December 23, 2020
2 min read
The Dietary Approaches to Stop Hypertension — or DASH — diet successfully reduces serum urate, particularly among those with hyperuricemia, according to data published in Arthritis & Rheumatology.
“The link between diet and gout has been described since antiquity,” Stephen P. Juraschek, MD, PhD, of Beth Israel Deaconess Medical Center, Harvard Medical School, told Healio Rheumatology. “However, the ideal dietary pattern for adults with gout is unclear. Traditionally, a low purine diet has been the focus for gout prevention, but this diet is not palatable and may involve foods that are detrimental to cardiovascular health. Meanwhile, 75% of adults with gout also have hypertension.”
“The DASH diet is proven to lower blood pressure in adults with elevated blood pressure or hypertension,” he added. “It also reduces LDL-cholesterol — the cholesterol associated with heart attacks — which is also elevated in adults with gout.”
To examine whether the DASH diet lowers serum urate, compared to an alternative diet that simply emphasizes high-fiber fruits and vegetables, Juraschek and colleagues conducted a secondary study of the DASH trial. According to the researchers, this 8-week, parallel-arm study randomized 459 adults with a systolic blood pressure of less than 160 mmHg, and a diastolic blood pressure of 80‐95 mmHg, into one of three feeding groups.
Stephen P. Juraschek
Between September 1994 and March 1996, participants — none of whom were using blood pressure medications — received either a typical American diet, used as the control; a diet that was high in fruits and vegetables but otherwise similar to the control; or the DASH diet, which emphasizes fruits, vegetables and low‐fat dairy products, as well as reduced fat, saturated fat and cholesterol overall. BMI was kept constant throughout the trial, with serum urate assessed at baseline and after 8 weeks.
A typical American diet was defined as potassium, magnesium and calcium levels matching the 25th percentile of U.S. consumption, and macronutrient profiles and fiber reflecting the average intake levels in the United States.
For their own study, Juraschek and colleagues in 2018 measured serum levels from available stored specimens from three of the four participating clinical centers. Specimens were collected from a total of 327 participants with available baseline and week-8 data, including 110 in the DASH group, 110 who received the fruits-and-vegetables diet, and 107 in the control group. Among these participants, the mean baseline serum urate was 5.7±1.5 mg/dL.
According to the researchers, the DASH diet reduced serum urate by 0.25 mg/dL (95% CI, –0.43 to –0.08), compared with the control group. In the fruit-and-vegetables group, serum urate was reduced by 0.17 mg/dL (95% CI, –0.34 to 0), compared with a typical American diet. These effects increased with higher baseline serum urate levels in the DASH group (P = 0.04), but not in the fruits-and-vegetables group.
“Our study shows that the DASH diet reduces urate, the most important risk factor for gout targeted by most gout drugs,” Juraschek said. “This reduction is great news as DASH also lowers blood pressure and cholesterol, potentially addressing three problems with a single strategy. Moreover, adults with higher urate level saw even greater reductions from the DASH diet in our study. We hope our study continues to highlight the importance of healthy diet, specifically the DASH diet, as a strategy for greater health among adults with gout.”