Alcohol and gout
Clinical bottom line
Compared with people without gout, those who do have gout drink more alcohol. Alcohol consumption in regular users increases serum uric acid concentrations. People with gout should probably avoid alcohol.
The relationship between gout and alcohol consumption has been with us for centuries. "When a few glasses of wine, ale, or porter, quickly and invariably produce....an inflammatory affection of a joint, such inflammation is of a truly gouty character". These words were written in 1876, but the exact relationship between alcohol consumption and gout is still hard to pin down. In this page we seek to review the evidence linking alcohol and gout. Is it the alcohol, or is it the purines that inevitably accompany fermented drinks?
Drinking behaviour in patients with acute gout
CR Sharpe. A case-control study of alcohol consumption and drinking behaviour in patients with acute gout. Canadian Medical Association Journal 1984 131: 563-567.
In this study, 24 patients with properly diagnosed gout according to the American Rheumatological Association criteria were matched with controls for age, weight and sex, and use of diuretic. Alcohol intake was determined by asking patients how much they drank on each occasion they were seen, over a five year period. When a range of intakes was given, the mean was taken.
Alcohol intake was calculated in grams, with one drink equalling 13.6 grams of ethanol. One drink was 340 mL Canadian beer, 43 mL of Canadian spirit, 142 mL wine or 85 mL of sherry, port or vermouth. Drinking behaviour was classified according to:
- Class 1 - abstention
- Class 2 - moderate drinking without loss of control
- Class 3 - occasional heavy drinking
- Class 4 - problem drinking, exceeding cultural limits, causing concern to family
- Class 5 - alcoholism - repeated excessive drinking that interferes with health, relationships or work
Excessive alcohol intake was set at 60 grams a day for men and 20 grams a day for women. There were 22 men and two women.
Patients with gout and controls were well matched, were seen on average over two years, and with an average of 1-2 assessments. The mean age was 54 years, weight 82 kg, and BMI 27.
The average ethanol intake in patients with gout was 240 grams a week, and for the control patients 94 grams a week, a statistically significant difference at the 1 in 50 level. More patients with gout drank excessively, and the relative risk for excessive drinking was 6 (Figure 1).
Figure 1: Drinking habits in 24 patients with gout and 24 controls
Ethanol and uric acid in men without gout
T Nishimura et al. Influence of daily drinking habits on ethanol-induced hyperuricaemia. Metabolism 1994 43: 745-748.
Five healthy men who regularly consumed no alcohol, or less than 20 grams occasionally, and five health regular drinkers who consumed more than 60 grams of alcohol a day were given an oral alcohol load of 0.5 grams of ethanol per kg body weight. Blood samples were taken for up to four hours for measurement of xanthine and xanthine metabolites and for uric acid.
Before taking alcohol, concentrations or uric acid and xanthines were the same in drinkers and non-drinkers.
For abstainers, ingestion of alcohol made no difference to concentration of uric acid and xanthines.
For regular drinkers, ingestion of alcohol resulted in prompt increases in xanthines (by 1.5 µmol/L for hypoxanthine and 5 µmol/L for xanthine) by 60 minutes. Uric acid also rose, by about 40 µmol/L, at 180 minutes (Figure 2).
Figure 2: Change in serum uric acid after alcohol in regular drinkers
Beer contains not just alcohol, but also contains purines. Standard beers have an alcohol content of about 1 gram per 100 mL, but they also contain about 8 mg purines per 100 mL. Some, especially low alcoholic beers, contain more. In a small study of four men with gout, beer, but not orange juice, vodka and orange, nor non-alcoholic beer resulted in a small but significant increase in serum uric acid (CJ Eastmond et al. The effects of alcoholic beverages on urate metabolism in gout sufferers. British Journal of Rheumatology 1995 34: 756-759).
The evidence linking alcohol and gout is not extensive, but is persuasive, especially when allied with several hundred years' of experience. Men with gout are probably best advised to refrain from alcohol.