April 13, 2017
Clinical Rheumatology
Abstract
The Dietary Approaches to Stop Hypertension (DASH) diet lowers serum uric acid (SUA) levels compared to the typical American (control) diet. However, the time required for the DASH diet to take effect is unknown. We analyzed data from a parallel arm, randomized-controlled trial in pre-hypertensive or hypertensive adults (N = 103), comparing the effects of DASH or a control diet on SUA measured at 30, 60, and 90 days. Effects were examined overall and within stratified subgroups based on baseline SUA status (SUA ≥6 mg/dL vs <6 mg/dL). The mean age of participants was 51.5 ± 9.7 years, 55% were women, 75% were black, 42% were obese, and 34% had hypertension. Twenty-four of the 103 (23%) participants had a baseline SUA ≥6 mg/dL. Overall, compared to the control, DASH lowered SUA by 0.5 mg/dL at 30 and 90 days. Among participants with baseline SUA ≥6 mg/dL, DASH lowered SUA by 0.8 and 1.0 mg/dL at 30 and 90 days, respectively. These findings demonstrate that the DASH diet reduces SUA within 30 days, with a sustained effect at 90 days, which is informative for healthcare providers counseling patients on time course expectations for uric acid reduction in response to dietary modification.
Nutritional strategies to lower uric acid
High levels of uric acid are now known to be a marker of metabolic dysfunction and cardiovascular mortality. Lowering uric acid should be a goal not only to treat gout but also to lower the risk of heart disease.
This study supported previous research showing that the Dietary Approaches to Stop Hypertension (DASH diet) reduced uric acid by about 1 point in those who started at levels ≥6 mg/dL. This change occurred within 30 days of starting the diet and persisted for 3 months. The participants were given the DASH foods, so compliance was high. The control diet was the typical American diet. The DASH diet is rich in vegetables, fruit, and low-fat dairy, with a reduced intake of saturated fat.
Nutritional treatment of gout
Gout is known as “the disease of kings” due to the association with heavy foods (red meat) and alcohol. Those foods that seem to be associated with the greatest risk of gout include beef, pork, and lamb. High intake of seafood and sugar can also increase the risk.
Purine-rich vegetables, which were once thought to increase the risk of gout, are now known not to be a causative factor. A low purine diet is no longer recommended. People with elevated uric acid should be encouraged to consume all vegetables, legumes, nuts, and fruit. Coffee, citrus, and cherry can also be protective.
Many can avoid having to take uric acid–lowering medications by following a DASH diet, losing weight, avoiding excessive alcohol, and switching off their loop diuretics.