Could taking vitamin C help reduce the chances of developing gout? A new study sheds light on this possibility.
Gout is a form of inflammatory arthritis that has been on the rise in the US in recent decades. Considered a lifestyle disease, some research has shown that instances of the condition have more than doubled in recent years as rates of obesity have skyrocketed. It's caused by uric acid in the blood that builds up and crystalizes in the joints. Flare-ups are so intense that the joints can turn a cherry red and vibrate with intense — and sometimes seemingly intolerable — pain.
While there are effective treatments, many people fail to take their medications when they're not in pain, and if the condition goes unchecked, it can get much worse and cause permanent damage to the joints.
"Gout can cause flare-ups that vary in frequency and severity; but sometimes when people aren't experiencing them, they're less likely to stay on top of their medications," says Stephen Juraschek, MD, an assistant professor of medicine at Harvard Medical School.
That's why lifestyle interventions are seen as particularly relevant to a disease like gout. Vitamin C, for example, has few side effects, and for those with higher levels of uric acid in the blood, it could reduce the likelihood of getting the condition. A recent study published in The American Journal of Clinical Nutrition found that people who were given 500 milligrams of vitamin C versus a placebo had a 12% reduced risk of getting gout. The study of over 14,000 male doctors showed that men who weren't overweight had the most significant reduction in the risk of getting the condition. (Excess weight has been shown to increase the risk of gout.)
As part of the study, participants responded to a questionnaire that asked whether they had ever been diagnosed with gout. Other studies have shown that vitamin C reduced the levels of urate in people without gout and broke down uric crystals in the blood, but this study took it a step further to show that the supplement actually reduced the risk of getting the condition.
"In addition to lowering levels of uric acid in the body, it's thought that vitamin C may also minimize the inflammatory response to urate crystals," says Juraschek. That's because when flare-ups develop in joints throughout the body, much of the painful irritation is caused by the immune system's response as it fights to break down the crystals.
Juraschek says this likely wouldn't change recommendations for patients with serious gout, but it could still have an impact.
"For individuals who were told that they have gout but have had fewer flare-ups, they might be more open to taking vitamin C," he says.
Will Settle, 42, of Hilton Head, SC, was not involved in the study, but he says he would be inclined to try most any safe preventive method. Gout runs in his family. His father and grandfather had it, and now, so does he. His flare-ups have slowed in recent years, which he says has a lot to do with his diet and lifestyle. He stopped eating seafood, started drinking more water, and stopped drinking as much alcohol — all of which he thinks has had a huge impact on the severity of his condition. (Both seafood and beer contain high levels of purines, which have been shown to increase the buildup of uric acid in the blood.) Settle says that other simple lifestyle changes like vitamin C would be an easy addition to his routine with few downsides. Plus, he hates having to take colchicine, a medication that's meant to relieve pain but causes him intense diarrhea when he takes it.
"Anything to reduce my flare-ups without having to take colchicine," he says.
But the jury is still out as to whether vitamin C will have any real benefits. Study co-author Robert H. Shmerling, MD, is the former clinical chief of the Division of Rheumatology at Beth Israel Deaconess Medical Center in New York. He says the study shows that the effect of vitamin C in those undiagnosed with gout was rather modest. Also, vitamin C did not show a reduction in gout flare-ups in those who were already diagnosed with the condition. Not to mention that the study lacked diversity, as the people in it were all male and mostly white. Still, there's little downside risk to taking vitamin C, and it might end up being worthwhile.
"Maybe it will turn out to be an effective treatment in those who are at high risk, but we're not there yet," he says.
Robert Terkeltaub, MD, chief of rheumatology at the Veterans Administration Medical Center in San Diego and a professor of medicine at the University of California, San Diego, says there's an unmet need when it comes to tools for gout prevention.
"The disease impacts some 10 million Americans, and we need to better identify these individuals so we can intervene earlier," he says.
While vitamin C had a small but significant association with fewer new cases of gout, it did not lower it in those who already had the disease, says Terkeltaub. What's more, researchers didn't measure the levels of uric acid in the blood, which would have painted a more accurate picture of whether vitamin C actually reduced it in the body.
"There remains no clarity on the potential role of vitamin C in either prevention or treatment of gout. That said, future research would be of interest," he says.
Still, gout patients like Settle aren't ruling it out. Anything to avoid the pain that, at times, makes it difficult for him to get out of bed. He's seen the benefit that simple lifestyle changes can make, and he's willing to try just about anything to live a normal, arthritis-free life.
"I'm always looking for simple ways to keep my flare-ups at bay," he says.
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Cite this: Sara Novak. Could Vitamin C Help Reduce Gout? - Medscape - Oct 06, 2022.