Gout and Alcohol Intake

Gout has been associated with drinking too much alcohol throughout the ages, but only now
has a study been done that analyses which sort of drink is most responsible. Here's a summary
of the results...

Summary

Alcohol intake - beer, and to a lesser extent spirits, but not wine - is strongly associated with
an increased risk of developing gout.

Introduction

The classical picture of gout derived from earlier times is that of an elderly, red-faced man
sitting with his foot up on a stool, drinking port wine. This relationship between alcohol
intake and gout has been recognized since ancient times, but only recently has it been fully
explored in prospective clinical studies. One of the first such prospective studies comes from
the Rheumatology Unit at Massachusetts General Hospital, Boston. It was published in the
medical journal Lancet, and we summarize it here.

What was done

The Health Professionals Follow-up Study has over 50,000 men enrolled - dentists,
optometrists, pharmacists, etc - who were aged 40-75 in 1986. From then onward they were
sent questionnaires every two years for 12 years. Those with a history of gout at baseline were
excluded from further analysis.

The questionnaire requested information on the average daily alcohol intake, the type of
alcohol taken, general nutrient intake, weight, medications used, and medical conditions. In
particular, participants were asked to report if they had been diagnosed as having gout by a
physician; those who indicated that they had, received follow-up questionnaires to confirm the
finding, e.g. were gouty tophi1 or crystals found?

Alcohol intake was adjusted to the actual grams of ethanol per day consumed. Participants
were classified into 7 groups according to their average alcohol intake, and into 5 groups
according to their frequency of drinking alcohol. The risk of developing gout was analyzed
across total alcohol intake and frequency of drinking after adjustment for a number of factors
- age, calorie intake, body mass index (BMI), diuretic use, high blood pressure, chronic
kidney disease, intake of meat, seafood, purine-rich vegetables, dairy food, and fluid intake -
that might influence the outcomes.

What was found

The average age of the 47,150 participants was 55; their average BMI was 25. There was an
increase in the average BMI, high blood pressure, and diuretic use in the higher alcohol intake
groups.
Overall, there were 730 newly diagnosed cases of gout in the participants during the 12-year
follow-up period. There was an increased risk of gout in those drinking more alcohol - see the
table below:

None 10-15 g/day 15-30 g/day 30-50 g/day over 50 g/day

Relative Risk 1.0 (set) 1.32 1.49 1.96 2.53

Using the frequency of alcohol intake figures, it was found that beer carried the greatest
relative risk:

Less than 1/month 1/month - 1/week 2 - 4/week 5/week - 1/day More than 2/day
Beer 1.0 (set) 1.01 1.27 1.75 2.51
Spirits 1.0 (set) 1.27 1.25 1.22 1.60
Wine 1.0 (set) 0.84 0.90 0.82 1.05

Comment

Previous studies have shown an association between alcohol intake and gout, but they have
either been weak from a statistical point of view, or without making allowance for other
factors. What's interesting about this one is the lack of a role for wine; the classical view of
relatively wealthy wine-drinkers being most susceptible seems to be wrong, unless there's a
co-factor effect (e.g. red meat) which was deliberately excluded in this analysis. And, of
course, the sample - health professionals - is not representative of the US population.

Gout has some features in common with the metabolic syndrome. A weight-reducing and
low-glycemic diet, as used in diabetics, is beneficial in lowering blood uric acid. While
elevated uric acid is partially a hereditary trait, the prevalence of gout is mainly due to
environmental factors - such as alcohol intake. This puts gout into the category of those
diseases where the patient can, by exerting a degree of self control, improve his situation. A
switch from beer to wine may be all that it takes!