Almost every adult in the United States has at least one alcoholic drink in their lifetime. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), nearly 87 percent of Americans drink a serving of alcohol at some point during their adulthood. While most people drink moderately, if at all, nearly 27 percent of people binge drink at least once per month, and 7 percent drink heavily. About 16 million people in the US struggle with alcohol use disorder, the medical term for alcoholism.
The risk of chronic health issues is on the rise, according to an article published by the Journal of the American Medical Association (JAMA). The number of Americans who drink alcohol at least once per week is as high as 30 million, and a similar number of adults reported struggling with alcohol abuse or dependence in 2017. Underage drinking in the US is declining, but adulthood binge and heavy drinking are rising steadily across all demographics. These forms of drinking put millions of Americans at risk for severe, long-term health problems, including heart disease, liver damage, addiction, and joint problems, including gout.
What Is Gout? How Is It Related to Alcohol Abuse?
Gout is a form of arthritis. According to the Arthritis Foundation, the condition develops as uric acid builds up in the joints, leading to periods of intense, burning or stinging pain, especially in the big toe joint. Uric acid creates crystals in the joint that cause damage to the area, so tenderness, redness, warmth like an infection, swelling, and serious pain can indicate an episode of gout.
Normally, uric acid is passed through the kidneys and expelled through the bladder, but sometimes, uric acid builds up in parts of the body because the kidneys don’t function, or there is too much uric acid. The body may experience a buildup of uric acid if you eat or drink foods that contain a lot of purines, a chemical compound that breaks down into uric acid in the body. Foods like bacon, lamb, steak, pork, sardines, anchovies, scallops, and herring are high in purines, with dried beans and peas also containing high levels. Most alcohol also contains a lot of purines, with beer and hard liquor having the highest concentrations.
After uric acid builds up, symptoms can occur suddenly, although they may not all occur together. Symptoms include:
- Intense joint pain, most notably the large joint in the big toe, ankles, elbows, knees, wrists, or fingers
- Flaring pain that lasts for 12 hours, followed by lingering discomfort that lasts days or even weeks
- Joints that are swollen, red, warm, and tender for a few days
- Joint stiffness over time due to consistent gout episodes
There are several stages of gout, with the four main instances being:
- Asymptomatic hyperuricemia: This is the period prior to the first gout attack, during which uric acid levels are on the rise and crystals begin to form, but there may not be any noticeable symptoms.
- Acute gout: The first attack, called acute gout, is joint pain triggered by an event that raises the levels of uric acid suddenly. For many people, this is a night of binge drinking. After the uric acid crystals are jostled and tissues damaged, inflammation and pain are the result. Intense pain and immobility may last for 12 hours, with aftereffects lasting for several days. The first attack puts you at greater risk for future attacks.
- Interval gout: This is the time between attacks when there is little to no pain. Gout is not gone, and low-level inflammation may continue to damage the joints, leading to more joint stiffness. During this period, it is important to seek help from a doctor who can help you make lifestyle changes to manage the condition and possibly prescribe medication to reduce inflammation.
- Chronic gout: Ongoing flares of pain over time because uric acid levels remain high for years. Attacks will become more frequent, especially if you do not make lifestyle changes or seek medical treatment. More joint damage can happen, which can reduce your ability to walk, move comfortably, or perform basic tasks. This stage is preventable if you seek treatment after the first acute attack.
Factors That Contribute to Developing Gout
- Genes and family history: If people in your family have gout, you are likely to develop gout.
- Chronic health problems: Being overweight and having diabetes or heart disease, high blood pressure, or high cholesterol all contribute to gout.
- Some medications: Diuretics remove water and raise uric acid levels, increasing the risk for gout. In addition, some drugs that treat rheumatoid arthritis can increase the risk.
- Age and gender: Men and people over 60 years old are more likely to develop gout. Women up to age 60 are, according to some medical researchers, protected by their estrogen levels.
- Diet: Drinking too many sugary drinks like soda, eating a lot of red meat, or eating a lot of shellfish increases the risk of gout.
- Gastric bypass surgery: Because the way the body absorbs nutrients changes after this procedure, uric acid can build up.
- Alcohol consumption: Drinking too much changes how much uric acid is in the body, with beer and liquor being more likely to trigger the first acute gout attack than some other forms of alcohol, like wine.
While it is hard to predict when an episode of gout will occur, your doctor will work with you to make lifestyle changes that can reduce the impact of uric acid on the body, which reduces the risk of future severe gout attacks and joint damage. These lifestyle changes may include:
- Drinking more water
- Limiting alcohol intake or avoiding alcohol altogether
- Focusing on lean proteins and low-fat dairy
- Limiting or stopping consumption of red meat and fish
- Exercising more to lower body fat
In particular, dramatically reducing alcohol intake can reduce the severity and frequency of gout attacks. This may be the main lifestyle change your doctor recommends you make. If you have struggled with alcohol use disorder or problem drinking, however, you likely need help from an addiction specialist to stop drinking.
Studies Linking Alcohol Consumption to Gout
An older study, published in The Lancet in 2004, followed 47,000 men for 12 years and examined how their lifestyles affected their gout. The medical study found a direct correlation between beer consumption and gout, with other kinds of alcohol also affecting the inflammatory condition. Men who drank even in moderation, which was just one 12-ounce serving of beer per day, increased their risk of gout attacks 1.5 times. Hard liquor also increased the risk while wine did not make a measurable difference.
A later study, published in 2015, found that wine did increase the risk of a gout attack, so drinking any amount of alcohol increases the risk of an episode of gout to some degree. The study followed 724 participants who were all over 50 years old and their drinking habits over one 12-month period anytime between February 2003 and January 2012. About 78 percent of the participants were men who struggled with obesity. About 44 percent of participants reported drinking any amount of alcohol before their gout attack, with the mean number of servings being between one during the control period and 1.4 during the hazard (high levels of drinking, low treatment) period. More than one drink in a 24-hour period was associated with a 36 percent increase in risk of a gout attack; 1-2 servings of wine, 2-4 servings of beer, and 2-4 servings of hard liquor were all correlated to an increased risk of gout within a 24-hour period of drinking. The prior studies’ bias against wine may have had to do with gendered differences in drinking rather than the actual risk of uric acid buildup associated with specific types of alcohol.
Getting Help for Alcohol Abuse Can Reduce Gout Risk
Reducing the risk of gout involves understanding your risk factors. If you have a family history or genetic risk of developing gout, you should drink less, eat less red meat, and find ways to maintain a healthy weight. If you struggle with excessive drinking, work with a physician to reduce or stop drinking, and get evaluated for a potential alcohol addiction.
If you already have gout, your doctor will work with you on lifestyle changes and may prescribe specific doses of medication, including nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, or corticosteroids, which can all reduce inflammation and pain. However, if you develop gout while struggling with alcohol use disorder, you need help from an addiction specialist to safely detox from alcohol dependence followed by treatment via an evidence-based rehabilitation program that can also help you manage gout.