Q. I take HCTZ for high blood pressure. It gave me gout in my big toe. Would tart cherries counteract this side effect?
A. The hydrochlorothiazide (abbreviated HCTZ, HCT or HZT) diuretic you are taking to control your blood pressure could be contributing to elevated uric acid levels. When uric acid crystalizes in soft tissues–like the big toe–the pain can be excruciating.
Gout Triggered by Diuretics:
People are not always warned that gout can be a complication of diuretic treatment. Furosemide (Lasix) and HCTZ are taken by nearly 30 million Americans.
Sometimes hydrochlorothiazide is included in combination blood pressure formulations that contain medications like lisinopril, losartan, propranolol, triamterene or valsartan. Many people may not even realize they are taking a diuretic that could raise their uric acid levels.
How to Lower Uric Acid Levels:
Trying to reduce uric acid levels while taking a diuretic can be challenging. It’s a little bit like climbing a mountain with lead overshoes. You may want to ask your doctor if there is another way to lower your blood pressure without a diuretic on board.
Tart Cherries:
As strange as it may sound, there is some evidence to suggest that tart cherry juice might be beneficial. The first report that cherries might work against gout appeared in the medical literature as early as 1950 (Texas Reports on Biology and Medicine). Since then there have been other articles on this phenomenon:
A small study published in the Journal of Functional Foods (online, Sept. 29, 2014) reported that one to two ounces of cherry juice concentrate diluted in 100 ml of water reduced blood and urinary levels of uric acid.
A study published in Arthritis and Rheumatism (Dec. 2012) concluded:
“In this large study of prospectively recruited patients with preexisting gout, we found that cherry intake was associated with a 35% lower risk of recurrent gout attacks, and intake of cherry extracts showed a similar inverse association…
“Several biologic mechanisms have been elaborated to link cherry consumption to the risk of gout attacks. A study conducted among 10 healthy women showed that consumption of cherries, but not other fruits, such as strawberries, grapes, or kiwi fruit, significantly reduced levels of both serum uric acid and plasma creatinine.”
An accompanying editorial offered the following commentary on this study:
“In 1978, Erma Bombeck penned a famous book entitled “If life is a bowl of cherries, what am I doing in the pits?” in which she offers much advice and good humor. At a minimum, we have learned from the gout online case-crossover study that if life serves up a bowl of cherries consumed on a regular basis, the risk of a recurrent gout attack may be meaningfully reduced.”
Celery Seeds:
Many years ago we interviewed one of the giants in botanical medicine, James Duke, PhD. When we asked him about treatments for gout, his recommendation was to consume some celery seeds (Apium graveolens). Dr. Duke knew that there were compounds in the seeds that had anti-inflammatory properties. What he didn’t know at the time was the exact mechanism.
A study in the journal Food Chemistry (Dec. 15, 2013) showed that an ingredient in celery, luteolin, can block an enzyme that facilitates uric acid formation. By inhibiting this enzyme it is entirely possible that luteolin could lower uric acid levels. One high-powered cellular study confirmed that luteolin protects the pancreas from uric acid damage (Journal of Biomedical Research, July, 2014).
A few Comments from Readers:
Jeff didn’t have any luck with cherries but celery seeds helped him:
“I have tried it all including cherries (in pills and juice), bananas, spinach, colchicine, allopurinol, steroids, ibuprofen (Advil) Tylenol, hot water heating pads, even leeches and acupuncture. Some worked better than others but recently I lost 70 pounds in three months on a no-carb diet, but my gout went through the roof. I didn’t know what to do. I couldn’t walk for 2 weeks.
“Every time it started to go away it would come back. I read about celery seed on line but was skeptical. I’ve had gout since I was 23 and would try anything no matter how pointless it seemed. Folks, celery seed WORKS. I was in the middle of another flare and ate a half a capsule filled with celery seeds. Within an hour I could walk. Within a day I walked pain free. My whole body felt better. It will flush you out but it worked for me.”
Richard shared this gout experience:
“I have been taking Celery seed capsules (500mg per day) for over 2 years to control my gout. About a week after I stop I start to get gout symptoms so I quickly get back on the celery seeds. Works for me.”
Bobby has used celery extract:
“I have been taking 1200 mg celery extract for 2 yrs now. I have not had an attack in the last 1.5 yrs. Not only does it lower uric acids levels it lowers blood pressure. It took about 4 months to get it under control after I started taking celery seed extract. I no longer worry about what I eat. I do stay away from sugar of all kinds.”
Not everyone will benefit from tart cherry juice or celery seeds. When uric acid levels are not controllable by natural means, a medication may be essential to treat gout. The classics are NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen, indomethacin, naproxen or celecoxib. Colcicine is another medication that doctors may prescribe. Sadly, digestive tract upset is common with this drug. Symptoms often include nausea, vomiting and diarrhea.
Corticosteroids like prednisone have also been prescribed for gout. For a list of complications check out this link. Finally, allopurinol can block uric acid formation (a bit like luteolin in celery seeds). Side effects include rash, itching, nausea, diarrhea, sleepiness, liver enzyme elevation and blood disorders.
Share your own gout experience in the comment section below and please vote on this article at the top of the page. Let others know what works and what doesn’t when it comes to gout.
