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Gout Dugout.Issue #073 | A new way to lower uric acid by diet
May 01, 2016
Hello and Welcome to the Spring 2016, edition of the Gout Dugout newsletter.
First an APOLOGY. I usually write this newsletter/ezine in the last week of the three month period. But I was "hit" by a series of urgent matters.
Then, they say trouble comes in two and threes - sure enough, I next went down with a nasty bug
Hence the delay to the Spring issue.
If you are searching for new techniques to lower uric acid in your blood – even by a small amount – you should find the following interesting. And it's new – the first time the Glycemic Index and uric acid has been the subject of a study.
There are not as yet any studies about whether a low carbohydrate diet is good for gout and reduces uric acid, although losing weight should have a lowering effect. The next best thing I guess (up till now) are the comments about gout in Robert Atkins’ low carb diet books
"Effects of Lowering Glycemic Index of Dietary Carbohydrate on Plasma Uric Acid Levels: The OmniCarb Randomized Clinical Trial."
(Full details below))But I'd recommend you read my article here a couple of times, to whet your appetite.
Detailed study numbers for the four diets - Glycemic Index values used, energy from carbs, energy from protein, energy from fat, amounts of fibre/fiber,vegetable protein, and other nutrients can be seen on Table 1 of the study.
A NEW STUDY ABOUT THE GLYCEMIC INDEX AND URIC ACID
Stephen Juraschek MD, of Johns Hopkins Hospital in the USA, reported the results of a Glycemic Index and uric acid study, (1) using data from the Omnicarb trial, in the December 2015 edition of Arthritis & Rheumatology. After the trial Dr.Juraschek concluded: "Whilst our study was not conducted in a population with hyperuricemia (high uric acid) or gout, we show that a low GI/high carbohydrate diet can modestly reduce uric acid levels. While similar studies are needed in patients with hyperuricemia or gout, it is reasonable for clinicians to recommend GI reduction as one aspect of a lifestyle based strategy to reduce uric acid."
I should add - when weight is not lost, because weight was not lost in the study. see below. And in this study the best results came when dietary carbohydrates were increased, not lowered.
However, before we all get too excited, keep in mind this is only the first such study. And the uric acid reductions were not that much.
So what is the Glycemic Index (GI)?
The GI score of a food measures the amount of blood glucose two hours (following a 12 hour fast), after eating an amount of food that contains 50 grams of net carbohydrates ( carbs in grams minus fibre/fiber in grams).
It can be used as an extra tool in restricted carbohydrate dieting, or as a diet in itself.
All GI measured foods (most have been) are scored between 0 and 100, based on 50 grams of net carbohydrate. One hundred is the standard, of pure glucose, (a carbohydrate) to which all others are compared. Sometimes the GI score for white bread is used as the standard which gives an alternative set of GI values for foods.
Fast conversion means blood glucose (blood sugar) levels are raised quickly, and thus insulin is called forth quickly to transport glucose into cells. Because it happens speedily, it is more likely, over time, to cause insulin resistance. Insulin resistance in many studies has been shown to raise uric acid blood levels.
You know what that can mean. But low or medium GI foods call forth insulin more evenly and slowly, and that is better. How does the GI score this process ? GI numbers between 70 – 100 mean high glucose conversion; GI numbers between 56 – 69 mean medium glucose conversion; GI numbers between 0 – 55 mean low glucose conversion.
One food may increase blood glucose more than another, despite both containing an equal amount of carbohydrate. And therefore also call forth different amounts of insulin.
The study and its results
Four groups of trialists led to four different outcomes. The results of the study were that reducing GI lowered blood plasma uric acid by 0.24 mg/dL when the percentage of carbohydrates in their diet was low, and by 0.17 mg/dL when the percentage of carbohydrates in their diet was high.
When GI was high and the percentage of carbohydrates was reduced, uric acid increased by 0.10 mg/dL when GI was high. It had no significant effect when GI was low.
If all that seems confusing, focus on this.
The best effect among the four groups was achieved by reducing the GI while increasing the percentage of carbohydrates. This combined approach reduced uric acid by 0.27 mg/dL. 0.27 mg/dL was after statistical adjustment for changes in kidney function, insulin sensitivity, and the products of glycolysis (the breakdown of glucose, a carbohydrate, into energy and the production of lactic or pyruvic acid).
What about protein and uric acid ? The study added some fuel to the argument that protein consumption increases uric acid, although that is not a done deal despite many believing it. The low carb group ate more protein and their uric acid went up but not much. Changes in protein intake also meant changes in fat intake, which might have confounded the protein result.
Note that you do not necessarily eat more protein on a low/restricted carb diet. You can find foods which are low carb and low protein especially fruits and vegetables. And on a low carb diet your appetite usually falls, so you eat less food.
The Glycemic Load
There is a more sophisticated version of the Glycemic Index (GI) called the Glycemic Load (GL). GL could also be the subject of a study to learn the numbers for effects on uric acid. If you know and understand what the Glycemic Load number of a food means, use that instead of the Glycemic Index. For example, watermelon has a high GI, but a low GL for the amount usually eaten.
Glycemic Index and uric acid - is it worth paying attention ?
You have to master the GI concept (and understanding the GL concept would help more), to make good use of it. That means quite a lot of study to get a potentially small reduction in uric acid. But mastering it helps you to do a restricted carb diet more effectively and that could reduce uric acid much more, through lost weight. However, I have lost a lot of weight on a low carb diet, but although I know the carbs in foods/drinks, I have never paid much attention to GI/GL.
This is the only GI diet study so far to see the effect on uric acid. Other confirming studies are needed, especially with people to have gout or hyperuricemia. I'd say make it an addition to a restricted carbohydrate diet where you lose weight, but only you can decide if it's worth it.
ZURAMPIC (LESINURAD) NOW APPROVED IN THE US AND EU NATIONS
We have a new gout drug.
Lesinurad was approved by the US FDA (just before last Christmas) Not long after (January 2016) it was approved in EU nations. Plus Iceland, Norway and Liechtenstein, which are non EU. If you live in Switzerland (also non EU) it seems not yet – check with your doctor. Lesinurad has been given the brand name Zurampic. It can be prescribed as 200 mg tablets and must be used with a xanthine oxidase inhibitor drug – i.e. with allopurinol or febuxostat.
If you use it, pay close attention to the box warnings which includes the risk of kidney failure at 400 mg (not an approved dose) and to what your doctor says. In the US, it was deemed effective unanimously by an FDA committee, but only a majority of one deemed it safe. It must be taken with a
xanthine oxidase inhibitor drug. If you have kidney or heart issues tell your doctor.
Use www.best-gout-remedies.com's search box, located towards the bottom of the Home Page, to find site references to any word you enter into it. It is a good way to find out where and what the site has to say about any gout topic. For example, want to know more about Rasburicase for gout ? Type – Rasburicase - in the site search box.
There are currently around 250 pages, including all the back issues of this newsletter. It works. Use it!
Thanks for reading. Best of gout free health !
John Mepham BA (Econ) Makati City, Philippines
(1) Stephen P Juraschek MD, PhD, Mara McAdams-Demarco PhD, Allan C Gelber MD, PhD, Frank M Sacks MD, Lawrence J. Appel MD, MPH, Karen White MS, RD and Edgar R Miller III MD, PhD Effects of Lowering Glycemic Index of Dietary Carbohydrate on Plasma Uric Acid: The OmniCarb Randomized Clinical Trial Arthritis & Rheumatology DOI:
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