Si Fan Dr. Slavin NUTR 642 Dec. 12,

Si FanDr. SlavinNUTR 642Dec. 12, 2017Dairyin Mediterranean Diet and Gouty ArthritisBackgroundMediterranean diet            The Mediterranean diet has beenrelated to longevity and quality of life, which reflects dietary habits ofseveral countries in the Mediterranean Basin during the early 1960s, somecountries of northern Europe, such as France, Italy, Greece, and Spain (Serra-Majem,Roman, & Estruch, 2006; A. Trichopoulou & Lagiou, 1997; AntoniaTrichopoulou et al., 2014).

In 1993, Oldways working withHarvard School of Public Health and the WHO created the Mediterranean DietPyramid, in which an emphasis on activity and social interactions were the baseof the pyramid; the main foods included whole grains, fruits, vegetables,beans, herbs, spices, nuts, legumes, and healthy fats such as olive oil; fish andseafood especially should be eaten at least twice a week with dairy foods, likefermented dairy frequently; still consumed eggs and occasionally ate poultrybut limited red meat and sweets; and water and wine were typical beverages (“Mediterranean Diet,” n.d.; “Mediterranean Dietpyramid,” n.d.

). Moreover, the Mediterranean diet has been shownfavorable influences on lipoprotein levels, diabetes and antioxidativecapacity, cardiovascular diseases, arthritis, cancer, body composition, andpsychological function (Serra-Majemet al., 2006).            However, this research will focus ondairy foods, especially fermented yogurt in the Mediterranean diet. Fermentedyogurt is a source rich in proteins, including whey proteins, which could be dissolvedinto water, and caseins, which is insoluble milk proteins (“Yogurt 101,” 2014).

The majority, almost 80% ofproteins in yogurt are caseins, which could promote the absorption of minerals,such as calcium and phosphorus (Holt, Carver, Ecroyd, & Thorn, 2013). A small amount, nearly20% of proteins found in yogurt are whey, which is a popular supply amongbodybuilders and athletes (“Yogurt 101,” 2014). What is more, wheyprotein also could supply diverse health benefits, like weight loss (Miller, Alexander, & Perez, 2014) and weight maintaining.Since both of casein and whey are abundant of essential amino acids, especiallybranched-chain amino acids (BCAAs) in whey, these macronutrients are beneficialfor human beings’ digestive system (“Yogurt 101,” 2014). Whereas, two-thirds ofindividuals in the United States do not meet the recommendation, three dailyservings of low-fat or no-fat dairy products, recommended by Dietary Guidelinesfor Americans (DGA). Strikingly, 90% of children and adults in the U.

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S. consumedless than 1 cup of yogurt per week, which is far less than recommended by DGA,1 serving of yogurt per day (Webb, Donovan, & Meydani, 2014).             Arthritis             Arthritis is inflammation of one ormore of joints, which is a rheumatic condition (“Arthritis,” n.

d.). Thus, patients with arthritistend to fell pain and aching. Other symptoms involve swelling, stiffness, anddecreased range of motion (“What Is Arthritis?,” n.d.-a). According to the Centers forDisease Control and Prevention (CDC), it reported that 54.

4 million adults inthe United States suffering some forms of arthritis (“Arthritis,” n.d.). People range from all ages,sexes, and races do have this disease. Moreover, there are over 100 differenttypes of arthritis and related conditions, including degenerative or mechanicalarthritis (osteoarthritis the most common type), inflammatory arthritis, infectiousarthritis, and metabolic arthritis (“Arthritis,” n.d.).                  In this article, it will focus onmetabolic arthritis, which is a condition that uric acid is accumulated in thebody through broking down purines (“Arthritis,” n.

d.). If the uric acid level builds upcontinuously but not reducing, it will turn to gout, a particular type ofmetabolic arthritis (“What Is Arthritis?,” n.d.-b). Diagnosing this kind of arthritisis complex, while the most reliable method diagnosing gouty arthritis is to dosynovial fluid analysis to detect uric acid or crystal formation levels inpatients’ body (“Gout Symptoms and Diagnosis | Johns HopkinsArthritis Center,” n.d.

). According to the CDC, it reportedthat 8.3 million Americans were influenced by gout (“Gout,” n.d.) and the prevalence of gout amongmen is higher than among women in the United States (HyonK. Choi, Atkinson, Karlson, Willett, & Curhan, 2004; Zhu, Pandya, &Choi, 2011). What is more, it is a disease relating to dietclosely, since purines could not only be found in human cells, but also couldbe found in several foods, such as red meats, shellfish, purine-richvegetables, and so on. Besides these purine-rich foods, some certain foodscould raise the level of uric acid, like alcohol, especially beer, and thosefoods containing high amounts of fructose (“What Is Arthritis?,” n.

d.-b). However, there is a decrease in theincidence of gout with increasing low-fat dairy products intake, soy productsintake and vitamin C supplements (HyonK Choi, 2010; Garrel et al., 1991; Shulten, Thomas, Miller, Smith, & Ahern,2009). Importantly, the complications of severe goutyarthritis could be related to cardiovascular, myocardial infarction (H.K. Choi & Curhan, 2007; Krishnan, Baker, Furst, & Schumacher, 2006), type 2 mellitus (H.

K. Choi, Vera, A, & Krishnan, 2008) and metabolic disease.Nevertheless, few studies conducting on the mechanism of dairy productsin gout patients.Therefore, researchers need to do more research to explore why dairy proteinshave positive impacts on preventing gouty arthritis.Metabolism of protein            The structure of proteins containsprimary, secondary, tertiary, and quaternary fourth levels. The primarystructure of a protein is the amino acid sequence, which is the basic frame ofproteins; the secondary structure of a protein is coiling, folding, interactingbetween and among amino acids; the tertiary structure of a protein is athree-dimensional configuration, which is a higher level of proteins; and thequaternary structure is two or more polypeptide chains interacting together,which is the highest structure of a protein.

Amino acids are the buildingblocks in forming the primary structure of a protein, which contains at leastone amino group (-NH2), at least one acid group (-COOH), and a sidechain (R group) structurally. As veryfew digestions of proteins happen in mouth and esophagus, the onset ofdigestion starts at stomach. Because of the internal environment of stomach, gastric pH less than 3, which caused byhydrochloric acid (HCl) presenting in gastric juice, proteins will be denaturedto the primary structure through quaternary, tertiary, and secondary structuresof protein. While, the primary structure of proteins could not be affected bythe hydrochloric acid, on the other hand, hydrochloric acid could activatepepsin from pepsinogen. Pepsin is an endopeptidase actively around pHless than about 3.5, attacking peptide bonds adjacent to the carbaoxy end oflong amino acid chains. The products of protein end in stomach including largepolypeptides primarily, oligopeptides and free amino acids.            The further digestion occurs in thesmall intestine, firstly in the duodenum.

In the duodenum, proteins andpolypeptides could be further digested with the release of pancreatic juice andzymogens. In the small intestine, several zymogens function the important rolesin this digestion process; to be more specific, a couple of peptidases are producedby enterocytes. The endproducts of this process are peptides and free amino acids, which could beabsorbed by human beings’ body. The most of amino acids are absorbed in theduodenum and jejunum across the brush border membrane through carriers. Thepeptide, especially dipeptide and tripeptide, also need a transport system, butthrough different transporters. After these products enter the enterocyte, theycontinue to transport into blood for use across basolateral membrane. And then throughcapillaries of the villi enter into blood, flowing in the blood stream to liver,kidney, and other organs.             Actually, protein could not bestored in tissues of the body, however, they are in continuous breakdown andsynthesis cycling, which called protein turnover.

The liver is the primary siteof amino acids metabolism. The first step of amino acid catabolism involvestransamination or deamination process. Transamination reactions containtransferring an amino group from an amino acid to an a-keto acid. Contraryto transamination reactions, deamination process involves only removing theamino groups from amino acids, releasing nitrogen as ammonia. Ammonia could be detoxifiedthrough a couple of pathways. For the remaining part, a-keto acid, hasmultiple uses in cells by further metabolism.

Through various reactions, aminoacid could be converted to pyruvate, acetyl CoA, and the intermediates of TCAcycle to generate energy. They also could be utilized for glucose, ketone body,cholesterol, and fatty acid production depending on the original amino acidform.              Hormones have an influential role incontrolling over the protein balance in the body. For catabolic process, stimulatedby cortisol and the higher ratio of glucagon-to-insulin in the blood. In contrastto degradative process, insulin could increase protein synthesis, and decreaseprotein degradation to rise the blood concentration of amino acid.

             One possible metabolism of milkprotein protecting gouty arthritis is the urate-lowing effect (Hyon K. Choi et al., 2004; Dalbeth & Palmano,2011). Since naturallybovine milk is low-purine products, which also could decline serum urate byabout 10% (Dalbeth & Palmano, 2011). Meanwhile, dairy products excretesegmental uric acid rapidly. Combined with the feature and the function, allmilk products have the feature of reduction of serum urate concentrations. Review of literature            Several studies have been shownadherence to the Mediterranean diet has a potential relationship with serumuric acid levels (Kontogianniet al.

, 2012), which could reduce the likelihoodof having gouty arthritis. Specifically, focused on moderated dairy productsprovided in Mediterranean diet, there are a couple of research suggesting increaseddairy intake negatively associated with the incident of gout (Dalbeth& Palmano, 2011; Kontogianni et al., 2012; Singh, Reddy, & Kundukulam,2011), especially low-fat dairy products (Kontogianniet al.

, 2012).             The potential reasons of inverserelationship between milk intake and serum uric acid level, involved thecomposition of bovine milk, and the metabolism of milk protein in the humanbeing’s body (Dalbeth& Palmano, 2011). Firstly, all milks have an effecton decrease serum urate.

Orotic acid in bovine milk is a uricosuric compound totransport out uric acid through kidney, which resulting in decreasing thereabsorption of uric acid (Dalbeth,Wong, et al., 2010). On the other hand, milk productscould improve the fractional execration of uric acid (FEUA) rapidly.

The higherrate excretion of uric acid through kidney, the lower level of serum urateflowing in the body. Additionally, dairy products also promote the excretion ofxanthine, which is a precursor of urate. With the reduction of xanthine, serumurate level subsequently decreased to avoid serum urate crystals formation.               Onereliable diagnosis of gouty arthritis is testing the uric acid level present inblood through synovial fluid analysis. Uric acid could be produced from theendogenous purine metabolism, and from the end products of exogenous foods,such as milk protein (Maiuolo,Oppedisano, Gratteri, Muscoli, & Mollace, 2016).             In addition, anti-inflammatoryproperties of some particles in milk might contribute to the decrease of therisk of gouty arthritis. Such as glycolmacropeptide and G600 milk fat extractcould inhibit the inflammatory response of monosodium urate (MSU) crystals withinthe joint (Dalbeth& Palmano, 2011). The initial process ofinflammatory response caused by macrophages phagocytosing MSU crystals, whichactivated and release a high-molecular, interleukin (IL)-1b.

Activated IL-1b continuous caused release ofseveral pro-inflammatory cytokines, like IL-8, TNF-a.Finally, neutrophils are recruited of inflammatory cells in the joint (Gonzalez,2012). According to Dalbeth,Gracey, et al. (2010), certain dairy fractions couldregulate the inflammatory response of gout. Glycolmacropeptide could inhibitIL-1b gene expression in the THP-1 cells. Moreover, G600milk fat extract inhibit IL-8 protein expression in the THP-1 cells (Dalbeth& Palmano, 2011). What is next?            There is still a lot of researchneeded to be done on the pathology of gouty arthritis, and the detailmetabolism of milk protein in preventing the risk of the gout.

Since thepathology of hyperuricemia is controversial, some patients with hyperuricemiadid not have the gout simultaneously.Thus, the pathology of gout need to be explored continuously. What is more, acouple of studies conclude that there is an inverse association between thedairy intake and serum uric acid level.

However, very few research could tellwhy there is a relationship between these two substances, and no researchidentify the specific metabolism during this process. Therefore, it isnecessary to do more research to explore the detail pathway within this investigation.             Considering inflammatory factors, poorlyunderstood of the molecular component of the inflammation recently (Gonzalez,2012), the effects of glycolmacropeptide and G600 milk fatextract required further exploration.            A further issue is to make therecommendation according to diet for gouty patients. Although it is importantto modify the dietary pattern for preventing the gout, there is norecommendation on how much patients should consume each day.

Meanwhile, fewintervention studies have conducted and examined the modification dietary inpatients with gouty arthritis. Thus, more research studied in this area couldhelp investigators and patients with gout understand and manage this disease successfully.Conclusion            A couple of research suggested thatadherence to Mediterranean diet could lower the likelihood of having goutyarthritis, which caused by hyperuricemia. To be more specific, the increase indairy intake has a negative association with serum uric acid level. Since thedairy products are low in purine content, simultaneously, milk products are featured withurate-lowering effects.

Moreover, the anti-inflammatory factors in bovine milkalso play significant roles in decreasing the risk of gouty arthritis. Nevertheless,more research needed to be done in pathology and detail metabolism with dairyprotein and gout to help followings and patients to manage this diseasesuccessfully.            ReferencesArthritis:Causes, types, and treatments. (n.d.

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