Week of March 13, 2004; Vol. 165, No. 11 , p. 165

Meat of the Matter: Fish, flesh feed gout, but milk counters it

Ben Harder, Science News

http://www.sciencenews.org/articles/20040313/fob6.asp

Alexander the Great had it. Benjamin Franklin and Charles Darwin also suffered from what was once known as the "patrician malady." Their common affliction was gout, an arthritic condition that causes spells of intense pain, most often in the big toe.

Nutrition research now consolidates an ancient notion that a rich-man's diet, heavy in meat and seafood, contributes to the disease. Not all animal products are bad, however. Low-fat dairy foods offer protection, at least for men who haven't yet developed gout.

The disease's link to overconsumption of meat, as well as alcohol, has been assumed for centuries. Once found mainly in wealthy men, gout has spread along with the availability of meat. Today, gout affects about 5 million U.S. residents, mostly men and postmenopausal women.

Scientists have long known that gout develops when joints become fouled with crystals of uric acid, which is a natural digestion product of purine. Because meat, seafood, and many legumes are rich in purine, doctors have advised that eating too much of these foods might overwhelm the body's capacity to eliminate uric acid through the kidneys.

Taking anti-inflammatory drugs and drinking plenty of water can shorten an attack of gout from several days to less than 24 hours. Alcohol consumption and kidney problems worsen gout by slowing down the body's elimination of uric acid.

To pin down the link between gout and dietary purine, Hyon K. Choi and his colleagues at Harvard Medical School in Boston followed 47,150 men who had volunteered for a broad study of diet and health. Every fourth year, each man completed a questionnaire about his eating habits. None of the men had gout initially, but 730 of them developed it during the 12-year study.

Men who consumed the most meat, including chicken and organ meat, were 41 percent more likely to develop gout than men who ate the least meat were, Choi and his colleagues report in the March 11 New England Journal of Medicine. The result for seafood was similar.

The team estimates that each daily serving of meat increased gout risk by 21 percent, while each daily serving of fish or shellfish increased it by 7 percent.

The men who consumed low-fat dairy products most frequently had just half the risk of gout as men who ate the fewest such products did. Each daily serving of skim milk or low-fat yogurt reduced gout risk by about 21 percent, the data suggest.

Neither high-fat dairy products nor purine-rich vegetables appear to influence gout risk, the researchers found.

Each daily serving of beer elevates gout risk by 49 percent, but other alcoholic beverages have less effect, Choi reported at a scientific meeting last October.

The study provides "scientific validation" of the suspected relationships between gout and meat, says Richard J. Johnson of the University of Florida in Gainesville. Meat-rich modern diets are already implicated in rising global epidemics of diabetes, obesity, and heart disease, he adds, and "it appears that gout should be considered part of that spectrum."

This article says "The men who consumed low-fat dairy products most frequently had just half the risk of gout as men who ate the fewest such products did."
But the abstract of the original paper says "the incidence of gout decreased with increasing intake of dairy products" and "a higher level of consumption of dairy products is associated with a decreased risk". No mention of low-fat. It's puzzling as to why science news added 'low-fat' to their summary.

abstract at: http://content.nejm.org/cgi/content/short/350/11/1093

Low Carb Diet and Gout

I recently received this letter from an IDEAL DIETER:

"This weekend, my husband had another gout flair up (his third in 9 months). His kidneys were damaged about 3 years ago with high-blood pressure, so their efficiency is reduced by like 25% or so each. Anyway, this makes him prone to gout because he doesn't efficiently remove uric acid from his system.

His Dr. has him on several medications (statins for cholesterol and a variety of blood pressure meds), and my husband has been avoiding the use of the Allopurinol because he "takes enough pills already and that may hurt my liver". But when gout hits, he's down for days in major pain. So he takes Allopurinol for awhile. His Dr. has told him he must take it continuously to "prevent the build up of uric acid" and because we eat lower-carb, I am left wondering if this is partly my fault.

When the gout attack hit in December, I restructured our meals to have less meat and more starch, trying to tip the scales away from purine production, but the results were that my husband gained water weight, saw his blood pressure climb, we both felt more hungry and he told me to stop: go back to low-carb because he preferred the benefits, even if it meant getting gout. *sigh*

I researched more and have been aiming at protein choices that are lowest in purines (chicken, eggs, cheese, some fish...) but gout came anyway this weekend. I researched some more and decided to try cherries. I had him eat about 30 cherries for breakfast on Sunday, another 10 for lunch, 10 more at dinner.. by Monday morning, he could walk. We continued with cherries at breakfast and again last night with dinner. This morning he says is foot feels fine.

I can't believe the Allopurinol that he started taking on Saturday night could have been responsible for such a quick change (it wasn't before in his previous 2 attacks), so the enzyme (or whatever it is) from the cherries must have played a part - wow!

So here are my questions for you:

1. What actually triggers the uric acid to form crystals? Could it be related to the blood pressure or cholesterol drugs that he takes?
2. What is it about cherries that stops this action?
3. Cherries aren't exactly "low-carb", but it seems to be smarter to eat cherries than to take Allopurinol... but are both appropriate?
4. If the low-carb diet is to 'blame', why didn't he get gout the first year we were eating this way? We have been low-carb now for more than 2 years, but the gout has only been here for 9 months or so.
5. Are low-carbers prone to get gout even if their kidneys are working perfectly?
I've read that people with reduced kidney function should avoid a low-carb diet, but when my hubby does, he feels so much worse. I really need to know how to keep his diet low-carb friendly without bringing on gout. If cherries once a week will keep gout away, that'll be great!

Reply:

A gout attack occurs when level of uric acid is so high that it no longer can remain dissolved in the bloodstream, and solid crystals are formed. This typically occurs in joints, most commonly the big toe, and results in a very painful inflammation. It is postulated this joint is commonly affected because it is damaged gradually by the wear and tear of walking, and that cooler temperatures in this area cause uric acid to become less soluble.

High uric acid levels do not occur simply from eating purine-containing foods. Many people with gout are found to produce too much uric acid due to genetic defects. Others do not excrete uric acid sufficiently due to a presumed genetic difference in their kidney function. Your husband has an additional factor, with reduced kidney function, which would make him prone to high uric acid levels.

Alcohol consumption promotes the production of uric acid, which can lead to an attack of gout. Persons with gout are on average 15 to 30 percent overweight, and 75 percent or more have high triglycerides. High uric acid levels are present in more than 80 percent of all persons who have high triglycerides. In some persons, weight reduction and abstinence from alcohol lower triglycerides, uric acid levels, excessive excretion and overproduction of uric acid.

There is no evidence that the medications your husband takes would be related to his gout attack. As for the cherries, an article in the Journal of Nutrition in June 2003 by R.A. Jacob, et al showed that uric acid levels decreased in healthy women five hours after eating two servings (280 g) of Bing cherries. The uric acid in their urine was noted to increase three hours after eating the cherries. Markers for inflammation also decreased marginally at three hours.

There apparently are chemicals in cherries that decrease inflammation and uric acid levels by promoting uric acid excretion by the kidneys. Increased excretion of uric acid can cause stones to form in the kidneys. Persons with gout are advised to drink 2 liters of water daily to help excrete uric acid and prevent stone formation. Your husband should check with his doctor to see if he should drink less due to his reduced kidney function.

The acid pH of the urine also promotes uric acid stones, and medications are available to keep the urine alkaline.

Many persons have high uric acid levels without having any gout attacks. It is not known why some persons form crystals while others do not. Your husband may have high uric acid even without the low carb diet. It is reasonable to use low-purine proteins. You can also limit protein and use more fat for energy needs.

Purines are chemicals that are part of DNA and RNA, the genetic code components of all living cells. They are most concentrated in the diet in animal meats. Studies show that uric acid levels decrease when purines are restricted in the diet. However, it appears that a person who has no problem with uric acid excretion would not be at risk for gout despite eating large quantities of these foods.

Allopurinol is a drug that decreases the production of uric acid, so it also decreases its excretion. It is not useful for treating an acute attack but is good for preventing a recurrence. You are correct in noting that your husband's symptoms cleared too quickly for Allopurinol to be responsible. Colchicine or other anti-inflammatory drugs are most useful for treating the attack.

Allopurinol can have side effects, especially when there is reduced renal function. I see no reason why your husband could not eat a few cherries each day. This should not hurt his low carb diet if he eats them as a snack apart from his meals. He must be sure to keep well hydrated, especially for 8 hours afterward while he is excreting more uric acid. Whether this will help keep uric acid levels under control on a long-term basis must be studied further.

It would be interesting to check your husband's serum uric acid levels while using the cherries on a regular basis. If you do this, let me know the results.

http://www.theidealdiet.com/newslet...WWZ/Mar04.htm#b

Sometimes I wonder about the validity of the results from a study where men are asked what they ate four years ago.

As a side note, Dr. Atkins has always said that those with severe kidney disease should not do low carb.

For those who have a predisposition to gout here is what the Atkins site has to say:

http://atkins.com/helpatkins/newfaq...lyDoAtkins.html

Can patients with high uric acid (gout) safely do Atkins? If so, how is the Atkins Nutritional Approach adjusted and will gout medication need to be changed?



Gout can be aggravated by the Atkins Nutritional ApproachTM. Modification usually requires slowing weight loss down to fewer than two pounds a week and taking 300 mg of the prescription drug Allopurinol. If the uric acid level remains low, Allopurinol may be tapered down and stopped after one month, both under a physician's care.

For what it's worth, my experience was that Atkins and then NeanderThin cleared up my gout and arthritis altogether. Don't know how or why but I'm happy, happy, happy.

According to Protein Power by Drs. Eades, gout is insulin related.