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The Gout Dugout.Issue #041. Caffeine and gout; sweet or sour cherries?; coffee (down) v beer (up);
May 18, 2011
Hello and Welcome to the May 2011 edition of the Gout Dugout newsletter, the free gout newsletter. Only ten minutes to read, and it gives you ideas about gout you might find usable.
THE UPS AND DOWNS OF URIC ACID - COFFEE COMPARED TO BEER
In last month's issue we saw that coffee lowers uric acid somewhat. You probably need to drink four or five plus cups of regular (not decaff) coffee a day to lower uric acid by about 0.40 mg/dL. It could take a few months or longer. And this is a statistic so it might not apply to you.
Another way of looking at a - 0.40 mg/dL reduction is that it is, more or less, the same amount of reduction as the amount of increase in serum (blood) uric acid from one glass of beer daily (0.46 mg/dL). (1)
Now the ghost of that gout sufferer Benjamin Disraeli - who famously said "there are lies, damn lies and statistics" - might protest at that one, although a modern statistician could answer that statistics has come on since Disraeli's nineteenth century days.
But you get the general idea.....
It takes a lot of coffee a day to reduce the uric acid increase of a single glass of beer. To carry on talking statistically, you could drink five or six coffees before you can have a single glass of beer, and not more, if you don't wish uric acid to rise. Or, if you have two beers you need 10 cups of coffee to undo the damage. Or, spare the thought, three beers means 15 cups.
These numbers are for amounts drunk over time. The studies mentioned have not shown you get an immediate reduction after, for example, just four cups of coffee. Or that uric acid rises after just one glass of beer.
And you'd have to find out whether these findings about coffee are true for you by frequent serum (blood) uric acid testing. Another personal consideration would be: if you need to lower uric acid by for example 3.0 mg/dL to reach the 6.0 mg/dL target (around 5.7 for women) at which good things might start to happen, wouldn't it be better to get that 0. 40 mg/dL reduction rather than allow the benefits from coffee to be cancelled out by a glass of beer?
(1) Beer, Liquor, and Wine Consumption and Serum Uric Acid Level: The Third National Health and Nutrition Examination Survey. Hyon K.Choi, Gary Curhan. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 51, No.6, December 15 2004. pages 1023-1029.
Just a reminder that around the end of this month, cherries will be in season in most of Europe and North America and you'll soon be seeing them in the shops, if not already. I won't say too much about buying cherries, because I've mentioned cherry buying tips in a previous issue
which you can read here.
But when buying cherries for gout, here are three important pointers to keep in mind:
First, go for the deepest skin colour (color), whether it's red, black or yellow. The deepest skin colour (color) ones will probably be the most expensive of the offering. So the people who do the pricing know they are better, even if they don't precisely know why. If they aren't, you have a bargain. The deepest skin colour (color) means the most antioxidants, which is what you're after.
Second, any colour (color) is O.K. No one has ever proved that red are better than black etc. If I'm not mistaken the Texas doctor who got the cherries for gout bandwagon going in 1950, used yellow cherries. From this point of view, a cherry, is a cherry, is a cherry.
Third, you'll probably want to eat sweet cherries, and that's fine. There is an old saw out there, frequently repeated, that says only sour (tart) cherries are O.K.
One of the cherry studies that lowered uric acid levels, plus one of the cherry studies that lowered markers of inflammation used sweet Bing cherries.
Nevertheless, perhaps sour (tart) are more effective than sweet against gout attacks and uric acid. There is at least one reader of this newsletter, a fully qualified gout sufferer, who believes sour is better than sweet, and he's tried both.
Drinking sour cherry juice is for him so good that he can even now have a few beers in moderation (beers were definitely on his gout trigger watch list) as long as he drinks sour cherry juice too. I just hope his uric acid level isn't rising, otherwise he might have to make the choice described in the first article above.
What do you think? Any views?
THE CONFUSION SURROUNDING CAFFEINE AND GOUT
No-one writing about gout likes decisive certainties more than I. I know so very well that readers want solutions that will work and my job is to explain them, if that is possible.
I once read a criticism of a best-gout-remedies.com web page which said there was too much "on the one hand, and on the other hand" about the article. That may have been so, and I've forgotten which page my critic was writing about, but the problem so often is, when trying to be decisive about gout remedies, that the evidence is contradictory.
This truth raised its annoying head this month. I'd spent a few days researching caffeine and gout after expanding the existing page about coffee and gout with a round up of more coffee and gout studies. This naturally led on to a desire to consider whether caffeine also affected uric acid and the risk of gout.
It seemed pretty clear cut. Four studies did not have caffeine affecting uric acid or the risk of gout, and another actually had it LOWERING the risk of gout in American nurses.
And then like a last minute goal, or score against your team in a vital game, another caffeine and gout study came into sight. In fact the last one to date, a presentation at the American Society of Rheumatologists Conference in November last year. This one had caffeine INCREASING the risk of gout by considerable percentages, in only 24 hours, from upwards of about three cups a day. And by more if you drank more. It seemed as if caffeine in enough cups of caffeinated beverages could cause a gout attack.
Coffee too Although it wasn't said, the researchers must have meant coffee too, because coffee has more caffeine than other beverages such as tea, drinking chocolate, cocoa, green tea, colas and energy drinks.
So where did that leave my earlier conclusion? Remember I'm always searching for a decisive result, if possible. A conclusion that can be used by gouty people with confidence.
This last study was a short term one - the effects on the risk of gout after just 24 hours, and the others were long term - the risk of gout after drinking coffee/ caffeine for a long time was lowered.
So a neat and logical conclusion, that supported the results of just about all the studies, was that in the short term, caffeine could raise the risk of gout, but long term it would lower it. And hopefully you wouldn't have a gout attack en route to the long term uric acid lowering effects.
Is this true? Perhaps.
I don't think we really know enough yet about caffeine and uric acid, but I do think that coffee will lower uric acid a little if you drink enough every day and that this is due to its antioxidants.
Details on the coffee and gout page.
Of course we really need more coffee and gout, and caffeine and gout studies.
And I can't be more decisive than that.
NEW GOUT DRUG NEWS
The developers of Krystexxa (pegloticase) announced on 4 May that they had submitted an approval application to the European Medicines Agency. We now wait to see if it will be approved for EU countries. This could take about up to a year.
If you can order from the U.S. (wherever you are) pHionbalance.com have a good offer, valid to 22 May - to be precise at 11.59 pm on 22 May Pacific Standard Time. 30% discount sitewide. I think you have to be on their mailing list to be eligible and you can join it by clicking here to visit the pHionbalance website. Click on the link below. If you miss out this time, there will be future useful offers from them coming into your inbox. And you can get the free alkalising (alkalizing) recipe book that you'll see on the home page.
John Mepham BA.(Econ).
799, Infantry Street,
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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