Improving Gout & Iron Guidelines is aimed at anyone who has any interest in the effects of iron on uric acid and gout.

The purpose of this article is to improve GoutPal’s gout & iron guidelines.

Current guidelines about iron on GoutPal.com are:

• Alternative Treatment For Gout – Blood Letting. The report on which this is based,
  and a book (Facchini FS. The Iron Factor of Aging. Why do Americans age faster?), are reviewed it “Back to Bloodletting? Article in Journal of the American Geriatrics Society 52(9) · September 2004 DOI: 10.1111/j.1532-5415.2004.52425.x”. There is dietary advice for reducing available iron. But, it needs reviewing carefully with respect to gout. My article should probably be republished as “Can I donate blood with high uric acid” or similar.
• Gout and Iron Revisited. Note, this is based on “Mascitelli L, Pezzetta F, Goldstein MR. Comment on: Gout: an independent risk factor for all-cause and cardiovascular mortality. Rheumatology (Oxford). 2010 Jul;49(7):1421-2; author reply 1422. doi: 10.1093/rheumatology/keq118. Epub 2010 Apr 27″‘ which should be cited correctly.
• Iron, Xanthine Oxidase, & Uric Acid

I would like these guidelines to help gout sufferers immediately. The guidelines must show which personal facts are important for managing iron and gout. Then, we can use the gout forum to help gout sufferers get personal management plans for iron.

At the moment, the gout & iron guidelines are fragmented. They also omit some relevant research. Once we have reviewed all relevant gout research, I will update the guidelines.

Gout & Iron Research Timeline

This is a partial list. The purpose of this article is to prompt readers to help fill this list with other gout and iron research.

Title	Author	Journal	Notes
Anemia and the onset of gout in a population-based cohort of adults: Atherosclerosis Risk in Communities study	Mara A McAdams-Demarco et al	Arthritis research & therapy 14(4):R193 · August 2012	Statistics show gout associated with anemia. Unexpected finding is explained by possibility of other diseases associated with anemia, or use of iron supplements.
Does inhibition of iron absorption by coffee reduce the risk of gout?	Mascitelli L, Goldstein MR.	Int J Clin Pract. 2011 Jun;65(6):713. doi: 10.1111/j.1742-1241.2011.02640.x.	The main phenolic compound in coffee, chlorogenic acid, is a potent inhibitor of nonheme iron absorption (3,4). In particular, it has been reported (3) that the polyphenolic content typical of a cup of instant coffee reduces iron absorption from a test meal by 60–90%. (3)=Hurrell RF, Reddy M, Cook JD. Inhibition of nonhaem iron absorption in man by polyphenolic containing beverages. Br J Nutr 1999; 81: 289–95. (4)=Fleming DJ, Jacques PF, Dallal GE, Tucker KL, Wilson PW, Wood RJ. Dietary determinants of iron stores in a free-living elderly population: the Framingham Heart Study. Am J Clin Nutr 1998; 67: 722–33
Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases.	Douglas B Kell	BMC Medical Genomics 2(1):2 February 2009
Iron catalyzed oxidative damage, in spite of normal ferritin and transferrin saturation levels and its possible role in Werner’s syndrome, Parkinson’s disease, cancer, gout, rheumatoid arthritis, etc.	Johnson S.	Med Hypotheses. 2000 Sep;55(3):242-4.
Effect of gradual accumulation of iron, molybdenum and sulfur, slow depletion of zinc and copper, ethanol or fructose ingestion and phlebotomy in gout.	Johnson S.	Med Hypotheses. 1999 Nov;53(5):407-12.

Gout & Iron Discussions

Old Iron and Gout Discussions

Old discussions about gout and iron often mentioned research, or raised interesting questions. Where appropriate, I will add these to the timeline above.

Here is a summary of key points from old gout & iron discussions:

Gout and Iron – September 13, 2008

Mentions gout and iron research:

Topic/Title	Author	Published	Quotes, Questions & Notes
Hepcidin: inflammation’s iron curtain.	Drs. Hugh McGrath and PG Rigby at the Louisiana State Health Services Center in New Orleans.	November 2004 issue of Rheumatology.	“A broader phlogistic potential of iron towards the joint comes from a recent report that iron depletion by serial phlebotomies diminishes recurrences of gouty arthritis.” I used that “recent report” to write my famous blood-letting article.
Iron and inflammation.	Janis Kelly.	Medscape Medical News.	Review of McGrath and Rigby.
About the role of iron in inflammation and in gout attacks.	Ghio, Rao, Cooke, Milller and Holdal. Duke Univeristy Medial Center in Durham, North Carolina.	September 1994 issue of Arch. Biochem. BioPhys.

Key points (not verified):

• Iron plays a pivotal role in the inflammation process.
• Iron from meat and seafood is more readily absorbed than iron from vegetables.
• Ask doctor about switching from multivitamin fortified with iron, to one without.
• Read packaging to avoid added iron in food.
• Low-fat dairy and coffee contain substances that limit iron absorption in the intestines.
• There are foods that help the absorption of iron in the intestines and those that inhibit the absorption of iron.
• One doctor from India supported reducing blood for gout patients. His patient reported successful treatment of affected joints with leeches. The treatment was painless, and reduced gout pain symptoms.

Unanswered questions:

• How much blood donation is reasonable?
• Can blood still be donated for other purposes if not suitable for transfusion?
• Is the benefit of blood transfusion explained by expelling uric acid in the blood?

Gout And Iron Supplements – May 25, 2011

A GoutPal member was concerned about iron in his multivitamin supplement.
I complained about UK breakfast cereal fortified with iron.
An American gout sufferer added:

In the U.S. ALL foods sold that are made with grains MUST be supplemented with iron. That’s EVERY bag of rice, every piece of bread, and every bag of pasta.

For men, it is iron poisoning, plain and simple. European studies have convincingly linked excess serum ferritin with heart disease.

Uric Acid and Iron – September 19, 2008

This starts with information about interactions between iron and uric acid. It is not referenced, but I suspect it is the Ghio research. In the discussion that followed, the following points were made:

• A suggestion that donating a pint of blood 4 times a year should be beneficial.
• 2 links for finding blood donation centers: USA redcrossblood.org and UK blood.co.uk.
• A suggestion that most gout patients would have blood ferritin levels above the 300-500 range, with 20 point reduction per blood donation.
• A reference to a PubMed study (not named!) that wheat grass is a better iron chelator than green tea.

A couple of food Q’s please – December 7, 2009

This was a discussion about the effects of the yeast extract, Marmite or Vegemite, on gout. We found that Marmite contains 25% RDA iron (1.8mg) in one 5g portion. We found no data on Vegemite. A reference to yeast extract suggests 0.2mg. We still need to confirm iron content of various yeast extract products.

In fact, we need to find clear evidence regarding the available iron content of all food. This is very complicated. Most data measures the iron content of food in the lab. Where’s the data that tells us how much iron will be absorbed from different foods as they are digested?

Current Gout & Iron Discussions

You can ask new questions about gout and iron in the gout forum.

I will add Gout Helpdesk messages about gouty arthritis and iron as feedback below.

Do you know any relevant research about gout & iron? Please share your findings in the comments below.