Gout & Plant-based Diet Research Topics
Vegetarians Have Lower Uric Acid
My first study aims to evaluate the impact of changing from typical Western diets to plant-based diets. Because the researchers were concerned about potential increases in uric acid. Citing research showing that wholly plant-based, vegan diets can lead to higher uric acid. However, the increase in uric acid in their experiment was minimal.
Unfortunately, this experiment was not undertaken on gout patients. But the researchers suggest that kidney disease and gout patients could change some plant foods for lower purine alternatives. For example, soy legumes, broccoli sprout, spinach, orange juice, soy tofu, dried shitake could be replaced with nonsoy legumes, cauliflower, red beet, hibiscus tea, chickpea hummus, raw or steamed shitake respectively.
Jakše, B., Jakše, B., Pajek, M. and Pajek, J., 2019. Uric acid and plant-based nutrition. Nutrients, 11(8), p.1736.
Plant-based diets (PBDs) are associated with a decreased risk for morbidity and mortality due to most chronic noncommunicable diseases, including cardiovascular diseases, certain types of cancer, metabolic syndrome, type 2 diabetes and obesity. […] studies that compared UA serum concentrations in vegetarians and non-vegetarians have consistently shown a lower mean UA serum concentration in vegetarians.
Plant-based Diet for Gout & Comorbidities
My second study aims to evaluate the association between plant-based diets and doctor-diagnosed cases of gout. In contrast to the first study, they found that vegan diets are associated with lower uric acid than non-vegetarian diets. Unfortunately, the number of vegans in the study was too small to evaluate risks of gout attacks. However, they did show that vegetarians had lower rates of gout compared to non-vegetarians. Furthermore, the incidence of common gout comorbidities was lower in vegetarians.
Chiu, T.H., Liu, C.H., Chang, C.C., Lin, M.N. and Lin, C.L., 2020. Vegetarian diet and risk of gout in two separate prospective cohort studies. Clinical Nutrition, 39(3), pp.837-844.
plant-based dietary patterns may be a clinically viable solution to prevent gout. […] Moreover, vegetarian diets may protect against many gout-associated comorbidities. Vegetarian diets have been shown to lower blood pressures in a meta-analysis of randomized controlled trials (SBP: −4.8 mmHg and DBP: −2.2 mmHg), and in a prospective cohort study (odds ratio: 0.66, 95% CI: 0.50, 0.87). Better control of blood pressures may reduce the needs for diuretic, further lowering uric acids. In addition, vegetarian diets are associated with lower cardiovascular diseases and diabetes. The use of soy to replace animal protein had also been shown to preserve renal function in a meta-analysis of randomized controlled trials. Taken together, vegetarian diets may offer a comprehensive solution to not only gout but also its devastating comorbidities.
Plant-based Protein for Gout
In my third study, researchers from earlier heart investigations re-analyzed blood specimens for uric acid. In order to evaluate the effects of Dietary Approaches to Stop Hypertension (DASH) diet. Which is a carbohydrate-rich diet that emphasizes fruit, low-fat dairy, and vegetables.
The study uses 3 versions of the DASH diet. With increased proportions of either carbohydrates, protein, or unsaturated fats. Resulting in lower uric acid only in the increased protein version. Here, 10% of carbohydrates from a standard DASH diet were replaced with mainly plant-based protein. Contrasting with a similar investigation which added animal protein, causing a rise in uric acid.
The researchers suggest several possible reasons for reduced uric acid from plant-based protein:
- Higher protein intake increases uric acid excretion
- Plant purines convert less readily to uric acid.
- Decreased insulin resistance reduces uric acid
- Reduced insulin secretion may increase uric acid clearance from the kidneys
- Wheat gluten (22 grams per day in this diet) can lower uric acid.
Belanger, M.J., Wee, C.C., Mukamal, K.J., Miller III, E.R., Sacks, F.M., Appel, L.J., Shmerling, R.H., Choi, H.K. and Juraschek, S.P., 2021. Effects of dietary macronutrients on serum urate: results from the OmniHeart trial. The American journal of clinical nutrition, 113(6), pp.1593-1599.
In conclusion, a DASH-style diet emphasizing a higher proportion of plant-based protein in comparison to carbohydrates or unsaturated fat lowered serum urate among obese or overweight adults with prehypertension or stage 1 hypertension. The protein-rich version of the DASH diet may be an optimal dietary approach to lower serum urate in adults with gout while also improving BP and lipids.
Lignans & Gout Diet
My 4th study is a doctoral dissertation with 3 aims:
Are 3 plant-based indices linked with gout?
Is dietary lignan linked with gout?
Is dietary lignan linked with weight change?
The study distinguishes between healthful and unhealthful foods. With healthful foods including dairy, tea & coffee, and whole grains. Each of which are associated with lower risk of gout. Whereas unhealthful fruit juice and sugar sweetened beverages are both linked with higher risk of gout.
The study identifies 4 lignans, matairesinol, secoisolariciresinol, pinoresinol, and lariciresinol, found in many foods. Including coffee, flax, fruits, red wine, tea, vegetables, and whole grain cereals. Higher intakes of matairesinol and secoisolariciresinol were associated with a significantly lower risk of incident gout. But not pinoresinol or lariciresinol. For specific foods associated with lower risk of gout, the study identifies added bran, cooked oatmeal or oat bran, and whole grain cold breakfast cereal.
The study found that high lignan intake is associated with less weight gain. Specifically recommending flaxseed, fruit, vegetables, and whole grains for gout sufferers who need to lose weight.
Rai, S., 2022. Plant-Based Diets, Lignan Intake, Weight Change, and the Risk of Gout (Doctoral dissertation).
Taken together, our findings support current dietary recommendations to eat a healthy plant-based diet and suggest that selecting food items that are rich in lignans (such as whole grains, fruits, vegetables, and flaxseed) may be beneficial for reducing gout risk and promoting weight control.
Metabolic Syndrome & Plant-based Diet
My final study addresses a problem with traditional views on gout nutrition. Namely, that focus on high or low consumption of individual foods ignores the impact on our entire metabolism. So it includes extensive analysis of how foods that affect uric acid can also affect other indicators of metabolic syndrome. Concluding that gout patients should:
- Choose foods that reduce metabolic syndrome.
- Take nutritional supplements for uric acid and inflammation.
- Consider food combined with gout medication for managing gout flares.
The study includes a diagram (Nutrition-induced systemic metabolism involved in gouty disease.*) that indicates the complex nature of gout and nutrition.
Zhang, Y., Chen, S., Yuan, M., Xu, Y. and Xu, H., 2022. Gout and Diet: A Comprehensive Review of Mechanisms and Management. Nutrients, 14(17), p.3525.
Evidence supports that a low-fat, low-carb, plant-based dietary intervention is suitable for gouty patients; however, we need to pay specific attention to the golden rule of healthy dietary intake, that is, moderation.
Plant-based Diet Research & Your Gout
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Gout & Plant-based Diet Research Footnote
- * From study 5:
Figure 2. Nutrition-induced systemic metabolism involved in gouty disease. Metabolites of fat, carbohydrate and protein and the resulting metabolic diseases promote the development of gout, including changing intestinal flora, accelerating purine metabolism, promoting MSU deposition, activating macrophages, and inhibiting uric acid excretion. ADP, adenosine diphosphate. AMP, adenosine monophosphate. ATP, adenosine triphosphate. FFAs, free fatty acids. F6P, fructose 6 phosphate. KHK, ketohexokinase. LPS, lipopolysaccharide. MSU, monosodium urate. NAFLD, nonalcoholic fatty liver disease. NAFPD, nonalcoholic fatty pancreas disease. TG, triglyceride. TLR, toll-like receptor. UA, uric acid. XO, xanthine oxidase