Gout And Alcohol Debate
Arguments about gout and alcohol continue, and I have summarized my thoughts on the main gout information site. I am sure I need to add more detail in some areas when I have a clearer idea about the real issues that affect gout sufferers. I have recently introduced a debate about uric acid lowering treatment and alcohol, and this debate runs alongside it, as I do not want to dilute the treatment debate with remarks about alcohol consumption and gout in general.
I have been particularly scathing in the past about remarks stating that gout will stop if you stop drinking alcohol. This annoys me on many levels, but the most significant is that there is never a single simple answer to stopping gout, or at least controlling it to the point where it does not impede your quality of life.
Every gout sufferer needs to understand their own personal circumstances with respect to gout, and develop their own personal plan to deal with it.
From that base, your starting point is clear, and the first consideration is if you are taking uric acid lowering medicine or not. So if you are taking allopurinol, febuxostat (sold under the Uloric brand in the States, and Adenuric elsewhere), probenecid or any other treatment designed to lower uric acid, please leave this debate now. You belong in the debate about uric acid lowering treatment and alcohol.
Alcohol And The Untreated Gout Sufferer
Just because you are not taking treatment to lower uric acid, you should still get a uric acid test at least once a year, and know your uric acid number. Forget about meaningless labels like high, normal or low – it is the number that is important.
You need this, because the only thing that matters about gout and alcohol is how it affects you. There are hundreds of investigations into links between alcohol consumption and gout, but almost all of them are statistical studies that do little or nothing to explain how alcohol affects gout. They certainly do not, and cannot, explain how alcohol affects your gout.
By all means, use the statistical studies to give yourself hints about how different types of alcohol might affect your gout. For instance, switching from beer to wine or cider might improve your gout. Total abstinence may make it better or worse depending on who you believe.
If you want to test these theories, you should get a first get uric acid test. Then change your amount or type of consumption for 4 weeks, then get another test and compare results. One test is not enough, so you have to keep testing different combinations until a pattern arises.
You should not measure results based on the number of gout flares, as this is no indication of how your gout is progressing.
Please share your opinions and experiences below. I am, particularly interested if you have been persuaded to change alcohol consumption based on something you have read, or your doctors advice. I have added some clarification about the best way to ask about gout and alcohol. Before you contribute to this debate, please explain your personal circumstances and be clear about what you are asking. Is your contribution relating to gout causes, gout treatment, gout diet, or something else?
Gout And Alcohol Debate: Related Topics
Please see these articles for explanations and more information:- Gout, Diet & Alcohol Guidelines
- Author: Robert Terkeltaub. Title: What Do We Now Tell Patients About Diet & Alcohol. May 2004.
- The effects of gout and alcohol - not as bad as you may think
- Do effects of gout and alcohol mean all social drinking should stop? No! Do not live by statistics. Plan your own alcohol & gout
You can also search for related topics (gout and alcohol):
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I would suggest not all forms of alcohol pose the same level of risk to the gout sufferer, whether on a gout medication, or not. My personal experience, for instance, is that some beers and deep red wines can cause me problems in short order, whereas white wines such as chardonnay have never precipitated a gout attack. Perhaps it is not alcohol per se that causes the problems, but rather other things that alcoholic beverages contain?
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I do believe that other substances, especially in red wine, can affect gout. And I have a theory that uric acid is more soluble in alcohol enriched blood than in normal blood. But these are mere beliefs, and do not really mean much, except to me.
My main point is that you cannot attribute good or bad status to alcohol, or anything else, based on whether it causes a gout flare or not. We know from our experience with uric acid lowering treatments that gout attacks can be induced from old crystals dissolving just as they can from new crystals forming.
Without precise knowledge of your uric acid level, you can never be certain if your gout flare is good or bad.
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I have suffered from Gout for over 25 years, I also have been drinking Beer and wine and Liquor all those years, Until recently I have given up on all Alcohol, and Meats ! I’m also having allot of trouble right now with my gout, I have been on Allopurinol for almost three years, I was just diagnosed with gout three years ago, But I had it for many years without problems a few flareups here and there, I take 300mg a day! this is no miracle drug by far, but does help some. My whole body is in pain all the time, I cannot sleep well, and it keeps me grouchy from the pain. I have tried so many pain pills, they only help a little. but never stop the pain. even Morphine did not stop the pain. A friend who also suffers advised me that his doctor told him that liquor wasn’t near as bad as Beer and Wine and he drinks that. I’m told that beer and wine are not good for gout. I know red meat isn’t I can eat a steak and it’s not good! So I gave up meats, pork is bad also. I’m interested to know if anyone has filed for Disability for there Gout, I did last year and was turned down,but only because I haven’t worked long enough so they say. I have an Attny now who is fighting for my Disability. I have lost several jobs over gout. Have been out of work now for a couple of weeks again because of gout. Life just isn’t good with this Gout. Thank you and try to have a good day! A.J Johnson
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You have my sympathies. Gout pain is terrible if allopurinol is not managed properly. It is very easy to allow alcohol, or more specifically attitudes to alcohol to cloud the judgment, but that is exactly what happens in most cases.
The fact that you have not mentioned your uric acid level speaks volumes. If it is not kept at, or below, 5mg/dL (0.30mmol/L) then you are simply not doing enough to help your gout in the long term, and you may be causing more gout pain in the short term.
As I wrote in the article that started this debate about gout and alcohol, you must get your treatment right BEFORE you start worrying about alcohol. If you cannot get uric acid to low enough levels, then you should consider reducing alcohol, and switching from beer to a couple of glasses of wine per day.
The disability is a whole different debate, but why even consider it when gout is so easy to treat. Of course, I say easy to treat, but if you do not control uric acid levels properly, then you will never control gout. My choice is controlling uric acid effectively, and enjoying my life without disability handouts and misery. I cannot understand why anyone would accept less than this, unless they have gout with other problems that prevent proper gout control.
The most likely thing that prevents controlling gout properly, is having a doctor who does not understand the importance of getting uric acid to 5mg/dL (and much less for at least six months to speed up dissolving old crystals). If this is your situation, let us move the discussion to a more fitting debate area, and work out a plan to get doctor and patient working together to fix gout properly.
Finally, you must realize that allopurinol works on the cause of gout by controlling production of new uric acid. It does absolutely nothing for the existing crystals that have built up throughout your body, except that it can create an environment where these can dissolve. It is essential that you do dissolve old crystals, but you must also be prepared for pain during the time these crystals are dissolving. The lower you get uric acid levels, the faster crystals will dissolve. Depending on your levels, it might be a few months to several years, but you must have pain relief either as a preventative, or as you require it. A combination treatment is best, including colchicine to stop inflammation increasing, NSAIDs to lower inflammation, and analgesics to block the pain. If you are not getting that, then I’d look at medical negligence before you look at disability claims.
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I first had an attack of gout three years ago, and the only thing the Doctor reccomended was cuting out or cutting down on alcohol, ( I would drink beer mostly, and maybe wine on occasions) since then i have associated Gout attacks with too much alcohol, after the last attack I cut alcohol to a minimum, but my gout has just flared up again.
I am now looking at my diet , and I think my trigger food is Duck, I feel if the Doctor had not told me that alcohol was the problem I could have had a wider view of things , instead of putting it all down to alcohol.
Thanks for a great website
Regards
Frank
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I’m sorry Frank, but your doctor is a fool. Gout is not an alcohol disorder, nor is it an eating disorder. It is an arthritic condition caused by excess uric acid. Now some people believe that alcohol, duck, fructose, vitamin C and thousands of other random substances cause gout. That is nonsense, only excess uric acid causes gout.
Now, the follow-on argument is that alcohol causes excess uric acid. If that is the case, then the only thing to do as a competent doctor is to measure uric acid, then stop alcohol, then measure uric acid again. This applies also to duck, and any thing else you care to think of.
By failing to measure uric acid, your doctor is wasting your time. Alcohol, or any other change to your diet is irrelevant unless it is compared to uric acid levels in your blood. Once you have had a gout attack, then you must get uric acid down to 5mg/dL (0.30mmol/L), or below.
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Dear gout pal,
Thank you for your prompt and informative reply, I have spent a good part of the day learning from your excellent website , I have ordered a uric acid tester and intend to monitor closely the reaction to my diet (beer included) and try and control it this way I dont want to be immobile fir another week if its in my power to change this, cheers frank
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That’s good, Frank.
It is in your power, and together we will beat it. Once you get your meter, if there is anything you are not sure about, please come back and we can discuss your uric acid numbers.
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Firstly, good site!
I live in the tropics and, at times, tend to neglect my water intake. During the week I my job requires me to socialize so my beer intake is usually high. My diet is balanced and I eat red meat once a week max. During the week I never have an attack, however, at weekends I cut right back on the beer and try to hydrate with water, tea etc. My weekend diet would be all fresh, home cooked food. Nothing processed. Yet all my attacks happen at the weekend or during holidays! and are becoming more frequent. Clearly, alcohol is not a factor, not that I can see.
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Thank you for that, B Goodenough. You make some interesting points. Watch out for that increased frequency – it is a sure sign that your gout is progressing to more serious stages, as it always does if left untreated. I agree that alcohol probably does not have much to do with it, or if it does, the actions are complicated and difficult to understand. Irrespective of your feelings on gout and alcohol, it would be good to get a handle on your uric acid number.
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I have added some clarification about the best way to ask about gout and alcohol. Before you contribute to this debate, please explain your personal circumstances and be clear about what you are asking. Is your contribution relating to gout causes, gout treatment, gout diet, or something else?
Please use the Main Gout Forum if you are new to discussions here.
Has anyone noticed how, as soon as I ask for a better debate by clarifying the issues between gout causes, gout treatment, or gout diet, I am immediately ignored? I guess alcohol just promotes indistinct discussion even when writing in a forum. I’m off back to the bar to ramble incoherently about gout to anyone daft enough to listen. :-)
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I guess we are a little defensive Keith. I drink a lot of red wine and it has never caused a gout flair. If I succumb to a beer, however, I have spectacularly debilitating, multi body part, gout flares, that last for weeks. People who learn I suffer from gout make the automatic assumption that all alcohol is bad and I am effectively getting my just deserts. My wife never stops riding her hobby horse on this and my arguments are all in vain. I just figure that beer is high in purines and that it is nothing to do with the alcohol content.
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Hi James,
All good points, but missing the most important one – uric acid levels. If you get a gout flare, and you do not know your uric acid level, how can you tell if alcohol is helping or hindering gout? We know, from the endless discussions about gout pain while taking uric acid lowering treatment, that gout flares can be caused by good things like falling uric acid levels.
As a second consideration, I’ve heard that there are some companies who follow the sacrilegious process of de-alcoholizing wines and beers. If the stories about different types of alcohol having different affects on gout, then surely this would follow through to the de-alcoholized versions?
Whenever we discuss alcohol and gout, we never really seem to get to the real issues. As you note, drinkers get defensive. Other people speak without any real knowledge about gout. The resulting confusion gets us nowhere, so we end up with “just desserts” and “hobby horses.” I’m not having a go here – just exploring the context of many gout and alcohol discussions, which almost never focus on facts.
The real issue for me is first getting a clear picture of how alcohol affects gout. Then, if it is shown that abstention from alcohol cures gout, the choice is clear. Unfortunately, most people start judging based on gout flares, but the only true measure is uric acid levels.
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Keith, in essence, I do agree with YOU. However, let me add my twist on the story of ALCOHOL and GOUT:
1) Alcohol per SE and its relationship to gout is a bunch of hogwash.
2) Alcohol has its affects on body and mind, regardless of gout.
3) An alcohol-dependent, or plain, alcoholic (goutie or not) is just looking for an excuse for another drink when s/he comes here to find out which alcohol is good or not for gout.
4) A whole year (2010) without a drop of alcohol, except ONCE (1/2 half a bottle of Crown Royal after having been sick of myself, others, and my gout and it didn’t hurt me and my gout) I went through the worst hellish gouty year of my life. And today, 2 years later, I drink beer, wine, hard liquor almost every day (but in moderation) and I haven’t had an attack in more than a year. However, I do have my gout (SUA) under control: ~3 mg/dL)
5) Alcohol, food, possessions. activities, anything in excessive supply or not enough supply, will be detrimental to any one’s mind and body, GOUT or NOT GOUT.
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1) Thank you for your incisive scientific contribution to the gout and alcohol debate.
2) Ditto.
3) Totally agree.
4) How dare you do that without offering me the other half?
5) Oh yes. For gout and alcohol, or gout and anything, we’ve said it before *moderation in all things*
Gimme an alcoholic beverage and let me toast the 3mg/dL :cheers:
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I say I am a 36 yr. gout sufferer, (71yr old) confirmed only 2 yrs. ago. Now on 400mg Alop.& 1.2 Colch. per day. Everything now under complete control,.3mm and running up to (in spring/summer) 100 miles per month. (extreme athl. stuff) I cannot touch Alcohol. One drink and bang I am down with .3mm reading during the attacks. Live two blocks from clinic and have ready access to blood tests. This is the only consumption (alcohol) item I have been able to prove up in 36 years and its 100% of the time. I am shocked there is not more gouties with this alcohol experience coming foreword on this site. Why would that be ???
Gerry Wilson
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Hi Gerry
When you say .3mm, do you mean a blood uric acid test result of 0.30mmol/L? If so, this is the safe level that proves your allopurinol dose is correct, but I cannot see what it has got to do with the effects of alcohol on gout. What does “One drink and bang I am down with .3mm reading during the attacks” mean? That is the same figure, and it is perfectly safe. This implies that alcohol has no effect on your uric acid levels, which is what I have always believed. If you are saying that alcohol is giving you pain, then that is a different thing entirely. Chances are that the pain has nothing to do with gout if it only occurs with alcohol.
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I see, thank you Keith for, something more to think about.
For your info., the blood uric acid level test taken during the attack registered .30mmol/l. This is also the third time I have had the same uric acid reading from a self-inflicted alcohol incident. I have had many others (alcohol related) in my life but no immediate uric acid test to go with it. If it isn’t gout it has exactly the same results and if not attended to will flare like a red balloon. My Ruemy. says it’s gout, as he has attended to one of these happenings,taken neddle samples and looked at it under his newest latest microscope and declared “Chrystal fragmentation” (old broken down chrystals) which my body happens to be sensitive about even at the acceptable blood uric acid (.30mml/l). His advice, “alcohol predisposes you gout/like attacks, remove it from your diet”.
I know I have other gout causers, as I purposely live on the edge of pain and stiffness through extreme exercise/Hot-cold pool/etc.etc. Ruemy. laughes as he thinks I am wingieee (which is probably the truth) but is interested in the results. He has trainees around in his office and also teaches this stuff at UBC.
Regards;
Gerry
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The good thing is that your uric acid level is remaining at 0.30 mmol/L. This is safe, and the crystals will go eventually – it just takes time.
I have also noticed, after alcohol, that stiff joints and aches are common, and of course, I put this down to gout. However, talking to a non-gouty friend, who drinks alcohol almost every day, he informs me that he gets the same. He takes a day or two off the alcohol, and the stiffness goes. After drinking days, he feels stiff, especially in the morning. Could this be an explanation?
We probably will never know, but here’s hoping that you get clear of this once all the old crystals have gone.
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Thank you again Keith for your point form comments. This type of communication is all new to me and I think I need the following clarifications ::
1/ Are you implying “not scientific enough to be acceptable, or say creditable” ??
4/ What is “the other 1/2 please” ??
5/ I do not get the point here. For further information though, I have not been what I would call a Drinker since the age of 36 (now 71). I imbibe anyways on odd occations.
Please, do enjoy your toast. I just wish we were close enough to allow me buy.
Respectfully and light;
Gerry Wilson.
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Gerry, you have not been around here long enough to understand the warped sense of gouties’ humor, including mine. Keith’s response, point 1 thru 5, was in response to my comments on April 20,.
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Thank you Hansinnm;
I have to confess, I am totally addicted to humor myself and as a result just hate to miss a good joke/laugh. Do excuse my freshmanism.
I now have two new acquaintances Keith and Hansinnm that I would like to buy a drink for. (Just a figure of speach though)
Regards;
Gerry Wilson
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If you are addicted to humor Gerry, that is good as it helps cope with the gout, but I must warn you to ignore anything from Hans, or tears will surely follow.
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I found alcoholic drinks like rum and liqueur to have no effect on gout. If anything I felt better. The key here is to drink a lot of water before and after having alcohol.
I found watermelon to be quite effective and I have a feeling that betel leaves (eaten i India after meals) are beneficial, but I still need to try these out over an extended period of time. I also wish to try out the beneficial effect of cod liver oil tablets which are claimed to be goo for gout prevention.A vigorous game or workout helps especially in case of Continuous exposure to AC environment.Please use the Main Gout Forum if you are new to discussions here.
From my article above: “You should not measure results based on the number of gout flares, as this is no indication of how your gout is progressing.”
Staying hydrated is a golden rule for all gout sufferers, and has little to do with the gout and alcohol debate.
I have removed some other comments about supplements and exercise. These are not necessarily wrong, just not relevant to a debate about gout and alcohol. Why not use the new gout forum?
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