Tart Cherry for Gout

The case for tart cherry in gout rests mainly on one study. Zhang and colleagues followed 633 people with gout online for a year and compared the two days before each flare with flare-free periods. Eating cherries was linked to a 35% lower risk of a flare (OR 0.65), and cherry extract to a 45% lower risk (OR 0.55). An observational design like this can't rule out other habits that travel with cherry eating.

The trials since have not settled it. A dose-finding trial in 50 people with gout found no effect of tart cherry concentrate on serum urate or flares over 28 days, and a 2026 meta-analysis of four trials found only a small, inconsistent fall in uric acid. The 2020 American College of Rheumatology (ACR) guideline reviewed the cherry data and made no recommendation either way.

A gout flare is an inflammatory reaction to monosodium urate crystals in a joint. Tart cherry concentrate's main anthocyanins (red-purple plant pigments) are cyanidin 3-glucosylrutinoside and cyanidin 3-rutinoside. In mice given the concentrate for 14 days before urate crystals were injected into the ankle, NF-kB activity (a master switch for inflammation) was about half that of control mice, with fewer inflammatory cells in the joint (Schlesinger 2022).

In people with a history of gout, cyanidin 3-glucosylrutinoside reached the highest blood levels of the absorbed anthocyanins, rising with the dose of concentrate (Brunetti 2023). That shows the compounds get in, not that they prevent flares.

Early studies reported that cherries lower uric acid. In 10 healthy women, plasma urate fell from 214 to 183 micromol/L five hours after 280 g of sweet cherries, while urinary urate rose (Jacob 2003). In 48 adults, tart cherry lowered uric acid by an average of 8% for up to 24 hours, but the fall did not last with continued intake (Hillman 2021).

A controlled crossover trial in 12 adults then found no difference between tart cherry juice and water: uric acid fell through the day either way (Lamb 2026). Uncontrolled acute studies may have mistaken that daily rhythm for a cherry effect. In people with gout, the dose trial found no change in urate (Stamp 2020), and its authors suggested any flare benefit would have to work some other way.

The placebo-controlled trial gave 7.5, 15, 22.5 or 30 mL of tart cherry concentrate twice a day for 28 days, and none of the doses lowered urate better than placebo (Stamp 2020). The 9-month pilot used 3,600 mg/day of cherry extract (Singh 2020). In overweight adults without gout, 240 mL/day of 100% juice for 4 weeks lowered serum urate by 19.2% (Martin 2019).

So there is no evidence-based dose for gout. Concentrate and juice also bring sugar: one hyperglycaemia event in the dose trial was judged possibly related to the concentrate.

The case-crossover study (Zhang 2012) is the main reason cherries are linked to gout. Among 633 people, cherry intake over two days was tied to a 35% lower flare risk, and the link held across subgroups by sex, weight, purine intake, alcohol, diuretics and gout medicines. Periods with both cherries and allopurinol had a 75% lower flare risk than periods with neither (OR 0.25).

The 9-month pilot (Singh 2020) randomised 84 people to cherry extract or dietitian-guided diet change, with no placebo. In the cherry group, the share with any flare fell from 98% before the study to 56% at 9 months (p < 0.0001), but the diet group improved too (98% to 65%), so the trial can't separate cherry from taking part. Its authors called for a placebo-controlled trial. A 2019 systematic review of six studies reached the same position: an association, not proof (Chen 2019).

Stamp and colleagues (2020) randomised 50 people with gout and serum urate above 0.36 mmol/L, half on allopurinol, to placebo or one of four concentrate doses for 28 days. Dose had no effect on serum urate, urine urate excretion or flares (P = 0.76). In 282 men starting febuxostat, a tart cherry and citrate mixture lowered urate no more than citrate or bicarbonate, though it gave lower CRP and less albumin in the urine at 12 weeks (Wang 2023). The mixture's effect can't be pinned on the cherry.

Outside gout, results are mixed. Juice lowered urate by 19.2% in 26 overweight adults over 4 weeks (Martin 2019). A 10-person trial of a 500 mg extract reported a 37.4% fall over 4 weeks (Jäger 2026), far larger than any other result and not yet repeated. A 2026 meta-analysis of four trials (392 participants) put the overall effect at SMD -0.22 (95% CI -0.43 to -0.01), with substantial heterogeneity (Zhang 2026).

A placebo-controlled trial with flares as the main outcome, long enough to count them. One is planned: a 12-month double-blind trial of Montmorency juice versus a cherry-flavoured placebo in 120 people with gout (Lamb 2020). Reviews of gout supplements in general found the trials mixed, often contradictory and of poor quality (Pardali 2025; Yang 2020).

Until then, the ACR guideline's lifestyle advice is to limit alcohol, purines and high-fructose corn syrup, and to lose weight if overweight; it recommends against adding vitamin C for gout. Other options with trials in gout include omega-3.

Side effects were uncommon in the gout trials. In the 28-day dose trial, 24 adverse events were reported and only one, hyperglycaemia, was judged possibly related to the concentrate (Stamp 2020). Over 9 months, gastrointestinal symptoms were reported by 28% on cherry extract and 27% on diet change (Singh 2020). Adverse events were similar with the cherry and citrate mixture and its comparators (Wang 2023).

The bigger risk is relying on cherry instead of treatment that works. Gout left above its urate target keeps flaring and can damage joints; the ACR strongly recommends a treat-to-target plan with a serum urate goal below 6 mg/dL.

No formal drug interaction studies exist for tart cherry. It has been taken alongside allopurinol and febuxostat in trials without a signal of harm: allopurinol did not change cherry's effect on urate (Stamp 2020), and adverse events were similar when a cherry mixture was added to febuxostat (Wang 2023).