01 January 2019

Michael Greger - Century Gout | Health and Nutrition

Thanks For Watching : Michael Greger - Century Gout | Health and Nutrition. You don't have to be Henry the VIII to get gout. Find out how to prevent and treat ...

you today we look at a disease that many

associate with English kings from the 17th century called gout but anyone who has it today can tell you it's a very real and painful condition it occurs when there's a buildup of uric acid in the blood and can be caused by the food we eat if the uric acid crystals that trigger gout comes from the breakdown of purines should gout patients avoid even healthy purine rich fruits such as beans mushrooms and cauliflower that'll be the first story I cover here over 2,000 years ago Hippocrates described gout as a disease of kings primarily because it was the wealthy who could afford the rich foods which seemed to precipitate Goudy attacks but now we can all eat like kings and acquire some diseases of royalty ourselves gout is caused by needle-sharp crystals of uric acid in our joints and uric acid comes from the breakdown of purines and purines are the breakdown product of genetic material DNA the foundation of all life so there's no such thing as a purine free diet but foods do vary in their purine content it was long thought that people with

gout just need to stay away from all high purine foods whether they're from animals like organ meats or plants like beans but this strategy proved ineffective yes all uric acid comes to the breakdown of purines so limiting meat makes sense but that means all kinds of meat and plant sources have now been largely exonerated the association of gout with more with both alcohol and take an increased dietary purine consumption it's been known since ancient times but there were no prospective trials to back it up until just a decade ago the harvard health professionals follow-up study about 50,000 men fall for a dozen years in alcohol intake strongly associated increased risk of gout in terms of food they found increased risk of gout with higher meat and fish consumption but not with our consumption of purine rich plant foods maybe because the purines and plants are less bioavailable so though it's been suggested that gout sufferers should moderate both purine-rich animal and plant foods the results suggest that this type of dietary restriction may be only applicable to purines of animal

origin although it was not surprising the meat and seafood had significant associations with the incidence of gout this lack of effect of purine rich plant foods was new there don't appear to be any long term studies showing purine rich foods plant plant foods increase risk though there are still some guidelines out there continuing to disseminate these outdated recommendations not only has the intake appearing rich plans not been associated with high uric acid levels but the vegetables gout sufferers are specifically told to stay away from mushrooms peas beans lentils cauliflower were actually found to be protective this may be because foods rich in fiber folate and vitamin C appear to protect against uric acid buildup and gout for example fiber has been recognized as having a potential and binding uric acid in the gut for excretion lack of association between purine rich vegetables in urate could be due to the co packaging of these beneficial plant components vitamin C dietary fibers and phytochemicals which may mediate the effect of purines on uric acid vegetable intake regardless purine content must be

protective in terms of getting rid of uric acid via excretion by changing the pH of our urine we can change uric acid clearance eating an alkaline diet a vegetarian diet in this case was found effective for removing uric acid from the body those eating the alkaline diet excreted significantly more akyurek acid than those eating the acidic diet as such uric acid levels in the blood of those eating the acid forming dyed rose within days someone would assume uric acid levels are lower in vegetarians and indeed those eating vegetarian long-term found have significantly lower levels in their blood to prove cause and effect though you need to do an interventional trial where you take people change the diet see what happens so they took ten guys for a study of the build-up of uric acid in the kidneys kept them on a standard Western diet for five days and measured their relative supersaturation for uric acid then they tried a vegetarian diet for five days the intake of the vegetarian diet led to a 93 percent decline in the risk of uric acid crystallization within days or you can do it the other way take a bunch of people with gout feed them a big meal of

meat and see if you can trigger an attack seven patients were put in the hospital stabilized on a low purine done and then challenged with a meat Laden dinner in response uric acid level shut up and they started getting gout attacks then the added alcohol and uric acid levels shot up even further and all just with single meals they were able to trigger gout attacks in six out of the seven patients now some meat has less purines than others super worms have particularly low purine levels super because they're like 2 to 3 inches long not all animal foods increase gout risk though low-fat dairy products are found to be protective if that's the case we would predict vegans would be at a disadvantage with which is indeed what was found though these were all within the normal range which is like 3.5 to spend should gout patients add milk to their diets well although drinking the equivalent of 10 cups of skim milk at a time and peers to have an acute lowering effect on uric acid levels in the long term over months at the equivalent of two cups a day there was not a statistically significant lowering

effect they gave skim milk powder to gout patients for three that did not appear to help though soy milk has also been associated with lower risk of the uric acid buildup there are no interventional trials to back that up the bottom line is that we now have good research on how to reduce the risk of gout without the use of drug treatments two modification of diet that's important because allopurinol is the drug of choice it's considered generally safe but what does it mean when doctors talk about a relatively safe drug well about two percent of patients develop hypersensitivity reactions which can sometimes be severe and fatal with a mortality rate of up to 20% and that's the safe drug the other leading drug colchicine has no clear-cut distinction between the non-toxic toxic and lethal dose in our next story we explore how sweet cherries compared to the drug allopurinol and a low purine diet for the treatment of the painful inflammatory arthritis gout 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 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 percent drop in c-reactive protein levels as well as an inflammatory protein with an inelegant acronym regulated on and activation normal t-cell expressed and secreted that's actually the name 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 and folks with higher levels of solid 20% drop in c-reactive protein 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 obscure Texas Medical Journal observations made by responsible physician suggested that in a dozen patients with gout eating half a pound of fresh or canned cherries help prevent flares of gout but had never been seriously tested until now gout is an excruciating ly painful inflammatory arthritis caused by the crystallization of uric acid in our joints affecting 8 million Americans such attacks caused tremendous pain hundreds of gout sufferers studied and cherry intake was associated with a 35 percent lower risk of gout attacks with over half the risk gone at 3 servings a measured over a two-day period which comes out to be about 16 cherries a day and that's the kind of efficacy they saw with a low purine diet uric acid is a breakdown product of purines the same research group found that purine intake of animal origin increased the odds for recurrent gout attacks by nearly fivefold heavy alcohol consumption it's 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 a leading drug allopurinol works but pills and produce appear to work even better and dietary changes in 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 big bowl of cherries uric acid levels in the blood significantly drop at the same time antioxidant levels and the blood go up as vitamin C levels start to rise so is it just an antioxidant effect and 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 non pharmacological treatments or prevention in the first place given the potential harms and high cost attention ought to be directed to dietary modification reducing alcohol and meat intake particularly sardines and organ meats and hey if life's is up a bowl of cherries consumed on a regular basis the risk of a recurrent gout attack may be meaningfully reduced sherry consumption has been shown to successfully prevent gout arthritis attacks but what about cherry juice constant over the last 40 years the burden of the gout painful inflammatory arthritis has risen considerably now affecting millions of Americans gathers now the most common inflammatory arthritis in men and older women in my video gout treatment with a cherry on top I profiled new research suggesting that even as little as a half a cup of cherries a day may significantly lower the risk of gout attacks fresh cherries aren't always in season though so it listed a few alternatives and frozen

appeared second best with cherry juice concentrate the runner up but does concentrated cherry juice actually help prevent attacks of gout we didn't know until now the first policy was a randomized control trial cherry juice concentrate versus pomegranate juice concentrate is the control for the prevention of attacks in gout sufferers who are having as many as four attacks a month the cherry group got a tablespoon of cherry juice concentrate twice a day for four months and the control group got a tablespoon of pomegranate juice concentrate twice a day for four months the number of gout flares in the cherry group dropped from an average of five down to two better than the pomegranate group which only dropped from about five to four and about half of those in the Cherry Group who were on prescription anti-inflammatory drugs were able to stop their medications within two months after starting the cherry juice as opposed to none of the patients in the pomegranate juice group the second study was a retrospective investigation over the longer term 24 gout patients went from having about seven attacks a year down to two the researchers conclude

cherry juice concentrate is efficacious for the prevention of gout flares certainly large long-term randomized control trials are needed to evaluate the usefulness of cherries and cherry juice country for gout flare prophylaxis but in the meanwhile our cherries now write for use as a complementary therapeutic in gout I understand the pharmaceutical industry can get nervous seeing studies where half of patients were able to stop taking their gout drugs given the billions of dollars at stake but what's the downside of eating I have a cup of cherries a day or worse comes to worse a few spoonfuls of cherry juice we would love it if you could share with us your stories about reinventing your health through evidence-based nutrition go to nutritionfacts.org forward slash testimonials we may share it with our social media to help inspire others