Should You Take Probiotics For Gout? A Dietitian Explains - Healthline

Gout is a common type of inflammatory arthritis that affects approximately 41 million adults worldwide.

It is marked by high levels of uric acid in the blood (known as hyperuricemia), which form monosodium urate (MSU) crystals in the blood.

Elevated levels of MSU crystals lead to an accumulation in the joints — most notably the big toe — intermittent gout flares, and symptoms like joint pain, swelling or tophi, heat, and redness.

Hyperuricemia is also a risk factor for the development of heart disease, high blood pressure, diabetes, and kidney disease.

Though there isn't a cure for gout, the appropriate combination of medical and dietary interventions can help manage symptoms, reduce the frequency of gout flares, and initiate remission.

Some dietary supplements, such as probiotics, are proposed to improve gout symptoms by reducing the amount of uric acid found in the blood and, by extension, reducing gout flares and the risk of other chronic diseases.

Probiotics are living microorganisms like bacteria or yeast that, when consumed by humans in adequate amounts, potentially confer health benefits.

In this article, we explain whether probiotics are effective for managing gout symptoms.

Some research indicates that people with hyperuricemia or gout have low levels of "good bacteria" in the gut.

Thus, it's been suggested that taking probiotics may correct these low levels of the beneficial bacteria, improve gut health, and reduce the frequency of gout flares and painful symptoms.

Laboratory research has demonstrated that some probiotic strains may be capable of managing gout symptoms because they break down the purine compounds that are responsible for elevated blood uric acid.

These probiotics may also repair the damaged gut wall to prevent the growth of "bad bacteria" and enhance the response of the immune system to counter the effects of hyperuricemia.

It's important to note that these research findings are based on test tubes, and human research is needed to determine the exact role of probiotics in the management of gout.

Test-tube, animal, and human research suggests that the following strains of probiotics may support symptom management in people with gout:

• Lactobacillus (lactic acid bacteria): degrades purines in the blood and may guard against kidney damage
• Bifidobacterium: counters the growth of harmful bacteria in the gut
• Clostridium: non-pathogenic strains are low in people with hyperuricemia, but have the potential to become a new generation of probiotics

People with hyperuricemia and gout often have low levels of Ruminococcus, Eubacterium, and some strains of Enterobacteriaceae as well. Research into their potential roles is ongoing.

These probiotics may be taken as a dietary supplement or found in a variety of foods.

For instance, pickled fermented foods, such as pickled cabbage, sauerkraut, and yogurt, are rich in lactic acid bacteria.

Jiangshui — a traditional fermented Chinese food made with cabbage and celery — is also rich in lactic acid bacteria.

To date, it's unclear what dosage of probiotics is best or how often you should take them to support the management of gout symptoms. More research is warranted.

Gout is primarily managed through urate-lowering medications, such as Allopurinol and Febuxostat, or by increasing the excretion of uric acid by the kidneys.

The goal of long-term gout management is to maintain blood urate levels of less than 360 μmol/L or an individualized target range set by your medical team.

Diet and nutrition play small but important roles in gout management. Recommendations include a low-purine diet or anti-inflammatory diets like the Mediterranean diet or Dietary Approaches to Stop Hypertension (DASH).

The Centers for Disease Control and Prevention (CDC) suggests a combination of strategies for self-managing gout flares and symptoms, like:

• A healthy diet: Avoid foods high in purines like red meat, seafood, organ meat, and alcohol.
• Physical activity: Aim for 150 minutes per week of low-impact and moderate physical activity like swimming, walking, and biking.
• Workshops: Consider engaging in self-management workshops for folks with arthritis.
• Weight management (if you and your healthcare team feel that it would be appropriate and beneficial)

Always consult with healthcare professionals for the best treatment options and self-management strategies for you.

Here are some common questions people have about taking probiotics for gout.

What supplements can help with gout?

A 2021 review highlighted that there is a lack of high-quality evidence regarding the use of dietary supplements to treat gout — in particular, glycomacropeptide-enriched skimmed milk powder and vitamin C.

These supplements slightly reduced the frequency of gout flares per month, but the findings were not significantly different compared with the control group of participants that did not take the supplements.

Along with the potential role of probiotics however, dietary supplements hold great potential to help with gout in the future following more high-quality human research.

Does gut health affect gout?

Yes, there is an association between low levels of beneficial gut bacteria and hyperuricemia or gout.

Furthermore, as the disease develops — even during asymptomatic stages — gut health is compromised and the diversity of "good bacteria" is reduced.

These changes promote the overgrowth of harmful bacteria (a condition called dysbiosis), which exacerbates symptoms and is also associated with other chronic conditions like inflammatory bowel disease, depression and Alzheimer's disease.

Can gut bacteria cause gout?

Recent research in humans suggests that there are low levels of beneficial bacteria in the guts of people with gout.

However, it's unclear whether gout causes poor gut health or if changes in gut health first lead to the development of gout.

For instance, blood levels of urate are regulated by both the kidneys and gut. Therefore, changes to gut health may disrupt this balance and encourage the development of hyperuricemia and gout.

On the other hand, some research suggests that hyperuricemia firstly triggers inflammation that subsequently damages the gut wall and disrupts the balance of bacteria.

Regardless of which came first, poor gut health is associated with gout.

Gout is a common type of inflammatory arthritis that is marked by high levels of monosodium urate crystals (MSU) and uric acid in the blood. The buildup of MSU in the joints causes joint pain, swelling or tophi, heat, and redness.

It has been determined that there are low levels of "good bacteria" in the guts of people with hyperuricemia or gout, creating a therapeutic opportunity for probiotics like Lactobacillus and Bifidobacterium in the managment of gout.

Diet and nutrition, physical activity, workshops for persons with arthritis, and weight management can also play important roles in the self-management of gout symptoms and flares.