Study: Sugary Soda, OJ Raise Gout Risk in Women

Beverage Industry Disputes Study, Says Fructose-Rich Drinks Are Not to Blame for Gout Risk

Medically Reviewed by Laura J. Martin, MD on November 09, 2010
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Nov. 10, 2010 -- Women who drink one or more servings of sugary soda or orange juice a day may be increasing their risk for developing gout. That’s according to new research presented at the American College of Rheumatology Annual Scientific Meeting in Atlanta. The findings will also be published in the Journal of the American Medical Association.

Still, researchers caution that this increased risk is modest in the face of the overall low rate of gout in women. Often thought of as a disease of overweight, older men, gout occurs when uric acid crystals form in the joints and surrounding tissue, causing intense pain and swelling. Gout attacks tend to recur and frequently affect the big toe, knee, and ankle joints.

"Fructose enhances the production of uric acid," says study author Hyon K. Choi, MD, DrPH, of the Boston University School of Medicine. Choi and colleagues also published similar findings in men.

Animal studies have shown that the effect of fructose on uric acid was not as strong in women as in men, but the new study found this was not the case. "Female hormones seem to protect against the uric acid-raising effects of fructose in animal studies, but this may only be the case in younger women," he says. The new study mainly comprised postmenopausal women, when levels of the female hormones decline. "These women may have lost the hormonal benefit and maybe that is what is going on," he says.

Sugary Soda and OJ Raise Gout Risk

Researchers tracked gout development and consumption of fructose-rich beverages among 78,906 women in the Nurses’ Health Study. During 22 years of follow-up, 778 women developed gout, and increasing intake of sugar-sweetened drinks was linked to increased gout risk.

Women who had one serving of sugar-sweetened soft drinks a day were 74% more likely to develop gout than women who drank less than one serving per month. Women who had two or more servings per day were at a 2.4-fold increased risk for developing gout, compared to women who drank less than one sugary soda a month.

Drinking orange juice also increased gout risk in women. Participants who had one serving of orange juice a day were 41% more likely to develop gout, and people who had two or more servings per day were at a 2.4-fold increased risk, compared with women who drank less than 6 ounces of orange juice per month.

Diet soft drinks did not increase gout risk among women in the new study.

Fructose May Also Trigger Gout Recurrence

Although the study looked at risk for developing gout, Choi says that women with gout should also cut back on sugary soda and juice to lower their risk of a gout attack. "People who already have gout have a more exaggerated response to fructose, so these findings are even more applicable in gout patients," he says.

"The evidence is strong that these types of drinks are strongly associated with a somewhat increased risk of gout," says Eric Matteson, MD, chair of the department of rheumatology at the Mayo Clinic in Rochester, Minn. "We know too that the risk of obesity, which is also associated with gout, is increased by consumption of soft drinks or 'empty calories,'" he says in an email. "I will tell my patients to limit their consumption of caloric, sugar-containing drinks for their general health and quite possibly reduce their risk of gout."

Industry Takes Issue With Study Conclusions

"This study fails to be meaningful when it comes to informing Americans about the real cause of gout," says Richard Adamson, PhD, a scientific consultant to the American Beverage Association, a trade group based in Washington, D.C.

"The compendium of research conducted on gout shows foods and beverages high in purines such as alcohol, beer, and certain meats are strongly linked to uric acid metabolism and therefore gout," he says in a written statement.

Soft drinks and orange juice do not contain purines.

Moreover, the fructose content of fruit juice and fruit is identical, yet the authors say that eating fruit does not increase gout risk, he says. "This clearly suggests that is not the fructose content that is leading to the increased risk for gout,” Adamson says.

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American College of Rheumatology 2010 Annual Scientific Meeting, Atlanta, Nov. 6-11, 2010.

Eric Matteson, MD, chair, rheumatology, Mayo Clinic, Rochester, Minn.

Statement, American Beverage Association.

Hyon K. Choi, MD, DrPH, Boston University School of Medicine, Boston.

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