Abstract

Background Lemon juice stimulates the formation of calcium carbonate released by the pancreas and aids in alkalization of the blood and urine, neutralizing acids such as uric acid.

Objectives To assess wheather drinking freshly squeezed lemon water changes serum uric levels (SUA) and influences urine pH.

Methods In a pilot study, we retrospectively analyzed the medical documentation of 75 individuals presenting to outpatient rheumatological clinic between 1/1/2013 and 30/6/2013. Each patient drank 2 freshly squeezed lemon in 2 liters of water per day. Gouty patients continued their urate lowering drug (ULD) and prophylaxis (colchicine or NSAID) if they have been taking these previously. Parameters collected at baseline and at 6 weeks included: SUA, serum creatinine, GFR and urine pH.

Results Seventy five individuals (23F,52M) aged 25-95 years were divided into 3 groups: Group A: gout patients, Group B: individuals with hyperuricemia, Group C: control: patients with RA, AS and PsA. The differences between demographic data of the 3 groups were not significant. A reduction in SUA was observed in all groups at 6 weeks: Group A 0.4-2.8 (mean 1.6mg/dL); Group B 0.3-2.3 (mean 1.3mg/dL); Group C 0.2-1.8 (mean 1mg/dL). A decrease in serum creatinine was observed in all groups at 6 weeks: in Group A 0-0.54 (mean 0.04ml/min), in Group B 0.02-0.54 (mean 0.305ml/min), in Group C 0.03-0.44 (mean 0,1ml/min). At 6 weeks urine pH increased in all groups: in Group A 0.5-2 (mean 1.25 pH unit), in Group B 0.5-2 (mean 1.5 pH unit), in Group C 0-3.5 (mean 1 pH unit). At baseline the number of pts with GFR <60 ml/min in group A (gout) was 7; improvement at 6 weeks varied from 0- 25 ml/min. In Group B (hyperuricemia) 2 pts had GFR <60 ml/min and at 6 weeks improvement in GFR was 12 and >15 ml/min. In Group C (control) all patients had GFR >60ml/min at baseline and at 6 weeks.

Conclusions To the best of our knowledge, this is the first study in the English literature to evaluate the use of lemon water in gout patients and individuals with hyperuricemia. In this study all individuals given lemon water showed a reduction in SUA, improvement of serum creatinine and GFR as well as urine alkalization after 6 weeks of lemon water. Lemon water may be a useful adjuvant in the treatment of patients with gout. Large randomized controlled trials are needed to further evaluate the hypourecemic effect of lemons and usefulness of lemons/lemon juice and lemon water as an adjuvant in the treatment of gout.