What are the benefits and risks of using tart cherry juice concentrate for medical conditions?

Tart Cherry Juice Concentrate: Limited Evidence for Medical Use

Tart cherry juice concentrate is not recommended for gout management based on current clinical guidelines, as the evidence is insufficient to support its use, and it should not replace proven pharmacological therapies. 1

Evidence for Gout Management

Guideline Recommendations

The American College of Rheumatology (2020) explicitly states that the certainty of evidence for cherries/cherry extract is low to very low, precluding specific recommendations for gout patients. 1 The voting panel reviewed available data but found it insufficient to make formal recommendations on this intervention. 1

The American College of Physicians (2017) evaluated sour cherry juice as a nonpharmacologic intervention but did not include it in their final clinical practice guideline recommendations for acute or recurrent gout management. 1

What Guidelines Actually Recommend Instead

For gout patients, evidence-based interventions include:

• Limiting alcohol intake (particularly beer and spirits) 1, 2
• Limiting purine-rich meats and seafood 1, 2
• Limiting high-fructose corn syrup 1, 2
• Weight loss for overweight/obese patients (>5% BMI reduction associated with 40% lower odds of recurrent flares) 1, 2
• Low-fat or non-fat dairy products (associated with lower gout risk) 2

Critical Context for Gout Treatment

Dietary modifications alone typically provide only 10-18% decrease in serum urate levels, which is insufficient for most patients with significantly elevated uric acid. 2 The primary treatment goal is achieving serum uric acid <6 mg/dL through pharmacological urate-lowering therapy (allopurinol or febuxostat), with colchicine, NSAIDs, or corticosteroids for acute flares. 2

Evidence for Athletic Performance and Recovery

Sports Medicine Context

The UEFA expert group statement (2021) specifically addressed tart cherry juice for football recovery and concluded: "recent investigation in football did not show improved recovery markers of function or subjective soreness. Therefore, the available evidence does not support its specific use in football." 1

Research Findings on Athletic Performance

Recent research shows mixed results:

• Timing is critical: Studies showing benefit required consumption for several days prior to exercise ("precovery" rather than recovery), not post-exercise supplementation. 3
• Typical dosing in studies: 8-12 oz twice daily (or 1 oz if concentrate), with 4-5 day loading phase before events. 4
• Performance benefits are modest: A 2024 study found no difference in cycling time trial performance (17±3 min cherry juice vs. 17±2 min sports drink) or substrate oxidation compared to a sports drink. 5
• Endurance performance meta-analysis showed small effect (SMD: 0.36), but clinical significance is questionable. 6

Potential Risks and Considerations

Interference with Training Adaptations

Tart cherry supplementation may not be optimal during the adaptation/build stage of training due to its anti-inflammatory properties potentially interfering with adaptive processes. 1, 4 High-dose antioxidants (vitamins C and E) are discouraged as they may impair muscle adaptation. 1

Lack of Standardization

• No established optimal dose exists for any specific type of cherry juice (fresh-frozen vs. concentrate). 3
• Tart cherry powder did not enhance any recovery metrics in available studies. 3
• Evidence quality is generally low with small sample sizes. 1

Clinical Bottom Line

For gout patients: Focus on proven interventions including weight loss, alcohol limitation, dietary purine restriction, and appropriate pharmacological urate-lowering therapy rather than relying on tart cherry juice. 1, 2

For athletes: If considering use, it must be implemented as a "precovery" strategy (starting several days before intense competition) rather than post-exercise recovery, and only when recovery—not adaptation—is the priority. 4, 3 However, benefits are modest and inconsistent. 1, 5

Common Pitfalls to Avoid

• Substituting cherry juice for proven gout medications when pharmacological therapy is indicated 2
• Starting cherry juice post-exercise expecting recovery benefits (evidence does not support this timing) 3
• Using during training phases where adaptation is the goal, as anti-inflammatory effects may impair beneficial adaptations 1, 4
• Expecting clinically significant benefits based on preliminary observational data when higher-quality trials show minimal effects 1, 5