Can a High Fibre Diet Ease Gout?

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What is Fibre?

A definition for what constitutes as dietary fibre was released mid-2015 by the Scientific Advisory Committee on Nutrition (SACN).

Dietary fibre is considered as all carbohydrates which our body is not able to digest and absorb in the small intestine, so it helps move food through the gastrointestinal tract and ferments within the large intestine (SACN, 2015).

Types of Fibre

There are two main types of fibre: soluble and insoluble fibre.

Fibre-rich Coconut Flour and Banana Pancakes

Soluble fibre, when consumed, dissolves in water. However as with all dietary fibre, when it moves through the digestive tract it remains undigested (our body is not able to break it down to be absorbed and utilised within the body). Soluble fibre can have an effect on the absorption of lipids (fats) and glucose (sugars).

Insoluble fibre adds bulk to the foods we have consumed. This impacts our bowel habits and increases the speed at which the food moves through our gastrointestinal tract.

In the colon, both insoluble and soluble fibre is partially fermented in your large intestines, feeding the good bacteria in your gut. You can read more about these benefits by clicking here in our blog on “Gut Health: Probiotics and Prebiotics”.

It has been discussed whether we should phase out these terms as the solubility of the fibre does not always forecast the effect that fibre will have on our body (SACN, 2015).

Which Foods Contain Fibre?

There are many different types of food which contain fibre and, especially if you are eating a varied diet with lots of types of food which has not been processed, you will consume some fibre.

 

 

Porridge with Lucy Bee Maca and Sautéed Apple

Some example of good sources of fibre include:

  • wholegrain cereals
  • breads
  • rice
  • pasta
  • oats
  • coconut flour
  • some vegetables –  including broccoli, turnips, pulses (including lentils, peas, chickpeas and beans)
  • nuts are another example of fibre, with their own range of health benefits as well which we have written about here
  • Fruits can also be a source of fibre (warning: even though dried fruits are high in fibre, they have had the water taken out of them so they are sugar-dense and it is easier to eat larger quantities than in their hydrated form. Also, fruit juices even fresh, have had most of their fibre removed from them so do not make a good source of fibre).

You can read more here, about the two types of fibre and foods that are classified within these.

How Much Fibre is Recommended in Our Diet?

It has been recommended by SACN that:

  • adults consume 30g/day of dietary fibre, which many of us do not regularly get on a daily basis
  • children aged between 2-5 years should aim to consume 15g/day
  • those between 5-11 years should consume 20g/day
  • those between 11-16 years should be aiming for 25g/day (SACN, 2015).

Many of us do not reach these recommendations and consume less than what is recommended.

What Impact Does a High Fibre Diet Have on Inflammation Caused by Gout?

A recent study has found that when consuming a high fibre diet, it may help to reduce inflammation caused by gout.

A Vegan Scotch Broth with split peas and lentils

What is Gout?

So, before we discuss more on what the study found and the science behind it, I thought I’d give a briefing on what gout is!

Gout is a form of arthritis where small crystals form inside and around the joints (NHS, 2015). This causes swelling and severe pain in the joints it affects, with the affected area feeling hot and tender to touch. The swelling and pain reduces after 3-10 days but a flare up again, is likely.

What Causes Gout?

Gout is caused by a build-up of uric acid in the blood, when we produce too much uric acid, or our kidneys are unable to filter out the uric acid.

When foods are digested and old cells are broken down a substance called purines (which is found in our cells and in some foods) is converted into uric acid, and is carried within the blood as salt (UK Gout Society, 2014). This then leads to the crystals forming in and around the joints, causing the pain and inflammation.

What Increases Your Risk of Developing Gout?

There are a couple of things which can increase your risk of developing gout including:

  • if you have diabetes
  • high blood pressure
  • if you are obese
  • having a close family member who also has gout
  • kidney problems
  • drinking too much beer and spirits
  • and eating foods that can cause a build-up of uric acid, including: red meat, offal, game, and some seafood (mussels, herring, and sardines) (UK Gout Society, 2014. And NHS, 2015).

Gout is Linked to an Increased Risk of Developing Type 2 Diabetes

Gout has also been linked to an increased risk of developing type 2 diabetes (whereby the cells in your body become unresponsive to insulin, or our body is unable to produce enough insulin).

Type 2 diabetes is predominantly caused by lifestyle factors that increase our risk of developing it. What was originally seen as a something that only occurred later on in life, we are now, also, finding an increase in cases of children being diagnosed with type 2 diabetes. You can read more about type 2 diabetes and its impact on our health in a blog here.

Studies have found that there is an association between gout and type two diabetes.

One study found that females who have gout are at higher risk of developing type 2 diabetes than males (Tung et al., 2016). However, other studies have found that patients who had both gout and type 1 or 2 diabetes were significantly more likely to be male (Collier et al., 2016).

It appears though, that most research indicates that gout is associated with an increased risk of type 2 diabetes, however it is more pronounced and a significantly larger risk for women than men (Rho et al., 2016).

The Study’s Findings

So, what did this study investigate?

This research was published in the Journal of Leukocyte Biology and was conducted by Vieira et al. in 2017 (Vieira et al., 2017). This study looked at the effect that a high fibre diet would have on the inflammatory response in gout in mice, as an experimental model.

When mice were fed on a high fibre diet, the fibre was metabolised by the microorganisms found within the gut and caused the production of a short-chain fatty acid (called acetate). When mice’s knee joints were injected with the crystals which cause gout (monosodium urate, MSU), it induced a flood of neutrophils and inflammatory hypernociception (Vieira et al., 2017). This essentially means that there was an increase in neutrophils (white blood cells) which respond when our body has a bacterial infection. They also increase in number when there is an increase in acute inflammation.

The inflammatory hypernociception is when there is an increase in levels of nociception (hyper-nociception), whereby it is the sensory nervous system’s response to harmful, or potentially harmful stimuli which causes tissue damage. This response leads to our body signalling to indicate there is pain, and in this case the pain is caused by the crystals formed around the affected joint.

The mice that were fed the high fibre diet, did not have a different inflammatory response to those not on the high-fibre diet, but they were able to induce a faster resolution to the inflammatory response through neutrophil apoptosis (death of cells) (Vieira et al., 2017).

Although we need an inflammatory response, in the case of gout, if we do not regulate the increased number neutrophils through apoptosis, our body will not be able to prevent the release of toxic compounds which can cause persistent damage to healthy tissues (Nathan, 2002).

This increased number of neutrophils causes an increase in inflammation and therefore pain, in gout cases. So, the high-fibre diet enables our body to increase the rate of cell death of neutrophils, which therefore decreases the inflammatory and pain response associated with gout.

The researchers also found that when mice were given the SCFA (acetate) it was also effective in the resolution of inflammation through apoptosis of neutrophils.

This study, therefore, concluded that “a high-fibre diet or one of its metabolic products, acetate, controls the inflammatory response to MSU crystals by favouring the resolution of the inflammatory response” (Vieira et al., 2017).

They also concluded that what we eat plays a role in how our body reacts and controls the inflammatory responses within our body for beneficial outcomes.

This therefore means that the foods that we eat (and in this case a high-fibre diet and the SCFA formed during its metabolism) can play a role in controlling the inflammatory responses of our body.

When individuals suffer with gout, a potential treatment may be the consumption of a high-fibre diet in reducing the inflammation and pain around the joint in which gout has formed.

“By understanding the way foods interact with living organisms, we may be able to create diets that help people with the disease, as well as their health overall,” said Mauro M. Teixeira, Ph.D.  (cited from ScienceDaily, 2017).

Conclusion on This Study

So, although this study was on mice, it does have some pretty interesting results. It means that there may be a chance that a high-fibre diet may help humans who suffer from gout, as well as the mice used within this study.

Why do we use animal studies for human research? Well, in some cases it can be either unethical or unfeasible to use humans for studies, so although we have found an effect here, further research will most likely be conducted using human cases now that they have found a link.

Research is an expensive and time-consuming field, so in many cases mice may be used first to see if there is any impact, and if so it may then be that the research may be redesigned for research using humans. So, of course, it should be taken with knowledge that this study was conducted on mice, but it is initial evidence for the impact that a high-fibre diet may have on gout.

What Else Does Fibre Help With?

It’s not just gout that fibre has a beneficial effect on. There are also many other effects including:

  • Cardiovascular: a review on cohort studies found that a greater dietary fibre intake was associated with lower risk of cardiovascular disease and coronary heart disease (Threapleton et al., 2013).
  • Digestive health: As we’ve seen from above, fibre feeds the bacteria in our gut, improving our overall gut health which has its own benefits, with more research indicating our gut health may have a larger impact on our health than we previously thought. By also keeping our food moving smoothly and efficiently through our gastrointestinal tract preventing constipation, it also helps to prevent diverticulitis, which affect the large intestines. This is where pockets form in the intestine, which then become infected or inflamed. By having a high fibre diet it helps to reduce the impact and risk of diverticulitis.
  • Weight gain: it has also been indicated that a higher intake of dietary fibre (especially cereal fibre) may prevent body weight and waist circumference gain. In this study, fruit and vegetable consumption also was associated with preventing waist circumference gain but not weight change (Du et al., 2010). It is important when looking at cereals however, that you do not buy any which are high in sugars, as this can have a negative impact.

Conclusion

Even though this study was conducted on mice, it does show some potential in having a beneficial impact on our health and, in this case, reduced inflammation and pain for gout.

Fibre is an important part of a diet which we are seeing more and more of in the promotion from the health sector. It helps keep the good bacteria in our intestine healthy and flourishing, whilst also helping with bowel movements and nutrient absorption.

Fibre can be achieved through a variety of food sources within our diet which we should be adding in anyway, due to their nutritional impact as well.

References:

SACN. (2015). SACN Carbohydrates and Health Report. Scientific Advisory Committee. Available here.

NHS. (2015). Gout. NHS Choices. Available here.

Vieira, AT. Galvão, I. Macia, LM. Sernaglia, ÉM. Vinolo, MAR. Garcia, CC. Tavares, LP. Amaral FA. Sousa, LP. Martins, FS. Mackay, CR. And Teixeira, MM. (2017). Dietary fibre and the short-chain fatty acid acetate promote resolution of neutrophilic inflammation in a model of gout in mice. Journal of Leukocyte Biology, 101(1), pp. 275-284. Available here.

UK Gout Society. (2014). All About Gout. UK Gout Society. Available here.

Nathan, C. (2002). Points of control in inflammation. Nature, 420(6917), pp. 846-852. Available here.

ScienceDaily. (2017). High fibre diets may alleviate inflammation caused by gout. ScienceDaily. Available here.

Tung, YC. Less, SS. Tsai, WC. Lin, GT. Chang, HW. Tu, HP. (2016). Association between gout and incident type 2 diabetes mellitus: a retrospective cohort study. The American Journal of Medicine, 129(11), pp. 1219.e17-1219.e25. Available here.

Collier, A. Stirling, A. Cameron, L. Hair, M. and Crosbie, D. (2016). Gout and diabetes: a common combination. Postgraduate Medical Journal, 92(1089), pp. 372-378. Available here.

Rho, YH. Lu, N. Pelogiun, CE. Man, A. Zhu, Y. Zhang, Y. Choi, HK. (2016). Independent impact of gout on the risk of diabetes mellitus among women and men: a population-based, BMI-matched cohort study. Annals of the Rheumatic Diseases, 75(1), pp. 91-95. Available here.

Threapleton, DE. Greenwood, DC. Evans, CEL. Cleghorn, CL. Nykjaer, C. Woodhead, C. Cade, JE. Gale, CP. And Burley, VJ. (2013). Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. The British Medical Journal, 347. Available here.

Du, H. van der, DL. Boshuizen, HC. Forouhi, NG. Wareham, NJ. Halkjaer, J. Tjønnwland, A. Overvad, K. Jakobsen, MU. Boeing, H. Buijsse, B. Masala, G. Palli, D. Sørensen, TI. Saris, WH. And Feskens, EJ. (2010). Dietary fibre and subsequent changes in body weight and waist circumference in European men and women. American Journal of Clinical Nutrition, 91(2), pp. 329-363. Available here.

About Lucy Bee Limited

Lucy Bee is concerned with Fair Trade, ethical and sustainable living, recycling and eating close to nature with additive free products for health.

Members of the Lucy Bee team are not medically trained and can only offer their best advice. Any information provided by us is not intended to diagnose, treat, cure or prevent disease.

Please note you should always refer your health queries to a qualified medical practitioner.

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Daisy has a Master’s Degree in Public Health Nutrition, which is Association for Nutrition (AFN) accredited. She, also, has a BSc degree in Psychology and Cognitive Neuroscience; and has completed an AFN accredited Diet Specialist Nutrition course. She is Lucy’s sister and is the Lucy Bee voice on all aspects of nutrition and its effect on the body. In addition to this, Daisy is shadowing a nutritionist in Harley Street and working for an NHS funded project, The Diabetes Prevention Programme.