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Purpose: Recent observational studies have highlighted the beneficial role of skim milk in prevention of gout. The aims of this study were to determine the acute effects of intact skim milk on serum urate concentrations, and to examine the mechanisms of the urate-lowering effects of skim milk.
Method: This was a short-term randomized controlled cross-over trial of skim milk in 16 healthy male volunteers. The following products were tested (each 80g protein); soy control, early season skim milk, late season skim milk (containing high concentrations of orotic acid, a naturally occurring uricosuric agent), and MPC 85 skim milk (an ultra-filtrated skim milk containing very low concentrations of orotic acid, purines and lactose). Each participant received a single dose of each product in random order. Serum and urine were obtained immediately before ingestion and then hourly over a three hour period after ingestion of each study product. Each study visit was separated by at least a week.
Results: Ingestion of the control soy led to an increase in serum urate by approximately 10%. In contrast, all skim milks led to a decrease in serum urate by approximately 10% (p<0.0001) (Figure). All products (including soy) rapidly increased the fractional excretion of uric acid (FEUA). Late season skim milk led to a greater increase in FEUA compared with MPC 85 (p=0.02) and early season skim milk (p=0.052). There were no significant differences over time or between groups in changes in serum oxypurines (xanthine and hypoxanthine) or purine-containing nucleosides (guanosine and inosine). However, all products led to an increased fractional excretion of xanthine (p=0.004).
Conclusion: This study has demonstrated that intact skim milk has a specific acute urate-lowering effect. These data provide further rationale for long term intervention studies to determine whether such dietary interventions play an adjunctive role in management of hyperuricaemia and gout.
Figure: Effects of soy and skim milks on changes in serum urate concentration. Data are presented as mean (95% CI).
