Lemon water found to have urate-lowering effect

Drinking lemon water regularly can be beneficial to people with gout and hyperuricemia, helping reduce serum urate levels and improve glomerular filtration rate (GFR), according to new research.

Over 6 weeks of lemon water intervention, serum urate levels decreased by a mean of 1.25 mg/dL among participants with gout, by a mean of 1.31 mg/dL among participants with hyperuricemia but without gout, and by a mean of 0.85 mg/dL among control participants with neither gout nor hyperuricemia. [Int J Rheum Dis 2025;doi:10.1111/1756-185x.70488]

The observed reductions in serum urate levels in both the gout and hyperuricemia groups were significant compared with the reduction seen in the control group (p=0.03 and p=0.003, respectively). None of the participants experienced gout flares during the intervention.

Additionally, GFR improvements were seen in participants with a GFR of ≤60 mL/min at baseline, ranging from 1 to >25 mL/min in the gout group and from 8 to >15 mL/min in the hyperuricemia group.

At week 6, urine pH level increased by a mean of 1.17 pH units in the gout group, 1.3 pH units in the hyperuricemia group, and 1.13 pH units in the control group. Serum creatinine also increased by a mean of 0.06 mL/min in the gout group, 0.13 mL/min in the hyperuricemia group, and 0.14 mL/min in the control group.

“This is the first study that shows that lemon water has hypouricemic and alkalizing properties in gout and individuals with hyperuricemia,” the investigators said. “Lemon water may be helpful as an adjuvant hypouricemic therapy for [this population].”

The analysis included 90 participants (mean age 49.2 years, 69 percent male), of whom 30 had gout, 30 had hyperuricaemia, and 30 were designated as controls. There were 78.9 percent of participants who had at least one of the following comorbidities: hypertension (28.9 percent), dyslipidaemia (74.4 percent), diabetes mellitus (12.2 percent), hyperglycaemia (18.9 percent), and ischaemic heart disease (11.1 percent).

Among participants with gout, 13.3 percent were taking nonselective nonsteroidal anti-inflammatory drugs, 6.7 percent were taking oral corticosteroids alone, 20 percent were taking colchicine alone, and 6.7 percent were on a combination of colchicine and corticosteroids (6.7 percent). In terms of urate-lowering medications or drugs with urate-lowering properties, 43.3 percent of participants were using allopurinol, 6.7 percent were using losartan, and 13.3 percent were using fibrates.

All participants consumed lemon water, which was created by mixing the juice of two squeezed lemons with 2 L of water, daily, in according with a general recommendation made by clinic providers.

“Compared with the commonly consumed citrus fruits [such as] oranges and grapefruit, lemons contain the highest concentrations of citric acid, nearly five times that of oranges,” the investigators noted.

“Thus, despite lemons being acidic, the citric acid in lemons, once absorbed, indirectly promotes bicarbonate production,” which aids in alkalinization of the blood and urine and neutralizing acids such as uric acid, they explained.

Moreover, drinking 2 L of water daily has been reported to be beneficial in reducing serum urate levels. [Arthritis Rheum 2009;60:762-763]

The study was limited by its retrospective design, small sample size, and a 6-week term follow-up. Large prospective randomized controlled trials are needed to establish the safety and efficacy of lemon water and elucidate its mechanism of benefit in gout and hyperuricemia, according to the investigators.