Health for life

AstraZeneca and Ardea Biosciences today presented results from a large study of allopurinol, a treatment commonly used to lower uric acid in patients with gout. The LASSO (Long-term Allopurinol Safety Study evaluating Outcomes in gout patients) study was a multinational, 6-month, open, prospective observational study involving 1,735 patients with gout and was designed to evaluate the safety and efficacy of medically appropriate doses of allopurinol. Results of the LASSO study showed no new safety signals with allopurinol doses of approximately 300mg/day. The study also revealed that at the time of last dose fewer than half (43%) of patients taking allopurinol achieved the target serum uric acid (sUA) level of <6.0 mg/dL, the level recommended by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). Results of the LASSO study were presented today at the ACR Annual Meeting in San Diego, CA.

Allopurinol, the most commonly used treatment to lower blood uric acid levels in gout, is a generic treatment that has been available for more than 50 years. It is a xanthine oxidase inhibitor, a class of drugs intended to reduce the bodys production of uric acid. Allopurinol is recommended at doses between 100mg and 900mg per day, depending upon disease severity. The LASSO study encouraged investigators to increase, or titrate, the dose of allopurinol over the six months of the study to a medically appropriate dose. There was a high rate of adherence to therapy (97% across doses) and the most commonly used dose was 300mg. Approximately 45% of patients finished on the same dose as their baseline dose. Results show that even among patients titrated to final doses above the most commonly used dose of 300mg/day, approximately 46% did not reach target sUA levels of <6.0 mg/dL.

"Gout is a painful form of arthritis that is often misunderstood and inadequately treated. The LASSO study demonstrates that many patients with gout fail to reach the recommended treatment goal," said study co-author Nicola Dalbeth, MD of the University of Auckland. "Failing to reach the recommended sUA target leaves patients with gout at risk for further disease progression and long-term consequences of gout."

The results of this large, multinational, prospective observational study of gout are consistent with published literature confirming many patients do not reach sUA targets with allopurinol therapy as currently used.

Specific findings from LASSO include:

- The study revealed no new safety signals with allopurinol (approximately 300mg/day).
- There were no cases of allopurinol hypersensitivity syndrome in this study.
At the time of last dose 43% of all patients in the study achieved target sUA levels of <6.0 mg/dL.
- Of patients in the study at final doses above 300mg/day, approximately 54% achieved target sUA levels of <6.0 mg/dL.
- Gout is the most common form of inflammatory arthritis with a prevalence of 8 million in the U.S. Gout is commonly misrepresented as a lifestyle disease. While diet can contribute to elevated levels of uric acid, the majority of uric acid is produced by the bodys naturally occurring processes, and gout is most often caused by the inefficient excretion of uric acid by the kidneys.
- In patients with gout, abnormally high levels of uric acid in the blood known as hyperuricemia lead to deposition of needle-like crystals in joints and soft tissues throughout the body, causing inflammation. Hyperuricemia results when the kidneys do not efficiently remove enough uric acid, or when the body produces too much. A persons genetics play a significant role in their risk of developing gout. The most common symptom of gout is extremely painful arthritis. Over time, the deposits of uric acid crystals may lead to joint damage, visible nodules called tophi, and impaired quality of life. Additionally, gout has been associated with serious health problems including cardiovascular disease, diabetes and kidney damage.

As part of its 2010 dietary guidelines released on January 31, the USDA recommended that the average American eat approximately 4.5 cups of produce per day. Broken down a bit more, that’s 2.5 cups of vegetables, and 2 cups of fruit. In a study released days later by the USDA’s Economic Research Service, researchers concluded all 4.5 cups could be purchased for between $2 and $2.50 per day.

Reactions on one major food blog ranged from supportive (“[I] like that they are promoting the fact that eating healthy doesnt have to expensive.”) to skeptical (“Where the hell are they shopping?”) to outright critical (“God, the USDA is full of such bull****”).

While I think the ERS researchers are correct with their $2.50 number (more on that in a minute), some of the skepticism is merited, for three big reasons:

1. They used food prices from 2008. A certain economic meltdown makes those numbers highly suspect today.
2. Among the vegetables counted towards the $2.50 total are white potatoes and corn, starchy foods not exactly known for their vitamins and minerals. Also included is iceberg lettuce, which has the rough nutritional value of licking a rock.
3. Juice is counted as produce, though the USDA itself admits, “Although 100% fruit juice can be part of a healthful diet, it lacks dietary fiber and when consumed in excess can contribute extra calories.”

With that in mind, for the huge majority of us who don’t live in food deserts, is it still feasible to pay $2.50 for 4.5 cups of produce per day? How? And going one step further, is it possible to purchase a variety thereof? Because anyone can buy seven bananas for $2, but cramming in spinach, yams, berries, and pluots gets a little harder.

My answer to each question is a resounding, “Heck yeah, but you have to do some legwork, first.” To that end, here are some suggestions to keep costs down, and nutrition way, way up.

Buy in season and on sale. These two occurrences frequently coincide, since supermarkets have to move surpluses of in-season fruits and vegetables before they rot. So, pay attention to produce calendars, hunt for bargains at farmer’s markets, and look out for circular sales in larger grocery stores. To wit: I recently scored a 5-lb. bag of gigantic navel oranges (13 in all) for $4.97 at my local Foodtown. That’s $0.38 per orange, which comes out to more than 1 cup of fruit.

Buy whole. Not cut up, drenched in cheese, or (sorry) pulped into juice. Whole fruits and vegetables are almost always cheaper and higher in nutrients than those that have been doctored. The perfect example? The humble carrot. A pound of whole carrots at my old supermarket was $0.89. ($0.66 on sale.) A pound of baby carrots, which are actually regular-sized carrots run through a peeling/whacking machine, cost $1.50. Prep them anyway you like once you’re home, but buy ‘em big before then.

Buy generic, or with coupons if you can nail a better price. While this might not apply to fresh fruits and vegetables, generic frozen and canned produce is generally a big bargain. In studies, many shoppers cant tell the difference between house and name brands, and frequently, the foods are cut and packaged in the same buildings. HOWEVER: if you have dynamite coupons, or can pair coupons with sales, name brands could be the bigger bargain. Do the math and see where you end up.

Buy fresh or frozen first, then canned. Then juice, I guess. While the USDA claims there’s no consistent price advantage of one over the other, I find A) (tomatoes excepted) fresh and frozen produce tastes better than canned, B) fresh and frozen produce is often sold/frozen at the height of growing season, giving it a bigger nutritional impact, and C) canned mushrooms are the devil. (Seriously. You can tell a good pizza joint by whether or not their mushrooms are fresh.) As for dried fruits, try purchasing them in a bulk food store or ethnic market, since theyre ludicrously expensive in many big chains. If juice is a necessity (you have children, for example), buying 100% fruit juice is best, and even then, not if you have to sacrifice other means of packing in the produce.

Find a happy medium between big nutrition and big savings. Though tasty and inexpensive, potatoes are somewhat lacking in the nutrient department. On the flip side, berries are powerhouses of vitamins and minerals, but often prohibitively pricey. Don’t forgo either extreme entirely (since a world without blueberries isn’t a world worth living in), but concentrate most of your cash on the guys in the middle. Cruciferae, leafy greens, root vegetables, citrus fruits, stone fruits, and melons are among the many options, and compromise is the name of the game.

Buy from the secret bin. Shoppers will often shy away from lightly bruised fruit, slightly limp broccoli, or salad close to its sell-by date. Their loss becomes your gain, since supermarkets will sell these products at a steep discount. Hidden at the back of many grocery stores is that shelf, which can be summed up thusly: Looks Iffy, Tastes Fine.  Go to it. Learn it. Love it. (Of course, dont buy rotted produce from it. Thats silly.)

Buy from multiple markets if you can swing it. Supermarkets within the same general area will frequently offer competing deals to lure customers in the door. In my old neighborhood ("Back in St. Olaf…"), one store would offer a 3/$5 deal on berries, while the place down the street promoted stone fruit for $0.99/lb. Purchasing from both promised variety, as well as big savings. Even if theres not a second market near you, the occasional trip to Trader Joes or CostCo. (which rarely have sales, but keep their prices consistently reasonable), can mean more produce at a lesser cost.

Before you finish up this article with a, “Harrumph! I knew all this already, and I still can’t afford 4.5 cups of produce on $2.50 per day,” check out the edible cup equivalents in the ERS study. These numbers, averaged across the nation, probably figure more importantly than retail price per pound, since they don’t include inedible parts of produce (corn husks, plum pits, etc.). Here are some examples - mean costs per cup, according to their 2/11 study:


So, 4.5 cups - a cup each of kale, sweet potatoes, navel orange, and pears, plus a half-cup of tomatoes – can be purchased for a grand total of $2.16. As mentioned, these prices have probably gone up since 2008, but A) please note we still saved $0.34, and B) some caul shopping should net you much better deals.

Honestly, everything I just wrote/everything you need to know can be found in two documents, both of which merit further study:

• The USDA’s Dietary Guidelines for Americans, 2010
• How Much Do Fruits and Vegetables Cost?

Readers, did I miss anything? Do you think its possible to get 4.5 cups of produce for $2.50 a day? Any tips? Let er rip.

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If this article interested you, you might also enjoy:

• 10 Cheap Ways to Simplify Food Shopping
• The 10 Cheapest, Healthiest Foods Money Can Buy
• 10 Foods You Should Always Splurge On