Investigating dietary recommendations, particularly tart cherries, in gout and cardiovascular disease management

Gout is a painful form of inflammatory arthritis that affects approximately 3% of adults in the United Kingdom (UK). It is associated with several comorbidities including cardiovascular disease (CVD). Diet can contribute to the prevention and management of gout and several evidence-based dietary guidelines for gout have consequently been published. Nevertheless, gout patients may use alternative sources for dietary recommendations, for example YouTube® videos. One dietary recommendation that has received considerable attention in the prevention and management of gout is the consumption of cherries, but evidence supporting this is limited to observational research and studies without appropriate controls. Therefore, over three studies, this thesis aimed to explore the role of dietary modification in the prevention and management of gout and CVD, with a particular focus on tart cherries. In Study 1, the accuracy, reliability, quality, and understandability of dietary information for gout provided on the YouTube® platform was assessed. This study highlighted that dietary recommendations for gout on YouTube® often fail to align with evidence-based guidelines in the UK, are inconsistent, and are not always suitable for patients. Almost 30% of videos analysed included advice to consume cherries. Study 2 compared the acute effects of tart cherry juice with a neutral water control on uric acid levels, inflammation, and CVD risk markers in healthy individuals. A single serving of juice was not found to exert any acute health benefits. However, diurnal fluctuations in markers were detected. The effects of 12 months of daily tart cherry supplementation on gout flares, uric acid levels, inflammation, and CVD risk in gout patients were evaluated in Study 3. Compared with a placebo drink, long-term tart cherry supplementation did not present any health-promoting benefits for gout or CVD. This study was limited by low sample size. Nevertheless, long-term cherry juice supplementation was shown to be feasible and accepted by individuals with gout. Overall, this thesis is unable to support a direct role of tart cherry juice in the prevention and management of gout and CVD, despite the prevalence of this recommendation. However, it appears to be an appropriate alternative to drinks that are known to exacerbate risk marker of gout and CVD. Placebo-controlled studies with larger sample sizes are required to confirm these findings.