Anti-hypertension DASH Diet May Reduce The Risk Of Gout

A diet which is known to reduce the risk of hypertension and cardiovascular disease may also reduce the risk of gout. The results of a 25-year-follow up study done by the investigators at the Massachusetts General Hospital suggest the DASH (Dietary Approaches to Stop Hypertension) diet which emphasizes increased consumption of fruits, vegetables and low-fat dairy products to lower the risk of gout. Though diet is known to reduce the risk of hypertension and cardiovascular disease it also reduces uric acid levels.

What is Gout?

Gout is caused by a defect in metabolism that results in an overproduction of uric acid, or a reduced ability of the kidney to eliminate uric acid. When the body breaks down purine, a compound found in the body, the resulting metabolite is uric acid.

• Gout is a condition with abnormally high levels of uric acid in the blood which accumulates in the joints.
• The deposits of hard lumps of uric acid in and around the joints cause recurring attacks of joint inflammation (arthritis).
• Intense joint inflammation causes pain, heat and redness of the joint tissues.
• Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes.

The treatment for gout involves two approaches - medications and lifestyle changes. Medications are used to treat the hot, swollen joint and to prevent further pain. Changes in the diet, regular physical activity and cutting down on alcohol are the lifestyle changes which reduce the severity of gout.

Purine is found in foods such as meat, liver, kidney, beef, pork, certain fish and shell fish - sardine, mackerel, herring, crab, lobster, oyster, shrimp, mussels and vegetables - asparagus, fava beans, mushrooms, peas, lentils, spinach and cauliflower among others.

"The current dietary recommendation for gout care is a diet low in purines, which are found in certain meats and seafood, but following such a diet has limited effectiveness and proves challenging for many patients," says Hyon Choi, senior author of the report, Director of the Gout and Crystal Arthropathy Center in the MGH Division of Rheumatology, Allergy, and Immunology.

A diet low in purine is recommended for those with high levels of uric acid and gout. Hence, avoiding or limiting the intake of foods which contain purine can result in a low protein diet as the foods which contain purine are high in protein.

Choi added, "This kind of low-protein diet may also promote increased consumption of refined carbohydrates and unhealthy fats - including trans fats - that can worsen cardiovascular and metabolic problems common in gout patients."

DASH Diet For Gout

 A typical western diet which includes breads, cakes made of refined flour, red meat and trans fat can worsen cardiovascular and metabolic problems common in gout patients.

The DASH diet is low in cholesterol, saturated fat, red meat, sodium, sweets and includes whole grains, fruits, vegetables, poultry, fish and nuts. Several studies have confirmed its ability to reduce risks for hypertension and cardiovascular disease.

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A recent clinical trial which analyzed the adherence of a diet which is rich in fruits, vegetables and low fat dairy - resembling the DASH diet reduced uric acid levels in those with gout.

About the Study

The research team analyzed data from more than 50,000 male health professionals aged between 40 to 75. They were part of the Health Professionals Follow-up Study, which began in 1986.

Every two years, their body weight, medication use and medical conditions for which they have been diagnosed were recorded. Details about their diet pattern, their frequency of various types of food were recorded using a food frequency questionnaire.

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The participants were not assigned any particular diet. The research team applied two scoring systems to assess the food intake of each participant. Information provided by 44,444 participants who had no history of gout prior to joining the study was analyzed.

A high score for dash diet was seen in those with a regular intake of fruits, vegetables, nuts and legumes, low-fat dairy products and whole grains. The scores went down in those with increased consumption of red or processed meats, sodium and sweetened beverages.

The Western dietary pattern score indicated the intake of red meat, processed meat, refined grains, sugar-sweetened beverages, sweets, desserts and fried food.

After 25 years of follow-up, from 1986 to 2012 - 1,731 participants were newly diagnosed with gout. Generally, the risk factors for gout are age, body weight, high blood pressure, kidney failure, intake of alcohol. None of the risk factors altered the association - individuals with a higher DASH score were less likely to be diagnosed with gout. The risk of gout increased in those with an elevated Western diet score.

Results of the Study

Researchers note that many individuals at risk for gout because of elevated uric acid levels may also have hypertension and so the effect of DASH diet would do them good. "For individuals at high risk for gout, especially those who also have hypertension, the DASH diet is likely to be an ideal preventive approach," said Sharan Rai, lead author, MGH Division of Rheumatology, Allergy, and Immunology.

However, those who have been diagnosed with have kidney disease should consult their doctor before starting the DASH diet as it is high in potassium and can affect the kidneys.

"The diet may also be a good option for patients with gout who have not reached a stage requiring urate-lowering drugs or those who prefer to avoid taking drugs. And since the vast majority of patients with gout also have hypertension, following the DASH diet has the potential of 'killing two birds with one stone', addressing both conditions together," said Rai.

Reference:

1. Gout Treatment - (http://www.arthritis.org/about-arthritis/types/gout/treatment.php)
2. Sharan Rai.K et al.,The Dietary Approaches to Stop Hypertension (DASH) diet, Western diet, and risk of gout in men: prospective cohort study, The BMJ (2017).

Source-Medindia