Milk Supplements Might Prevent Gout Flares

NEWS REFERENCE EDUCATION Medical News
Janis C. Kelly January 24, 2012

 A proof-of-concept clinical trial by New Zealand researchers suggests that skim milk powder (SMP) enriched with 2 dairy fractions may prevent gout flares.
 Lead author Nicola Dalbeth, MD, associate professor of medicine at the University of Auckland, New Zealand, and colleagues report in an article published online January 23 in the Annals of the Rheumatic Diseases that a daily dose of SMP enriched with glycomacropeptide (GMP) and
 The supplement was compared with SMP alone, as well as with lactose powder.
 The enriched SMP also reduced mean pain scores during the 3-month period.
The SMP/GMP/G600 treatment did not boost weight gain or increase the levels of potentially harmful blood lipids. Dr. Dalbeth told Medscape Medical News that "[SMP] enriched with GMP and G600 led to a greater reduction in gout flares, and to greater improvements in the pain of gout flares and fractional excretion of uric acid.
I think that this research raises interesting questions about the advice that we give our patients about diet interventions for gout.
Most of the dietary advice is based on observational studies (which have been very well-conducted), rather than clinical trial data, and this study is the first randomized controlled study of a dietary intervention for gout.
This is quite surprising, given the strong perception within the community, and also within the medical profession, that gout is a disease that is caused, in large part, by diet."
 The study was a 3-month randomized double-blind controlled trial in 120 patients aged 18 years or older with recurrent gout flares, defined as at least 2 flares in the preceding 4 months.
Exclusion criteria included lactose intolerance and severe renal impairment (estimated glomerular filtration rate, <30 mL/minute).
The primary end point was change in the frequency of gout flares.
 The patients were randomly assigned to daily treatment with lactose powder, SMP, or SMP enriched with GMP and G600. Each powder was mixed in 250 mL of water as a vanilla-flavored shake. "This is the first reported randomized controlled trial of dietary intervention in gout management, and suggests that daily intake of skimmed milk powder enriched with GMP and G600 may reduce the frequency of gout flares," conclude the authors.

 Dr. Dalbeth said, "This study has highlighted a potential new dietary intervention for managing gout, which may be useful as an adjunct to medical treatment. I think it is important to recognize that the effects seen in this study were modest, and that SMP/GMP/G600 will not replace treatments such as allopurinol for effective management of gout.
However, for patients with gout who wish to try a dietary approach as part of their gout management plan, this may be a very useful option. We spend quite a lot of time in the clinic advising people with gout what they shouldn't eat, so it would be nice to have some positive advice to give to patients."

 Dr. Dalbeth's group initially became interested in the potential of milk products for gout after reports by Hyon Choi, MD, that intake of low-fat dairy was protective in the development of gout and was associated with lower serum urate levels.
 "The specific fractions were identified in a previous study in our lab, where we screened a number of milk fractions for anti-inflammatory properties in models of gout," Dr. Dalbeth said.
"GMP and G600 were found to have anti-inflammatory properties in the laboratory assays, and for this reason we took these fractions into the clinical trial." Dr. Dalbeth said that the supplement is not currently commercially available, but that the researchers are working with the Fonterra Dairy Research Center to develop the product for commercial use.
 S. Louis Bridges Jr, MD, PhD, Marguerite Jones Harbert-Gene V. Ball Professor of Medicine and director of the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham, reviewed the study for Medscape Medical News. Dr. Bridges found this research "definitely worth pursuing," but stressed the need for validation studies. "This proof-of-concept study was well designed and well done, but like most proof-of-concept studies, it was of short duration with small numbers of patients: only 40 per group," Dr. Bridges said. "We have known for some time that decreased dairy intake is associated with increased gout risk, but this is the first randomized controlled trial to raise the question of whether more dairy intake would lower the frequency of gout flares. The fact that flare incidence decreased in all 3 study groups does also raise the question of whether the effect was due to the posited anti-inflammatory effects of the GMP and G600 supplements added to the skim milk powder...or more an overall result of more dairy intake, but this approach clearly deserves more study." The study was supported in part by LactoPharma, a joint venture between Fonterra Ltd, Fonterra R&D Ltd, and Auckland Uniservices Ltd. Lactose, SMP, and G600 milk fat extract were provided by Fonterra Co-operative Group Ltd. GMP was provided by Arla Foods Ingredients.
Dr. Dalbeth and one coauthor are named inventors on a patent application related to milk products and gout. Three coauthors are employees of Fonterra. Dr. Bridges has disclosed no relevant financial relationships.
 Ann Rheum Dis. Published online January 23, 2012. Abstract