- Is Purine The New Gluten?
- Gout and Alcohol Consumption
- All alcohol, even wine, raises risk of gout flare-ups: study
- Fruit juice ‘more likely to cause gout than alcohol’
- Does Coffee Help Gout or Cause It? What You Need to Know
- Caffeine May Cause Gout
- Proceedings of the 1st International Conference on Inter-professional Health Collaboration (ICIHC 2018)
Is Purine The New Gluten?
All About Beer Magazine – Volume , Issue May 17, 2012 brianyaeger
My cousin has gout. OK, by his admission, he had a gout attack. In a heartbreaking email, he told me that his doctor, as a result of the attack, told him to avoid beer!!! The reason, he continued, is that beer is full of purines. Before we get to what purines are and their place in beer, let’s do a quickie stat. When we checked in on the surge in gluten-free beers, we learned that 1 in 133 Americans is allergic to gluten, hence the rise in GF brews. But 1 in 119 people are afflicted with gout. Five percent of those with arthritis suffer from what is considered one of the most painful rheumatic conditions. Where are the beers for them?
If you’ve never heard of purine–kinda sounds like a dog food made from dried plums—your doctor will tell you that’s a good thing. What the heck is a purine? “Purine is a compound found in nucleic acids, heterocyclic compounds made of imidazole rings and pyrimidine.” (Glad ya asked?) A build-up of purines prevents kidneys from performing their job of eliminating uric acid, which is more painful than it sounds. Worst of all, lists of foods and drinks high in purines start with beer (and not because they go in alphabetical order, otherwise they’d start with anchovies.) Surprisingly, it’s mostly brewer’s yeast to blame. Gout was considered a rich man’s disease and used to be called “the disease of kings” because it tends to strike those who overindulge in food and drink, especially nibbles not everyone is accustomed to eating such as caviar and organ meats (sweetbread, anyone?)
Now, personally, if I ever get the gout, I’ll easily give up pate and foie gras—foods that ever so rarely pass my lips but the very same lips that welcome in an abundance of beer. The aforementioned cousin works for a Japanese company and as such often travels to the land of the rising sun. Cousin John said, “In Japan I saw a low-purine beer. I imagine it tasted as good as low-carb, low-calorie, beer, but it was interesting.”
Indeed, the large Japanese breweries make and sell happoshu, a low-malt beverage designed to evade the higher tax category that beer fits into. Then they turn around and tout these cheapo drinks as being brewed for health benefits. Kirin Tanrei W is marketed on its strength of being 99 percent purine-free.
Can a highly-hopped, berry-infused, patented purime-centrifuging technique be far behind?
Beer and hard liquor have long been known to increase the risk of gout, the most common form of inflammatory arthritis, but according to a 2014 study in The American Journal of Medicine, wine also can contribute to recurrent gout attacks.
Gout occurs when excess uric acid builds up around joints – often in the big toe, but also in the feet, ankles, knees, wrists and elbows – leading to episodes of intense pain, redness and swelling. It affects more than 8 million adults in the United States, and the numbers are rising sharply, due mainly to obesity and other lifestyle factors.
In the 2014 study, 724 gout patients completed questionnaires every few months as well as after gout attacks about their diet, medications, exercise and number of alcoholic drinks consumed. The researchers compared what a participant consumed on an average day to what that participant had consumed in the 24 hours before a gout attack. Researchers looked at the overall effect of alcohol on gout attacks as well as the individual effects of wine, beer and liquor, while taking diet and other factors into account.
Results showed that a single serving of wine, beer or liquor (either straight or in a mixed drink) in a 24-hour period didn’t significantly increase the chance of repeat gout attacks. But consuming more than one to two drinks a day did – by 36%. With two to four drinks, the risk rose 50%, and it continued to rise with the amount of alcohol consumed.
When the three types of alcohol were compared, wine was actually a significant trigger. Drinking between one to two glasses of wine in the 24 hours before the attack raised the risk of recurrent attacks by 138%; in other words, it more than doubled the risk of a gout attack, compared to drinking no wine. By contrast, drinking two to four beers in the 24 hours before an attack increased the risk by 75%.
The researchers point out that these results apply to men; findings for women are less clear, mainly because so few women were in the study. Study author Tuhina Neogi, MD, a professor at Boston University School of Medicine, says, “But the patterns of alcohol’s effects on risk of gout attacks were generally similar to seen in men.”
Dr. Neogi says, “Based on this study, I would counsel gout patients that any type of alcohol may trigger an attack; it’s not just beer or liquor but also wine. Each patient is different, so a ‘safe’ limit can’t be uniformly set, but obviously abstaining from alcohol would avoid any risk of attack due to .”
- Controlling Your Weight May Be Effective for Lowering Gout Risk
- What Causes Gout?
- The Best Diet Advice for Gout: Eat Less Meat
Gout and Alcohol Consumption
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.
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.
Have you been drinking?
All alcohol, even wine, raises risk of gout flare-ups: study
NEW YORK (Reuters Health) – Bad news for gout sufferers who enjoy drinking the fruit of the vine – new research finds that all types of alcohol, even previously exempt wine, can bring on attacks of the painful condition.
“I don’t want to sound too dogmatic and say, ‘You must stop drinking,’” lead author Dr. Tuhina Neogi told Reuters Health. But, the Boston University rheumatologist said, “based on this study, I would counsel patients that any type of alcohol may trigger an attack.”
“It’s not just beer or hard liquor that can trigger attacks, but also wine,” she said.
Gout is a potentially debilitating form of arthritis that afflicts more than 8 million American adults, and the number is rising, Neogi’s team writes in The American Journal of Medicine.
The so-called disease of kings causes joints to swell and redden. It most often strikes overweight men’s big toes but also claims feet, ankles, knees, hands and wrists. A link between intoxicating beverages and gout has been suspected since ancient times.
A 2004 landmark study of more than 47,000 men found that drinking beer and hard liquor – but not wine – increased the risk of developing gout.
Neither has wine been shown in other studies to bring on attacks in people who already have gout, the way beer and liquor have.
Nonetheless, Neogi said, some of her patients report “they can’t even sniff wine without having a gout attack.”
To investigate the effects of all types of alcohol on the short-term risk of a gout flare-up, Neogi and her team examined survey responses from 724 adults with gout, 78 percent of them men, from across the United States between 2003 and 2012.
Study participants completed questionnaires every few months about their gout attacks, medications, exercise, alcohol use and diet.
The more alcohol they drank, Neogi’s team found, the greater their risk of having a gout attack within 24 hours.
A five-ounce glass of wine, a 12-ounce beer or up to 1.5 ounces of liquor were considered one drink.
The researchers compared the study participants to themselves on days when they had no alcohol.
When participants had a single drink, the risk of gout attack didn’t change much. But with one to two drinks in a 24-hour period, the risk of a gout attack rose by 36 percent. With two to four drinks, the risk rose by 50 percent.
Wine was one of the worst triggers, at least for men. Regularly drinking a glass or two of wine hiked the odds of recurrent attacks by 138 percent, and drinking two to four servings of beer raised the risk by 75 percent.
“Moderate drinking,” which is one drink for women and two drinks for men, did not significantly raise women’s risk, but there were too few women in the study to estimate the effect, the researchers note.
“Our study results indicate that alcohol intake, regardless of type, can increase the risk of gout attacks,” Neogi said. “Additionally, increasing amounts of alcohol intake of any type, even at moderate levels, can increase risk of gout attacks.”
Wine may not have raised the risk of developing gout in past studies for a variety of reasons, Neogi’s team points out in their report. People who drink only wine tend to have healthier diets and lifestyles, overall, than people who drink only beer, for example.
“They’re making healthier food choices, exercising more and not smoking as much as beer and hard liquor drinkers,” Neogi said. That may have masked wine’s effect on gout in the 2004 study.
Dr. Gary Curhan of Harvard Medical School, senior author of that study, told Reuters Health in an email, “I do think that doctors should advise their patients with gout to minimize their alcohol intake.”
Because his study controlled for diet, Curhan discounted the notion that wine drinkers’ healthier lifestyles explained differences between his and Neogi’s results.
Though Curhan’s study considered some food categories associated with gout, such as meats and seafood, it failed to include other categories, such as processed foods, or other lifestyle factors, like exercise and smoking, Neogi said.
“It just may be that without accounting for these other factors, we can’t see the true effects of wine,” she said.
SOURCE: bit.ly/1l24LWJ The American Journal of Medicine online January 21, 2014.
Our Standards:The Thomson Reuters Trust Principles.
‘This established role for diet in step 2 has, incorrectly, been assumed to be important in step 1. Our research published recently in the BMJ showed this not to be the case.’
He added, ‘With respect to wine, our BMJ data showed a minor effect on urate levels (step 1).’
But wine may carry higher risks in the second stage of gout. In 2006, a study published in the American Journal of Medicine found that all types of alcohol contributed to gout attacks to varying degrees in existing sufferers.
Citing the 2006 study, Merriman said that only excessive wine consumption – considered to be more than five 5oz servings ( five 150ml glasses) in the last 48 hours – was shown to be significant in triggering flare-ups.
Merriman said that there needed to be more study on the dietary and genetic causes of the disease.
‘It is important that more research be done in this area. From a clinical perspective this is important in order to create the correct balance between “lifestyle” advice and efforts to establish patients on gout-preventive urate-lowering medications.’
The UK Gout Society has a dietary advice sheet, which can be found here.
The attack came out of the blue and the pain was excruciating. Getting out of bed one morning, I placed my feet on the floor – and lurched headlong into the blanket box. My right big toe felt like it was being skewered by a pitchfork. Struggling back on to the bed, I saw that the toe and joint was swollen with a bright red sheen, and agonising to touch. Limping heavily (my wife had to steady me as I got dressed), I managed, with some effort, to manipulate my foot into a slipper.
My GP diagnosed gout. Like many people, I associated it with Henry VIII and rich living. Not quite. Gout – which comes on suddenly, over a few hours and often during the night – is determined by how well the body manages the breakdown and excretion through the kidneys of DNA protein, otherwise known as purines. If it can’t control this, the purines break down to produce higher than normal levels of uric acid. These then build up and form crystals, which gather in a joint, causing inflammation and acute pain.
As many as one in 100 people will experience this at some point, rising to five in 100 for men aged 65 and over. And with people now living longer, these figures are likely to increase. It’s an illness more common in men than in women, who tend to have lower levels of uric acid in their blood. It’s also a condition that recurs. According to the British Medical Association, around 60% of sufferers will have a second attack within a year, more than 75% within two years, and over 80% within three years. “Incidents of gout are increasing and constitute the most acute inflammation for between 1-2% of men in the western world,” says Dr Ian Rowe, a consultant rheumatologist.
Yet one of the difficult aspects of the illness for me is the assumption that it is brought on by rich living. Mention gout and people automatically assume that you gorge on rich food and down the booze in equal measure. Having limped in agony to the local shop, I mention the g-word and I am greeted by a smile and words along the lines of, “Too much of the good life, eh? You like your food and drink, eh?” And I have to put up with this whenever I explain my laboured gait.
It’s true that GP’s guidelines advise you to consider diet and lifestyle: moderate, or almost zero, consumption of purine-rich foods – red meat, liver, kidneys, shellfish – is recommended; and instead of red wine, stouts and spirits, I was told I should stick to a sensible intake of white wine and lager. Rowe says: “A healthy lifestyle is important. That means reducing consumption of alcohol and purine-rich foods and not going on a high-protein or crash diet.”
So I couldn’t help wondering if the occasional burger and bottle of red had actually been my undoing. But Richard Hull, consultant rheumatologist at Queen Alexandria hospital in Portsmouth, says not. “If my patients take their medication properly, I don’t put too much emphasis on their eating habits,” he says.
“Diet only affects up to 10% of purines, but of course, moderation is sensible. As for the benefits of drinking white wine, this is an old wives’ tale. Consuming more than the recommended levels of alcohol does cause dehydration, which increases the likelihood of a gout attack.” But the condition is also related to diabetes, kidney complaints, obesity and medications such as diuretics, or water tablets, for high blood pressure.
Even when you get treatment – usually anti-inflammatory drugs – it takes around a week to 10 days to work, and during this time the pain can be extremely disabling: lifting your foot to rest it on the sofa can cause agonising stabs. The preventative drug, allopurinol, can only be administered when the condition has calmed down, and has to be taken for the rest of your life as does the newly approved medication, febuxostat.
Since the first attack four years ago, my gout has returned annually and kept me company for a fortnight. I always keep my anti-inflammatory tablets to hand, because, despite my best efforts, I can’t rule out another attack during the night.
Fruit juice ‘more likely to cause gout than alcohol’
Men who consumed large amounts of fruit juice or fructose-rich fruits, such as apples and oranges, also had a higher risk of the condition. However, those who drank diet soft drinks showed no extra risk.
The researchers believe the findings could explain why cases of gout have doubled in America in recent decades.
Attacks of gout, which are caused by too much uric acid in the body, usually start in the toe but affect the joints most severely as this is where the acid lies and crystallises. Dieticians traditionally advise sufferers, of whom there are about 600,000 in Britain, to restrict their intake of purines – chemicals found in meat and alcohol that turn into uric acid.
But many soft drinks and fruit juices contain large amounts of fructose, a naturally occurring sugar that can increase uric acid levels.
The report stresses, however, the benefit of fruit and vegetables to prevent other chronic disorders such as high blood pressure, coronary heart disease and certain cancers.
The authors, Hyon K Choi, from British Columbia University in Vancouver, and Gary Curhan, from Harvard Medical School, said: “These findings support the importance of recommending a reduction in fructose intake in patients with hyperuricaemia and gout in order to reduce the risk of gout”.
Sian Porter, from the British Diatectic Association, said: “Gout sufferers are often told to increase their intake of fluids, sometimes by up to three or 3.5 litres a day.
“This study suggests there could be problems if patients start to follow that advice by increasing their intake of soft drinks instead of water.”
• Babies as young as 18 months are going under general anaesthetic to have teeth removed because they have been fed sugary drinks. Borghild Breistein, the clinical director of dentistry at the Belfast Health and Social Care Trust, said that one baby had to have six of her eight teeth surgically extracted.
Does Coffee Help Gout or Cause It? What You Need to Know
Most scientific research studies suggest that coffee can play a role in lowering your risk of gout. Coffee contains a wide variety of beneficial compounds, including minerals, polyphenols, and caffeine. See more about the health benefits of coffee.
Coffee is thought to reduce gout risk by lowering uric acid levels through several mechanisms. Coffee may lower uric acid levels by increasing the rate that your body excretes uric acid. Coffee is also thought to compete with the enzyme that breaks down purines in the body. This can lower the rate at which uric acid is created.
A recent review of the research found that in many cases, drinking coffee was associated with lower levels of uric acid and fewer episodes of hyperuricemia.
In one Japanese study mentioned, researchers found that coffee consumption had an inverse relationship with uric acid levels. Those who drank the most coffee (roughly five cups per day) had the lowest uric acid levels among the study participants. Although both coffee and tea were tested, these results seemed to apply only to coffee.
This evidence implies that compounds in coffee other than caffeine may play a role in lowering uric acid levels.
Another systematic review seems to support this idea. In this 2014 review, the researchers mention two coffee and gout studies from the Third National Health and Nutrition Examination Survey. In one of the studies, both coffee and tea consumption were analyzed next to serum uric acid levels. The researchers found that coffee consumption, but not tea consumption, was associated with lower uric acid levels and hyperuricemia risk.
Why coffee might be beneficial
There are a few reasons why coffee may provide a protective effect against the buildup of uric acid. To understand why, we first need to understand how certain medications for gout work.
There are two types of gout medication that your doctor may prescribe: xanthine oxidase inhibitors and uricosurics.
Xanthine oxidase inhibitors function by inhibiting the activity of xanthine oxidase. Xanthine oxidase is an enzyme that helps the body metabolize purines. Since purines are a source of uric acid, inhibiting this enzyme can help to keep uric acid levels low.
Caffeine is considered to be a methyl xanthine. Therefore, it can also compete with and potentially block the action of xanthine oxidase.
Uricosurics function by helping the kidneys rid the body of uric acid. Although caffeine isn’t necessarily considered a uricosuric, it may function in a similar manner.
Research has suggested that chlorogenic acid, a polyphenol found in coffee, may help to improve insulin sensitivity. One study found that in people with hyperinsulinemia, there was a decline in both sodium and uric acid excretion via the kidneys. When insulin levels decreased, and insulin sensitivity improved, sodium and urate elimination improved as well.
Caffeine May Cause Gout
Gout is an inflammatory disease similar to arthritis, where uric acid builds up in the joints and tendons causing swelling and pain.
Since 1984 reported gout attacks have increased 45% and 8 million Americans were diagnosed with gout in 2008 alone.
But, is caffeine really to blame?
Gout and Caffeine Studies
Since gout is on the increase there have been many studies which seek to identify the cause(s) for this dramatic increase.
Below are just a few of the studies that have looked at caffeine, coffee, tea and their influence on a person developing gout.
- A study sponsored by the American College of Rheumatology found that men who are coffee drinkers actually decrease their risk of experiencing gout. src.
- A study from the American Society for Nutrition showed that women who are coffee drinkers also had less risk of developing gout. src.
- Another study showed that people who binge on caffeine are more likely to have a gout attack. This means that people who usually have little caffeine daily but occasionally have a lot of caffeine in one day are at risk.
- A related study looked at the lifestyles of 79,000 women over a 25 year period and found that women who consumed at least one sugary beverage daily were twice as likely to suffer with gout than women who very rarely drank sugary beverages. This study didn’t list caffeine as a factor, but just the sugar content of the beverage. src.
What Can We learn From This?
- It looks like if you want to reduce your chances of getting gout, caffeine should be consumed at a consistent amount daily instead of binging.
- Also, choose sugar-free energy drinks or unsweetened coffee and tea as a way to get your caffeine fix without increasing your risk of a painful gout attack.
- Daily coffee consumption may decrease risk of gout since it lowers the uric acid concentrations in the bloodstream. src.
- Your dominate beverage should be water, especially if you have a history of gout.
It seems like most of the studies show that caffeine consumed in the form of coffee actually decreases gout risk.
It is most likely that sugary drinks are the most dangerous as far as gout risk is concerned, which is independent of caffeine content. Gout treatment includes many dietary restrictions but so far moderate caffeine seems to be ok.
Written by Ted Kallmyer, last updated on September 17, 2014
Proceedings of the 1st International Conference on Inter-professional Health Collaboration (ICIHC 2018)
Background: Uric acid as the nitrogen compounds produced from catabolism purine from both diet and from endogenous nucleic acids (DNA deoxyribonucleic acid). One of the factors that can increase uric acid levels is the factor of excessive purine intake. The habit of consuming coffee can reduce levels of uric acid because the content of polyphenol compounds in coffee such as chlorogenic acid can inhibit the activity of the enzyme xanthine oxidase, thereby reducing levels of uric acid. The purpose of this study was to determine differences in uric acid levels between subjects who consumed coffee and did not consume coffee in the Eastern Puskesmas area in 2018. Methods: This study included an analytical study with research design cross-sectional. The number of study subjects was 46 subjects aged 45-54 years. The level of uric acid in the blood was measured by spectrophotometer Rayto, data on the history of gout and consumption habits were obtained using an observation sheet. Data analysis used test Mann-Whitney. Results: there were differences in uric acid levels between subjects who consumed coffee and did not consume coffee in the East Rim Health Center area in 2018, the uric acid level of subjects who consumed coffee was lower than subjects who did not consume coffee (CI 95% 6.20, 7.80 ; p =0.001). Conclusion: uric acid levels of subjects who consume coffee are lower than subjects who do not consume coffee, coffee can be used as a non-pharmacological alternative treatment and prevention of Gout.