Image Credit: Valdemar Fishmen / Flickr. This image has been modified.

How to Treat Gout With Diet

The Washington State Fruit Commission, our largest cherry producer, can fund reviews that cherry-pick studies on the anti-inflammatory effects of cherries in a petri dish and animal models. But what we’ve needed are human studies. For example, if we 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 we could never eat that many. (In fact, if we tried, it could end badly. One poor guy who ate 500 cherries whole—without spitting out the pits—ended up fatally obstructing his colon.)

A decade ago, we didn’t have many human studies, but thankfully, now we do. A study published in The Journal of Nutrition had men and women eat about 45 cherries a day for a month (I wouldn’t mind being part of that study!). The researchers found a 25% drop in C-reactive protein levels (a marker of inflammation), as well as an inflammatory protein with an inelegant acronym RANTES (“Regulated on, Activation, Normal, T cell, Expressed, and Secreted”). Even a month after the study ended, there appeared to be residual anti-inflammatory benefit from the cherry fest.

These subjects were all healthy, with low levels of inflammation to begin with, but a follow-up study, highlighted in my video, Gout Treatment with a Cherry on Top, on folks with higher levels found similar results for C-reactive protein and for a number of other markers for chronic inflammatory diseases. Do cherries, then, help people who actually have a chronic inflammatory disease?

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 the issue had never seriously been tested, until recently. Gout is an excruciatingly painful inflammatory arthritis caused by the crystallization of uric acid within joints. 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 people.

Hundreds of gout sufferers were 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 (about 16 cherries a day). That’s the kind of efficacy the researchers 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 five-fold. Heavy alcohol consumption isn’t a good idea either.

There are some high-purine non-animal foods, like mushrooms and asparagus, but the researchers found no significant link to plant sources of purines. So, the researchers recommended eliminating meat and seafood from the diet. This may decrease risk substantially, and adding cherries on top may decrease risk of gout attacks even further. Same thing with the leading drug: allopurinol works, but adding produce appears to work even better.

Often, dietary changes and cherries may be all patients have, as doctors are hesitant to prescribe uric acid-lowering drugs like allopurinol due to rare but serious side-effects.

In addition to fighting inflammation, cherries may also lower uric acid levels. 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. So, is it just an antioxidant effect? Would other fruit work just as well? No. Researchers 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 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. “If life serves up a bowl of cherries (consumed on a regular basis), the risk of a recurrent gout attack may be meaningfully reduced.”

More about the inflammation fighting effects of sweet cherries in my video Anti-inflammatory Life is a Bowl of Cherries.

I’ve previously mentioned gout and controlling uric acid levels in my videos:

Other foods that may help tamp down inflammation:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live year-in-review presentations Uprooting the Leading Causes of Death, More Than an Apple a Day, From Table to Able, and Food as Medicine.

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


29 responses to “How to Treat Gout With Diet

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  1. Is millet harmful to the thyroid? I see various sources online claiming that when millet is cooked the levels of goitrogens increases, unlike broccoli where the levels decrease. Is this a legitimate concern regarding thyroid health and millet consumption? Thanks.

    1. Since people have been eating millet since before recorded history, it seems that any effect it has must be mild on most people. If you have a thyroid condition, it might be wise to limit it and to get extra iodine in your diet since it seems that millet affects iodine absorption. Sea vegetables contain iodine but I prefer to get a measured amount each day by taking one kelp tablet containing 225 mcg. of iodine. I think this is an especially good idea of you don’t use salt to any extent, since iodized salt is the normal source of iodine for most people.

    2. Good question I think it depends on many factors. Several foods contain the ‘goitrogens’ that you mention, but they are only harmful when iodine is lacking in the diet. Plus, cooking drastically lowers goitrogen activity. Click this post to read all about if iodine supplementation is needed.

      1. Joseph, thanks. Millet seems to be the exception, though, as cooking has b been reported to dramatically INCREASE goitrogens in millet, while cooking lowers goitrogens in other foods. And none of us (i think) are eating raw millet. So, cook your millet……you take in a bigger dose of goitrogens than had you not cooked it. This seems like a very important issue, as many in the gluten free crowd indulge in cooked millet.

        1. Is that right? I didn’t know that, if it’s true forgive me for being so blind I guess I don’t have all the answers. Can you help me understand why that is? Thanks!

          1. I am not sure why this might be the case, but all the sources I find online claim that it is. I wonder if “science” has determined this, or speculation, but I see no reason for people to be making this up. I find it concerning….as I mentioned, some in gluten-free crowd indulge in millet. Maybe Dr. G can explore.

  2. I had classic gout last year – or at least I assumed it was.
    I was wholefood vegan for over 20 years and even since I deviated, it describes my diet well over 90 percent, but the past 10 years or so I’ve experimented with fish – came to think of sardines as medicinal – B12, omega 3 etc – so last summer I was chucking them in my meals day after day – and then my right big toe swelled up so I couldn’t get my shoe on.
    I’d had that happen once before though a lot less intense.
    I packed in the sardines and it went away and never resurfaced – though I tried sardines a few times since …

    But I also have yeast extract a couple of times a week and recently have been eating half a pound of mushrooms most evenings with no ill effects…

    In practice, I saw last year’s attack as a warning sign that my mild obesity was starting to affect me organically (brought the threat of diabetes into focus) and so have started actively dieting and I’m now 20 pounds lighter and on the way to losing another 30 or so and getting back to a weight I haven’t seen for 20 years.

    Dr. Greger hasn’t fully convinced me that I should give up on fish (not least because I’m hoping to retire to the French coast) – but for the time being I’m fully vegan and finally taking a B12 supplement on a regular basis as well as chucking ground flaxseed in my three main meals…

    1. Thanks for sharing. Yes, fish is higher in purines which contribute to gout. Best of luck on your heath journey I hope everything has resided and you’re feeling better!

    2. Hi gentlegreen- most fish are heavily contaminated with mercury, pcb, and other toxins. Mercury and pcb are neurotoxins, so I wonder if that was part of the problem for your toe.

      Regarding the mushrooms, do you eat then raw or cooked? There was recently a discussion on these boards about how raw mushrooms have a toxin that impairs the immune system, but this toxin is destroyed by cooking. Bonne chance, with your French retirement plans.
      -Mark

      1. I’m somewhat sceptical that it was mercury or PCBs in the fish …

        The mushrooms are cooked. – moderately well nuked in the microwave along with half a pound of carrots and a pound of brussel sprouts – my attempt to eat such a huge quantity of veggies I don’t have room to reach for the muesli – my one weakness as I work on the years of excess.

        What I have failed to discover in my reading about gout is why certain kinds of foods are worse than others – in my understanding the bulk of these purines come from the breakdown of two of the four DNA bases – so there’s going to be just as much in any animal or vegetable cell – perhaps more in plant material because plants have more DNA.

        I know QUORN was a major culprit until they worked out how to process it out – another kind of fungus.

        I’ve seen fruit juice implicated too – coming from a different angle and I was a massive abuser of fruit juice.

        I did at the time – after working out that it probably was gout habitually grab cherries when they were available and was also eating cherry pie filling.

  3. Sounds like I need to bump my cherry intake a little. I’m a non drinking vegan that eats significant amounts of vegetables. I do eat mushrooms but only sporadically and typically not in huge quantities when I do. I’m slightly overweight but generally fit (exercise regularly) and my doctor has no concerns re. my weight. I nonetheless had a couple of gout attacks over the last couple of years, stumping my doctor re. what to suggest other than taking the drug Colchicine at the onset of a flair. So I guess we vegans aren’t immune from gout (maybe a genetic component) and Dr. Greger’s recommendations re. cherries seem useful. I’ve been putting something on the order of 10 frozen tart cherries in my smoothies in the morning but am now wondering if that’s sufficient, both in terms of quantity and, as Dr. Greger hasn’t mentioned frozen cherries in any of his discussions, if there’s any lessening of efficacy re. frozen cherries.

    1. I seem to recall a video in which Dr. Greger noted that cherries in fresh, frozen, and juice form were all beneficial but that dried cherries were not.

    2. After having posted the song “Vegans Don’t Get Gout” ( bit.ly/vegans-dont-get-gout ), it’s disappointing hearing about a vegan getting gout, so maybe that song should be remade into “Few Vegans Get Gout”? That seems safe to say.

      1. Gout is not really a nutritional problem. Maybe 25%. Your body produces uric acid on its own. In some cases people over produce uric acid and then their kidneys also fail to be able to handle the excess. Yes, eating a bunch of liver will make it worse. But, like with me, I can eat nothing but plants and still get nasty outbreaks without medication. Anyway, the idea that vegans can’t get gout isn’t a thing. Maybe vegans who aren’t already predisposed to the kidney malfunction that causes it, but, then, there wouldn’t be much of a gout problem in the first place.

  4. when i took the preventive care pharmacology class with dr. Jerrold Petrofsky [former part of the bobby fischer experiment & genius-in-residence of Loma Linda Unversity Health], he mentioned Orange Juice being the only back then that had been shown to not cause any kind of inflammation, with the research marker being the molecules used by the body to make up the cell walls

  5. I have had 3 gout attacks so severe I ended up being treated for the pain in emergency rooms. I started taking Allopurinol “for the rest of my life.” 4 years ago I switched to a plant based diet…no gout. 3 years ago I stopped taking the pills…no gout!

    1. Since gout is really caused by a disorder of the kidney, what do they attribute the healing to? I’m in the same boat as you. I had my first gout attack at 16 years old. I’m 50 and it still is a crippling disability if I stop taking medication. I’ve reversed lots of things — cholesterol and HBP, but this doesn’t reverse because it’s mostly a genetic anomaly. I eat zero sugar, zero animal protein, no spinach or mushrooms. If I leave Allopurinol for more than about 6 weeks, I have huge flares. I would give anything to stop it because it causes crazy weight gain.

      1. Hello Rob,
        I’m a family doctor with a private practice in lifestyle medicine. I’m sorry to hear about your problems with gout. You are correct that gout is, in part, genetic. But that certainly doesn’t mean that you can’t alter your uric acid levels by modifying your diet. There are several risk factors for gout besides consuming animal protein. These include:

        – alcohol consumption, especially beer
        – overweight/obesity: makes your body produce more uric acid, and your kidneys have a harder time eliminating uric acid
        – certain medical conditions, including diabetes/pre-diabetes, metabolic syndrome, hypertension (although you said your BP is normal)
        – certain medications, especially thiazide diuretics
        – recent surgery or trauma
        – consumption of fructose (fruit sugar), not just sucrose.

        I don’t know if you have any of these risk factors.

        You state that “gout is really caused by a disorder of the kidney.” I’m not sure where you heard that. Gout is due to accumulation of urate crystals in your joints, which causes inflammation. Urate crystal can form when you have high levels of uric acid in your blood. There is a lot of variability in what level of uric acid causes a gout attack, in different people. Your body produces uric acid when it breaks down purines.

        Where the kidneys come in is that they might not excrete enough uric acid into the urine. There are drugs which can increase that excretion — e.g. probenecid.

        But excess production of uric acid is another cause, which is somewhat independent of kidney function. Allopurinol blocks the production of uric acid, and I’m happy that this helps you. Hopefully you don’t suffer any side effects.

        I hope this gives you a few ideas to pursue.
        Dr.Jon
        PhysicianAssistedWellness.com
        Health Support Volunteer for NutritionFacts.org

    1. Thanks so much for posting- this is enormously helpful info. I have a friend who suffers from gout, and am forwarding this newsletter to her right away. I am hoping she will again be able to go out and about with me without being in such pain, often seemingly with every step!

      I am so grateful for all your good work, and always look forward to seeing your posts in my inbox. My husband – who was long resistant to going vegan until seeing your videos- and I are both huge fans of yours! [Also, VERY much looking forward to your new book!]

  6. I used to suffer recurrent gout attacks. It didnt travel anywhere without colchicine. Reading a internet publication somebody established a link between different types of symptoms and liver function and recommended consumption of milk thistle tea. I tryed tea made with a spoonful of seeds. Two days later dandruff disappeared (had it for years ) and since then (3 months) I have not had any gout. Perhaps it will be interesting to look in another direction. It may be that the improper processing of purines in the body has something to do with the liver function. I do not know if there is something published about this, in any case, a cup of seeds of milk thistle infusion daily is cheap and not seems to be toxic.

  7. Hi Dr. Greger,
    Fresh cherries are not available where I live. Do frozen cherries work as effectively? Does it matter if they are sweet or sour cherries?

  8. It seems lowfat dairy is often recommended with gout.

    Gout is what caused me to stop eating meat and most fish about 2 years ago. That along with allopurinol eliminated my gout. But i consume about half a cup of organic lowfat yogurt and 2 slices of cheese each week.

    Does the potential benefit of lowfat dairy make it worth keeping in my diet.

  9. I am looking for help for my brother who is suffering severely with gout. He has been a vegan for years but this has gotten progressively worse, stumping the doctors. A couple of years ago he stopped eating any wheat and the flare ups disappeared. If he eats something with even a trace of wheat the flare ups return. Now he is trying not to eat any protein on top of gluten-free vegan but nothing is working. There has to be something causing inflammation in his body that is producing the high uric acid levels. I am very worried about him. He is young with 3 kids.

  10. Sorry to hear about your brother’s difficulties. I found a few other videos that you might find helpful:
    https://nutritionfacts.org/video/preventing-gout-attacks-with-diet/
    https://nutritionfacts.org/video/treating-gout-with-cherry-juice/
    https://nutritionfacts.org/video/gout-treatment-with-a-cherry-on-top/
    https://nutritionfacts.org/video/which-spices-fight-inflammation/

    Hope that information helps. Wish your brother all the best from us here at nutritionfacts.org

    Kelly
    Moderator

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