On Alcohol and Gout, Cheers!

Image from altamarkings.blogspot.com

Heavy alcohol consumption has long been associated with increased risks of developing gout. Likewise, it is recognized that alcohol can trigger recurrences of the disease. That’s why a lot of old doctors advise against ANY alcohol intake when a patient is diagnosed with gout.
But cardiologists would be quick to argue that there is a J-curve in terms of cardiovascular events (strokes, heart attacks) and alcohol intake – that is, moderate amounts of alcohol is actually good for the heart.This made me ask, should we REALLY advise against ANY alcohol intake among patients with gout?

The Health Professionals Follow-up Study (HPFS, 1986-98) looked into the relation of alcohol intake with new-onset (aka incident) gout. They asked participants to document their food intake using a semi-quantitative food frequency questionnaire (the Willett Food Frequency Questionnaire, the “gold standard” in nutritional epidemiology) with specific sections on alcohol consumption. A standard serving was defined as: 355ml of beer, 118ml of wine or 44ml of spirits. They then computed alcohol intake by multiplying the servings by its ethanol content (12.8g for beer [11.3g if light], 11.0g for wine and 14.0g for spirits). Characteristics of those who developed gout were compared against those who didn’t. They found that those who took >15g ethanol/day were more likely to develop gout (RR 1.49 [95% CI 1.14, 1.94]). Likewise, beer (RR 1.49 [95% CI 1.32, 1.70]) and spirits (RR 1.15 [95% CI 1.04, 1.28]) were more associated with incident gout, wine was NOT (RR 1.04 [95% CI 0.88, 1.22]). The chances of one developing gout were also much higher when alcohol was taken >4/week for beer and >1/month for spirits. No such association was found with wine consumption.
So it appears that moderate intake of WINE will not increase an individual’s chances of developing gout. But how about those patients who already have gout? Will similar recommendations apply?
Researchers from Boston University Medical Center recruited patients diagnosed with gout using an internet ad and patients were screened following accomplishment of an electronic informed consent form. Eligible patients then participated in the case crossover study where they were asked to document certain details 48 hours prior to an attack, during the attack and after. The relation between alcohol consumption and recurrent gout flares were analyzed using conditional logistics and multivariate regression models. At the end of the 1-year study period, they found that intake of >5 servings of alcohol was associated with a significantly higher chance of an acute gout attack 24 hours after intake (OR 2.4 [95% CI 1.1, 5.1]). Only alcohol intake of >7 servings increased the chances of having a gout attack within 24 hours (OR 3.4 [95% CI 1.1, 10.7]). However, they found NO difference in the chances of having a gout attack whether one was taking beer, spirits and wine.
So among patients with gout, intake of 5 or more servings of alcohol (regardless of what type) significantly increase the chances of having a gout attack. The more alcohol one takes, the sooner the attack would occur.
Now, back to the question, should we or shouldn’t we? Well, it appears that moderate consumption of alcohol preferably wine may be allowed in patients with or without gout. But we have to individualize our recommendations – discussing the risks and benefits of such interventions – to our patients and guide them in making informed decisions about their health.

Author: Sids Manahan MD 🇵🇭

Rheumatology. Internal Medicine. Educating Patients and Colleagues. Curating Rheumatology. Bloggero-Wanabe.

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