Gout and Alcohol Don’t Mix: : Evidence of Increased Gout Flare Risk Following the Consumption of Alcoholic Beverages.

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gout

gout
Gout is a form of arthritis that occurs when uric acid crystals are deposited in the joints. Uric acid is normally found in the blood and is harmful only in large amounts. Gout is a painful and potentially debilitating condition that most often affects the big toe joint. However, other joints can be affected too. Gout “flares” can come without any warning. When the amount of uric acid deposits in the joints is high, the joint starts to swell, becomes red and painful. In Canada, about 3% of the population suffers from gout, and men are four to six times more likely to get gout than women1.

Genetic factors, diet and environment have all been linked to gout. Several studies showed that drinking alcohol increases your risk of getting gout. Less is known about the effect of different types of alcohol and the amount of alcohol that trigger the recurrent gout attacks. Throughout history, such as in Roman historical documents, wine has been associated with gout, however it is unclear whether the real reason was contamination of wine with lead during the Roman era. Some observant gout patients do report that gout attacks often follow their night out with a bottle of wine. However, no formal studies have confirmed how much alcohol is enough to increase the risk of a gout flare, or which type of alcohol is the gout patient’s worst enemy.

A group of scientists at the Boston University conducted a long-term online study2 between 2003 and 2012 to determine how beer, liquor and wine affect the risk of recurrent gout flares in 724 patients who have been diagnosed with the condition. Each patient responded to questions about their diet, environment, physical activity, medication use and alcohol intake 24 hours before they had gout attacks during the course of the study. The same questions were asked at different periods when the patients did not have any gout flares. For each patient, responses during the attack period were compared to gout-free periods to isolate the effect of alcohol on the flares.

The researchers found that moderate alcohol consumption (up to 2 drinks in 24 hours) increased the risk of recurrent gout attacks by 41% for men. Interestingly, the authors did not see the same effect for women. However, the number of women in this study was small (only 22% of all patients were women), so it is likely that the effects of alcohol on gout in women are underestimated.  Moreover, all three types of alcoholic beverages – wine, beer and liquor – increased the risk of gout attacks, even when consumed in moderate amounts.

The risk of gout flares increased even more when alcohol was combined with foods high in purine, or when diuretic medications were used. Purine-rich foods include meat (especially organ meat, such as liver and kidneys), certain types of seafood, such as sardines and anchovies, as well as beans and bacon, among others. Diuretics also increased the risk of gout flares. Expectedly, use of medications for the treatment of gout, such as colchicine and allopurinol, decreased the risk.

Alcohol can increase the amount of uric acid in the blood. Through several mechanisms, alcohol is responsible for making the body produce more uric acid, while preventing this excess uric acid to leave the body. All this extra uric acid in the blood risks being deposited in the joints and triggering an attack.

This effect of alcohol on uric acid in the blood has already been established previously. Now the researchers showed that regardless of the type of beverage, the risk of gout flares increases with increasing alcohol intake.

This study has important implications for the patients who suffer from gout. Anecdotal reports (meaning reports that were not supported by thorough research) have long been suggesting a link between alcohol and gout flares. However, until this study was done, it was unclear how much and what kind of alcohol could put you at risk. Now we know that no amount of alcohol is safe. Better skip that glass of red, or make sure you have some cochicine handy, just in case.

References:

  1. Wong, R., Davis, A.M., Badley, E., Grewal, R., Mohammed, M. (2010). PREVALENCE OF ARTHRITIS AND RHEUMATIC DISEASES AROUND THE WORLD: A Growing Burden and Implications for Health Care Needs. MOCA:07-002
  2. Neogi, T., Chen, C. et al. (2014). Alcohol quantity and type on risk of recurrent gout attacks: An internet-based case-crossover study. Am J Med. 127(4): 311–318.