Regulation by Means of Diet/Nutrition

Treatment Options for Gout by Dr. med. Bettina Engel, Dr. med. Johannes Just, Dr. med. Markus Bleckwenn, and Prof. Dr. med. Klaus Weckbecker in issue 13/2017

Concerning non-medicinal measures, the authors (1) do quote the guidelines of the American College of Rheumatology (2) and mention a fluid intake volume of more than 2 liters, but they forget about the measure for alkalinizing the urine (Table 3) (2).

In addition to the guidelines, the working group around A. Kanbara also mentions the alkalinization of urine in order to increase the excretion of uric acid as a suitable measure (3).

Remer and Manz classified foods by their potential renal acid load (PRAL) value. In people whose dietary intake consists of at least 70% fruit (not containing too much fructose) or vegetables with clearly negative PRAL values, a pH value of at least 7 adjusts itself in the morning (4). This means that notably less uric acid is readsorbed and much more is excreted. If a value of 7 cannot be achieved by dietary measures, sodium, potassium, and/or magnesium salts of citric or carbonic acid can be ingested. Many food supplements containing these salts are available.

As many patients with hyperuricemia also have arterial hypertension, it should also be mentioned that losartan is the only angiotensin II type 1 receptor antagonist that increases renal excretion of urine.

DOI: 10.3238/arztebl.2017.0506a

Prof. Dr. med. Dr.-Ing. Holger Kiesewetter

Berlin

References

1. Engel B, Just J, Bleckwenn M, Weckbecker K: Treatment options for gout. Dtsch Arztebl Int 2017; 114: 215–22

2. Khanna D, FitzGerald JD, Khanna PP, et al.: 2012 American college of rheumatology guidelines for management of gout. Part I: systematic non-pharmacologic and pharmacologic therapeutic aproaches to hyperuricemia. Arthritis Care Res (Hoboken) 2012; 64: 1431–46

3. Kanbara A, Miura Y, Hyogo H, Chayama K, Seyama I: Effect of urine pH changed by dietary intervention on uric acid clearance mechanism of pH-dependent excretion of urinary uric acid. Nutr J 2012; 11: 39

4. Remer T, Manz F: Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc 1995; 95: 791–7