Urate (kidney stones, gout) reduced by Calcium – RCT June 2022

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Urate-lowering effect of calcium supplementation: Analyses of a randomized controlled trial

Clin Nutr ESPEN. 2022 Jun;49:86-91. doi: 10.1016/j.clnesp.2022.02.121 behind $$ paywall
Flávia Galvão Cândido 1, Raquel Duarte Moreira Alves 2, Dayse Mara de Oliveira Freitas 2, Jersica Martins Bittencourt 2, Daniela Mayumi Usuda Prado Rocha 2, Rita de Cássia Gonçalves Alfenas 2

Objective: To investigate if the gout-protective effect of low-fat dairy products could be attributed to the urate-lowering effect of calcium.

Methods: This is a placebo-controlled trial in which thirty-five adult (aged 18-42 years) female low-calcium consumers (<800 mg/d) were randomized to one of three treatment groups: low calcium breakfast (control, ∼70 mg of calcium/d) -C or high-calcium breakfast (∼770 mg/d) from calcium citrate - CIT or from skim milk - SM, during 45 consecutive days. Breakfasts were matched for potential confounders and were provided as part of an energy-restricted normoprotein diet containing an additional 800 mg of calcium/d. Dual-energy X-ray absorptiometry measurements (body fat assessment) and fasting blood samples (urate, ionic calcium, PTH, and 1,25-(OH)2-D3) were taken at baseline and the end of the experiment.

Clinical trial registration: http://www.ensaiosclinicos.gov.br/ (RBR-7Q2N33).

Results: Despite no significant changes in total body weight/fat, CIT and SM led to a significant reduction in serum urate and ionic calcium, but did not affect PTH and vitamin D concentrations compared to C. CIT and SM reduced baseline serum urate by ∼14% and ∼17%, respectively. There was a trend to a positive correlation between changes in serum urate and changes in ionic calcium on day 45 (r = 0.327, P = 0.055).

Conclusions: Calcium supplementation (770 mg/d from dairy or calcium citrate) reduced serum urate concentrations, suggesting that the gout-protective effect of low-fat dairy consumption is at least partly due to a urate-lowering effect of calcium.

References online

• Management of asymptomatic hyperuricemia: integrated diabetes & endocrine academy (IDEA) consensus statement.
  Diabetes Metab Syndr. 2020; 14: 93-100 https://doi.org/10.1016/j.dsx.2020.01.007
• Uric acid as a risk factor for chronic kidney disease and cardiovascular disease-Japanese Guideline on the Management of Asymptomatic Hyperuricemia.
  Circ J. 2021; 85: 130-138 https://doi.org/10.1253/circj.CJ-20-0406
• Hyperuricemia.
  StatPearls Publishing, Treasure Island (FL)2021 https://www.ncbi.nlm.nih.gov/books/NBK459218/
• Update on the epidemiology, genetics, and therapeutic options of hyperuricemia.
  Am J Transl Res. 2020; 12: 3167
• Purine-rich foods, dairy and protein intake, and the risk of gout in men.
  N Engl J Med. 2004; 350: 1093-1103 https://doi.org/10.1056/NEJMoa035700
• The association of dietary intake of purine-rich vegetables, sugar-sweetened beverages and dairy with plasma urate, in a cross-sectional study.
  PLoS One. 2012; 7e38123 https://doi.org/10.1371/journal.pone.0038123
• Evaluation of the diet wide contribution to serum urate levels: meta-analysis of population based cohorts.
• Association between dairy product consumption and hyperuricemia in an elderly population with metabolic syndrome.
• The effect of calcium supplementation on serum urate: analysis of a randomized controlled trial.
• Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid: the Third National Health and Nutrition Examination Survey.
• The Effect of dietary protein on intestinal calcium absorption in rats.
• The effect of calcium supplementation on serum urate: analysis of a randomized controlled trial.
• Phenotypic and molecular genetic aspects of pseudohypoparathyroidism type Ib in a Greek kindred: evidence for enhanced uric acid excretion due to parathyroid hormone resistance.
• Significant association between parathyroid hormone and uric acid level in men.

Etc

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VitaminDWiki - Gout and Vitamin D - many studies contains

Reasons to believe that Gout is associated with low vitamin D

1. Acute gouty arthritis is seasonal. 1998
   Increased by 32% in Spring (when vitamin D levels are the lowest)
2. Clinical Trials for Gout and Vitamin D
   Study of Vitamin D and Uric Acid Lowering on Kidney and Blood Vessel Function
   Good: 50,000 IU weekly, unfortunately: D2, not D3
3. Vitamin D reduces Rheumatoid arthritis 118 items
4. Vitamin D reduces Pain 167 items
5. Vitamin D reduces Inflammation category listing with 174 items
6. Higher incidence of gout with age (less vitamin D and gastric acid as you get older)
7. Increased gout at higher Latitude (Gout and Goutiness a 1899 book
8. Increased gout with soda pop
   JAMA study from 2010.2 women >2 cans of soda daily 2X more likely to develop gout (Note that soda decreases vitamin D levels)
9. 2X more Gout if Dark Skin
   WikiPedia gout is twice as likely in African American males as it is in European Americans
10. Gout and Calcium and vitamin D
    Calcium and Vitamin D. The relationship of gout to calcium and vitamin D is complex.
    Gout is associated with insulin resistance, low vitamin D levels, and inflammation, all of which interfere with muscle synthesis.
    One study has found that patients with gout have lower vitamin D3 levels correlated with higher urate.
11. Increased gout recently (along with increased number of people being vitamin D deficient)- both blacks and whites
    New Zealand 2009 publication
    
    Gout incidence has been increasing (while vitamin D has been decreasing)
    
12. Gout has increased, but appears to be correlated with obesity/ hypertension 2011
    note: both obesity and hypertension are associated with low vitamin D {FONT}

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VitaminDWiki - Overview Kidney Stones and vitamin D 29 studies

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VitaminDWiki - Overview Calcium 226 studies

Note: A vegi-calcium supplement appears to be much better than a rock-Calcium supplement

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Google Scholar - 41,000 studies of Urate AND Calcium - May 2022

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Google Scholar - 18,000 studies of Urate and "Kidney Stones" - May 2022