Gout was first recognized as a distinct clinical entity in antiquity. Our understanding of the epidemiology and treatment of gout has evolved over millennia intertwined with observations about social class and plant and animal sources of food, beverages and medicines. Investigators have identified various aspects of diet that relate to gout risk and recurrence. Some of our most useful medications for the treatment of gout were developed from herbal precursors. Traditional dietary recommendations for gout patients have included limiting high purine meat and alcohol consumption. More recent work suggests diets leading to weight loss through calorie and carbohydrate reductions may be effective for lowering serum urate levels, as well as the risk of gout.
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Nuki G, Simkin PA. A concise history of gout and hyperuricemia and their treatment. Arthritis Res Ther. 2006;8 Suppl 1:S1.
Bhattacharjee S. A brief history of gout. Int J Rheum Dis. 2009;12:61–3.
Zhang Y, Chen C, Choi H, Chaisson C, Hunter D, Niu J, et al. Purine-rich foods intake and recurrent gout attacks. Ann Rheum Dis. 2012;71:1448–53. One of a number of studies from the Boston University Online Case-Crossover Study of Triggers for Recurrent Gout Attacks clarifying the relationship of dietary factors long associated with the occurrence of gout flares using an innovative online technique for gathering diet related data.
De Oliveira EP, Moreto F, Silveira LV, Burini RC. Dietary, anthropometric, and biochemical determinants of uric acid in free-living adults. Nutrition J. 2013;12:11.
Dessein PH, Shipton EA, Stanwix AE. JoffeBI and J Ramokgadi. 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. Ann Rheum Dis. 2000;59:539–43.
Kontogianni MD, Chrysohoou C, Panagiotakos DB, Tsetsekou E, Zeimbekis A, Pitsavos C, et al. Adherence to the Mediterranean diet and serum uric acid: the ATTICA study. Scand J Rheumatol. 2012;41:442–9.
Choi HK, Atkinson K, Karlson EW, et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. N Engl J Med. 2004;350(11):1093–103.
Choi HK, Liu S, Curhan G. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid. Arthritis Rheum. 2005;52:283–9.
Dalbeth N, Gracey E, Pool B, et al. Identification of dairy fractions with anti-inflammatory properties in models of acute gout. Ann Rheum Dis. 2009;69(4):766–9.
Dalbeth N, Palmano K. Effects of dairy intake on hyperuricemia and gout. Curr Rheumatol Rep. 2011;13:132–7.
Zhang Y, Neogi T, Chen C, Chaisson C, Hunter DJ, Choi HK. Cherry consumption and decreased risk of recurrent gout attacks. Arthritis Rheum. 2012;64:4004–11. Interesting prospective verification of the utility of the folk practice of consuming cherries to prevent gout attacks.
Gaffo AL, Roseman JM, Jacobs DR, Lewis CE, Shikany JM, Mikuls TR, et al. Serum urate and its relationship with alcoholic beverage intake in men and women: findings from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort. Ann Rheum Dis. 2010;69:1965–70.
Lee SJ, Terkeltaub RA and A Kavanaugh. Recent developments in diet and gout. Curr Opin Rheumatol 18:193-198.
Wang M, Jiang X, Wu W, Zhang D. A meta-analysis of alcohol consumption and the risk of gout. Clin Rheumatol. 2013. doi:10.1007/s10067-013-2319-y.
Choi HK, Willett W, Curhan G. Fructose-Rich Beverages and Risk of Gout in Women. JAMA. 2010;304(20):2270–8.
Rivard C, Thomas J, Lanapsa MA, Johnson RJ. Sack and sugar, and the aetiology of gout in England between 1650 and 1900. Rheumatology. 2013;52:421–6.
Zgaga L, Theodoratou E, Kyle J, Farrington SM, Agakov F, Tenesa A, Walker M, McNeill G, Wright AF, Rudan I, Dunlop MG and H Campbell. The association of dietary intake of purine-rich vegetables, sugar-sweetened beverages and dairy with plasma urate, in a cross-sectional study. PLoS ONE 7(6): e38123. doi:10.1371/journal.pone.0038123.
Teng GG, Tan CS, Santosa A, Saag KG, Yuan J, Koh W. Serum urate levels and consumption of common beverages and alcohol among Chinese in Singapore. Arthritis Care Res. 2013;65:1432–40.
Huang HY, Appel LJ, Choi MJ, et al. The effects of vitamin C supplementation on serum concentrations of uric acid. Arthritis Rheum. 2005;52:1843–7.
Juraschek SP, Miller ER, Gelber AC. Effect of oral vitamin C supplementation on serum uric acid: a meta-analysis of randomized controlled trials. Arthritis Care & Res. 2011;63:1295–306.
Stamp LK, O’Donnell JL, Frampton C, Drake JM, Zhang M, Chapman PT. Clinically insignificant effect of supplemental vitamin C on serum urate in patients with gout. Arthritis Rheum. 2013;65:1636–42. Prospective, randomized controlled trial of vitamin C supplementation in gout patients underscores the complex mechanisms by which uric acid is handled in the body and how ingested substances might affect clinical endpoints, as well as the difficulty of trial design with subjects on varied medications.
Jung SM, Schumacher HR, Kim H, Kim M, Lee SH, Pessler F. Reduction of urate crystal-induced inflammation by root extracts from traditional oriental medicinal plants: elevation of prostaglandin D2 levels. Arthritis Res Ther. 2007;9:R64.
Li X, Han M, Wang Y, Liu J. Chinese herbal medicine for gout: a systematic review of randomized clinical trials. Clin Rheumatol. 2013;32:943–59.
Zhang S, Liu J, He K. Treatment of acute gouty arthritis by blood-letting cupping and herbal medicine. J TCM. 2010;30:18–20.
Bag A, Bhattacharyya SK, Chattopadhyay RR. The development of Terminalia chebula Retz. (Combretaceae) in clinical research. Asian Pac J Trop Biomed. 2013;3:244–52.
Gautam R, Jachak SM, Saklani A. Anti-inflammatory effect of Ajuga bracteosa Wall Ex Benth. mediated through cyclooxygenase (COX) inhibition. J Ethnopharm. 2011;133:928–30.
Breeher L, Gerr F, Fuortes L. A case report of adult lead toxicity following use of Ayurvedic herbal medication. J Occ Med Toxicol. 2013;8:26.
Genuis SJ, Schwalfenberg G, Siy AJ and I Rodushkin. Toxic element contamination of natural health products and pharmaceutical preparations. Plos ONE 7(11):e49676.
Posadzki P, Watson L, Ernst E. Contamination and adulteration of herbal medicinal products (HMPs): an overview of systematic review. Eur J Clin Pharmacol. 2013;69:295–307.
Hedner T, Everts B. The early clinical history of salicylates in rheumatology and pain. Clin Rheumatol. 1998;17:1725.
Lee WB, Woo SH, Min B, Cho S. Acupuncture for gouty arthritis: a concise report of a systematic and meta-analysis approach. Rheumatology. 2013;52:1225–32.
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Sharon L. Kolasinski declares that she has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the author.
This article is part of the Topical Collection on Crystal Arthritis
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Kolasinski, S.L. Food, Drink, and Herbs: Alternative Therapies and Gout. Curr Rheumatol Rep 16, 409 (2014). https://doi.org/10.1007/s11926-014-0409-8
- Herbal medicine
- Complementary and alternative medicine
- Vitamin C