Gout and protein (whey & soy) supplements – What scientific evidence says ?

Being a rheumatologist, I do get queries on whether protein supplements can cause gout. The simple answer is, it doesn’t appear to. But, then I did try to collate all evidence on it and realised that there are some if’s and but’s to this answer. There are many articles on the web which are not particularly written by a doctor or gout expert. The problem is, there is no specific research study done to answer this question. The opinion below is guided mostly by educated deductions on best available evidence. First understand everything about uric acid and gout in less than 5 minutes, by this infographic here.

It will be better to elaborate on this topic by answering following questions

• Do proteins in diet increase risk of gout ?
• Do protein supplements (whey and soy protein) increase gout risk ?
• Do gym-going and bodybuilding practices increase gout risk ?
• What if one already has gout? How diet protein and protein supplements will affect that patient?

1) Do increase dietary proteins increases one’s risk of having gout?

No. There is good evidence to support this answer.

• A large study by Choi & colleagues did show that total protein intake in the diet is not associated with increased gout risk.  Yes, higher levels of purine consumption in form of meat and seafood do increase the risk of gout. Since meat is high in protein, it did wrongly impress that increased protein in the diet causes gout. But, a balanced diet, with protein from multiple sources doesn’t seem to increase the risk. One reason for this could be higher protein intake having a urine washing out effect on uric acid (known as uricosuric effect).
• Egg white, dairy protein & plant protein sources like beans, lentils, spinach, soy etc, contain a mild to moderate amount of purines. These purine source do not tend to increase gout risk.
• Gout doesn’t occur due to one reason. Poor lifestyle and genetic factors together play a role in gout risk.

Do protein supplements (whey and soy) increase gout risk ?

The protein supplements have a higher amount of protein by weight compared to a normal diet. The following facts do support notion that these supplements do not increase gout risk. (No good research on this topic though).

• Whey is a dairy protein obtained from milk as a by-product while making cheese. It has lacta-albumin which might be helpful in decreasing uric acid. (Click here for study).
• Higher soy intake in food (not supplements) by some Asian populations is  associated with increased gout risk (study).
• Most of these supplements do not have fructose sugars. Fructose can get converted to uric acid and potentially increase gout risk.
• Though not clearly mentioned on most supplements, these protein supplements do not tend to have a high purine content.

  There is no specific research, but it can be safely said that protein supplements do not appear to increase gout risk. There might be some precautions required in gout patients consuming high amounts of protein in diet and via protein supplements. The potentially harmful supplement consumption and practices of bodybuilders makes the association with gout much more complicated.  

Do gym-going and bodybuilding practices increase gout risk ?

We couldn’t find any study on the frequency of gout development in dedicated body builders with their practices. There should not be any increased of gout in average gym going person, keen on building some muscle mass.  The theoretical concern in dedicated bodybuilders is when they use anabolic (muscle-building) steroids along with other potentially harmful unregulated products. These along with ‘bulking’ & ‘cutting’ cycles, besides many other possible side effects, may damage kidneys (study 1 and study 2).  Kidney damage can increase gout risk. (Remember, gout can damage kidneys and reversely poor kidney function can lead to gout by decreasing uric acid excretion in urine).

I have gout, how proteins in diet and supplements will affect me?

The following advice applies to one who has gout. Have protein in diet, but cut down ‘gout-unsafe’ sources of protein High purine foods like liver, glandular meats and certain sea food should be avoided. Protein sources in the form of lean meat, poultry and fish should be restricted to 100-120 grams/day. Low fat dairy, egg white and plant protein sources are good in protein and not harmful for gout patients. (For complete dietary advice on gout click here). Take your medicines Gout risk is partly due to the genetic tendency. One will still suffer from gout arthritis if uric acid is above 6 mg/dl (or > 350 umol/l). Diet and medicines are both required in most gout patients to keep uric acid below 6 (#Reachforsix ). Neither can work alone. Body builders and Gym-goers having gout – Avoid dehydration and harmful supplements We are not aware of studies which look specifically at gout patients into body building or aggressive gym use. I have put the following advice with facts and reasoning.

• High protein diets can cause diuresis or increased urination. This is more likely when somebody has recently started high protein diets. This can cause relative dehydration and trigger gout attack in a known gout patient. Dehydration during exercise can also precipitate an attack. Hence, hydration is important. Good amount of water intake daily also helps washing out uric acid in gout patients.
• ‘Bulking’ and ‘cutting’ cycles by body builders may lead to uric acid fluctuations and gout attacks. ‘Cutting’ down cycles can lead to tissue and breakdown of body cells. Body cell breakdown can release purines, increases uric acid formation and worsen gout. The use of other supplements by body builders can make the scenario more complicated.

Regular moderate exercises are good for gout patients Increased weight and poor lifestyle increases risk and makes gout treatment less effective . Exercise helps gout control and decreases heart disease risk in these patients. Kidney damage and protein intake in gout patients High protein consumption as such does not cause kidney damage. But high protein intake increases the load on damaged kidneys. In gout patients, kidneys might be not functioning well due to many reasons. Such patients must be cautious about their protein intake and discuss it with their doctors. Gout patients have increased tendency of kidney stone formation. There have been some studies claiming that increased protein consumption might increase stone formation in normal people. But again this hasn’t been definitely proven. Can protein supplements in gout cause increased tendency of kidney stones ? – I don’t think there is any evidence to answer that.

Summary

Points to consider – Gout patients, exercise and protein supplements

• Protein supplements are unlikely to increase the risk of gout in a healthy person.
• Discuss diet and supplements with treating rheumatologist, who can give individualised advice. Take medicines properly as advised (#Reachforsix).
• Regular exercise is good for gout patients
• It is better to have proteins from natural gout-safe dietary sources and not through supplements.
• If consuming protein supplements, check their content and use branded ones. Keep track of any gout worsening with the use of new supplements.
• Avoid fructose sugar, anabolic steroids and other potentially harmful unregulated supplements.
• Maintain good amount of water intake.
• Avoid sudden increase or decrease in exercise regimes and ‘fast’ weight loss programs.
• Avoid exercise during acute attacks.

References

• Choi HK, Atkinson K, Karlson EW, Willett W, Curhan G. Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men. N Engl J Med [Internet]. 2004 Mar 11 [cited 2017 Jul 18];350(11):1093–103. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMoa035700
• Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology Guidelines for Management of Gout . Part 1 : Systematic Nonpharmacologic and Pharmacologic Therapeutic Approaches to Hyperuricemia. 2012;64(10):1431–46.
• Khanna D, Khanna PP, Fitzgerald JD, Singh MK, Bae S, Neogi T, et al. 2012 American College of Rheumatology Guidelines for Management of Gout . Part 2 : Therapy and Antiinflammatory Prophylaxis of Acute Gouty Arthritis. 2012;64(10):1447–61.
• Garrel DR, Verdy M, PetitClerc C, Martin C, Brulé D, Hamet P. Milk- and soy-protein ingestion: acute effect on serum uric acid concentration. Am J Clin Nutr [Internet]. 1991 Mar [cited 2017 Jul 17];53(3):665–9.
• Herlitz LC, Markowitz GS, Farris AB, Schwimmer JA, Stokes MB, Kunis C, et al. Development of focal segmental glomerulosclerosis after anabolic steroid abuse. J Am Soc Nephrol [Internet]. 2010 Jan 1 [cited 2017 Jul 18];21(1):163–72. Available from: http://www.jasn.org/cgi/doi/10.1681/ASN.2009040450
• Nanavati A, Herlitz LC. Tubulointerstitial Injury and Drugs of Abuse. Adv Chronic Kidney Dis [Internet]. 2017 Mar [cited 2017 Jul 18];24(2):80–5.
• Hattori CM, Tiselius H-G, Heilberg IP. Whey protein and albumin effects upon urinary risk factors for stone formation. Urolithiasis [Internet]. 2017 Mar 22 [cited 2017 Jul 20].

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