Transcript: Gout Treatment with a Cherry on Top
The fruit commission of Washington state, our largest cherry producer, can fund reviews cherry-picking studies on the anti-inflammatory effects of cherries in a petri dish and animal models, but what we need are human studies. For example, if you stuff the human equivalent of up to a thousand cups of cherries down the throats of rats, it appears to have an anti-inflammatory effect, but you couldn't eat that many. And in fact if you tried, it could end badly. This is a case report of a poor guy who ate 500 cherries whole—without spitting out the pits, which ended up fatally obstructing his colon.
But we didn't have many human studies, until now. Men and women were asked to about eat 45 cherries a day for a month. I wouldn't mind being part of that study. 25% drop in C-reactive protein levels, as well as an inflammatory protein with an inelegant acronym “Regulated on, Activation, Normal, T cell, Expressed and, Secreted.” As you can see even a month after the study ended there appeared to be residual anti-inflammatory benefit from the cherryfest.
Now these were all healthy people, with low levels of inflammation to begin with, but the same was found in a follow-up study on folks with higher levels, a solid 20% drop in CRP, and a number of other markers for chronic inflammatory diseases. But how about trying out cherries on people who actually have a chronic inflammatory disease to see if they actually work.
Well, back in 1950, in an obscure Texas medical journal, observations made by responsible physicians suggested that in a dozen patients with gout, eating half a pound of fresh or canned cherries helped prevent flares of gout, but it had never seriously been tested until now. Gout is an excruciatingly painful inflammatory arthritis caused by the crystallization of uric acid within joints, affecting eight million Americans. Based on the National Health and Nutrition Examination Survey 2007–2008, the prevalence of gout in the US is estimated to be 3.9% among US adults, which translates into 8.3 million US adults. Such attacks cause tremendous pain, as famously captured in this caricature.
Hundreds of gout sufferers studied, and cherry intake was associated with a 35% lower risk of gout attacks, with over half the risk gone at three servings measured over a two day period, which comes out to be about 16 cherries a day. That’s the kind of efficacy they saw with a low-purine diet—uric acid is a break-down product of purines. This same research group found that purine intake of animal origin increased the odds for recurrent gout attacks by nearly fivefold. Heavy alcohol consumption isn't a good idea either. There are some high-purine nonanimal foods, like mushrooms and asparagus, but they found no significant link to animal sources of purines. So they recommended eliminating meat and seafood from the diet.
This may decrease risk, and adding cherries on top may decrease risk of gout attacks even further. Same thing with the leading drug. Allopurinol works, but pills and produce appear to work even better.
And dietary changes and cherries may be all many patients have, as doctors are hesitant to prescribe uric acid-lowering drugs like allopurinol due to rare but serious side-effects, including the most feared of all drug side-effects, Stevens-Johnson syndrome, in which your skin, can detach from your body.
In addition to fighting inflammation, cherries may actually lower uric acid levels as well. Within five hours of eating a big bowl of cherries, uric acid levels in the blood significantly drop. At the same time, antioxidant levels in the blood go up as vitamin C levels start to rise. So it is just an antioxidant effect? Would other fruit work just as well? NO. They tried grapes, strawberries, and kiwi fruit and none significantly lowered uric acid levels, supporting a specific anti-gout effect of cherries.
There are some new gout drugs out now, costing up to $2,000—per dose. And also carry a risk of toxicity that may be avoided by using nonpharmacologic treatments or prevention in the first place. Given the potential harms and high costs, attention ought to be directed to dietary modification, reducing alcohol and meat intake, particularly sardines and organ meats and hey, if life serves up a bowl of cherries—(consumed on a regular basis) the risk of a recurrent gout attack may be meaningfully reduced.
To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.
Please consider volunteering to help out on the site.