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The Gout Dugout.Issue #044 | Uncle Sam's gout | The successful gout diet | Parsley for gout |
August 22, 2011

Hello and Welcome to the August 2011 edition of the Gout Dugout newsletter. Only ten minutes to read, and it gives you ideas about gout you might find usable. I'll start with an item about growing gout in the U.S. population.


I wonder whether I should dress the website mascot Toby Gout, as Uncle Sam ? U.S debt isn't the only thing in America that's currently over bloated.

The latest figures for gout affected people in the U.S., published in the Journal Arthritis & Rheumatism from research conducted at Boston University, showed that the number of gout sufferers there has risen.

Up 36% in the past twenty years or so. The increase has been put down to obesity rates and high blood pressure ahead of other causes. The days of the unfortunately ridiculed port drinker seem well and truly over.

From a statistical analysis of 5,707 participants in the NHANES (National Health and Nutrition Examination) 2007-2008 survey, and compared with the results of the NHANES III 1988-1994 survey, researchers projected that 8.3 million people in the U.S. are affected by gout - 6% of US men and 2% of US women. That's about the whole population of Austria, or Bulgaria or Haiti. In 1988-94 it was 6.1 million.

Note, dear reader, it has increased more in patients over 60. The biggest rise occurred in people over 80.

And the prevalence of gout has doubled since the 1960's.

The other, I think equally interesting finding, is that uric acid (UA)levels in the American people have risen too. In the 1920's the uric acid level in men was well below 6.0 mg/dL, probably around 3.5 mg/dL. According to this research, the average uric acid level in the U.S. is now 6.14 mg/dL in men and 4.87 mg/dL in women. In men that's almost double the 1920's level.

About 1 in 5 of U.S. adult men and women (43.3 million) have hyperuricaemia, that is uric acid levels above 7.0 mg/dL (men) and 5.7 mg/dL (women). The link between the uric and level and gout is of course well established. A high UA doesn't always cause gout but without it gout is much, much less likely.

Is what's happening in the U.S. probably the case in your country too? In most places I wouldn't be surprised. It has been said that gout cases are rising in European countries, and in the Far East. One figure for Japan is that it has 1.1 million cases in males. Hyperuricaemia there affects 20-25% of the population, about the same as in the U.S. And more people there are visiting hospitals for gout treatment.(2) So what of the future? Will these numbers fall? This isn't the time to go into the reasons, but I think these numbers for U.S. men and women are just markers on a rising trend, not the top of it.

Uric what? Here's just one reason for the time being.....a recent survey showed only about 1 in 5 Americans knew some of the risk factors for gout. (Happily 1 in 3 knew obesity was a risk factor).I'm sure it's no different among people in other countries too.

When will the rising trend end? If average uric acid levels have more or less doubled since the 1920's to 6.14 mg/dL (men) by 2100 it could be around 12.0 mg/dL. At that level perhaps 1 in 5 (20%) U.S. men would be gout affected. Of course that's only a rough guess and straight line trends are a poor way of forecasting the future. And who knows. We may even learn how to prevent gout, or invent the miracle gout cure-all, or solve the obesity problem.


If you live in a country where chefs place a sprig of parsley on top of a piece of fish or on the side of a plate, for decoration, the chances are you greatly under-rate this nutrition powerhouse that can be eaten on any gout diet. When I started to write a feature about parsley for gout I thought it would be a simple 500 words piece, but it turned out to be a much bigger subject. It now amounts to a long webpage. And even now I haven't really finished - there are still a few points to add.

Because parsley contains large amounts of the flavonoid flavone, apigenin, there is the possibility (and that's all one can say at this stage) that parsley in large enough amounts would reduce uric acid. In a study published earlier this year (1) apigenin was found to inhibit xanthine oxidase activity, just as allopurinol does. I have my Sherlock Holmes magnifying glass out. Watch this space.

In the meantime it will do gout sufferers some good to make sure they eat some parsley as often as possible.

The main problem with parsley is finding ways of eating a decent portion – say 3½ ounces (100 grams) rather than a couple of tablespoons which only weight 10 grams and don't really deliver enough nutrition. Parsley sauce, a favourite in many Western countries, is nice with fish or ham, but there's not enough parsley in it.

One gout diet recipe idea on the website is fried parsley – you can watch a video of it being prepared.

Click to the

Another parsley gout diet recipe is to use copious amounts in a Tabbouleh salad. This popular Middle Eastern salad (it could be called a parsley and bulgur wheat salad) uses a lot of parsley and is very gout friendly. Watch how to make it here at YouTube courtesy of

And this video – a slightly different way of preparing it - from

Most likely you don't eat the flat bread if you're on a carb restricted diet.

This salad can be eaten on many types of gout diet. But bulgur wheat, which tastes to me like porridge oats (oatmeal), is high in carbs – about 76 carb grams per 100 grams of bulgur. So allow for the carbohydrates (use much less) if you're on a restricted carb diet.

Any ideas for eating lots of parsley? Please let me know, so that I can broadcast them.


Because growing obesity is one cause of Uncle Sam's growing gout - only a maverick would think otherwise - the chances are in many cases that insulin resistance is the cause of gout.

Which leads me on to mention one of my favourite (favorite) web pages on the website - the study of insulin resistance cases of gout and how Barry Sears' Zone diet was successfully used to lower uric acid, gout attack frequency, and some insulin resistance markers in 13 gouty males. They each had quite serious gout - at least two attacks in the previous four months.

I like it because it had much success with the gouty males, whose gout appeared to be caused by insulin resistance and by being overweight. It wasn't about purines. The study ignored some of the standard beliefs surrounding what should be a diet for gout patients. The participants ate "red" meat and fish and drank alcohol and yet most managed to lower uric acid and reduce or end (for at least an extra year, reported in the study) gout attacks.

I mention this inspiring study in this newsletter from time to time, because new subscribers arrive just about every day and they probably haven't read of this diet on the website. Only 1% of's visitors visit this study's page.

Sadly there have been insufficient gout diet studies, but this is one, and it was revealing. On the study's page there is also a link to the study itself which you can download free courtesy of the Annals of the Rheumatic Diseases (British Medical Journal Group). Register for free access, not much information is required. The study is called:

Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study.

The South African researchers suggested that in a similar study, the diet was beneficial because of an improvement in insulin sensitivity. They thought the loss of weight, and a change in the balance of protein, carbohydrate and fat participants ate, had lead to the success.

Alternative Health Research/Flamasil™


A few days ago the ultimate owner of febuxostat, Japan's Takeda Pharmaceuticals, announced it had signed a febuxostat distributership with Astellas Pharma for 6 South-East Asian countries and India. Astellas will apply for marketing approval, and should it be forthcoming - it would be a huge surprise if it isn't – to market the drug in the following countries:

Thailand, Philippines, Indonesia, Singapore, Malaysia, Vietnam and India.

So if you live in one of them, they are all on a febuxostat countdown to 2015, by when it’s hoped it will be approved in all.

Febuxostat has now been approved for marketing in Taiwan. And if you live in Hong Kong, there may be good news by the end of this year.

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 the United States and Canada, from Britain.


A friend of in the U.S. state of Indiana sent me his gout diet and told me his reduced uric acid level was doctor tested. Do you think a uric acid fall of 2.0 mg/dL in just a month from a gout diet is good? I do. That's what he achieved. A lot of people taking allopurinol, febuxostat or probenecid would be very pleased with that result. So what was his low purine gout diet? Click to the low purine gout diet testimonials page to view it.

If you are not a subscriber to the Gout Dugout, this free monthly 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.

Thanks for reading and all the best of health.

John Mepham BA.(Econ).

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

(1) Olea europaea leaf (Ph.Eu.) extract as well as several of its isolated phenolics inhibit the gout-related enzyme xanthine oxidase. Flemmig J, Kuchta K, Arnhold J, Rauwald HW. Phytomedicine. 2011 May 15;18 (7):561-6.

(2) Abstract. Epidemiology of hyperuricemia and gout in Japan. M.Hakoda, Japanese Journal of Clinical Nutrition 2008.

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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