This is the first of three pages about tea and gout.
This page about tea and gout, first page, was last reviewed or updated on 17 August 2015
IT'S TEA TIME - BLACK OR GREEN TEA FOR GOUT?
There is so much praise for the health benefits of green tea that writers often forget green tea is not everyone’s favourite (favorite) cup of tea. Many people want to know about black. And globally four times more black is drunk. Many ignore the fact that tea, called black tea in America, is healthy too. It also contains various flavonoids which have been shown are good for gout sufferers.
Both teas are leaves from the same plant (Camellia sinensis) but are the outcome of different processing. Overall, green has more nutrients than black. There are other colours (colors) and types, but here we discuss black and green, the ones the world most consumes.
Why tea for gout?
Studies have shown its flavonoids are good for gout. Tea’s five tea catechins, which include epigallocatechin3-gallate (EGCG), perhaps the best performer, have been shown to inhibit xanthine oxidase. Tea's flavonoids are also useful anti-oxidants - meaning they scavenge damaging free radicals - and that is good for gout too. XO is the enzyme which is required to turn purines into uric acid and inhibiting it is how the gout drugs allopurinol and febuxostat work. Black teas’ theaflavins – post tea fermentation oxidised catechins – have also inhibited xanthine oxidase. (XO, but it’s not brandy!).
In one study (1) a theaflavin, Theaflavin-3, 3'-digallate, (TF-3) which is found much more in black than in green tea, was the best XO inhibitor. In fact it is almost absent from green tea. The theaflavins (a class of thearubigins), and the thearubigins themselves, (see the list of tea’s nutrients on page 2), are compounds in tea you have probably heard of – the tannins.
EGCG is a member of a flavonoid sub class called flavonols. Flavonoid classes are described on our anti-oxidants in gout page where you can read how and why anti-oxidant foods need to be in a gout diet. It has also been described as possessing cancer fighting properties, stronger indeed than vitamins C and E, and useful against the risk of type 2 diabetes and, in general, inflammatory diseases.
Green tea contains more EGCG than tea (black tea): Green 70.20 mg/100 grams; Black 9.36 mg/100 grams. But these are very averaged numbers.
So that’s the catechins and thearubigins. But there’s more that is gout positive...…
There are other flavonoids in teas which interest gout scientific researchers because of their reputed ability to inhibit xanthine oxidase. These are: apigenin, luteolin, kaempferol and myricetin. They are also found in some foods. They crop up regularly on this website in other foods. (Use our search box on the home page).
Finally a mention for quercetin, which can be purchased as a dietary supplement. It is yet another useful flavonoid in both black and green tea. It has lowered uric acid in studies on rats and in test tubes. Green tea has slightly more quercetin than black tea: 2.49 mg/100 grams, green and 2.19 mg/100 grams black. As far as inhibiting XO is concerned, quercetin is in the top three of tea’s flavonoids along with EGCG and TF-3.
These substances are the reasons why both black and green tea could lower uric acid. But do they?
Black tea lowers uric acid study (2)
a study on the small Indian Ocean island nation of Mauritius in 2010, 232 trialists
completed the experiment. They were not gout patients but people susceptible to
heart diseases or healthy folk – drank
the equivalent of three cups of (black) tea daily for 12 weeks. The tea had no
additives such as milk, lemons or sugar. Among those participants with uric
acid of more than 7.0 mg/dL (men) or 6.0
mg/dl, (women) uric acid fell by 8.5% and in those with uric acid of more than 7.0
mg/dL, it fell by even more - 9.4% (men) and 7.1% (women). This was the group with the highest baseline (starting) uric acid level. In amounts, that was 0.79mg/dL (men) and 0.48 mg/dL (women). Both are useful reductions.
But curiously in those with lower baseline blood uric acid, it rose.
It also fell among those in the experiment’s control group who drank the equivalent amount of hot water. Hmmm, a good endorsement for water too, but doctors usually want gout patients to drink more than three cups of water. Maybe they would have done better if five or six cups were drunk.
Green tea lowers uric acid study (3)
Thirty healthy participants – they were not gout patients – in Chiang Mai, Thailand, published in 2014 were divided into 3 groups who drank 2, 4 and 6 grams of green tea extract twice daily for two weeks. Its chief results were that each group achieved modest reductions ( 3.53%, 2.54% and 1.19% in serum (blood) uric acid and a greater fall in uric acid clearance. After the green tea drinking was discontinued, blood uric acid rose again but clearance did not rise back to pre-study levels within the one week time period. And in this study anti-oxidants in the blood were also measured and they had risen - a positive sign. A rise in anti-oxidants has occurred in other green tea studies. A longer study – the drinking period was for only two weeks – may have seen it fall more.
What about large population studies to discover links between tea and gout?
Is there any large population evidence that those who drink tea are less prone to developing gout? And do tea drinkers have lower uric acid levels? The answer to both seems to be no.
In one enquiry (4) over 45,000 men were tracked for 12 years during which time 757 developed gout. The researchers concluded that their tea consumption was not linked to their gout.
Similarly, over 89,000 women were tracked for 26 years (5) during which time 896 developed gout. But again tea consumption was not linked to their gout.
What about tea and uric acid in the blood? Researchers analysed dietary data from nearly 15,000 participants in the U.S. Third National Health and Nutrition Survey. (6) They concluded that tea was not linked to movement in the uric acid level, either up or down.
But, but, but, we do not know what sort of tea they all drank. Teas’ ability to inhibit xanthine oxidase varies considerably. An Indonesian study (8) found that 3 of 15 grades of black tea inhibited xanthine oxidase in a test tube by more than 50%, and those teas had certain qualities. The other 12 also inhibited it, but not as much, or hardly at all. And YOU are not a large population.
Tea was not successful ?
In a Singapore study (7) uric acid rose in tandem with more consumed green tea but not with black. And black tea did not lower it. This was surprising because flavonoids in teas have been found to lower uric acid (as discussed above) albeit moderately. And tea successes have been established in other studies. EGCG has even inhibited xanthine oxidase as powerfully as allopurinol in one and the flavonoid theaflavin Theaflavin-3, 3'-digallate inhibited xanthine oxidase by about 60% of allopurinol’s inhibition in a test tube study in an Indonesian study. (8) In this study they may not have been drinking the type of teas that inhibit XO the most.
There have not been studies among gout sufferers, nor with milk added to tea. Milk has lowered uric acid, but how they might work together is not known.
What else should you, or shouldn’t you, drink if you have gout? Go to our drinks for gout page.
Note In books and articles about nutrition, flavonoids may be called polyphenols, phenols, or phenolic compounds
(1) Lin L.K et al Inhibition of xanthine oxidase and suppression of intracellular reactive oxygen species in HL-60 cells by theaflavin-3,3'-digallate, (-)-epigallocatechin-3-gallate, and propyl gallate. J. Agric Food Chem 2000 Jul;48(7):2736-43.
(2) Bahorun T et al Black tea reduces uric acid and C-reactive protein levels in humans susceptible to cardiovascular diseases. Toxicology. 2010 Nov 28;278 (1):68-74. doi: 10.1016/j.tox.2009.11.024. Epub 2009 Dec 4.
(3) Kanon Jatuworapruk, MD; Somdet Srichairatanakool, PhD; Sakaewan Ounjaijean, PhD; Nuntana Kasitanon, MD; Suparaporn Wangkaew, MD; Worawit Louthrenoo, MD. Effects of Green Tea Extract on Serum Uric Acid and Urate Clearance in Healthy Individuals Journal of Clinical Rheumatology 2014;20(6):310-313.
(4) Choi HK, Willett W, Curhan G. Coffee consumption and risk of incident gout in men: a prospective study. . (Tea drinking also analysed) Arthritis Rheum 2007 Jun;56(6):2049-55
(5) Choi HK, and Curhan G, Coffee consumption and risk of incident gout in women: the Nurses’ Health Study . (Tea drinking also analysed) Am J Clin Nutr. 2010 Oct; 92(4): 922–927.
(6) Choi HK, and Curhan G, Coffee, tea, and caffeine consumption and serum uric acid level: the third national health and nutrition examination survey. Arthritis Rheum 2007 Jun 15;57(5):816-21.
(7) Abstract Teng GG et al Serum urate levels and consumption of common beverages and alcohol among Chinese in Singapore. Arthritis Care Res (Hoboken) 2013 Sep;65(9):1432-40. doi: 10.1002/acr.21999.
(8) Dadan Rohdiana et al Xanthine Oxidase inhibitory and immunomodulatory activities of fifteen grades of Indonesia orthodox black tea International Journal of Pharmacy and Pharmaceutical Sciences Volume 6, Issue 5, 2014.
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