Water, Skim Milk May Improve Gout Control

PHILADELPHIA — Drinking water or skim milk can improve gout control, according to findings from two studies that highlight the important contribution of lifestyle factors on gout prevention and management.

“Our results show that drinking water is a simple, safe, and effective means of trying to reduce recurrent gout attacks,” Dr. Tuhina Neogi said at the annual meeting of the American College of Rheumatology.

The study included 535 people who had had a gout attack within the past year (78% male; mean age, 53 years) and who provided information via the Internet about food, drink, medications, physical activity, and other possible gout risk factors during periods preceding the attack and during attack-free periods. Through use of a case crossover study design, the participants acted as their own controls. Medical records were accessed to verify gout diagnosis, explained Dr. Neogi of Boston University.

The findings showed that increasing water intake was associated with decreased risk for recurrent gout attacks. Compared with those who drank no water or one 8-ounce glass of water per day, those who drank five to eight glasses had a 40% lower chance of a gout attack and those who drank more than eight glasses had a 46% lower chance.

“Our results were adjusted for total fluid intake. They were specific for water,” commented Dr. Neogi. “This suggests that dehydration, which can potentially affect uric acid in the blood and its solubility, may indeed be an important trigger for gout attacks.”

In the second study, researchers from New Zealand measured the acute effects of skim milk consumption on serum urate concentrations in 16 healthy male volunteers, in light of reports that skim milk was beneficial in gout prevention. The randomized, controlled, crossover study was designed to assess the effects of skim milk that was from the early season and the late season, as well as MCP85, a milk protein concentrate that contains 85% protein. The effects of soy milk consumption also were assessed, and it was considered the control.

“Late-season” skim milk, which is primarily available from countries where milking is seasonal and cows are grass fed, is high in orotic acid, a substance known to promote uric acid removal by the kidneys, explained Dr. Nicola Dalbeth, a senior lecturer in clinical medicine at the University of Auckland (New Zealand). MPC85 skim milk is ultrafiltered and contains very low concentrations of orotic acid, purines, and lactose.

Each participant received a single dose of each product in a random order, with each study visit separated by a week. The amount consumed was equal to about 3.5 8-ounce glasses of milk. Serum and urine were obtained immediately before ingestion and then hourly over the next 3 hours.

Drinking soy milk led to a 10% increase in serum urate. In contrast, all skim milks decreased serum urate by about 10% (P less than .0001). All products, including soy, led to an increase in the fractional excretion of uric acid (FEUA).

Interestingly, there were differences among the types of skim milk, which may shed light on the underlying mechanism. Late-season skim milk led to a greater increase in FEUA, compared with either ultrafiltered skim milk or early-season skim milk, suggesting that the acute urate-lowering effect of orotic acid may explain these effects.

“We cannot necessarily extrapolate these results from [healthy individuals] to those with gout,” Dr. Dalbeth acknowledged. “Furthermore, I am not saying drinking milk should replace allopurinol. But one of the key things we do is spend a lot of time telling people with gout what not to do, such as do not eat red meat. It is very useful to have some positive information.”

Dr. Neogi reported having no conflicts of interest. Dr. Dalbeth said that her study was funded in part by the Fonterra Dairy Cooperative, and that one of the study authors was an employee of Fonterra.

PHILADELPHIA — Drinking water or skim milk can improve gout control, according to findings from two studies that highlight the important contribution of lifestyle factors on gout prevention and management.

“Our results show that drinking water is a simple, safe, and effective means of trying to reduce recurrent gout attacks,” Dr. Tuhina Neogi said at the annual meeting of the American College of Rheumatology.

The study included 535 people who had had a gout attack within the past year (78% male; mean age, 53 years) and who provided information via the Internet about food, drink, medications, physical activity, and other possible gout risk factors during periods preceding the attack and during attack-free periods. Through use of a case crossover study design, the participants acted as their own controls. Medical records were accessed to verify gout diagnosis, explained Dr. Neogi of Boston University.

The findings showed that increasing water intake was associated with decreased risk for recurrent gout attacks. Compared with those who drank no water or one 8-ounce glass of water per day, those who drank five to eight glasses had a 40% lower chance of a gout attack and those who drank more than eight glasses had a 46% lower chance.

“Our results were adjusted for total fluid intake. They were specific for water,” commented Dr. Neogi. “This suggests that dehydration, which can potentially affect uric acid in the blood and its solubility, may indeed be an important trigger for gout attacks.”

In the second study, researchers from New Zealand measured the acute effects of skim milk consumption on serum urate concentrations in 16 healthy male volunteers, in light of reports that skim milk was beneficial in gout prevention. The randomized, controlled, crossover study was designed to assess the effects of skim milk that was from the early season and the late season, as well as MCP85, a milk protein concentrate that contains 85% protein. The effects of soy milk consumption also were assessed, and it was considered the control.

“Late-season” skim milk, which is primarily available from countries where milking is seasonal and cows are grass fed, is high in orotic acid, a substance known to promote uric acid removal by the kidneys, explained Dr. Nicola Dalbeth, a senior lecturer in clinical medicine at the University of Auckland (New Zealand). MPC85 skim milk is ultrafiltered and contains very low concentrations of orotic acid, purines, and lactose.

Each participant received a single dose of each product in a random order, with each study visit separated by a week. The amount consumed was equal to about 3.5 8-ounce glasses of milk. Serum and urine were obtained immediately before ingestion and then hourly over the next 3 hours.

Drinking soy milk led to a 10% increase in serum urate. In contrast, all skim milks decreased serum urate by about 10% (P less than .0001). All products, including soy, led to an increase in the fractional excretion of uric acid (FEUA).

Interestingly, there were differences among the types of skim milk, which may shed light on the underlying mechanism. Late-season skim milk led to a greater increase in FEUA, compared with either ultrafiltered skim milk or early-season skim milk, suggesting that the acute urate-lowering effect of orotic acid may explain these effects.

“We cannot necessarily extrapolate these results from [healthy individuals] to those with gout,” Dr. Dalbeth acknowledged. “Furthermore, I am not saying drinking milk should replace allopurinol. But one of the key things we do is spend a lot of time telling people with gout what not to do, such as do not eat red meat. It is very useful to have some positive information.”

Dr. Neogi reported having no conflicts of interest. Dr. Dalbeth said that her study was funded in part by the Fonterra Dairy Cooperative, and that one of the study authors was an employee of Fonterra.

PHILADELPHIA — Drinking water or skim milk can improve gout control, according to findings from two studies that highlight the important contribution of lifestyle factors on gout prevention and management.

“Our results show that drinking water is a simple, safe, and effective means of trying to reduce recurrent gout attacks,” Dr. Tuhina Neogi said at the annual meeting of the American College of Rheumatology.

The study included 535 people who had had a gout attack within the past year (78% male; mean age, 53 years) and who provided information via the Internet about food, drink, medications, physical activity, and other possible gout risk factors during periods preceding the attack and during attack-free periods. Through use of a case crossover study design, the participants acted as their own controls. Medical records were accessed to verify gout diagnosis, explained Dr. Neogi of Boston University.

The findings showed that increasing water intake was associated with decreased risk for recurrent gout attacks. Compared with those who drank no water or one 8-ounce glass of water per day, those who drank five to eight glasses had a 40% lower chance of a gout attack and those who drank more than eight glasses had a 46% lower chance.

“Our results were adjusted for total fluid intake. They were specific for water,” commented Dr. Neogi. “This suggests that dehydration, which can potentially affect uric acid in the blood and its solubility, may indeed be an important trigger for gout attacks.”

In the second study, researchers from New Zealand measured the acute effects of skim milk consumption on serum urate concentrations in 16 healthy male volunteers, in light of reports that skim milk was beneficial in gout prevention. The randomized, controlled, crossover study was designed to assess the effects of skim milk that was from the early season and the late season, as well as MCP85, a milk protein concentrate that contains 85% protein. The effects of soy milk consumption also were assessed, and it was considered the control.

“Late-season” skim milk, which is primarily available from countries where milking is seasonal and cows are grass fed, is high in orotic acid, a substance known to promote uric acid removal by the kidneys, explained Dr. Nicola Dalbeth, a senior lecturer in clinical medicine at the University of Auckland (New Zealand). MPC85 skim milk is ultrafiltered and contains very low concentrations of orotic acid, purines, and lactose.

Each participant received a single dose of each product in a random order, with each study visit separated by a week. The amount consumed was equal to about 3.5 8-ounce glasses of milk. Serum and urine were obtained immediately before ingestion and then hourly over the next 3 hours.

Drinking soy milk led to a 10% increase in serum urate. In contrast, all skim milks decreased serum urate by about 10% (P less than .0001). All products, including soy, led to an increase in the fractional excretion of uric acid (FEUA).

Interestingly, there were differences among the types of skim milk, which may shed light on the underlying mechanism. Late-season skim milk led to a greater increase in FEUA, compared with either ultrafiltered skim milk or early-season skim milk, suggesting that the acute urate-lowering effect of orotic acid may explain these effects.

“We cannot necessarily extrapolate these results from [healthy individuals] to those with gout,” Dr. Dalbeth acknowledged. “Furthermore, I am not saying drinking milk should replace allopurinol. But one of the key things we do is spend a lot of time telling people with gout what not to do, such as do not eat red meat. It is very useful to have some positive information.”

Dr. Neogi reported having no conflicts of interest. Dr. Dalbeth said that her study was funded in part by the Fonterra Dairy Cooperative, and that one of the study authors was an employee of Fonterra.