Treating the disease of kings with diet

Gout has long been termed the “disease of kings” because hundreds of years ago in Europe, it was the royalty who were primarily impacted by the disease.

I’ve personally seen how gout can impact not just a person’s life but also all of those around them. I have a family member who suffers from it and have seen how he has struggled with the disease for years, much to the dismay of his wife and children. My grandfather also had it, and I remember when I was young how some days he was essentially bed-restricted from the pain.

Now neither my grandfather nor any other family members are royalty (despite how we may sometimes act). But as it turns out, it’s has nothing to do with royalty, but more often than not is commonly found in overweight and obese people who consume rich foods and drink alcohol. Historically only the very wealthy could afford to eat such foods with such frequency which is why the disease has the reputation it does, but today nearly everyone has access to these debilitating foods, and as such, gout now affects nearly 1-2% of the American population at some point in their lives, and as high as 5% of men over the age of 65. This makes it the most common inflammatory arthritis in men and older women.

For some time we’ve know that foods high in purines tend to trigger and set off gout. Purines are a compound found naturally in certain foods that form uric acid. Gout accrues when that uric acid crystalizes in our joint fluid, causing a very painful form of inflammation. As such, when a person suffers from gout they are told to avoid foods that contain a high level of purines.

Seafood and organ meats are among the highest purine-containing foods (chicken and other meats are high on that list as well). However beans are also surprisingly high on that list of foods with purine.

However a study published in the Annals of the Rheumatic Diseases found that the risk for a gout attack increased five times with the consumption of animal protein when compared to those consuming plant-protein.

So then why are beans always excluded from a gout-prescribed diet? Well Brenda Davis, R.D. figured it out. Most lists of purine containing foods, display the amount of purines found in 100 grams of a food. Now 100 grams of beans is roughly half a dry cup, which when cooked is closer to 1.5 cups. The average serving size for a portion of beans is 1/2 cooked cup.

This means that most lists of high-purine foods are measuring triple the recommended serving size for beans. Imagine if we tripled the serving size of chicken? Most beans fall in the moderate range, and have a purine count of  20-75 mg per serving. 

Diets typically suggest avoiding the highest purine foods which have over 200 mg purines per serving or more (these are typically seafoods and organ meats), greatly reducing foods that contain 100 mg purines per serving (this is where white fish, pork, steak and chicken all fall) and eating no more than one portion  per day of moderate foods, or those that have between 50-100 mg per serving (hello beans!). 

The authors of the above study also cited other studies which found that long-term, habitual consumption of purine-rich vegetables was not associated with an increased risk of gout. That means eating beans may not be a bad thing, even for those suffering with gout.

I would be remiss if I didn’t mention that a different study from the EPIC-Oxford group found that vegans actually had the highest levels of blood uric acid compared to vegetarians, fish eaters, and meat eaters, but the authors did not look specifically at gout, and even still they found that the vegans had the lowest scores for other risk markers of gout, including Body Mass Index. They attributed the high level of uric acid to consumption of soy protein, and a lack of dairy, which may have some benefits for uric acid - although it could have many other serious health risks (see: here, here, here, here, here).

At first this paper seems contradictory from what we normally know. However, this is in fact, one of those papers where they actually over adjust, skewing the end result. They adjusted for BMI, which is the problem. It's problematic because we know that meat consumption leads to weight gain (In fact, according to one EPIC study, chicken is the biggest offender!) Weight gain tends to go hand and hand with higher levels of uric acid, which is why overweight and obese people have much higher incidence rates of gout, so when they adjust the studies statistics, they take the majority of meat eaters out, in favor for the minority whose bodies seem more adapt at processing heavy animal products. Also exercise was not added into the equation, and it remains possible that some of the patients included in the study switched to a vegetarian or vegan diet after they first got gout.

Finally, there may be one fruit that seems uniquely helpful when dealing with this painful disease. The same research team that published on animals vs plants proteins, uric acid, and gout incidence, published a second paper that same year which found that cherries seem to be a particularly protective when trying to control gout. But unlike the EPIC-OXFORD research, this one specifically examined patients suffering from gout.

They studied 633 individuals who were suffering from gout, and found they had a 35% decreased occurrence rate of gout when consuming just 1/2 cup of cherries per day - they did not change anything else (including any medications they were taking) - but simply ate cherries. The other fruits they tested did not have the same benefits.

When patients who were taking medications to help control their attacks added cherries, the researchers saw even greater benefits, reducing attack occurrences by 75% compared to an untreated control. 

Another paper found that fresh, frozen, and even cherry juice all worked well. As little as 1 tablespoon of concentrated cherry juice per day could decrease the flare ups. The cherry juice decreased flare up occurrences by as much as 50%, and nearly 50% of all the patients in the study were able to stop taking their medication for the crippling disease. 

So if you suffer from the disease of kings, you may be able to greatly reduce or completely stop your flare ups by simply making some small changes in your diet, namely minimizing or eliminating alcohol and meats, while increasing your consumption of fruits and veggies (potentially beans as well) and especially by adding cherries (in almost any form - although I haven't been able to track down a study showing the benefits of cherry pies yet!). While all the studies recommended more research be done on treating gout with diet, the only know side effects of eating cherries or even adopting a plant-based diet is better health. 

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Schlesinger, N. et al. “Previously reported prior studies of cherry juice concentrate for gout flare prophylaxis: comment on the article by Zhang et. al” Journal of Arthritis 2013 April. 

Schmidt, J et al. “Serum Uric Acid Concentrations in Meat Eaters, Fish Eaters, Vegetarians and Vegans: A Cross-Sectional Analysis in the EPIC-Oxford Cohort.” PLoS ONE 8(2): e56339.

Vergnaud, A.C. et. al. “Meat consumption and prospective weight change in participants of the EPIC-PANACEA study” American Journal of Clinical Nutrition. 2010 August 92 (2).

Zhang, Yuging et al. “Cherry consumption and decreased risk of recurrent gout attacks” Journal of Arthritis 2012 64 (12).

Zhang, Yuging et al. “Purine-rich foods intake and recurrent gout attacks” Annuals of Rheumatic Diseases Sept. 2012, 71 (9).

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.