April 15, 2004 -- For centuries, gout has been known as the "disease of kings" because overindulging in rich food and drink is a major cause of the painful joint condition. But it now appears that when it comes to alcohol, the biggest culprit is the beverage long favored by the common man.
In the largest study of its kind, researchers found that as few as two to four beers a week increased the risk of gout by 25%. But men who drank at least two beers a day were more than 200% as likely to develop gout as non-beer drinkers. And the more beer they drank, the more likely they were to suffer an attack of gout.
Liquor drinkers also suffered a gouty fate, though not as severely. As little as one liquor drink a month increased the risk, but the chance of gout jumped 60% with two or more liquor drinks a day.
No increase in risk was seen among wine drinkers.
While there had been some suggestion that beer drinkers may be more at risk than imbibers of alcohol in other forms, lead researcher Hyon K. Choi, MD, of Massachusetts General Hospital, says the strength of the difference was a surprise.
"It certainly suggests that individuals with gout should try to limit or even cut out their beer consumption, whereas wine may be allowed, given other health benefits associated with moderate alcohol consumption," he says.
Middle Aged Men Most at Risk
Although exact figures are not known, it is estimated that 2 million Americans have gout. A type of arthritis that occurs most frequently in overweight, middle-aged men, gout is caused by the buildup of needle-like crystals of uric acid in the joints.
While there is certainly a genetic link to the disease, there is also no question that lifestyle is a key contributing factor. The link between alcohol and gout has been suspected for thousands of years, but the new research is some of the first to actually confirm the association.
The study involved 47,000 men followed for 12 years. During this time, 730 of the men developed gout. The findings are published in the April 17 issue of The Lancet.
"We showed a sight protective effect for wine drinking among people who drank less than two drinks per day, although the effect was not statistically significant," Choi tells WebMD. "But it is intriguing and deserves further study."
Beer Is High in Purines
People with gout are often told to avoid foods that contain high levels of purines, a substance that breaks down into uric acid. High-purine foods include organ meats such as liver, fatty red meats, and certain types of seafood. Beer contains much higher amounts of purines than other alcoholic beverages, and the researchers suggest that this may explain their findings.
Arthritis expert Roland Moskowitz, MD, says it is probably a good idea for people with gout to cut beer and high-purine foods out of their diets while they are getting the condition under control. But he adds that new treatments that block the formation of uric acid have made diet less of a factor in controlling the disease.
"Gout is now an imminently treatable disease, so maintaining a rigid diet is not as important as it once was," he tells WebMD. "I wouldn't want my gout patients to eat a pound of steak every day, but eating a steak once in a while and drinking alcohol in moderation is probably fine."
SOURCE: Choi, H. The Lancet, April 17, 2004; vol 363: pp 1277-1281. Hyon K. Choi, MD, department of medicine, Massachusetts General Hospital, Harvard Medical School, Boston. Roland Moskowitz, MD, spokesman, American College of Rheumatology; professor of medicine, Case Western Reserve University, Cleveland.