Alcohol And Seniors  

 

Alcohol and Gout


 

What is Gout?


Gout  is a painful rheumatic disease. It causes the inflammation of the joints and often starts in the feet or toes - for 70% of sufferers a joint in the big toe is the first to be affected. Gout mainly affects men aged between 40 and 60. It  causes acute, intermittent and painful attacks of arthritis in the joints of the foot, knee, ankle, hand and wrist.

Gout results from excess blood levels of uric acid. This is a waste product that is produced when proteins are broken down. Normally uric acid is eliminated in the person's urine, but if there is too much uric acid, it forms crystals that get deposited around joints and tendons. This cause serious inflammation, swelling stiffness and severe pain. It can lead to significant disability in the long term. Gout is on the rise in Canada and other developed countries.

 

Alcohol and  the Risk of Developing Gout


In a recent  reported study, US researchers followed 47,150 men aged 40 to 75 over 12 years, looking at their drinking habits (how many grams of alcohol they consumed per day). None of the men had gout in the beginning. The researchers documented 730 confirmed incident cases of gout among the men by Year 12.  Compared with men who did not drink alcohol, the risk of developing gout increased with the amount of alcohol that the person was consuming. (Choi, et al, April, 2004).

For men drinking  on average < 1 standard drink a day, the relative risk (RR ) was 1.32; this relative risk of developing gout  increased to 1.49  for men drinking on average  1 to 2 standard drinks a day),. At  2 to 3.7 standard drinks a day), the RR was  1.96 and this jumped to 2∑53 for men who were consuming more than 3.7 standard drinks a day.

In Canada, 13.5 g. of alcohol = 1 standard unit. In the US, it is 14 grams alcohol and in the UK it is 7.9 grams.

The researchers found that drinking beer showed the strongest independent association with the risk of gout (12-oz serving per day, the relative risk was 1∑49).

Drinking spirits (e.g. brandy, whiskey, gin, vodka etc) was also statistically significantly associated with developing gout  but the risk was lower (multivariate RR per drink or shot per day was 1∑15). However, wine consumption was not (multivariate relative risk (RR) per 4-oz serving per day was 1∑04).

The study notes there did not appear to be an association between drinking two 4 oz.  glasses of wine a day and developing gout, regardless of whether the men were drinking red or white wine. Yet it is acknowledged that port, some red wines and stouts contain purines or oxypurines, which lead to an increased purine load.

{However,  there may have been few if any port drinkers this American sample  in the first place}

 

Why Might  Drinking May Lead to Gout


GP Notebook notes that the relationship of alcohol consumption and the development of gout occurs in a number of ways:

Did you know that the white pasty material from birds that ends up on your carís windshield is also uric acid?

 

Why Might  Drinking Beer Lead to Gout


 

Beer contains purines. Purine breaks down into uric acid, and beer is recognized to have a large purine content.

Other research by the same people points out that higher levels of meat and seafood consumption by men are also related to an increase risk of developing gout. (Choi et al. March, 2004)

While feasting and drinking are often culprits in gout attacks (some British folks call this "alderman's gout"), it is the drinking that seems to have the greater contribution (Fam, 2002)

 

Preventing Gout Attacks


A low purine diet and avoiding beer is advised for people who have gout attacks. There are several principal sources of purines that people are suggested to limit or avoid in their diet:

Vegetables high in purines such as peas, beans, asparagus, mushrooms interestingly don't seem to affect the gout risk,  even though for many years it was assumed they might (Choi et al , March 2004)

People with a history of gout are advised to drink plenty of fluid, approximately 2 litres per day (non-alcoholic).

In Japan,  in 2003, at least one brewery has developed a low purine beer. (Chromadex, 2003)


Public Education

If you are looking for a handout on diet and gout (how to reduce gout attacks), check out this one from Rochester Medical Centre.

www.stronghealth.com/services/primarycare/pdf/Restrictgout.pdf

 


Sources


Choi, H. K. , Atkinson, K., Karlson, E.W., Willett, W. & Curhan, G. (April 17, 2004). Alcohol intake and risk of incident gout in men: a prospective study. Lancet, 363 (9417).

Choi, H. K , Atkinson, K., Karlson, E.W., Willett, W. & Curhan, G. (March 11, 2004). Purine-rich foods, dairy and protein intake, and the risk of gout in men. New England Journal of Medicine. 350, 1093-1103 .

Chromadex  www.chromadex.com/SciNews/cheesy_ice.htm

Fam, A. (July, 2002) Gout, diet, and the Insulin Resistance Syndrome. Journal of Rheumatology. Online at : www.jrheum.com/subscribers/02/07/1350.html

Kirkey, S. (Friday, April, 16, 2004).  "Beer, liquor increases risk, but wine is just fine" Vancouver Sun, A13.

General Practice Notebook "Low purine diet, alcohol and gout" Online at : www.gpnotebook.co.uk/cache/1536819218.htm

 

Page last updated Sunday October 31, 2004

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