This page about cherries and gout - 2nd and 3rd trials - was last reviewed or updated on 5 March 2013
This article discusses a report of three trials study (1) about cherry juice concentrate for gout. The 2nd and 3rd trials are described on this page. To read about the 1st trial click on the link at the bottom.
In the medicine professors’ second cherries and gout study, patients who were taking CJC (cherry juice concentrate) were examined for four plus months. Again the "dose" was 1 tablespoon twice daily.
Did some participants see their gout flares fall as they had in Study 1?
CHERRY STUDY 2 - GOUT FLARES DOWN AGAIN.
In the medicine professors’ second cherries and gout study, patients who were taking CJC (cherry juice concentrate) were examined for four plus months. Again the "dose" was 1 tablespoon twice daily. Did some participants see their gout flares fall as they had in Study 1?
This fella fights gout
The good news is that yes some did. Among the 24 monitored gout patients, all taking cherry juice concentrate – 11 also taking uric acid lowering meds, 13 not taking uric acid lowering meds – gout flares (attacks) fell from an annual rate of 6.85 (equivalent to an average attack rate of just about every two months) to an annual rate of 2.0 (an average attack rate of every six months). Sound good to you? It does to me, an excellent reduction that can be compared with the results you usually get from drugs, but sometimes don’t.
And from only two tablespoons a day but which the researchers said is equal to 90-120 cherries, which is a lot.
Was it the meds? Apparently not, or not entirely.
Allopurinol plus cherry juice concentrate performed well
Many sufferers take allopurinol and sweet or tart cherry juice for gout daily. In those who did here, there was encouraging uric acid news – the expected fall. Trialists start-line uric acid was 8.4 mg/dL. In 4-6 months it had fallen to 6.2 mg/dL. At 6.2 mg/dL it was at just about the change of uric acid zones to the potentially gout conquering one of below 6.0 in men, a bit less in women. At 6.2 many patients would end gout flares. But the fall was due to the allopurinol, not the cherry juice concentrate.
A CHALLENGE TO A CONVENTIONAL GOUT BELIEF
This second study threw up some curious gout news. Doctors, rheumatologists, gout researchers, in fact the whole gout industry, say and write that you need to get your uric acid down below 6.0 mg/dL (0.357 mmol/L) to reach gout’s "promised land." I assumed that for example, in the above paragraph about allopurinol. But in this study, it seems the action of cherry juice caused patients to become flare free at 7.8 mg/dL (average, all patients).
That is, without scarcely a fall in uric acid as noted above. This is much higher than 6.0. Among the 36% (4 of 11) who were not also on uric acid lowering therapy, they were flare free at 8.7 mg/dL which is extraordinary.
A uric acid reduction of 7.8 down to 6.0 (-1.8), or 8.7 down to 6.0 (-2.7) are large falls that can take gout sufferers a lot of work, diligence and medications to achieve.
It sounds good, but I still think most gouty folk would be wise to get their uric acid below 6.0 mg/dL (women a bit less) and keep it there. You have to deal with gout for your remaining lifetime and it gets slowly worse if untreated or not treated well. You may not succeed again at 7.8 or 8.7. So aim for 6.0 and below. But it might mean that on your journey to 6.0 you end flares before you get that low, as was the case here. It’s an enticing prospect.
Study 2 Dosage Same as Study No.1. That is one tablespoon of concentrated tart (sour), pure, (nothing added) cherry juice, twice daily.
Main snags of these two cherries and gout trials? The small number of trialists. And the studies were only for 4 months or so.
Read on if you are interested in a scientific explanation for why tart (sour) cherry juice concentrate, and maybe other cherries' forms did halt, or reduce, gout flares in a sizeable number of the trialists
CHERRY STUDY 3 - IS THIS WHY CHERRY JUICE CONCENTRATE WORKED IN SOME?
The third study in this report was an in vitro (i.e. test tube/petri dish) study to find out if CJC, and PJC (pomegranate juice concentrate), could inhibit interleukin (IL) and TNF-a secretion as a consequence of the addition of gout’s MSU crystals to two kinds of human cells in petri dishes. Some research scientists think IL-1B drives gout's inflammation. i.e. it facilitates the flow of neutrophils into the joint(s), which causes the swelling. Cherries have other anti-inflammatory properties.
The very interesting news was that both the cytokines IL-1B and TNF-a, whose secretion was stimulated by the addition of gout MSU crystals to these cells in a petri dish, were inhibited by CJC. In the case of IL-1B in one type of cells by up to 60%. And an up to 50% inhibition by CJC of TNF-a. Note that’s not 100%, but in a few cases in Studies 1 and 2 gout flares among real life gout sufferers, ended using cherry juice concentrate for gout, so perhaps partial inhibition of the secretion works for some types of gout sufferer, maybe in those with milder attacks and in those who are at an earlier stage of gout – e.g. In those whose attack has been caused by fewer crystals.
Not achieving a 100% success rate could be why cherry juice concentrate delivers irregular results in real life.
But pomegranate juice did not help
Pomegranate juice concentrate (PJC) had either a weak, or no effect, or even stimulatory, effect on IL-1B and TNF-a. So it doesn’t seem it could help gout’s inflammation, or only help very little. In fact it just might even make it worse. (We are not measuring the effect on uric acid here).
Cherry juice compared to drugs
The companies who developed Ilaris (canakinumab) and Arcalyst (rilonacept) designed these medications to inhibit IL-1B. Both these drugs have so far been refused approval by the U.S. FDA although it may come later. They were not refused because they didn’t appear to have a useful success rate, it was for other reasons. But here we see cherry juice concentrate do the same thing, but not as well. On the other hand cherry juice concentrate is not going to cause side effects.
Why you should consider using cherry juice concentrate
Before you next buy cherry juice or cherries for gout note the type used in these studies. The professors used 100% natural, only made from fresh cherries, tart (sour) cherry concentrate to which you would normally add water and a sweetener. No added sugar or sweeteners, preservatives etc. I think the cherry juice concentrate was 68 brix, the most concentrated cherry juice concentrate. The researchers said one tablespoon of the concentrate was the equivalent of 45-60 cherries. That’s probably why they used it – you get many more cherries than from already made juice, and it’s easier to take than 45-60 cherries, not to mention much cheaper. Cherries are one of the most expensive fruits in many countries. Where I live fresh cherries cost about US$30 a kilo. And cherries don’t have to be in season.
Show it to your doctor, or tell him/her about it. S/he has probably heard of cherry juice and gout but not the concentrate or this study. Please don’t self experiment without discussing your ideas with your doctor, especially if you are already taking medications for gout. Cherries and their juice are NOT a panacea for gout.
Read about the 1st cherries and gout trial here. Its results were similar to the 2nd one.
(1) Schlesinger N, Schlesinger M, (2012) Pilot Studies of Cherry Juice Concentrate for Gout Flare Prophylaxis.J Arthritis 1:101. doi:10.4172/jahs.1000101