Gout Treatment with a Cherry on Top

Gout Treatment with a Cherry on Top
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How do sweet cherries compare to the drug allopurinol and a low-purine diet for the treatment of the painful inflammatory arthritis gout?

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

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, we couldn’t eat that many. And, in fact, if we tried, it could end up 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 eat about 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.” That’s actually the name. As you can see, even a month after the study ended, there appeared to be residual anti-inflammatory benefit from the cherry fest.

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 [in our] joints,” affecting eight million Americans. “Such attacks cause tremendous pain,” as famously captured in this caricature.

Hundreds of gout sufferers studied, and “[c]herry 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 breakdown 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. Now, there are some high-purine non-animal foods, like mushrooms and asparagus, but they found no significant link to plant sources of purines. So, they recommended eliminating meat and seafood from the diet.

That 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, which can detach our skin from our body. I will spare you the photos.

In addition to fighting inflammation, cherries may actually help 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 carries “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, “[a]ttention 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.”

Please consider volunteering to help out on the site.

Images thanks to NEW! Pink Sherbet via flickr, and James Gillray via Wikimedia

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

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, we couldn’t eat that many. And, in fact, if we tried, it could end up 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 eat about 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.” That’s actually the name. As you can see, even a month after the study ended, there appeared to be residual anti-inflammatory benefit from the cherry fest.

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 [in our] joints,” affecting eight million Americans. “Such attacks cause tremendous pain,” as famously captured in this caricature.

Hundreds of gout sufferers studied, and “[c]herry 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 breakdown 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. Now, there are some high-purine non-animal foods, like mushrooms and asparagus, but they found no significant link to plant sources of purines. So, they recommended eliminating meat and seafood from the diet.

That 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, which can detach our skin from our body. I will spare you the photos.

In addition to fighting inflammation, cherries may actually help 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 carries “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, “[a]ttention 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.”

Please consider volunteering to help out on the site.

Images thanks to NEW! Pink Sherbet via flickr, and James Gillray via Wikimedia

Doctor's Note

For more about the inflammation-fighting effects of sweet cherries, see Anti-inflammatory Life is a Bowl of Cherries.

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

For other foods that may help tamp down inflammation, see:

If you haven’t yet, you can subscribe to my videos for free by clicking here.

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