- Does Soda Cause Gout?
- Curtin Call
- Sugary Soft Drinks Linked To Increased Risk Of Gout In Men
- Some drinks may affect gout
- Pop goes the question of gout
- Where did the story come from?
- What kind of scientific study was this?
- What were the results of the study?
- What interpretations did the researchers draw from these results?
- What does the NHS Knowledge Service make of this study?
- Sir Muir Gray adds…
- Links to the headlines
- Links to the science
- Soda, OJ may increase risk of gout
Does Soda Cause Gout?
Sugary sodas have recently been implicated in everything from obesity to high blood pressure. But if you’re worried about gout, it may be especially important to steer clear of the sweet stuff.
Ongoing research has examined the relationship between rising soft drink consumption and an increase in gout. Consider this: The number of people with gout back in the 1970s was 20 per 100,000. By the mid-1990s, that number had more than doubled to 45.9 per 100,000. Likewise, soda consumption among adults rose by 61 percent from 1977 to 1997.
This link between soda intake and gout makes sense since the “source of almost all of the sweetness in sugary drinks comes from fructose — and fructose elevates uric acid levels, gout,” explains Hyon Choi, MD, DrPH, clinical associate professor of medicine in the rheumatology section at Boston University School of Medicine. Dr. Choi also points out that fructose is used to make high-fructose corn syrup, a substance commonly used to sweeten many foods and beverages besides soda.
Soda and Gout: The Link
Uric acid is usually filtered by the kidneys and excreted from your body in your urine. Gout occurs when uric acid builds up in the blood, causing uric acid crystals to form in one or more joints and leading to intense pain and swelling. There are a number of factors that can cause elevated uric acid levels, including heavy fructose consumption.
Choi’s research has shown that study participants who consumed two or more servings of sugar- or fructose-sweetened soda each day had an 85 percent increased risk of developing gout, compared with participants who consumed less than one serving of sugary soda per month. Even sugary fruit juice, such as orange juice, raises the risk.
If diet soda is your vice, you may not have to worry as much about developing gout. “With diet soda, we did not find the association,” Choi says.
Choi and his colleagues did find a slight increase in gout risk with consuming high-fructose fruits, such as apples and oranges. However, Choi emphasizes, artificially added fructose found in soda is linked to a higher risk of gout than naturally occurring sources of fructose like fruit.
Soda and Gout: What This Means for You
Traditionally, gout prevention strategies have focused on limiting protein-rich foods and alcohol, which can encourage uric acid accumulation in the body. This new research, however, suggests that cutting back on soda consumption may be just as important in preventing future gout attacks.
Also keep in mind that in the United States, the biggest single source of calories is soda sweetened with sugar or fructose. This means that beyond reducing your risk of developing gout, avoiding the empty calories in soda may also help you shed excess weight and keep your blood sugar levels in check. So instead of reaching for another soda or sugar-sweetened drink at your next meal, opt for water instead — your joints will thank you.
My initial instinct was to not actually put the word “aspartame” on my website without changing those a’s to @’s so the “aspartame trackers” wouldn’t find me, but you know what??? I DON’T CARE.
I had been suffering from severe foot pain since the time I woke up on Friday. Not wanting to pay the emergency room visit fee, I was trying to put off seeing anyone until Monday, when I could call my primary care physician. I surfed the web, trying to figure out what I might have done to cause such pain. By Sunday, I couldn’t wait any longer and found out that I could go to a local urgent care facility and only have to pay the fee for an office visit. I was there immediately.
They looked at my foot, did x-rays to rule out that I hadn’t done anything in my sleep (after all, I BROKE MY HIP sleepwalking and never woke up!) then did blood work to test my uric acid level, sending me on my way believing I had gout. I was horrified. Old men that drink whiskey get gout. How could I have gout????
Go home and read about the foods that cause it, I was told. So, I thought and thought and thought about what I had changed in my routine recently. The first thing listed on one of the sites was “artificial sweeteners”. Ah-hah! Crystal Light! Over the past 10 days to 2 weeks, I have been consuming Crystal Light lemonade and/or iced tea on a daily basis. So I googled “aspartame gout” and what I found positively horrified me (again).
Well, I called yesterday for the results of the blood work and, sure enough! They were negative for gout. I have been taking the anti-inflammatory medication and AVOIDING Aspartame and in just two days, I would say the joint pain has decreased by ~90%.
If you don’t believe me, google “aspartame”. I can’t say how disgusted I am that the FDA has approved a substance that shows as many as 92 side effects. I can say that I’ll take my chances of gaining weight and use sugar when needed. At least that’s a natural substance that my body will know what to do with.
Sugary Soft Drinks Linked To Increased Risk Of Gout In Men
Gout is a joint disease which causes extreme pain and swelling. It is most common in men aged 40 and older. It is caused by excess uric acid in the blood (hyperuricaemia) which leads to uric acid crystals collecting around the joints.
In the United States, levels of gout have doubled over the last few decades, which coincided with a substantial increase in the consumption of soft drinks and fructose (a simple sugar and the only carbohydrate known to increase uric acid levels).
Conventional dietary recommendations for gout have focused on the restriction of purines (found in high levels in meat and meat products, especially liver and kidney) and alcohol but with no restriction of sugar sweetened soft drinks.
So researchers in the US and Canada examined the relation between intake of sugar sweetened soft drinks and fructose and the risk of gout.
They followed over 46,000 men aged 40 years and over with no history of gout. The men completed regular questionnaires on their intake of more than 130 foods and beverages, including sugar sweetened soft drinks and diet soft drinks, over a period of 12 years. Different types of fruits and fruit juices (high in natural fructose) were also assessed.
At the start of the study, and every two years thereafter, information on weight, regular use of medications and medical conditions were also recorded. Gout was diagnosed according to American College of Rheumatology criteria.
During 12 years of follow-up, the researchers documented 755 newly diagnosed cases of gout.
The risk of gout increased with increasing intake of sugar sweetened soft drinks. The risk was significantly increased with an intake level of 5-6 servings per week and the risk was 85% higher among men who consumed two or more servings of sugar-sweetened soft drinks per day compared to those who consumed less than one serving per month.
These associations were independent of other risk factors for gout such as body mass index, age, diuretic use, high blood pressure, alcohol intake, and dietary factors.
Diet soft drinks were not associated with the risk of gout.
Fruit juice and fructose rich fruits (apples and oranges) were associated with a higher risk of gout. However, the authors stress that this finding needs to be balanced against the benefit of fruit and vegetable intake to prevent other chronic disorders like high blood pressure, coronary heart disease, stroke and certain types of cancer.
In conclusion, our findings provide prospective evidence that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout, say the authors. Furthermore, fructose rich fruits and fruit juices may also increase the risk. In contrast, diet soft drinks were not associated with the risk of gout.
Some drinks may affect gout
Patients who experience gout pain symptoms may benefit from taking a closer look at what they drink.
A group of rheumatologists recently spoke to AOL Health about purines, which can increase the risk of gout. Purines are compounds that can be found in high-protein foods and also in some drinks.
The first drinks mentioned were alcoholic beverages, specifically beer. Rheumatologist Jennifer Sloane, M.D., told the news source that a recent study estimated that people who drink 12 ounces of beer daily are 1.5 times more likely to develop gout than people who do not. Beer was named the drink most likely to cause gout, but other alcoholic beverages also pose a risk.
“Alcohol causes the kidneys to excrete alcohol instead of excreting uric acid. That increases the amount of uric acid in the blood, which could provoke a gout attack in about one or two days,” David Freeman, MD, told AOL Health.
Sloane also recommended against consuming soft drinks. Studies have shown that drinking just one sugary soft drink a day nearly doubles the risk of developing gout for women. Diet soda was not found to increase the chance of getting the disorder, suggesting a connection between the levels of sugar in a beverage and its likelihood of contributing to gout.
In the past, artificially sweetened drinks have been connected to the disease, along with some naturally sweetened beverages. Freeman suggested to AOL Health that fructose levels in sodas and juices could be to blame for their role in increasing a person’s risk of developing gout. While fructose is added to most artificially sweetened beverages, it occurs naturally in orange juice, making it just as likely to affect a person’s risk.
The news source also reported that caffeine has been shown to be somewhat of a contradiction when it comes to gout. While some studies have shown that consuming caffeine can protect against the disease, since it has similar properties to medications used to treat it, others have found that dramatically increasing caffeine intake can raise the risk of gout symptoms by as much as 80 percent.
Until more research can be conducted, the rheumatologists recommended avoiding energy drinks due to their high levels of caffeine and fructose.
According to the National Center for Biotechnology Information, the exact cause of gout is unknown. The groups at a higher risk for the disease are males, postmenopausal women and people who drink alcohol. The organization also states that gout can develop in people who already have another chronic condition. People with kidney disease, diabetes, sickle cell anemia, leukemia and those who are obese may also become afflicted with the disorder.
The Mayo Clinic describes a gout attack as coming on with little warning, and causing extreme pain. The clinic uses the example of feeling like the inflicted joint is on fire, to the point where even the weight of a bed sheet can prove unbearable. It recommends making lifestyle changes to combat the disorder, such as avoiding alcohol and other drinks previously mentioned.
Most of us know how sugar affects our waistline. Too much of the sweet stuff contributes to obesity, and with it, diseases like diabetes and heart disease. Overdoing it on one type of sugar in particular—the high fructose corn syrup found in sodas and processed foods—can also set off painful gout. Considering that the average American eats 22 to 30 teaspoons of sugar daily, gout is yet another health risk worth noting.
Fructose is a natural sugar found in fruit and honey. High fructose corn syrup is a man-made sweetener produced from corn. It’s composed of 55 percent fructose and 45 percent glucose. Why is this type of sugar harder on your joints than other forms, like glucose? “Fructose is metabolized differently from glucose,” explains Peter Simkin, MD, emeritus professor of medicine in the University of Washington School of Medicine division of Rheumatology.
As the body breaks down fructose, chemical compounds called purines are released. The breakdown of purines produces uric acid—the substance that forms painful crystals in the joints and causes gout. Within minutes after you drink high fructose corn syrup-sweetened soda, your uric acid levels rise.
Soft Drinks and the Rise of Gout
Gout used to be known as a “rich man’s disease,” because at one time, wealthy men were the only people who could afford the rich foods—veal, scallops, red meat, alcohol—that caused it. Today, gout is any man’s disease—and many women’s, too.
The number of people living with this painful form of arthritis has doubled in the past few decades, an increase experts link to rising soda consumption in the U.S. A 2008 study found that men who drink two or more sugary sodas daily have an 85 percent higher risk for gout than men who drink less than one soda a month.
The Obesity Connection
Sugary soft drinks and processed foods also contribute to obesity, which is itself a risk for gout. People who are overweight produce more uric acid, and their kidneys don’t remove it as quickly.
One study found that the relative risk for gout is nearly double in people who are obese compared to those who aren’t obese. And, very overweight people get gout an average of three years sooner than those of normal weight.
Does Fruit Cause Gout Too?
Researchers have also linked fruit juice and certain types of fruit, such as apples and oranges, with gout risk. In one study, men who drank two glasses or more of fruit juice a day were nearly twice as likely to get gout as those who drank less than a glass daily.
Yet that doesn’t mean you should abandon fruit in your diet. “I think it’s probably a question of quantity,” Simkin says. Fruit is high in nutrition; you just don’t want to overdo it. It’s especially important to watch your portion size when it comes to fruit juice, which is more concentrated in fructose—especially if you’re already at risk for gout because of your weight or other factors.
Controlling Gout Risk
Limiting or avoiding sugary sodas and processed foods is one way to lower your odds of getting gout. Once you have the disease, diet should be just one part of your strategy. Medicine should be another.
“If you can control hyperuricemia you can control gout. But it’s a lifelong problem. It doesn’t go away,” Simkin says.
Drugs called xanthine oxidase inhibitors—allopurinol (Aloprim, Lopurin, Zyloprim) and febuxostat (Uloric)—reduce the amount of uric acid your body makes. Probenecid (Probalan) helps your kidneys remove more uric acid.
Simkin recommends taking your medicine continuously, even if you start to feel better. And watch out for all foods that increase uric acid in your body—including meat, seafood, and alcohol. “With adherence to medication and diet, we can help most gout patients very much,” he says.
- Learn more about Gout
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- Wine Implicated in Gout Flares
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Men who consume large amounts of fizzy or sugary drinks are at higher risk of contracting gout than those who abstain, a new study has concluded.
Researchers from Harvard and the University of Vancouver found that those who consumed five or six sweet beverages a week were nearly 30% more likely to suffer attacks of the illness than those who drank less than one serving monthly. The risk rose to 85% for those drinking two or more a day.
As well as sugar in drinks, the study found that natural fruit sugar, or fructose, posed a substantial risk for gout.
That means people who drank orange or apple juice or even ate those fruit regularly were prone to the illness. Meanwhile, diet soft drinks, which often contain sweetener rather than fructose, were not found to be associated with gout.
“The risk of gout was about twice as high among men in the highest fifth of free fructose consumption than among men in the lowest fifth… the current study provides prospective evidence that fructose and fructose-rich foods are important risk factors in the primary prevention of gout in men.”
Hyon K Choi and Gary Curham surveyed over 46,000 male medical professionals aged 45-70 with no history of the illness over a period of 12 years, as part of a wider study into diet and general health. A total of 755 reported incidents of the condition. The link between gout and sugary drinks and fructose remained even when accounting for age, alcohol consumption, body mass and high blood pressure.
Gout is caused by a build-up of uric acid in the bloodstream and can cause joint swelling, inflammation and acute pain in the extremities. Uric acid is produced by the kidneys and digestive system from purines, which normally occur in rich food, meat and beer. Women are less likely to suffer from the condition.
Fructose is often used as a substitute for sugar, especially in high-fructose corn syrup, which is cheaper than cane sugar. It is a common ingredient in fizzy drinks. The risk is such that researchers caution that patients who switch from purine-rich food to improve their gout could in fact make it worse if they start eating large amounts of fructose.
The study is published in the latest edition of the British Medical Journal.
Pop goes the question of gout
“Soft drinks ‘bigger gout risk than alcohol’” read the headline in The Daily Telegraph today. It reported that “drinking too many sugary soft drinks and fruit juices can substantially increase the risk of gout”. Gout can be extremely painful and is caused by a build up of uric acid that crystallises in the joints. Uric acid is formed by the breakdown of purines which occur naturally in the body as well as in the diet. Traditionally, the advice is to avoid red meat and alcohol as they have high levels of purines and can make gout worse. However the Telegraph said “the risks associated with these drinks were higher than with certain types of alcohol”.
This story is based on a well-designed study in more than 46,000 men that found those who drank two or more cans of soft drinks a day increased their risk gout by 85 per cent compared with men who drank less than one soft drink a month. It provides yet another reason why drinking sugary fizzy drinks is not good for your health.
Where did the story come from?
Drs Hyon Choi and Gary Curhan from the Universities of British Columbia and Harvard carried out this research. The study was funded in part by the National Institutes of Health and TAP Pharmaceuticals. It was published in the peer-reviewed_ British Medical Journal_ .
What kind of scientific study was this?
This study was part of a large prospective cohort study looking at the health of male health professionals. This study recruited 51,529 men aged 40 to 75 in 1986 and the researchers selected the 46,393 men who did not have gout at the start of the study.
Upon enrolment, the men filled out standard questionnaires about their food and drink consumption, including their consumption of fizzy drinks and foods and drinks containing fructose, a type of sugar found in fizzy drinks, fruit, and products such as corn syrup. The men provided updated information about their food and drink consumption every four years.
Every two years, the men were sent a questionnaire, which asked whether they had been diagnosed with gout. A second questionnaire with detailed questions was posted to the men who reported a gout diagnosis. This allowed the researchers to confirm the diagnosis based on accepted criteria from the American College of Rheumatology, but not a blood test. The study lasted for 12 years.
The researchers then compared the risk of developing gout in men with different levels of average fizzy drink and fructose consumption over the 12-year period. They adjusted these analyses for factors which might affect results, such as the men’s consumption of alcohol, meat, seafood, vitamin C and vegetables rich in purine, their use of certain medicines (diuretics), body mass index, total amount of energy consumed, age, and the presence of high blood pressure or chronic kidney failure.
What were the results of the study?
About 1.5% of the men (755) developed gout during the study. Men who drank more fizzy drinks were more likely to develop gout than those who drank fewer fizzy drinks.
Men who had more than one fizzy drink a day increased their risk by 45%; two or more drinks a day increased the risk by 85%, compared with men who drank less than one fizzy drink a month. Diet fizzy drinks did not increase the risk of gout. People with the highest intake of fructose doubled their risk of gout compared with those with the lowest intake.
What interpretations did the researchers draw from these results?
The researchers concluded that consuming non-diet fizzy drinks and fructose increases the risk of developing gout. They say that the increase in risk seen with two or more soft drinks a day is slightly higher than that seen with alcoholic spirits.
What does the NHS Knowledge Service make of this study?
This was a well-designed and conducted study which has several strengths, including its large size, prospective design, its use of accepted criteria for the diagnosis of gout, and the use of repeated food questionnaires. Some points to consider when interpreting the study are that:
- As with all cohort studies, there is the possibility that the results are affected by imbalances between the groups other than the one of interest (fizzy drink consumption). The authors did try to adjust for these, which increases confidence in the results, although the possibility that some other factor is playing a role cannot be ruled out completely.
- This study only looked at men who were health professionals and mainly white, this may explain the relatively low overall risk of developing gout and implies that these results may differ in women or for other groups of men.
- Although fructose is contained in fruit and fruit juices, the benefits of eating fruit are likely to far outweigh the risk of developing gout. Reducing fructose intake from non-fruit sources, such as fizzy drinks, is a better strategy for reducing risk of gout.
This study provides yet another reason why sugary, fizzy drinks are not good for your health.
Sir Muir Gray adds…
Less fizzy drinks + more walking = less gout.
Analysis by Bazian
Edited by NHS Website
Links to the headlines
Soft drinks ‘bigger gout risk than alcohol’.
The Daily Telegraph, 1 February 2008
Fizzy drinks linked to gout.
The Times, 1 February 2008
Fizzy pop increases gout risk.
The Sun, 1 February 2008
Two fizzy drinks a day ‘can give you gout’.
Daily Mail, 1 February 2008
Fizzy drinks ‘cause gout’.
Metro, 1 February 2008
Gout surge blamed on sweet drinks.
BBC News, 1 February 2008
Channel 4 News, 1 February 2008
Links to the science
Choi HK, Curhan G.
Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study.
BMJ 2008 Jan 31
Soda, OJ may increase risk of gout
Women who consumed two or more cans of non-diet soda per day were twice as likely to develop gout. STORY HIGHLIGHTS
- Soda, other sugary drinks could raise risk of gout, an especially painful form of arthritis
- Gout rates seem to be higher among men and blacks than among white women
- Estrogen appears to protect against gout
- The percentage of adults affected by gout rose to almost 4 percent in 2008
- Diet and Nutrition
(Health.com) — Drinking too much soda, orange juice, or other sugary drinks appears to increase the risk of developing gout, an especially painful form of arthritis, according to a new study in the Journal of the American Medical Association.
Women who consumed two cans or more of non-diet soda per day were more than twice as likely to develop gout as women who rarely drank soda, the study found. (Diet soda had no apparent effect on risk.) Drinking 12 ounces or more of orange juice per day increased risk by roughly the same amount.
Women who had just one soda or 6-ounce glass of OJ per day were at 74 percent and 41 percent greater risk, respectively, compared with women who rarely drank either.
Health.com: Can fruit juice be worse than soda?
The culprit appears to be fructose, says the lead author of the study, Dr. Hyon Choi, M.D., a professor of medicine at Boston University School of Medicine. A sugar found in oranges as well as the high-fructose corn syrup used to make many non-diet sodas, fructose increases levels of the chemical uric acid, which causes gout. When uric acid levels in the body get too high, the acid hardens into sharp crystals that are deposited in joints.
Cutting back on sugary drinks “would help you, particularly for gout patients or if you have high levels of uric acid,” says Choi, who presented his findings today at the annual meeting of the American College of Rheumatology, in Atlanta. (The findings corroborate a similar 2008 study in men, also led by Dr. Choi.)
The overall risk of developing gout is very low, however. Over a 22-year period, just 1 percent of the nearly 79,000 women included in the study developed gout, and the increased risk linked to soda and juice consumption was confined almost exclusively to women who had gone through menopause.
Health.com: 8 tips for eating healthy during menopause
Estrogen appears to protect against gout, Choi says. As many as 98 percent of gout cases in women occur after menopause, when estrogen levels decline, he adds.
The study participants, who were part of a long-running, government-funded trial known as the Nurses’ Health Study, were mostly white and between the ages of 30 to 55. Gout rates tend to be higher among men and blacks than among white women, so the increased risk of gout associated with sugary drinks may be slightly higher in the population at large than in the study, the authors note.
Still, fructose may play a relatively small role in the development of gout. Although the researchers controlled for body mass index and a number of dietary factors that have been linked to gout (such as alcohol, meat, seafood, and dairy intake), fructose consumption is difficult to untangle from other factors that can contribute to the disease, says Karen Congro, R.N., director of the Wellness for Life Program at the Brooklyn Hospital Center, in New York City.
Health.com: 10 food rules for pain patients
“We can’t prove 100 percent that is the one item that is causing gout when there are so many other issues,” Congro says. “Is it drinking beverages with high-fructose corn syrup, or is it the whole diet?”
Gout is a growing problem in the U.S. The percentage of adults affected by the condition rose from 2.7 percent in the late 80s and early ’90s to almost 4 percent in 2008, according to other research presented at the meeting.
Copyright Health Magazine 2011