4 servings improved this risk. Cherry extract also provided lower risk of gout attacks. The results also suggest that risk of gout flares was 75% lower when cherry intake was combined with allopurinol, a uric-acid reducing drug, than in periods without exposure to cherries or treatment. (3)
Summary: Gout Attack Prevention
- Choi HK, et al found the following foods affect the risk of gout attacks (1):
- The highest quintiles of meat and seafood consumption were associated with a 41% and 51% higher risk of gout attacks respectively.
- An increased intake of dairy products, (especially low fat) resulted in a 44% lower risk of gout attacks.
- Interestingly, patients are traditionally taught by physicians to avoid purine rich vegetables, but an intake of vegetables rich in purines was not found to be associated with gout attacks.
- Vegetable proteins had a reduced risk of gout attacks by 27%, and dairy had a 48% lower risk of gout.
- Alcohol use and body mass index greater than or equal to 25% each increased the risk of gout beyond any current dietary habits.
- Richette P and Bardin T. expressed that uric acid levels increase with intake of fructose and animal source purines, but a gout attack risk was found to be significantly lower from vegetable source purines compared to animal source purines (2).
- Zhang Y, et al found that patients with gout who consumed cherries over a two-day period were shown to have (3):
- A 35% lower risk of gout attacks compared to those who did not eat the fruit, and the lowest risk of gout attack occurred when patients consumed about 3 servings of cherries within the previous 2 days OR=0.39 (range 0.20–0.77 with 95% CI)
- Any range of cherry intake from 1 to 4 servings improved the risk of gout.
- Cherry extract also provided a lower risk of gout attacks.
- The results also suggested that risk of gout flares was 75% lower when cherry intake was combined with allopurinol.
References: Gout Attack Prevention
1.Zhang Y, Neogi T, Chen C, Chaisson C, Hunter DJ, Choi HK. Cherry consumption and decreased risk of recurrent gout attacks. Arthritis Rheum. 2012 Dec;64(12):4004-11. http://www.ncbi.nlm.nih.gov/pubmed/23023818
2.Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004 Mar 11;350(11):1093-103. http://www.ncbi.nlm.nih.gov/pubmed/15014182
3.Richette P, Bardin T.Purine-rich foods: an innocent bystander of gout attacks?Ann Rheum Dis. 2012 Sep;71(9):1435-6. doi: 10.1136/annrheumdis-2012-201838. Epub 2012 Jul 17. http://www.ncbi.nlm.nih.gov/pubmed/22805973