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Gout
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Serum Uric Acid
Lowering With Empagliflozin in Heart Failure With Reduced Ejection Fraction
- Medscape, 10/26/22 - "SUA was reduced by an
average of 1.12 mg/dL (66.2 μmol/L) with empagliflozin vs. placebo in this
study, a relatively modest reduction compared with that achievable with
xanthine oxidase inhibitors such as allopurinol.[12] However, the modest
reduction in urate in EMPEROR-Reduced was associated with a significant 32%
reduction in adverse gout outcomes. This is important because hyperuricaemia,
and also clinical gout, often co-exist with heart failure, and this causes
difficulties with therapeutic choices in the management of patients,
particularly with diuretics that can worsen hyperuricaemia. Empagliflozin
treatment in EMPEROR-Reduced was also associated with an impressive 30%
reduction in hospitalizations for heart failure, which was the main driver
of the 25% reduction in the primary outcome of first hospitalization for
heart failure or cardiovascular death. However, interestingly, this finding
was independent of the decrease in SUA observed with empagliflozin therapy"
- See
empagliflozin inhousepharmacy.vu.
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Treatment of Gout with TCM
Using Turmeric and Corn Silk: A Concise Review Article and Pharmacology Network
Analysis - Evid Based Complement Alternat Med 2022 Oct 14 -
"This work aimed to study the compounds, targets, and
pathways of turmeric and corn silk for gout and to explore the mechanism of "the
same disease with different treatments" based on network pharmacology and
molecular docking ... Turmeric and corn silk can treat the same disease, gout,
through different pathways and targets. The scientific connotation of "same
disease with different treatments" can be preliminarily clarified by analyzing
targets and pathways" - See curcumin at Amazon.com and
corn silk extract at Amazon.com.
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Could Vitamin C Help
Reduce Gout? - Medscape, 10/6/22 - "In addition
to lowering levels of uric acid in the body, it's thought that vitamin C may
also minimize the inflammatory response to urate crystals ... But the jury
is still out as to whether vitamin C will have any real benefits. Study
co-author Robert H. Shmerling, MD, is the former clinical chief of the
Division of Rheumatology at Beth Israel Deaconess Medical Center in New
York. He says the study shows that the effect of vitamin C in those
undiagnosed with gout was rather modest. Also, vitamin C did not show a
reduction in gout flare-ups in those who were already diagnosed with the
condition. Not to mention that the study lacked diversity, as the people in
it were all male and mostly white. Still, there's little downside risk to
taking vitamin C, and it might end up being worthwhile." - See
vitamin C products at Amazon.com.
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Chlorogenic Acid
Prevents Hyperuricemia Nephropathy via Regulating TMAO-Related Gut Microbes
and Inhibiting the PI3K/AKT/mTOR Pathway - J Agric Food Chem 2022 Aug 11
- "Hyperuricemia is an independent hazard factor of
renal injury and can induce renal fibrosis, promoting the development of
chronic kidney disease (CKD). This study aimed to explore the probability of
chlorogenic acid (CGA) as a potential substance for preventing hyperuricemia
nephropathy (HN) ... CGA delayed kidney fibrosis in HN rats as evidenced by
regulating the cascade response of the microbiota-TMAO-PI3K/AKT/mTOR
signaling pathway. In summary, CGA can be an excellent candidate for HN
prevention" - See chlorogenic acid at
Amazon.com.
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Effects of vitamin C
supplementation on gout risk: results from the physicians' health study II
trial - Am J Clin Nutr 2022 May 16 - "The
incidence rate of new gout diagnoses during follow-up was 8.0 per 1,000
person-years among those assigned vitamin C versus 9.1 per 1,000
person-years among those assigned placebo. The vitamin C assignment reduced
new gout diagnoses by 12% (HR 0.88; 95% CI: 0.77, 0.99; P = 0.04). These
effects were greatest among those with a BMI <25 kg/m2" - See
vitamin C products at Amazon.com.
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SGLT2 in Patients With
Type 2 Diabetes Lowers Risk of Gout - Medscape, 2/8/22 -
"During a median 5.6-year follow-up, treatment with
an SGLT2 inhibitor was associated with a 54% (P < .0001) lower rate of
incident gout and a 62% (P < .0001) lower rate of all-cause mortality
compared with DDP4 inhibitors in propensity-score matched groups in a
multivariable Cox analysis, after adjustment for significant demographics,
past comorbidities, other drug use, and subclinical biomarkers" -
See
empagliflozin at ihouseepharmacy (no affiliation).
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High fiber diets may alleviate inflammation caused by gout - Science
Daily, 1/4/17 - "diets high in fiber trigger
microorganisms in the gut to produce short chain fatty acids (SCFAs), which
induce neutrophil apoptosis and the resolution of inflammation. These
findings have important implications for the treatment of gout, and possibly
for the treatment of arthritis"
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Quercetin lowers plasma uric acid in pre-hyperuricaemic males: a randomised,
double-blinded, placebo-controlled, cross-over trial - Br J Nutr. 2016
Jan 20:1-7 - "The intervention included one tablet
containing 500 mg quercetin daily for 4 weeks, compared with placebo, with a
4-week washout period between treatments ... After quercetin treatment,
plasma uric acid concentrations were significantly lowered by -26·5 µmol/l
(95 % CI, -7·6, -45·5; P=0·008), without affecting fasting glucose, urinary
excretion of uric acid or blood pressure" - See
quercetin at Amazon.com
 .
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Lowering Dietary
Glycemic Index Reduces Plasma Uric Acid - Medscape, 1/13/16 -
"A low–glycemic index (GI) diet including foods such
as legumes, dairy products, and some fruits might help prevent the
development of gout or the occurrence of gout flares ... Reducing GI lowered
uric acid by 0.24 mg/dL when the percentage of carbohydrates was low and by
0.17 mg/dL when the percentage of carbohydrates was high (both P < .001).
Conversely, reducing the percentage of carbohydrates increased uric acid by
0.10 mg/dL when GI was high (P = .05) and had no significant effect when GI
was low. The largest effect was seen with reducing the GI while increasing
the percentage of carbohydrates, which reduced uric acid by 0.27 mg/dL (P <
.001), an effect maintained even after adjustment for changes in kidney
function, insulin sensitivity, and products of glycolysis"
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Eating cherries lowers risk of gout attacks by 35%, study suggests -
Science Daily, 9/28/12 - "Our findings indicate that
consuming cherries or cherry extract lowers the risk of gout attack ... The
gout flare risk continued to decrease with increasing cherry consumption, up
to three servings over two days.” The authors found that further cherry
intake did not provide any additional benefit" - See
cherry extracts at Amazon.com.
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Foods to Avoid if You Want to Avoid Gout Attacks - WebMD, 5/30/12 -
"People who had the highest amounts of compounds
called purines in their diets increased their risk of having a gout flare-up
by almost five times compared to those eating the least purine-rich foods, a
new study shows ... Foods with the highest purine content include liver,
organ, and game meats, sardines, mussels, anchovies, herring, and beer ...
Foods with moderate levels of purine include red meats, chicken, fish,
asparagus, mushrooms, peas, beans, lentils, cauliflower, and spinach"
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Polyphenols may reduce risk of gout: Study - Nutra USA, 12/13/10 -
"Gout is a painful form of arthritis caused by
disturbances in uric acid metabolism, when an overload of uric acid leads to
the formation of urate crystals in bodily tissues, especially the joints –
leading to recurring attacks of joint inflammation ... Hyperinsulinemia and
insulin resistance can lead to increased uric acid re-absorption in the
kidneys, which in turn can lead to a rise in serum uric acid concentration
... these results suggest that Oligonol lowers serum uric acid through
inhibition of xanthine oxidase, and may be effective for prevention and
treatment of hyperuricemia and/or gout" - See
oligonol at Amazon.com.
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Fructose-rich beverages associated with increased risk of gout in women
- Science Daily, 11/10/10 - "Compared with
consumption of less than 1 serving per month, women who consumed one serving
per day had a 74 percent increased risk of gout; and those with 2 or more
servings per day had a 2.4 times higher risk ... Orange juice intake was
also associated with risk of gout. Compared with women who consumed less
than a glass (6 oz.) of orange juice per month, women who consumed 1 serving
per day had a 41 percent higher risk of gout, and there was a 2.4 times
higher risk with 2 or more servings per day"
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Coffee
consumption and risk of incident gout in women: the Nurses' Health Study
- Am J Clin Nutr. 2010 Aug 25 - "There was an
inverse association between higher coffee intake and the risk of gout. The
multivariate relative risks (RRs) for incident gout according to
coffee-consumption categories [ie, 0, 1-237, 238-947, and >/=948 mL coffee/d
(237 mL = one 8-ounce cup)] were 1.00, 0.97, 0.78 (95% CI: 0.64, 0.95), and
0.43 (95% CI: 0.30, 0.61; P for trend < 0.0001), respectively. For
decaffeinated coffee, the multivariate RRs according to consumption
categories (0, 1-237, and >/=237 mL decaffeinated coffee/d) were 1.00, 1.02,
and 0.77 (95% CI: 0.63, 0.95; P for trend = 0.02), respectively. There was
an inverse association between total caffeine from all sources and the risk
of gout; the multivariate RR of the highest quintile compared with the
lowest quintile was 0.52 (95% CI: 0.41, 0.68; P for trend <0.0001)"
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Vitamin C May Help Prevent Gout - WebMD, 3/9/09 -
"men who had the highest vitamin C intake from
supplements and food were up to 45% less likely to develop the painful
condition than those who had the lowest ... the results suggest that taking
vitamin C supplements at the levels in the study (less than 2,000 milligrams
per day) may be a safe and effective way to prevent gout" - See
vitamin C products at Amazon.com.
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Vitamin C May Prevent Hyperuricemia, Gout - Medscape, 9/26/08 -
"Hyperuricemia is considered a precursor of gout,
which is the most common inflammatory arthritis in adult men ... An
association was observed between greater vitamin C intake and lower
prevalence of hyperuricemia defined as > 6 mg/dL. The multivariable odds
ratio for hyperuricemia for the highest intake of vitamin C (>1000 mg/d)
compared to the lowest (<90 mg/d) was 0.34 ... These findings support a
potential role of vitamin C in the prevention of hyperuricemia and gout"
- See
vitamin C products at Amazon.com.
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Increased Coffee Consumption May Reduce Risk for Gout in Men - Medscape,
5/25/08 - "During the 12-year study, there were 757
confirmed incident cases of gout. Increasing coffee intake was inversely
associated with the risk for gout, with multivariate relative risks (RRs)
for incident gout of 1.00, 0.97, 0.92, 0.60 (95% confidence interval [CI],
0.41 - 0.87), and 0.41 (95% CI, 0.19 - 0.88) for coffee consumption
categories of 0, less than 1, 1 to 3, 4 to 5, and 6 or more cups per day,
respectively ... For decaffeinated coffee, the multivariate RRs for 0, less
than 1, 1 to 3, and 4 or more cups per day were 1.00, 0.83, 0.67 (95% CI,
0.54 - 0.82), and 0.73 (95% CI, 0.46 - 1.17), respectively"
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Vitamin C Intake and
Serum Uric Acid Concentration in Men - J Rheumatol. 2008 May 1 -
"An inverse dose-response association was observed
through vitamin C intake of 400-500 mg/day, and then reached a plateau ...
Greater vitamin C intake was associated with lower prevalence of
hyperuricemia (serum uric acid > 6 mg/dl). Multivariate odds ratios for
hyperuricemia across total vitamin C intake categories were 1 (reference),
0.58, 0.57, 0.38, and 0.34 (95% CI 0.20-0.58; P for trend < 0.001). When we
used dietary data, which were assessed 4-8 years before blood collection, as
predictors, we observed similar inverse associations between vitamin C
intake and uric acid ... These population-based data indicate that vitamin C
intake in men is inversely associated with serum uric acid concentrations.
These findings support a potential role of vitamin C in the prevention of
hyperuricemia and gout" - See
vitamin C products at Amazon.com.
- Drinking 4 or More
Cups of Coffee a Day May Help Prevent Gout - Medscape, 8/23/07 -
"the risk for developing gout decreased with
increasing coffee consumption. The risk of gout was 40 percent lower for men
who drank 4 to 5 cups a day and 59 percent lower for men who drank 6 or more
cups a day than for men who never drank coffee"
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Coffee Consumption May
Lower Uric Acid Levels - The Precursor of Gout - Medscape, 8/23/07 -
"levels of uric acid in the blood significantly
decreased with increasing coffee intake, but not with tea intake"
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Drinking Four Or More Cups Of Coffee A Day May Help Prevent Gout -
Science Daily, 5/25/07 - "the data revealed that the
risk for developing gout decreased with increasing coffee consumption. The
risk of gout was 40 percent lower for men who drank 4 to 5 cups a day and 59
percent lower for men who drank 6 or more cups a day than for men who never
drank coffee"
Other News:
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Gout
medicine improves survival for heart failure patients, study finds - Science
Daily, 5/19/22 - "Researchers reviewed the records of
more than 1,000 patients admitted to University of Virginia Medical Center
between March 2011 and February 2020 for worsening heart failure. Patients who
received colchicine for a gout flare had a survival rate of 97.9%, compared with
a 93.5% survival rate for patients not receiving colchicine ... While colchicine
is a well-established treatment for gout, the UVA research team believes the
medication's anti-inflammatory properties may also be key to improving outcomes
for heart failure patients. They think that colchicine may modulate inflammation
in the heart and blood vessels with potential for improving outcomes, especially
in the acute phases of heart failure hospitalizations"
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Empagliflozin and uric acid
metabolism in diabetes: A post hoc analysis of the EMPA-REG OUTCOME tri -
Diabetes Obes Metab 2021 Sep 24 - "Empagliflozin reduced
UA levels and the composite of gout episodes or prescription of antigout
medication. These clinically important findings expand the utility of
empagliflozin as a potential antigout treatment in patients with T2D, beyond its
well-established cardio-renal benefits"
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New
drug aids gout patients not helped by standard treatments - Science
Daily, 8/16/11 - "Injections of pegloticase, a
modified porcine enzyme, can produce significant and sustained clinical
improvements in 2 out of 5 patients with chronic gout that is resistant to
conventional therapies"
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Gout Drug May Lower Blood Pressure - WebMD, 9/23/09 -
"A new study suggests a direct link between a
high-sugar diet and high blood pressure ... allopurinol could lower high
blood pressure by lowering uric acid" - Note: Kind of a confusing
article. Yeah, high blood sugar probably is a cause of high blood pressure
and high uric acid but the article implies that allopurinol lowers blood
pressure by lowering the uric acid not the blood sugar so why is it
discussing blood sugar? I've written WebMD before about articles like that
and they've agreed and changed it. This one is minor I guess.
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New Gout Drug Gets FDA Panel Nod - WebMD, 11/24/08 -
"Uloric should be the first new gout drug to be
approved in over 40 years ... Unlike allopurinol, very little Uloric is
excreted through the urine, making Uloric safe for patients with kidney
problems"
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Blame
Sweet Soda for Gout? - WebMD, 1/31/08 -
"Compared with men who almost never drank sugar-sweetened soft drinks --
fewer than one per month -- frequent soft-drink drinkers were significantly
more likely to suffer gout: ... Two or more soft drinks each day upped gout
risk by 85% ... One soft drink each day upped gout risk by 45% ... Five or
six soft drinks each week upped gout risk by 29%"
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Sugar-sweetened soft drinks, diet soft drinks, and serum uric acid level:
The third national health and nutrition examination survey - Arthritis
Rheum. 2007 Dec 28;59(1):109-116 - "sugar-sweetened
soft drink consumption is associated with serum uric acid levels and
frequency of hyperuricemia, but diet soft drink consumption is not"
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