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Gout Dugout.Issue #057 good news about cherry juice concentrate for gout | alkaline diet spreadsheet
September 30, 2012

Hello and Welcome to the September 2012 issue of the Gout Dugout newsletter. It's the ten minutes' read that gives you ideas that may help you with your gout. If you have difficulty reading it from the screen, by all means copy and print.

This month there's cheery news from a cherries and gout study (1) and it supports what many gout sufferers have said about various forms of cherries for gout. It's more than a reminder that cherries are one of the good foods for gout. Finish the cherries piece, and you'll have read a scientific explanation for why cherries often work to end gout flares.


Two tablespoons daily led to reduced or eliminated gout flares in some gout sufferers, but not in others.

Last month cherries were the natural gout remedy that had received the most positive responses from website visitors in my simple, non-scientific survey.

This month I can report on an interesting scientific cherries and gout study, originally published earlier this year. In fact it was a report about three cherries for gout trials and experiments, by two professors of medicine. They trialed more participants than in the 2003 Agricultural Research Service/US. Dept.of Agriculture study. And over a much longer period.

In these new studies the effect of cherries was to inhibit inflammatory agents, and this often lead to fewer, or zero flares, in many.

The researchers used tart cherry concentrate. In the first study two tablespoons a day were associated with zero gout flares after four months in 55% of the participants who previously had almost five attacks in four months. They were able to stop taking Celebrex or indomethacin. The average fall in the group after four months was about 3½ attacks.

In the second study, in four plus months, there was a 50% or more fall in gout attacks in 12 of the 24 patients consuming only cherry concentrate. 36% of those who only took cherry juice concentrate were flare free in four to six months, while eight of 13 (62%) on uric acid lowering medication and cherry juice concentrate were free of flares at four to six months.

But, contrary to a couple of previous cherries and gout studies, the researchers did not find a statistically significant reduction in uric acid despite the participants taking the equivalent of 90-120 tart (sour) cherries a day for four months.

Use 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, just made from fresh cherries, tart cherry concentrate to which you would normally add water. No added sugar or sweeteners, preservatives, fillers. I think the cherry juice concentrate was 68 brix, the highest 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 are a luxury food which cost about US$30 a kilo. And cherries don't have to be in season.

But if you are on a restricted carbohydrate diet, you have to note the carbs – about 19 in 1 fluid ounce of tart cherry concentrate. But cherries are not especially high on the Glycemic Index (see next article) which makes the carbs less problematic.

Some people think you need to drink tart cherry juice for gout or eat tart cherries. But sweet or sour (tart) doesn't matter. It's cherries' flavonoids (including their anthocyanidins) which are thought to act, plus probably their vitamin C, and both sweet and sour have them. Same applies to their colour (color) – black, red or yellow.

Uric acid didn't fall much As mentioned, the disappointing news was that uric acid hardly fell in the two in vivo (real life) studies in the report whereas in the 2003 ARS/USDA study it did. For example, in that study, 45 sweet cherries lowered it in blood plasma in 10 healthy women in just 5 hours. Average fall was 0.50 mg/dL. But in one of these latest studies there was only a 0.20 mg/dL fall in four months from the equivalent of 90-120 cherries a day, and in the other a fall of 0.30 mg/dL. These were not statistically significant.

Because uric acid hardly fell it could not have had the positive effect on gout attacks. So what did?

Inflammation/ petri dish study The third study described in this report was a laboratory petri dish experiment aimed at seeing if cherry juice concentrate, and pomegranate juice concentrate, would stop or slow human monocytes (a type of white blood cell) from secreting interleukin. In this experiment, and to put it somewhat simply interleukin was secreted when gout's MSU crystals were added to human monocytes in a petri dish. The as yet unapproved, new gout drugs rilonacept (Arcalyst) and canakinumab (Ilaris) work on gout's inflammation by inhibiting Interleukin IL-1b. IL1b is thought to be the main "pusher" of gout's inflammation – the effect of neutrophils in the affected joint which swells and discolours (discolors).

Again, putting it simply, the professors added gout's MSU crystals to two kinds of monocytes (cells). The cells excreted interleukin. Then added cherry juice concentrate inhibited interleukin IL-1b secretion by up to 60%. Note that is not 100%, which is probably why forms of cherries are not always helpful.

That's over simplified, but you can see why, from my partial explanation, cherry juice concentrate can have a positive effect and why it can end gout flares.

Pomegranate Juice for gout At the same time pomegranate juice delivered very mixed results in the human studies. In the petri dish it had a very weak inhibitory effect, or even stimulated IL-1b secretion. And it had a very weak, or no effect, on TNF-a secretion, another relevant secreted substance. So its results were not encouraging.

So you thought the uric acid target was 6.0 mg/dL? The other interesting result in the two real life studies here was that patients who became flare free had an average serum (blood) uric acid of 7.8 mg/dL. Now that is encouraging. It's a much better level to end gout flares, because for most it will happen sooner, other things equal – less of a uric acid fall is required.

The conventional wisdom, which if you've read a lot about gout you've read many times, is that uric acid needs to be 6.0 mg/dL or lower in men and a bit lower in women. But here flares ended when it was much higher than 6.0.

I am glad to say the report is free. Its full name is: Pilot Studies of Cherry Juice Concentrate for Gout Flare Prophylaxis. Naomi Schlesinger.

You can download it here courtesy of the Journal of Arthritis.

I know not everyone wants to read these studies with their difficult medical language, intense focus on statistics, and complicated scientific methods and terminologies. In which case, note there will be a website page up within a week which has more results from these studies than I have described here. And a reminder of it in next month's Gout Dugout plus a clickable link.

If you have been prescribed any medication for your gout, please don't give it up without discussing it with your doctor.

(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

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I've been pleased with the numbers of responses to the offer of the free alkaline and acid diets spreadsheet, and I just want to say a few more words about what it is. It lists the alkaline diet (and the acid diet) foods used in the study that raised uric acid excretion solely by using the alkaline diet. The foods and quantities were listed at the back of the study, but there are no recipes. The link to a free download of the study is below.

The spreadsheet shows how many calories and carbohydrates are found in the quantities of these foods used in the study. Since the number of calories totaled about 2,000 on both diets you have the reassurance that if you were to use these foods you probably would not put on weight. The participants in the study did not. The carbohydrates number, around 270 grams/day, also shows most people would not gain weight, although some would. And these foods tended to be lower on the Glycaemic (Glycemic) Index, which means their carbs are likely to have less effect on blood sugar and weight gain propensity. (But no guarantees). The lower a food’s GI number, the less effect the food has on glucose (blood sugar).

The total fructose amount in these diets is also shown on the spreadsheet, and it's under the daily 25 fructose grams (on both the alkaline and the acid diets), which it's been said by experts is a safe limit. Although there is some missing information on fructose, a glance at the what's-missing-foods tells you they are not fructose or other sugar loaded. There are a few missing numbers for carbs and calories too, but they are not significant. The purines load of both diets is also shown on the spreadsheet.

Finally, the acid load was calculated by the researchers. The acid load – the likely amount of generated acid from the food eaten – was 8,039 mg/day for the alkaline diet and 19,458 mg/day for the acid diet.

Although you would probably not be as accurate as they are, you could replace those foods you couldn't use or find with others you've learnt are alkaline. Try to replace acid foods with alkaline. Check the purines in your replacement foods too. My feeling about purines intake is that you don't have to be too precise. Avoid high purine foods; eat medium in moderation and don't be concerned about low purine foods.

Look up purines in foods on's purines page

A purines table with over 200 foods

So that's what it is. The foods are Japanese and Asian and most are known internationally. You will need diligent research and it will take a lot of learning and practice.

Please always speak to your doctor first about implementing any gout diet. S/he may know reasons why you shouldn't attempt it. There may be something about an alkaline diet that isn't suitable for you. And note that the alkaline diet's success has been so far with women, not yet men, and it has not yet been studied in gout sufferers.

Email me for the spreadsheet. No charge.

The study's name: Urine alkalization facilitates uric acid excretion.

Download the study here free, courtesy of Nutrition Journal.

A new study is likely I have asked one of this study's researchers what are the future plans? He said they next plan a similar study among men. i.e. will an alkaline diet also excrete more uric acid in men? (The two studies were among women). So we await the results with great interest.

The UASure is a DIY home uric acid test kit. It measures the level of uric acid in the blood. Click on the link below to visit a company who can ship it world-wide, including to the United States and Canada, from Britain.


My request for photos has brought some excellent gout pictures which will be used. But I'd still like more.....Do you have any photos of your gout? Any part of the body - elbows, arms, hands, ankles, feet, wrists, fingers, toes and big toes, knees, ears, wherever. I know many like to keep their gout confidential so if you don't wish to be identified, don't send me faces – not likely anyway since gout of the ear isn't common. Or, on request, I could always crop out, or blur them.

Please email me at:

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Tip Use the website'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. There are currently nearly 200 pages, including all the back issues of this newsletter. It works. Use it!


Among other items we'll look at another cherries and gout study, published just days ago, where it was found that consuming cherries, or cherry extract, or both, lowered the risk of a gout attack among a large group of gout sufferers.

Thanks for reading, and all the best of health.

John Mepham BA.(Econ).

799, Infantry Street,
Palar, Armor Vllage,
Makati City 1201,

P.S. You may distribute this newsletter freely and free-of-charge, providing any links in it remain unchanged and it remains intact. Partial copying is not allowed.

NB. The contents of this newsletter contain medical information, not medical advice. Please always discuss gout remedies with a doctor, or other health care professional, before implementing any treatment.

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