Back to Back Issues Page
Gout Dugout.Issue #064. Mediterranean diet for gout | Krystexxa's new owner | gout & Christmas
December 24, 2013

Hello and Welcome to the Winter (December) 2013, edition of the Gout Dugout newsletter. A very Merry Christmas to all readers. The Gout Dugout is the 10 minutes' read that gives you ideas that may help with your gout. Copy and print if you prefer to read a version on paper. If you are extra busy because it's Christmas time, save it for later.

I am not sure if I should be writing about diets at Christmas time, but you must bring discipline to the table all year round, and a timely reminder that uric acid production does not go away at Christmas may help, so here goes....


If you think there is only one diet for gout, there really isn't. There are many diets that can lower uric acid and some are supported by studies among gout patients. Any diet that loses you weight will probably lower uric acid somewhat, as long as your weight loss is significant.

That includes Atkins or another kind of restricted carbohydrate diet too. Atkins is not a "meat only" diet, and diets which include meat and seafood have lowered uric acid. The Atkins diet in gout has not yet been scientifically studied. What an interesting one that would be!

But there has been a lot said about the Atkins diet for gout, including by me. I went through every Atkins book going back to 1972 to find everything he said about gout, when I wrote the Atkins page of the website, and the first page is here

But enough of Atkins.

There have been at least three studies published in the past two and a bit years, that delivered reasonably encouraging results for the Mediterranean diet and uric acid, which means gout too. They were probably the first ever Mediterranean diet for gout studies.

What is the Mediterranean diet?

Simply put, the traditional Mediterranean diet is that people in Mediterranean countries eat more fruit and vegetables, whole grains, nuts, legumes (beans, lentils, soybeans, peanuts, peas, others); more wine and less beer; less dairy products; herbs and spices; for fats they use olive oil; less butter; less sugar; less meat and maybe less fish (seafood); less sugar and fructose sweetened beverages; fewer trans fats; less refined carbohydrates

That's trying to sum it up in a few sentences. Here's a longer description if you want it, from the Mayo clinic.

Of course you can adapt all this to your country's cuisine, and your normal eating, too. So too can those folks in Med diet countries who don't eat as much of their traditional food.

From a gout perspective, what it amounts to is fewer purines. And IMO fewer of those refined carbohydrates which raise blood sugar especially those foods with a higher Glycemic Index score. (That's where the GI comes into gout diets theory). An excess, or unstable amount of blood sugar can cause gout thought the insulin resistance route.

The studies' gout positive results. These studies were conducted in Mediterranean countries, in this case Greece and Spain. All were analyses of the diets of large populations and their effect on gout or uric acid. All, no surprises, found that eating meat and seafood was likely to raise uric acid (more eaten) or lower it (less eaten); all praised olive oil as a good fat, but you already know that.

All studies (except one set of results among women), found much less likelihood of hyperuricemia. This is high-ish uric acid, at levels that might trigger gout i.e. the risk of gout, defined as 7.0 mg/dl and above in men, and 6.0 mg/dl and above in women, with better adherence to a Med diet.

However, taken as a group of studies, there was a contradiction. In one study, (3) whereas serum (blood) uric acid rose or fell according to the degree of adherence (more adherence = lower; less = higher) in elderly men, it did not amongst 281 elderly women. It seems Med eating had no effect on the elderly women’s uric acid. All participants were free of heart disease. But the study's design has been called into question so maybe that explains it.

But in a later study,(2) also in Greece but with a larger population of women, and using the same definition of hyperuricemia (7+ or 6+) there was what scientists call inverse association in the women, as well as the men. That is, better adherence to the diet meant uric acid lower; worse and it was higher. The study summary called the association significant. It was, no doubt, what the researchers were hoping.

In the third Mediterranean diet for gout study (1) I cover in this article, this one in Spain, research scientists also found higher adherence to the Med diet was associated with less hyperuricemia. Amongst a larger study population of 4,449 elderly participants with a high risk of heart disease, including women. And those who did best had been eating more Med diet food before the study began. Benefits did not require weight loss or scientific counseling.

And this was the case even if patients were overweight, hypertense, drank alcohol, smoked or didn't, exercised or didn't. And despite their age. Sounds almost too good.

Very simply put, the score is 2-1 to the Med diet v hyperuricemia here. But the "goal" hyperuricemia in females scored may be significant and not a one-off. More Mediterranean diet for gout studies are needed, and I expect we shall get them.

Mediterranean diet - Drawbacks for gout patients This newsletter has a reader, and correspondent, who lives in the Mediterranean country and who is convinced his gout is caused by fructose, the fruit sugar also found in honey, some vegetables and with which glucose, forms table sugar. Fructose is regarded as a probable cause of gout in large populations. So fruit has its minuses too.

Descriptions of the Med diet say eat fish at least twice weekly. But many fish, especially the heart healthy ones high in Omega-3 like sardines and mackerel, are high purine.

You can read this page on the website about how to deal with the fish dilemma.

And in study (3) a quarter of those who didn't have hyperuricemia at the beginning developed it over a five year period, despite Med diet adherence. On the other hand, 44% of those that did, managed to reverse it.

Although it's called the Mediterranean Diet it is not a diet where you lose weight but a way of eating.

I only read the abstracts (summaries) of 2 of these 3 studies so please treat these remarks as tentative. The studies did reach other conclusions I have not focused on here. I'll be doing a web page with more details and will announce it here, probably in the March issue. If you want to dig into them further they are listed below.


Savient Pharmaceuticals, the U.S. company who so patiently, (but not without mistakes), developed Krystexxa (pegloticase), sought and obtained US and EU approval, and brought it to the U.S. market, went into Chapter 11 bankruptcy in the U.S.

I had noticed US sales were not very good. Then, this summer, the NHS in the U.K., a potentially big customer, said that it cost too much for them. At about $60,000 per course and a far from 100% success rate, I am not surprised although Krystexxa is for harder to treat gout patients. It also took much longer to get to market than it need have. There was a year's delay gaining US approval because there could have been more attention paid to FDA approval requirements.

Then just after the drug did get US approval, Savient put themselves up for sale. But there were no takers and that was significant. None of the big boys of world pharma wanted it enough.

On 11th December it was announced that most of Savient's assets, including Krystexxa, easily their most important one, have been sold to a new start up U.S. company called Crealta Pharmaceuticals LLC, which appears to be capitalised by a long-established Chicago-based private equity firm. They may need deep pockets.

Crealta paid about US$120.4 million in an auction, more than double the money for which Savient originally agreed to be purchased by another company. Let's hope they haven't overpaid, or the drug might bomb. Crealta's Chairman and CEO said:

"We are thrilled to be able to acquire Krystexxa from Savient, thus ensuring the continued availability of an important therapy for patients suffering from what can be a debilitating condition."

So Krystexxa's ongoing supply is now more guaranteed. All this has set back its roll-out around the world, which is a shame of course. Its market development is probably about 18 months behind where it could have been. We wait with interest for a statement from Crealta about its plans for its global development.

If any reader has personal experience of Krystexxa I'd be very interested to hear from you.


I have littlenew to say this year about getting though a gastronomic Christmas unscathed. But if you’re looking for tips and techniques, have a look at:

December 2008 Find out why you might want to be careful of mince pies and cranberry sauce.

December 2010 Say boo to a goose.

December 2011 This one includes a write up about a Xmas low purine meal.

And the December 2011 issue has a good list of foods to avoid at Christmas.

I'll just add one new point. The study (1) listed below and discussed above in the Med diet article said sofrito sauce (Spanish style, there are other versions) is good for gout. More than 2 servings a week meant a lower risk of hyperuricemia in 4,449 elderly participants. It's tomatoes, garlic, onions and pepper cooked in olive oil.

Click on the Flamasil ad to go to the Flamasil website

Alternative Health Research/Flamasil™

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.


Most of the website's pages now have the new, open-face wide spaced look, which I hope makes the experience of visiting more enjoyable and interesting. And it puts more available information in view. It's not yet fully completed because there will be another column on every page on the right. The Home Page will be changed too. But the newsletter back issues' appearance do not change.

Also not yet done is its mobile optimisation to look better on mobile phones and make navigation easier on them. Just over a third of visitors now arrived from a mobile. When the mobile feature is ready I'll let you know, probably in the March issue.

If you are not a subscriber to the Gout Dugout, this free gout newsletter, you can sign up at this page - click on the link below.

Go to the home page by clicking on the link below.


Oh dear! My piece last issue about the purines table in German got a bit of friendly light flak from a few readers. You do not need to translate word by word using online translators. You can use Google translate. Here's how to use Google translate.

Go to Put the German website's URL into the designated box and click on Translate. It's so easy, even I can do it.

How accurate it is something for you to judge. But I looked at over 200 of the spellings in English and they were correct. Some brands and words remain in German because there is no word in English, but with the Internet you don't need to be Sherlock Holmes to find out what they are. Thanks to a reader in Spain for this.

Or you could try this.

This is a link to a Google Chrome browser with automatic translation.

For mobiles/handphones, search something like “Language translators mobile phones.” Also, visit: on your mobile phone to view Google Translate, optimised for your mobile device.

For those in countries where the Internet connection can be poor or quality fluctuates, you can also get an offline translator APP.

I may have given the impression that there is no online purines table in English because I didn't mention one, but talked only about the German one. There is. It’s here.


There will be 4 issues of the Gout Dugout in 2014, same as 2013. Spring, Summer, Autumn (Fall) and Winter – March, June, September and December. Watch out for it in your email inbox towards the end of these months.


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 around 210 pages, including all the back issues of this newsletter. It works. Use it!

Thanks for reading, all the best of health. And a gout free 2014.

John Mepham BA (Econ).
Makati City,

(1) Mediterranean Diet and Risk of Hyperuricemia in Elderly Participants at High Cardiovascular Risk Mònica Bulló, Nancy Babio, Miguel A. Martínez-González, Ramon Estruch, María-Isabel Covas ,Julia Wärnberg, Fernando Arós, José Lapetra, Lluís Serra-Majem, Josep Basora and Jordi Salas-Salvadó Gerontol A Biol Sci Med Sci(2013) 68 (10): 1263-1270.doi: 10.1093/gerona/glt028

(2) Abstract Adherence to the Mediterranean diet and serum uric acid: the ATTICA study. Kontogianni MD, Chrysohoou C, Panagiotakos DB, Tsetsekou E, Zeimbekis A, Pitsavos C, Stefanadis C. Scand J Rheumatol. 2012;41(6):442-9. doi: 10.3109/03009742.2012.679964.

(3) Abstract Long-term adherence to the Mediterranean diet reduces the prevalence of hyperuricaemia in elderly individuals, without known cardiovascular disease: the Ikaria study. Chrysohoou C, Skoumas J, Pitsavos C, Masoura C, Siasos G, Galiatsatos N, Psaltopoulou T, Mylonakis C, Margazas A, Kyvelou S, Mamatas S, Panagiotakos D, Stefanadis C. Maturitas. Volume 70, Issue 1, Pages 58-64, September 2011. NB. Hyperuricaemia, with an "a", is the British English spelling.

Back to Back Issues Page