When you head to the grocery store this summer make sure to pick up some cherries. I love them for their texture, rich color and even more - for their healing properties. When you have a dish of fresh cherries on the table you know that summer is finally here, as they show up in stores reasonably priced, right around Memorial Day weekend. 

I recently enjoyed a quiet evening at home, with a light dinner of shrimp cocktail with a side of canapes with fresh garden lettuce and herbs (more in DocOnFood). I could not prevent thinking of my many patients who call me with complaint of gouty swollen big toe, and after a few rounds of questions they finally admit that they had a gout attack provoked by a leisurely meal of seafood, shrimp included. Shrimp are loaded with purines that when digested by humans produce a lot of uric acid which is responsible for gout and gout flares. We do not have uricase, the enzyme that helps to reduce uric acid to soluble allantoin, which then can be excreted by kidneys. There is many reasons why any of us can be afflicted by gout, but the more common reasons are male sex, certain medicines, like diuretics, metabolic derangements and obesity, among others. So what is the connection between shrimp and cherries one might ask?There is quite an interest expressed by my patients in natural remedies to prevent and fight gout attacks, and I am asked by my patients about cherries as remedy for gout. Even my dentist shared with me the gout story story that will weave well into this post: one day he/she woke up with a nasty gout attack in the driving foot, barely made it to the grocery store, got a bag of cherries that he/she consumed on the way to work, when his/her attack was much eased, possibly due to cherries. Cherries have a uric acid lowering effect, according to some animal studies, along with anti-inflammatory and antioxidant action of anthocyanin abundant in the fruit. It is possible that vitamin C, which also has a uric acid lowering effect, plays a role. In 2012 Zhang and co. published a study on the subject of reduction of gout attack incident by cherries in patients followed for a period of one year in this case cross-over study. It was published in one of two official journals of American College of Rheumatology (the ACR does not officially endorse the cherries as gout treatment in its guidelines - see second button below video). You can press the link below for details of the study, but the highlight of that work was 35% risk reduction in gout attack risk over a two-day period when participants consumed cherries. The interesting design of the study, and case crossover studies in general, is that patients constituted their own control in period when they did not eat cherries. In addition if patient ate cherries and took uric acid lowering allopurinol the gout attack risk was reduced by 75% compared to period without either. How much cherries made a difference? Based on this study the benefits were seen around 3 servings of cherries over two-day period, and one serving is described as 10-12 cherries, or half cup consumed 2 days prior to gout attack. This was not randomized and prospective study, but nevertheless provided some thought provoking data of the benefits of the cherries in gout prevention. What do I tell my patients then? First, avoid gout triggers like large amounts of seafood, meat, fructose, beer, then stay hydrated in summer months, (or any period when dehydration may be an issue, like intense physical exercise or strain, medical illness: like infection, or surgery), so as not to provoke gout flares. If you are prone to frequent gout attacks either primary doctor or rheumatologist can very effectively reduce the suffering with pharmacological and lifestyle remedies. If interested in healthy and natural way to go about gout flare reduction and prevention one can try fresh cherries or cherry extract that was also used in above study with similar benefit that fresh cherries had. There are many variations on what is available over the counter and I see cherry capsules, tablets and cherry juice concentrates (may be very high in sugar), but the data for the latter is less clear as these products are not studied and endorsed by FDA, and actual active cherry ingredients of those may be subject of debate.