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Back to Roles on Certain Health Conditions

Milk Products and Gout

Milk products have been recognized as an important dietary factor in reducing the risk of gout development. The consumption of milk products is also recommended to manage this condition.

Highlights

  • Milk products, particularly low-fat milk products, have been inversely associated with the development of gout;
  • High-fat milk products do not appear to have an effect on gout risk;
  • Milk products, calcium and lactose have been associated with lower plasma urate concentrations;
  • Several dairy fractions and components may play a role in preventing and managing gout.

Facts on Gout

Gout is the most common inflammatory arthritis in men over 40 years.1

Gout arises when uric acid builds up in the blood because the body either makes too much uric acid or cannot eliminate it effectively. However, the exact cause that triggers this accumulation is unknown. In the long term, the accumulation of uric acid leads to hyperuricemia, and this can generate the formation and deposition of monosodium urate crystals in the joints and/or kidneys.2

Lifestyle and dietary modifications are key to preventing and managing gout. While various foods have been found to increase the risk of gout, others, including low-fat milk products, are protective. In fact, dietary advice to reduce gout risk includes the consumption of low-fat milk products.3,4

The Evidence

A narrative review published in 2011 examined the evidence on the effects of milk products on hyperuricemia and gout.4

  • The Health Professionals Follow-Up Study (HPFS) indicated that milk products were associated with a lower risk of gout, with a multivariate relative risk of 0.82 per additional daily serving of milk products (95% CI: 0.75-0.90);
  • The Nurses’ Health Study (NHS) also showed a strong inverse association between milk product consumption and the incidence of gout;
  • In both the HPFS and NHS, the reduced risk of gout was primarily associated with low-fat milk products;
  • High-fat milk products were not associated with gout risk;
  • These epidemiological data provided strong evidence on the protective effect of milk products, especially low-fat milk products, against gout.

In their 2012 study, Dalbeth et al. conducted a 3-month randomized, double-blind, controlled trial of milk products for the prevention of gout flares. This dietary intervention consisted of 120 patients with recurrent gout flares. The patients were randomized to three separate treatment groups: lactose powder, skim milk powder, and skim milk powder enriched with two dairy fractions (glycomacropeptide and G600 milk fat extract).5

  • A decrease in the frequency of gout flares was observed in all three treatment groups over the 3-month study period;
  • A significantly greater reduction in the frequency of gout flares was observed for the group that received the enriched skim milk powder compared to the lactose control;
  • Greater improvements in fractional excretion of uric acid and in pain, in addition to trends of improvements in tender joint count, were observed in the enriched skim milk group.

A recent cross-sectional study published in 2012 was carried out to test the association between plasma urate concentration and different food items, including milk products. A total of 2,073 healthy adults aged 21 to 82 years participated in the study.6

  • Using a multivariate regression analysis, dairy, calcium and lactose intakes were inversely associated with urate (p = 0.008, p = 0.003, p = 0.0007, respectively);
  • The consumption of skim milk and low-calorie yogurt was inversely associated with urate;
  • Semi-skim and full-fat milk as well as low-fat and full-fat yogurt were not associated with plasma urate concentration.

Potential Mechanisms

It has been suggested that milk products are protective against gout due to the uricosuric effect of the milk proteins casein and lactalbumin. Data from randomized controlled interventions indicate that cow’s milk also has an acute urate-lowering effect because it has a low purine content and it increases the fractional excretion of xanthine (a precursor of urate) and uric acid.4,7

Additionally, orotic acid, which is present in milk, decreases the reabsorption of uric acid and promotes its excretion by the kidneys.4,6

Certain dairy fractions may have anti-inflammatory properties. In experimental models, glycomacropeptide and G600 milk fat extract were found to have an inhibitory effect and to regulate the inflammatory response to monosodium urate crystals.4,8

Conclusion

The consumption of milk products, particularly low-fat milk products, is inversely associated with gout risk and may be recommended to prevent and manage hyperuricemia and gout. High-fat milk products do not appear to be associated with gout.

The beneficial effect of milk products against gout has been attributed mainly to certain milk proteins and dairy fractions; however, their mode of action is still unclear. More studies are needed to fully understand the mechanistic actions of these milk components.

Keywords: gout , casein , dietary factors , recommendations


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