Treat Gout with Vitamin C — Experiments on Battling Gout      

        Gout and Vitamin C? Most studies say Vitamin C is good for gout.     

        Effect of oral vitamin C supplementation on serum uric acid: a meta ...

Gout and Vitamin C? Yes Vitamin C is  good for gout, but there's a small caution

http://www.best-gout-remedies.com/gout-and-vitamin-c.html

This page about gout and vitamin C was last reviewed or updated on 5 May 2015

Vitamin C for gout? Yes it's a good connection, if not 100% reliable. It is that Vitamin C is reckoned in many studies to lower uric acid levels somewhat, but don't expect the kind of reduction you get from medications.

Recall that vitamins and drugs work in two ways to reduce uric acid levels. One is restricting its supply by inhibiting purine breakdown into uric acid, the other is improving uric acid’s excretion in the urine. Vitamin C is thought to be a uric acid excretor, not an inhibitor. Improving excretion may reduce your uric acid more than reducing production. That is often the case with drugs medications.

GOUT AND VITAMIN C STUDIES 

The connection between gout and Vitamin C has been the subject of a number of studies over the past 30 years. They have concluded that Vitamin C will reduce the uric acid level, but have differed in the amount of Vitamin C given to study participants. A U.S. study of 184 non smokers, published in 2005 looked at gout and Vitamin C. It concluded that the amount of Vitamin C required to achieve a serum (blood) uric acid level reduction was only 500 mg daily. 

The Vitamin C was taken as a supplement. 500 mg daily is not a mega dose. Previously it has been thought that the amount needed was at least 4,000 mg (4 grams) daily. Dr Robert Atkins,(the Atkins diet), in another of his books, "Dr.Atkins' Vita Nutrient Solution," recommended 5,000 -10,000 mg (5 - 120 grams) as part of his formula for a natural remedy for gout.

In the 2005 study, how much did 500 mg of Vitamin C reduce participants' uric acid level? It found an average, across all, reduction of about 10% (0.5 mg/dL). And reductions were larger among participants who had higher levels of uric acid at the start of the study. Participants took the 500 mg daily amount for two months. Those who were given a placebo (i.e. a dummy) showed a slight increase in uric acid levels. Vitamin E was also given to participants but had no effect on uric acid levels.

0.5 mg/dL is a useful reduction but for most people probably not a natural remedy for gout, although the 0.5 mg/dL figure is an average and some participants did better. But a 0.5mg/dL reduction will not be enough for most to reduce uric acid below the 6.0 mg/dL level at which the MSU gout crystals may dissolve. However, when combined with other vitamins for gout, a low purine diet and the other natural remedies for gout described elsewhere on this website, it could be a very useful reinforcement.

A small caution 

Such a rapid change concerned the authors of one study in the 1970’s who also examined the link between gout and Vitamin C. They recorded that mega doses of Vitamin C (4,000 mg and 8,000 mg daily) reduced uric acid levels significantly, and by more than in the 2005 study. i.e. the same conclusion as Dr. Robert Atkins. However, as far as Vitamin C induced rapid changes in uric acid levels is concerned, this kind of change has not been reported in any study.Rapid changes in uric acid levels can trigger a gout attack. This rapid change can be brought about by many factors in addition to mega doses of Vitamin C, including by drug medications that lower uric acid. (It's why doctors prescribe prophylatic medicines such as Colchicine or NSAIDS, along with uric acid lowering medicines). People who are susceptible to gout must consider these rapid changes. 

Vitamin C for preventing gout 

If 500 mg daily of Vitamin C can reduce uric acid levels, then Vitamin C ought to act as a preventative gout vitamin too. A Taiwan study of males in the late 1990’s examined the weight, diet and lifestyles of gout and non-gout patients in Taiwan. It concluded that Vitamin C, and folic acid (folate) were protective against gout. Folic acid is the dietary supplement form; folate is the food form. It also found fibre (fiber) is protective against gout. And it reached the well known and accepted conclusions that hypertension (high blood pressure) and obesity are risk factors for gout. 

1,000 mg plus doses

If you wish to try Vitamin C for gout in doses over 1,000 mg as part of a natural gout remedy discuss it with your doctor, or a qualified naturopathic doctor. The 500 mg level is below the British government’s 1,000 mg (1 gram) daily recommended upper safety level safety limit for Vitamin C. It’s half of the maximum amount (1,000 mg) in a Vitamin C tablet sold in the U.S. and many other countries. 

To avoid excess acidity (lower pH) also take alkalizing minerals, or another alkalizing agent recommended by your doctor. Drink plenty of water and check your urine pH regularly. Acidic urine can lead to kidney stones

Or take an Ester-C version of Vitamin C, because this is non-acidic. 

Use Vitamin C products that have added flavonoids, because flavonoids improve its absorption, as do time release versions. One flavonoid added to better Vitamin C products is rutin.  A 2009 study found that rutin itself lowered blood uric acid levels in rats with elevated blood uric acid. The other flavonoid that did this in this study was quercetin.

These preparations cost a bit more, but it's a bit more money well spent.

Click here to read how 12 healthy people lowered uric acid levels with just two glasses of orange juice a day. No kidding !

However don't expect 100% reliability from Vitamin C..... A New Zealandstudy, published in mid 2013 in the journal Arthritis & Rheumatism, found that Vitamin C at a dose of 500 mg daily for 8 weeks, scarcely lowered uric acid. 

But this has also sometimes happened in earlier studies about Vitamin C and uric acid. A meta-analysis (a study of studies) of 13 Vitamin C and uric acid studies between 1990 and 2009 found that it fell in 9, rose in 4, and there was no change in 1. When Vitamin C was the only substance taken (9 of 13 studies), the uric acid fall was a useful – 0.54 mg/dL. 

Dr.Atkins in his Vita Nutrient Solution book said 8 grams of Vitamin C was needed to lower uric acid.

This meta-analysis was an important analysis of what Vitamin C can do, so I’ve written a page about it. The only caveat is that the studies were not in gout patients. And there have been other Vitamin C studies at higher doses which lowered uric acid by more, or did not lower it, but were not included in the 13 of the meta-analysis. Some patients in these studies were gout patients.

If you want to read the 2005 study click here to download it. It's called: "The Effects of Vitamin C Supplementation on Serum Concentrations of Uric Acid". The study is provided free by Wiley InterScience. When the page arrives click on the Full Text: HTML or PDF (64k) links above the study title. If you want the PDF version you need Adobe Reader.

Related pages you may enjoy

Visit the Vitamin C and uric acid page where we discuss a mega study that on the whole was favourable for Vityamin C's lowering of uric acid.

What do the Vitamin C studies mean. Read our conclusions.

Everyone knows orange juice contains Vitamin C. Can orange juice lower uric acid ?  Read our orange juice for gout page.

VITAMIN C FROM FOODS AND BEVERAGES

Try to eat more foods with high amounts of Vitamin C.

Our link which enables you to download the free National Nutrient database is on this page. Use this link to download the database itself or download a list of foods high in Vitamin C sorted by highest amount first downwards.

Scarcely known high Vitamin C foods

Of course you know some foods high in Vitamin C such as oranges and other citrus fruit.

But here's some not very well known foods which are very high in Vitamin C - Acerola cherry (aka the Barbados cherry); Indian gooseberry (from which Amla powder is made); Kakadu plum; various types of pepper. Horseradish is surprisingly high in Vitamin C, which is why it was a remedy for scurvy in past centuries.

 Vitamin C and gout: an interview with Prof. Lisa Stamp

Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)

http://www.news-medical.net/news/20130604/Vitamin-C-and-gout-an-interview-with-Prof-Lisa-Stamp.aspx

Which previous studies have suggested that vitamin C moderates gout risk?

A previous study in by Choi et al in the USA showed that people with a higher vitamin C intake have a lower risk of gout. There are also studies in healthy volunteers that suggest that vitamin C supplements reduce blood uric acid levels.

What mechanism did these studies propose for moderation of gout risk by vitamin C supplementation?

It is thought that vitamin C increases the excretion of uric acid in the urine.

The exact mechanism is not known, however, it is thought to be something to do with the way the kidneys excrete uric acid.

There is some evidence that vitamin C might also reduce production of uric acid as well but the major mechanism is thought to be through increasing excretion through the kidneys.

Please can you outline your recent research into vitamin C supplementation in gout patients?

We recruited gout patients who had blood uric acid levels greater than the treatment target level of 0.36 mmol/L (6 mg/100 mL). 

Of the 40 participants with gout, 20 patients taking allopurinol were given an additional 500 mg dose of vitamin C daily or had the dose of allopurinol increased, while another 20 patients were either started on allopurinol or vitamin C (500 mg/day). 

We analyzed blood levels of vitamin C (ascorbate), creatinine and uric acid at baseline and week eight.

What were the findings of your study?

Our study showed that a modest vitamin C dose (500mg/d) for eight weeks did not lower urate levels to a clinically significant degree in gout patients, but did increase blood levels of ascorbate (vitamin C). 

Did your research involve patients taking vitamins pills or adjusting their diet to increase their vitamin C intake?

Patients were given vitamin C pills.

Do you think your results would have differed if patients had increased their vitamin C intake by diet modification rather than taking vitamin C pills?

No. The dose of vitamin C we gave was higher than the daily recommended intake and the blood levels of ascorbate (vitamin C) increased suggesting that patients were receiving adequate amounts.

Were you surprised by the results of your study?

Not really. The degree of change in uric acid levels is similar to that seen in other studies. The amount of change is unlikely to have any significant clinical benefit for patients with gout.

Are the results of your research conclusive or is further research needed to confirm whether vitamin C is beneficial to gout patients?

Higher doses of vitamin C could be studied, however the risks of higher doses needs to be considered.

The dose we gave is already above the recommended daily dose and the blood levels reached a point where increasing them further was unlikely to have any extra effect.

Although your research looked at the effects of vitamin C supplementation on uric acid levels, do you think there may be other benefits of gout patients taking fruits containing vitamin C? For example, are fresh cherries and cherry juice effective at lowering uric acid levels?

Cherries have been reported to lower uric acid levels in women. They have also been reported to reduce the number of gout attacks. The mechanism by which cherries exert these effects is not entirely clear. It has been suggested that cherries increase uric acid excretion via the kidneys and may lower urate production. There are also other anti-inflammatory chemicals in cherries that may have an effect. The amount of vitamin C in cherries is probably not high enough to have any effect.

Why do many patients fail to reach appropriate urate levels despite taking current treatments?

The two most common reasons patients don’t reach appropriate urate levels are not taking the medicines that lower uric acid levels regularly and that the dose of the medicine is too low.

How was your research funded?

The research was funded by the Health Research Council of NZ.

Do you have any plans to research other alternative therapies for gout?

We have plans to look at the effects of omega three fats in acute gout.

There are two things you need to do when you are treating gout. Firstly, you need to treat the acute attacks as they come, secondly, in the long term you need to lower the uric acid to prevent the attacks from coming.

Omega three fats work like a natural anti-inflammatory. The study, which is being led by one of my colleagues in Wellington, will look at whether we could treat those acute attacks of gout by omega three fats rather than using anti-inflammatory drugs. Anti-inflammatory drugs can have quite a lot of side effects.

Where can readers find more information on research into gout treatments?

Patients can look on the clinical trial registry web sites for studies on gout medicines.

Readers can find our research paper here:http://onlinelibrary.wiley.com/doi/10.1002/art.37925/abstract;jsessionid=CBF67F2B57C8F7B5DF8F6E2C58A29DBB.d03t03?systemMessage=Wiley+Online+Library+will+be+disrupted+on+18+May+from+10%3A00-12%3A00+BST+%2805%3A00-07%3A00+EDT%29+for+essential+maintenance

About Prof. Lisa Stamp

Professor Lisa Stamp is a Rheumatologist at the University of Otago, Christchurch and Christchurch Hospital.

She is director of the Canterbury Rheumatology Immunology Research Group and the University of Otago Arthritis Research Theme.

She received a University of Otago Early Career Award for Distinction in Research in 2009 and the Rowheath Trust Award and Carl Smith Medal for Research in 2011.

Professor Stamp has an active clinical role in adult rheumatology. Her research interests include individualization of drug treatments in gout and rheumatoid arthritis.

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