PHILADELPHIA — Drinking water or skim milk can improve gout control, according to findings from two studies that highlight the important contribution of lifestyle factors on gout prevention and management.
“Our results show that drinking water is a simple, safe, and effective means of trying to reduce recurrent gout attacks,” Dr. Tuhina Neogi said at the annual meeting of the American College of Rheumatology.
The study included 535 people who had had a gout attack within the past year (78% male; mean age, 53 years) and who provided information via the Internet about food, drink, medications, physical activity, and other possible gout risk factors during periods preceding the attack and during attack-free periods. By using a case crossover study design, the participants acted as their own controls. Medical records were accessed to verify gout diagnosis, explained Dr. Neogi of Boston University.
The findings showed that increasing water intake was associated with decreased risk for recurrent gout attacks. Compared with those who drank no or one 8-ounce glass of water per day, those who drank five to eight glasses had a 40% lower chance of a gout attack and those who drank more than eight glasses had a 46% lower chance.
In the second study, researchers from New Zealand measured the acute effects of skim milk consumption on serum urate concentrations in 16 healthy male volunteers, in light of reports that skim milk was beneficial in gout prevention. The randomized controlled crossover study was designed to assess the effects of skim milk that was from the early season and the late season, as well as MPC85, a milk protein concentrate that contains 85% protein. The effects of soy milk consumption also were assessed, and it was considered the control.
“Late-season” skim milk, primarily available from countries where milking is seasonal and cows are grass fed, is high in orotic acid, a substance known to promote uric acid removal by the kidneys, explained Dr. Nicola Dalbeth, a senior lecturer in clinical medicine at the University of Auckland (New Zealand). MPC85 skim milk is ultrafiltered and contains very low concentrations of orotic acid, purines, and lactose.
Each participant received a single dose of each product in a random order, with each study visit separated by a week. The amount consumed was equal to about 3.5 8-ounce glasses of milk in one sitting (80 g of protein in 800 mL). Serum and urine were obtained immediately before ingestion and then hourly over the next 3 hours.
Drinking soy milk led to a 10% increase in serum urate. In contrast, all skim milks decreased serum urate by about 10% (P less than .0001). All products, including soy, led to an increase in the fractional excretion of uric acid (FEUA).
Interestingly, there were differences among the types of skim milk, which may shed light on the underlying mechanism. Late-season skim milk led to a greater increase in FEUA, compared with either ultrafiltered skim milk or early-season skim milk, suggesting that the acute urate-lowering effect of orotic acid may explain these effects.
“We cannot necessarily extrapolate these results from [healthy individuals] to those with gout,” Dr. Dalbeth acknowledged. “Furthermore, I am not saying drinking milk should replace allopurinol. But one of the key things we do is spend a lot of time telling people with gout what not to do, such as do not eat red meat. It is very useful to have some positive information.”
“Even though gout has been known since antiquity, and we have had treatments around for decades, it is not a well-managed disease. Medical management is still the cornerstone. Still, there are a lot of lifestyle and behavioral aspects that people with gout can do for themselves to reduce their risk,” Dr. M. Elaine Husni, vice chair of rheumatology and director of the arthritis and musculoskeletal center at the Cleveland Clinic, said when she was asked to comment on the results of both studies.
Dr. Neogi reported having no conflicts of interest. Dr. Dalbeth said that her study was funded in part by the Fonterra Dairy Cooperative, and that one of the study authors was an employee of Fonterra.
Elsevier Global Medical News