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Gout and drinking

People with gout, and their carers, tend to the obsessive when it comes to food, and especially drinking; alcohol and coffee are often banned completely. All of which makes for a bland existence, which is why a frequently asked question is what gout sufferers can drink without exacerbating their condition. A large US survey has reported on coffee, tea, and various forms of alcohol [1,2]. The results will warm the cockles of some hearts.

Studies

A representative sample of the US population was selected and studied between 1988 and 1994. Subjects were interviewed at home, and attended an examination, with blood and urine sample collection. During the interviews, a food frequency questionnaire was used which ascertained the frequency of consumption of coffee, tea, and alcoholic beverages, as well as soft drinks that might contain caffeine. Serum uric acid was measured also.

Results

The survey used data from over 14,000 people aged over 20 years of age. Those with gout, or taking allopurinol or uricosuric agents were excluded.

Coffee, tea, and caffeine

Using a quintile of consumption approach, uric acid levels were identical across quintiles of intake of total caffeine and tea. For coffee (including decaffeinated), drinking more than four cups of coffee a day significantly lowered serum uric acid levels, by about 8% at maximum (Figure 1). The reduction of uric acid by coffee remained after adjusting for a whole range of variables and dietary factors.



Figure 1: Reduction in mean serum uric acid levels according to quintiles of daily intake of coffee





Alcohol

Using the quintile of consumption approach drinking wine did not affect serum uric acid levels at any level of consumption up to one serving per day or more. The consumption of spirits, and especially beer, did increase serum uric acid levels (Figure 2), even after adjusting for a whole range of factors. Beer and spirits drunk daily increased serum uric acid by about 10%; wine did not. The results were similar in men and women, and at lower and higher levels of BMI.



Figure 2: Effect of different daily consumption (quintiles) of different alcoholic beverages on mean serum uric acid levels





Comment

This constitutes useful additional knowledge about what gout suffers might do to avoid increasing their serum uric acid, and perhaps precipitating an attack, or making the pain worse. Drinking beer and spirits are out, but tea and wine have no effect, while coffee actually seems to reduce uric acid levels. We have had some straws in the wind about coffee before, but this adds weight.

More weight comes from a large study of coffee consumption and incident gout in men [3], following 46,000 men with no history of gout at baseline for 12 years. There were 750 cases of incident gout, and the risk was lower with higher coffee consumption, before and after adjustment for a whole host of different possible confounding factors (Figure 3). So increased coffee drinking is linked with both reduced serum uric acid levels and reduced incidence of clinical gout.



Figure 3: Relative risk of incident gout in 12-year follow up of 46,000 men, according to quintiles of daily coffee consumption





We also have information about what we eat and the risk of incident gout [4]. This has been examined in detail on the Bandolier Internet site, but the main results are worth reiterating. Increased consumption of meat was associated with increased risk of gout, but only with beef, pork, and lamb. There was less association with seafood, and none with purine rich vegetables. Increased consumption of dairy food reduced the risk of gout. We find the same now for uric acid [5] where high meat and to a small extent seafood consumption is associated with higher uric acid levels, but dairy food with lower uric acid levels. Much food for thought for those with gout and for healthy eating.

References:

  1. HK Choi, G Curhan. Coffee, tea, and caffeine consumption and serum uric acid level: third National Health and Nutrition Examination Survey. Arthritis & Rheumatism 2007 57: 816-821.
  2. HK Choi, G Curhan. Beer, liquor, and wine consumption and serum uric acid level: third National Health and Nutrition Examination Survey. Arthritis & Rheumatism 2004 51: 1023-1029.
  3. HK Choi et al. Coffee consumption and risk of incident gout in men. Arthritis & Rheumatism 2007 56: 2049-2055.
  4. HK Choi et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. NEJM 2004 350:1093-1103.
  5. HK Choi et al. Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid. Arthritis & Rheumatism 2005 52: 283-289.

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