Milk for gout. Here's a study that could result in a commercial milk product for gout symptoms





This page about milk for gout was last reviewed or updated on 18 April 2013.

THE LATEST MILK AND GOUT STUDY (1)

In recent years a number of studies have suggested that forms of milk will reduce serum (blood) uric acid (UA), inflammation, and improve UA excretion. In one study, in the case of serum (blood) UA, not by a huge amount, but by slightly above 0.5 mg/dL, which is a useful reduction.

Two dairy substances, glycomacropeptide (GMP, a derivative of the K-casein milk protein), and G600 milk fat extract have been found in cell assays to inhibit Interleukin 1 B (IL-1B) which is associated with gout flares and inflammation. (2).

The gout drug Ilaris, approved for EU countries in early 2013, inhibits IL-1B. So too has cherry juice concentrate in a study. Gout flares were reduced in the cherry juice concentrate study, just as the milk products in this study reduced them.  Most people can drink milk without side effects of course, although some in this study dropped out.

Orotic acid in milk is thought to stimulate uric acid excretion, and the two other leading milk proteins, casein and lactalbumin, are thought to lower it in serum (blood).

And now, details of this milk for gout study, which was conducted by the University of Auckland in New Zealand.

THE PARTICIPANTS

Gouty folk taking part in this study had suffered at least two flares in the previous 4 months, but the average in all three groups was 3.9 up to 5.1 attacks in the previous four months. So you can say participants had suffered an average of at least one attack a month, a number that indicates gout is quite entrenched.

AS you read this it is important to bear in mind that this milk and gout study did not test  a glass of original, whole, full cream, full fat, non powdered milk, from which nothing has been removed, nor a glass of skimmed (skim) milk.

The milk drinks tested were made from powdered milk, or lactose (a milk sugar). So this study wasn't exactly about a glass of milk for gout, as most of us think of it. These were specially prepared milk drinks, not a whole milk daily pinta.

This milk for gout study measured participants' uric acid level, rate of uric acid excretion, changes of frequency of gout flares (the study's chief objective), gout pain scores and changes to two other gout symptoms – the number of tender joints and the number of swollen joints.

Number of participants  A useful number of gout patients were studied, 120 started and 102 finished. Divided at random into three groups of 40 each, each group drank one of three forms of powdered milk products in 8½ fl.ozs of water (a standard glass size, 250 ml) – lactose powder, skim milk powder (SMP) and skim milk powder enriched with glycomacropeptide (GMP) and G600 milk fat extract, which I'll refer to as GMP/G600.

These were the two substances which in the earlier study had inhibited IL-1B.(2) The drink was administered as a tasty vanilla flavoured (flavored) shake. No nasty medicine here. They drank a glass every day for three months. 

RESULTS

The milk fat and GMP enriched milk powder performs best

The results were very encouraging. All the three forms of powder in water, even the lactose powder, reduced the frequency of gout attacks. Interestingly, the group that performed best in this was the group drinking the skimmed (skim) milk powder with added glycomacropeptide (GMP) and G600 milk fat extract. This group was also best of the three in improving uric acid excretion, lowering it in serum (blood), in reducing gout pain scores, and it was the best group for improvements in tender joints.

The only major downside in the study was that none of the milk drinks positively affected swollen joints. Maybe these milk drinks did have enough GMP/G600 to do that.

How much better was the fall of attacks in the GMP group compared to the other two groups?

To give you an idea of how much flares fell..... the midpoint change in gout attack frequency in the GMP/G600 group in month three (the last month of the trial) showed a fall of nearly one attack a month, from nearly two attacks a month in the group taking this drink. The highest fall in this group was almost 1.5 per month in month three. Very approximately GMP/G600 was 75% better than the lactose powder drink, and twice as good as the skimmed milk powder (SMP) drink for the fall in the number of flares (attacks) a month.

Here's another noticeable pattern. The longer participants drank the milk products, the more flares fell in the GMP/G600 group. i.e. month 3 was better than month 2, which was better than month 1. This was also true in the way the gout attack pain scores fell.

Urate (uric acid) excretion in the urine rose (more was excreted) with GMP/G600, but not with the other two; the serum (blood) urate (uric acid) did not fall with lactose powder. However, it did fall in serum (blood) with the GMP/G600 powder and there was less of a fall with SMP powder. And with GMP/G00 the change was greater in month three than in month one. The GMP/G600 fall ranged from 0.37 mg/dL at mid point to 0.87 mg/dL (best).  This is a useful reduction, and might have been greater if the study had been longer. But a drug medication would reduce uric acid much more than this.

Whatever else it might do for your gout, a milk product isn't likely to lower uric acid much. That's been found in other milk for gout studies too. But it can do other beneficial things. Apart from reducing attack frequency, here are some more.....

Pain scores  were lowered, but not eliminated, by all three products, but by most (again) by the GMP/G600 product. The other two were about of equal benefit. Very approximately, the GMP/G600 product reduced pain twice as much as the other two. With GMP/G600, and the others, there was less pain in month three than in month one.

Tender joints were beneficially affected. There was a trend towards fewer of these from the use of all three trial products, but again the GMP/G600 drink performed best.

The number of swollen joints  however were not much affected. i.e. the products could beneficially affect the number of gout flares, flare pain, uric acid excretion, (in the case of the GMP/G600 product) and serum (blood) uric acid levels, but scarcely reduce the number of swollen joints.

As mentioned above, glycomacropeptide (GMP) and G600 milk fat extract were found in an earlier study by the University of Auckland to reduce the body's inflammatory response to gout crystals. So the results in the latest study supported the findings in the earlier one, (2)In this study skimmed (skim) milk powder with added GMP and G600 was more beneficial for gout attacks and the other study objectives than milk powder without them. Yes you read that right, the milk fat extract and the milk protein derivative GMP did some good. How much good each did has still to be determined.

Moreover, the study did NOT find the fat fractions in the milk powder with this milk fat extract led to increased fats in the blood or weight gain. There was no increase in participants' total cholesterol, LDL and HDL cholesterol, and triglycerides. 

WHY WAS THIS TRIAL SUCCESSFUL? 

So why did gout attacks fall? Probably not because serum uric acid fell (because there was not much of a fall and not at all in two of the groups, which nevertheless, otherwise, delivered some successes), and flares also fell (but less) in the other two groups.
 
More likely because of the GMP and the G600's anti- inflammatory properties, and maybe because there are other anti-inflammatories in milk.

Although real milk itself (whole or skim/fat free) was not tested, as long as you don't have allergies to milk, or if there's another reason why you can't drink it, a glass of milk a day is a good idea.  Even without the, as yet, ironclad proof for milk itself. Or if you prefer skimmed (skim) milk, and drink it regularly for some time, why not? Population studies have shown people drinking skimmed (skim) milk are likely to have a lower uric acid level.

And low  dairy intake has been linked in studies to an increased risk of gout. Plus milk and its derivative products: butter, cheese, yoghurt (yogurt), cream, whey et cetera, are all low purine.  Even ice cream and milk shakes might be a good idea as long as you can take the carbohydrates.

Of course, if a commercial product does come out of this research, "gout remedy milk" that you buy at a pharmacy will be a good drink for all gout sufferers who can drink milk. It clearly isn't better than medications at lowering uric acid but if it gets to market, your doctor will see it as a useful, easy-to-prescribe, assist to colchicine, Ilaris and corticosteroids in reducing pain and flares. And to drugs which lower uric acid in serum (blood), like allopurinol and febuxostat.

It's speculated there might be a commercial milk product for gout within two years. i.e. perhaps in 2014.

If you want to read the study itself you can download it at the British Medical Journal (BMJ) Publishing website. Costs GB£24. (US$38) at current exchange rates).



(1) Nicola Dalbeth,  Ruth Ames,  Greg D Gamble, Anne Horne, Sumwai Wong, Barbara Kuhn-Sherlock, Alastair MacGibbon, Fiona M McQueen, Ian R Reid, Kate Palmano Effects of skim milk powder enriched with glycomacropeptide and G600 milk fat extract on frequency of gout flares: a proof-of-concept randomised controlled trial.  Annals of the Rheumatic Diseases  doi:10.1136/annrheumdis-2011-200156

(2) Nicola Dalbeth, Eric Gracey, Bregina Pool, Karen Callon, Fiona M McQueen, Jillian Cornish, Alastair MacGibbon, Kate Palmano Identification of dairy fractions with anti-inflammatory properties in models of acute gout  Annals of the Rheumatic Diseases 2010;69:766 769 doi:10.1136/ard.2009.113290





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