Are tart cherries effective for managing gout?

Tart Cherries for Gout Management

Tart cherries may modestly reduce gout flare frequency as part of a comprehensive lifestyle approach, but should not replace standard urate-lowering therapy as there is insufficient evidence to support their use as a primary treatment for gout.

Evidence for Cherry Consumption in Gout

According to the 2017 EULAR guidelines, epidemiological studies have shown that consumption of cherries is negatively associated with gout, and eating cherries may reduce the frequency of acute gout attacks 1. However, the evidence is limited and primarily observational.

The 2020 American College of Rheumatology (ACR) guidelines note that the evidence for cherries/cherry extract is drawn mainly from observational studies with low or very low certainty, which precluded specific recommendations on this topic 1.

Effectiveness of Tart Cherries

Recent research on tart cherry effectiveness shows mixed results:

• A 2020 randomized controlled trial found that tart cherry concentrate had no effect on serum urate levels or urine urate excretion across various doses 2
• Another study in overweight and obese adults reported that tart cherry juice reduced serum uric acid concentration by 19.2% 3
• A systematic review concluded there was a positive correlation between consumption of tart cherry juice and decreased serum uric acid concentration, but noted the inability to conduct effective meta-analysis due to limited studies and methodological variations 4

Recommended Approach for Gout Management

First-line Treatment

• Urate-lowering therapy (ULT) remains the cornerstone of gout management
• Allopurinol is recommended as first-line ULT, starting at a low dose (100 mg/day) and titrating upward to reach target serum uric acid levels <6 mg/dL (360 μmol/L) 1

Lifestyle Modifications

Incorporate these evidence-based lifestyle changes:

• Weight loss if overweight/obese (can reduce serum urate levels) 1
• Limit alcohol intake, especially beer and spirits 1
• Limit purine-rich foods (meat and seafood) 1
• Avoid sugar-sweetened drinks and foods rich in fructose 1
• Consider low-fat dairy products, which are inversely associated with urate levels 1

Role of Tart Cherries

Tart cherries can be considered as a complementary approach:

• May be used as an adjunct to standard ULT and anti-inflammatory medications
• Should not replace pharmacologic therapy for acute flares or long-term management
• May provide modest benefits through anti-inflammatory properties

Important Considerations

1. Do not delay standard therapy: Relying solely on cherry products without proper ULT may lead to continued crystal deposition and joint damage.

2. Medication adjustments: Consider medication modifications when appropriate:

   • Substitute diuretics if possible
   • Consider losartan for hypertension
   • Avoid adding or switching to fenofibrate solely for urate-lowering effects 1

3. Monitor serum urate: Regular monitoring is essential to ensure target levels are maintained regardless of complementary approaches used.

Conclusion

While tart cherries show some promise in gout management through potential anti-inflammatory effects, the evidence is insufficient to recommend them as a primary treatment. They may be used as a complementary approach alongside standard urate-lowering therapy and lifestyle modifications, but patients should maintain their prescribed medications and follow evidence-based guidelines for gout management.