Alcohol and Gout: What’s the Relationship?

Author: Thomas Roth

Alcohol and gout share a complex and intertwined relationship. This common form of inflammatory arthritis, known for its sudden and intense bouts of pain, often rears its head after certain triggers. Unfortunately for many alcoholics, alcohol is a major trigger. In fact, studies suggest that regular consumption of alcohol, especially certain types like beer, can significantly increase the risk of developing gout.

On the surface, it’s a battle of indulgence against health, but the relationship between alcohol and gout goes deeper than that. It’s a story of how the breakdown of alcohol in the body can lead to increased levels of uric acid, the primary culprit behind gout. Moreover, alcohol’s impact on hydration and kidney function can further worsen gout symptoms.

In this article, we’re going to break down the science behind gout and the role alcohol plays in its development and progression. By understanding this relationship, we can better manage and possibly prevent gout, providing relief to millions of people worldwide who suffer from this painful condition.

Read on to learn more below.

What is Gout?

Gout is a type of arthritis that results from an excess of uric acid in the bloodstream. This acid is a byproduct of breaking down purines, chemicals naturally present in the body and in certain foods. Usually, uric acid is dissolved in the blood and passed out of the body through urine. However, if the body produces too much uric acid or excretes too little, it can build up, form crystals, and cause gout.

Typically, gout manifests as sudden and severe pain, often in the joint of the big toe, though it can affect other joints too. Besides pain, gout can cause redness, swelling, and a warm sensation in the affected joint. These symptoms can be episodic, meaning they come and go.

There are several factors that can increase the risk of developing gout. These include a diet rich in purines, obesity, certain medications, and medical conditions such as high blood pressure and kidney disease. However, one factor that’s often overlooked is the role of alcohol in gout’s development and exacerbation.

What is Uric Acid? 

Uric acid is a chemical created when the body breaks down substances called purines. Purines are both produced in the body and consumed through the diet. They can be found in high concentrations in certain foods such as red meat, organ meat, and seafood.

In a normally functioning body, uric acid dissolves in the blood, travels to the kidneys, and is then excreted through urine. However, there can be situations where the body produces too much uric acid or the kidneys do not excrete enough. When this happens, uric acid can build up and form sharp, needle-like crystals.

When these crystals accumulate in and around joints, they can cause intense pain and inflammation – the hallmark symptoms of gout. Elevated uric acid levels in the bloodstream, a condition known as hyperuricemia, is the primary risk factor for developing gout. However, not everyone with hyperuricemia will develop gout, and the triggers that cause gout flares in those with hyperuricemia can vary. One common and notable trigger is the consumption of alcohol.

What are Purines?

Purines are naturally occurring substances found in many foods and are also produced by the body. These organic compounds are essential for many biological processes, including the formation of our DNA and RNA. They come in two types: adenine and guanine, both crucial for life.

Purines become a concern when they’re broken down in the body and form uric acid. Foods high in purines, such as red meat, organ meat, and certain types of seafood, can lead to increased levels of uric acid in the blood. Also, beverages that contain yeast, like beer, are high in purines.

What Are the Symptoms of Gout?

Gout typically manifests itself in sudden and severe bouts of pain, often starting at night. The symptoms can appear without warning and may include the following:

1. Intense Joint Pain
2. Lingering Discomfort
3. Inflammation and Redness
4. Limited Range of Motion

More about each symptom of gout below.

1. Intense Joint Pain 

This pain usually affects one joint at a time, often the large joint of the big toe. However, it can also affect other joints like the ankles, knees, elbows, wrists, and fingers. The pain is usually most severe in the first 12 to 24 hours after onset. Once the first 12 to 24 hours have passed, pain becomes more manageable. However, gout may still be excruciating if you touch the joint. For this reason, many people can’t sleep with a sheet over their joints during a gout attack.

People with gout have described the pain as:

• Being hit in the toe with a hammer constantly
• The feeling of glass shards being stabbed into the joint
• An intense feeling of pressure
• Intense throbbing
• 10/10 on the pain scale
• Comparable to a broken toe

These descriptions have been sourced from forums and other publications.

2. Lingering Discomfort

After the most severe pain subsides, some joint discomfort may persist from a few days to a few weeks. Subsequent attacks may last longer and affect more joints. Failing to treat gout in a timely manner can cause attacks to become more frequent and severe. This can result in deformed joints and other chronic illnesses.

3. Inflammation and Redness 

The affected joint or joints might swell, feel warm, and appear red and tender. Depending on the joint, swelling may spread to surrounding areas of the body and make movement uncomfortable. Additionally, gout may look more purple than red in some cases. It ultimately depends on the person and severity of gout.

4. Limited Range of Motion

As gout progresses, you may not be able to move your joints normally. For example, if gout is impacting your big toe joint, you might not be able to move it up or down. However, moving the joint when you can may provide you with some relief. Range of motion may also be limited in surrounding joints if the gout attack is severe. In some cases, gout may even impact multiple joints as once.

Occasional flare-ups are followed by periods of remission, where one feels fine. However, over time, gout attacks could become more frequent and prolonged, leading to joint damage and loss of mobility. Because the symptoms of gout are similar to those of other conditions, it’s important to get a proper diagnosis from a healthcare professional. 

Furthermore, understanding what triggers a gout flare-up, like excessive alcohol consumption, can be crucial to managing this condition. When dealing with gout it’s always best to reduce alcohol consumption to avoid problems.

What Causes Gout?

Gout is caused by the buildup of uric acid in the blood, a condition known as hyperuricemia. This excess uric acid can form crystals that deposit in the joints, causing the inflammation and intense pain characteristic of gout.

We list the key cause of gout below.

• • Diet: Consuming foods high in purines can increase the level of uric acid in the body. These include red meats, organ meats, and certain types of seafood. Drinks high in fructose and alcohol, especially beer, can also lead to increased uric acid levels.
  • Obesity: People who are overweight or obese are more likely to develop gout because they tend to produce more uric acid and their kidneys have a harder time eliminating it.
  • Medical conditions: Certain diseases and conditions increase your risk of gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
  • Certain medications: The use of thiazide diuretics (commonly used to treat hypertension) and low-dose aspirin can also increase uric acid levels.
  • Family history: If other members of your family have had gout, you’re more likely to develop the disease.
  • Age and sex: Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men are also more likely to develop gout earlier (usually between the ages of 30 and 50), whereas women generally develop signs and symptoms after menopause.
  • Recent surgery or trauma: Recent surgery or trauma has been associated with an increased risk of developing a gout attack.
  • Alcoholism: Abusing alcohol over many years increases the risk of developing gout due to high purines and poor kidney function.

Depending on the person, these are only some of the causes of gout.

What are the Effects of Gout?

Gout has many effects on the body. It impacts kidney function, liver function, and even joint function. Depending on the severity of gout, frequent attacks can wear down the body and cause permanent damage.

Learn about the effects of gout on different parts of the body below.

How Does Gout Affect the Kidneys? 

Gout can affect the kidneys in two primary ways: kidney stones and long-term kidney damage.

Kidney Stones

The excess uric acid that causes gout can also lead to the formation of urate kidney stones. These stones form when there’s too much uric acid in the urine, a common condition in those with gout. Kidney stones can cause severe pain and may require surgical removal if they are too large to pass naturally.

Kidney Disease

Long-term, chronic gout can lead to gouty nephropathy, a form of kidney disease. This can occur when deposits of uric acid crystals cause direct damage to the kidney tissues. In severe cases, this can progress to chronic kidney disease, and eventually, kidney failure.

For these reasons, it’s important to monitor your kidney function and reduce uric acid levels. Doing so ensures long-term health and wellness.

How Does Gout Affect the Brain?

New research is emerging about gout and brain health. Primarily, about how uric acid interacts with cognitive function. That said, this research is still new and more studies are necessary to fully understand the long-term impact of gout on the brain.

Below we list some of the preliminary results.

• Cognitive Function: A study published in the journal “Rheumatology” suggested that gout could be associated with a small but significant decline in cognitive function, potentially leading to mild cognitive impairment or dementia over time.
• Mood Disorders: Chronic pain conditions like gout are often linked with mental health conditions, including depression and anxiety. Living with the persistent pain of gout could impact mental well-being, and thus indirectly affect brain health.
• Stroke Risk: Some research suggests that people with gout have a higher risk of stroke. While strokes directly affect the brain, it’s unclear if this increased risk is directly due to gout or related to the overall higher rates of cardiovascular risk factors in people with gout.

Brain damage doesn’t occur in everyone who struggles with gout. However, alcohol-related brain damage combined with gout increases the rate of dementia, cognitive decline, and other severe mental health disorders.

How Does Gout Affect the Joints?

Gout affects joints in a few ways. Early gout attacks may not have a long-term impact on joints but the damage is still felt in millions of people across the United States. In the early stages of gout people are more likely to experience severe pain.

Below we list the other effects of gout on the joints:

• Uric Acid Crystals: Gout is caused by the buildup of uric acid in the bloodstream. When there’s too much uric acid in the blood, it can form needle-like crystals that settle in the joint spaces. This is more likely to occur in lower temperatures, which is why the joint of the big toe (being the part farthest from the heart and hence cooler) is often the first one affected.
• Inflammation and Pain: These uric acid crystals trigger an intense inflammatory response from the body’s immune system. White blood cells engulf the crystals, which causes the release of chemicals that lead to inflammation and swelling in the joint. This process results in the sudden and severe pain typical of a gout attack.
• Tophi: In chronic, untreated gout, these crystals can form large deposits known as tophi. Tophi can deform and damage the joint and surrounding bone, leading to chronic pain and reduced joint mobility.
• Limited Range of Motion: Repeated gout attacks can lead to lasting damage to the joints, leading to a limited range of motion and even disability over time.

Taking care of your body and taking medications for gout can help reduce the impact of these long-term effects. Changing your diet and lifestyle, like reducing alcohol intake, is also essential.

Does Alcohol Cause Gout?

Yes, alcohol can cause gout but it’s an indirect consequence of excessive alcohol consumption. For example, someone who abuses alcohol has a higher risk of developing gout but that doesn’t always mean it will happen. Typically, alcohol causes gout because alcohol is high in purines. These purines are broken down by the body, which leads to a build-up of the acid in the body. This leads to symptoms of gout in some people.

Additionally, alcohol impairs the body’s ability to remove uric acid from the blood because it impacts kidney function. Pairing this with alcohol’s diuretic properties is a recipe for an increased risk of gout flare-ups.

Learn more about how alcohol and gout interact below.

What Types of Alcohol Cause Gout? 

All types of alcohol can contribute to gout because alcohol is high in purines and can interfere with the body’s ability to eliminate uric acid. However, some types of alcohol pose a higher risk than others.

Beer, in particular, is known to increase the risk of gout. It’s not only high in purines but also contains a specific type of purine called guanosine that leads to a sharp increase in uric acid levels. Additionally, beer contains gluten, which can raise uric acid levels in the body.

Spirits, such as vodka, whiskey, and rum, can also increase the risk of gout. While they contain fewer purines than beer, heavy consumption can lead to dehydration, which makes it harder for the kidneys to remove uric acid from the body.

Can Non-alcoholic Beer Cause Gout? 

Yes, Non-alcoholic Beer can cause gout attacks or flare-ups. Non-alcoholic beer contains fewer purines than regular beer, so it’s less likely to cause a surge in uric acid levels. However, non-alcoholic beer still contains some purines, so it’s not entirely risk-free.

Also, non-alcoholic beers can still contribute to dehydration, especially if consumed in large amounts. Dehydration can impair the kidneys’ ability to eliminate uric acid, potentially contributing to a gout flare-up.

It’s worth noting that individual responses to foods and beverages can vary significantly. While non-alcoholic beer is generally a safer option for people with gout, it’s always a good idea to monitor your body’s response and to discuss any dietary changes with your healthcare provider.

What Are the Best Types of Alcohol for Gout? 

When it comes to gout, there’s really no “best” type of alcohol to consume. All alcohol can contribute to higher uric acid levels and, potentially, gout attacks. However, if you choose to drink, some types of alcohol may pose a lesser risk compared to others.

Moderate wine consumption seems to pose less of a risk for gout than beer or hard liquors, according to some studies. This is because wine contains fewer purines, the substances that the body breaks down into uric acid. However, it’s important to understand that “less of a risk” doesn’t mean “no risk”. Even with wine, excessive consumption can lead to dehydration, hinder uric acid excretion, and possibly trigger a gout attack.

The keyword here is moderation. Light to moderate drinking may not pose a significant risk for most people, but heavy drinking or binge drinking can significantly increase the risk of a gout attack. Before making any decisions, discuss your alcohol consumption with your healthcare provider, especially if you have gout or are at high risk. They can provide guidance based on your personal health history and current condition.

Can Quitting Alcohol Cure Gout?

Quitting alcohol can’t cure gout, but it can significantly help manage the condition and reduce the frequency of gout attacks. Alcohol, especially beer, is high in purines which get converted into uric acid in the body, contributing to the high uric acid levels that cause gout. Alcohol also can impair the kidneys’ ability to remove uric acid from the body, leading to its buildup in the blood.

By quitting alcohol, you can reduce these risk factors. However, since gout is a complex disease with multiple contributing factors like genetics, diet, weight, and underlying health conditions, simply quitting alcohol may not be enough to “cure” gout or prevent all gout attacks.

Effective gout management usually involves a combination of lifestyle changes, including a healthy diet low in purines, maintaining a healthy weight, regular exercise, adequate hydration, and possibly medication to reduce uric acid levels or manage inflammation. 

Can You Drink Alcohol with Gout Medications?

Yes, you can usually drink alcohol with your medications. However, it’s important to discuss your alcohol consumption with your healthcare provider. For example, having a few alcoholic beverages per week versus more than the standard limit (7 for women and 14 for men) can cause problems.

Learn about alcohol’s interaction with the following medications below.

Can You Drink Alcohol with Allopurinol (Lopurin and Zyloprim)? 

Allopurinol is one of the most commonly prescribed medications for gout. It’s a medication that’s taken daily to moderate uric acid levels. While allopurinol doesn’t directly interact with alcohol, drinking can increase uric acid levels, working against the purpose of the medication.

Can You Drink Alcohol with Colchicine?

Used to treat gout attacks, it doesn’t have a known interaction with alcohol. However, both alcohol and colchicine can cause gastrointestinal issues, so combining them might exacerbate these side effects.

Can You Drink Alcohol with Febuxostat?

Similar to allopurinol, this medication reduces uric acid production. While it doesn’t directly interact with alcohol, drinking can counteract the medication’s effectiveness. Always avoid mixing alcohol with medications like febuxostat to reduce the risk of gout attacks.

Probenecid

You shouldn’t mix high quantities of alcohol with probenecid medications. Probenecid helps the kidneys remove uric acid. Alcohol can interfere with this process and might increase the risk of kidney problems. Therefore, it’s best to keep drinking alcohol to a minimum when taking probenecid.

NSAID (Aspirin, Ibuprofen)

Nonsteroidal anti-inflammatory drugs, often used to manage gout pain, can cause stomach upset, ulcers, or bleeding, especially when taken for long periods. Alcohol can increase these risks. For these reasons, it’s never a good idea to drink with medications like ibuprofen, Aleve, and other pain killers. Also, avoid drinking when taking drugs like meloxicam.

These are only some of the gout medications that are dangerous to mix with alcohol.

Get Help with Alcoholism Today

Gout is one of the most painful conditions that someone can develop. It’s described as being a 10/10 on the pain scale, which is comparable to a broken bone. Alcoholism is one of the leading causes of gout, kidney damage, and other conditions that wear down the body. For your health, getting treatment for alcoholism is one of the best ways to reduce the risk of a gout flare up.

To get help with alcoholism today, locate an alcohol rehab center near you. Plenty of options are available, so make sure you look for alcohol rehab programs in your state. Remember, help with alcoholism is only one call away.

Sources

 

• Neogi, T., Chen, C., Niu, J., Chaisson, C., Hunter, D. J., & Zhang, Y. (2014). Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. The American journal of medicine, 127(4), 311–318.

• Kramer H.M. Curhan G. The association between gout and nephrolithiasis: the National Health and Nutrition Examination Survey III, 1988-1994. Am J Kidney Dis. 2002; 40: 37-42

• Alcohol Consumption as a Trigger of Recurrent Gout Attacks Zhang, Yuqing et al. The American Journal of Medicine, Volume 119, Issue 9, 800.e11 – 800.e16: