The Beneficial Effects of Tart Cherry Supplementation on Patients with Gout

by | Jan 18, 2024 | 2023, Arthritis, Fruits and Vegetables, Gout

Written by Harold Oster, MD. Results suggest that supplementation with tart cherry powder may decrease inflammation and albuminuria in patients with gout.

x-ray of feet with goutGout is the most common inflammatory arthritis, with a prevalence of over 3% of adults. It is associated with multiple medical conditions, including renal disease, coronary disease, stroke, metabolic syndrome, and diabetes1. Gout is a metabolic disorder where hyperuricemia leads to the formation of monosodium urate crystals, which trigger inflammation in and around joints and tendons. Treatment of the acute episodes includes anti-inflammatory medication, while urate-lowering treatment, primarily allopurinol or febuxostat, may be prescribed to prevent flares and decrease end-organ damage2. Alkalinization of the urine is sometimes recommended to increase the excretion of uric acid by the kidneys3. Tart cherries have anti-inflammatory properties4 and may have benefits in patients with gout5.

Can Wang, et al. studied the beneficial effects of a tart cherry and citrate mixture in patients with gout. Three hundred fifty-four adult males with gout were recruited from a clinic in Qingdao, China. All participants had acidic urine (pH ≤ 6) and were about to start febuxostat to lower uric acid levels. They underwent a 14-day washout period where they were instructed to eat a diet low in purines, which are metabolized to uric acid, and stop any medication that might affect uric acid levels. They were randomized to receive one of three supplements for twelve weeks: one gram of sodium bicarbonate three times a day, a citrate mixture containing citric acid, sodium citrate, potassium citrate, and sodium carbonate twice a day, or the tart cherry citrate mixture containing 875 mg of tart cherry powder, citric acid, sodium citrate, potassium citrate, and sodium carbonate twice a day. All patients started febuxostat 20mg daily, to be increased to 40mg daily if the serum uric acid level was above 360 µmol/L (6 mg/dL) after four weeks. Participants were evaluated every four weeks for adverse reactions and gout flares (defined as a flare by the patient and associated with pain scoring three or higher on the visual analog scale)6. At baseline, demographic and medical history information were obtained. At every visit, blood pressure and body mass index were assessed, urine was tested for pH, albumin, and creatinine, and blood was tested for uric acid, lipids, C-reactive protein (a test for inflammation), and multiple parameters to assess for covariables and signs of adverse effects. At baseline and at the end of the study, a dual-energy CT scan (DECT) of affected joints was performed to quantify the volume of uric acid crystals7.

The authors noted the following:

  • Based on inclusion criteria, 254 participants completed the study.
  • At baseline, demographic and clinical features were similar among the three groups.
  • Urine pH increased similarly in all three groups.
  • Serum urate levels decreased similarly in all three groups.
  • Participants in the tart cherry and citrate mixture groups experienced fewer gout flares than those in the sodium bicarbonate group (0.56 and 0.58 per participant versus 0.94). There was no difference noted between the tart cherry and citrate groups.
  • C-reactive protein dropped significantly in the tart cherry group (3.5 mg/L to 2.0 mg/L) and did not change in the other groups.
  • The urine albumin to creatinine ratio, a measure of early kidney disease8, improved in all three groups, improving to a greater extent in the tart cherry group compared to the other groups.
  • Urate crystal volume measured by DECT decreased in all three groups without a difference between groups.
  • No other clinical differences were noted between the three groups.
  • Adverse effects were similar in the three groups.

The authors concluded that tart cherry supplementation resulted in greater improvement in C-reactive protein levels and the urine albumin to creatinine ratio than urinary alkalinization without tart cherry. A limitation of the study was the lack of a placebo.

Source: Wang, Can, Wenyan Sun, Nicola Dalbeth, Zhongjun Wang, Xuefeng Wang, Xiaopeng Ji, Xiaomei Xue et al. “Efficacy and safety of tart cherry supplementary citrate mixture on gout patients: a prospective, randomized, controlled study.” Arthritis Research & Therapy 25, no. 1 (2023): 164.

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Posted January 18, 2024.

Harold Oster, MD graduated from medical school in Miami, Florida in 1992 and moved to Minnesota in 2004. After more than 25 years of practicing Internal Medicine, he recently retired. Dr. Oster is especially interested in nutrition, weight management, and disease prevention. Visit his website at haroldoster.com.

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