According to a survey compiled by the National Institute on Alcohol Abuse and Alcoholism, 132.9 million Americans ages 18 and older have consumed at least one alcoholic beverage in the past month. Additionally, 60.4 million adults reported binge drinking (four to five drinks on one occasion).1) and 16.3 million adults reported heavy drinking (4 to 5 drinks per day).2) within the last month.3
This is a concerning figure because alcohol consumption is strongly linked to an increased risk of gout. According to the Mount Sinai Health System, approximately 8.3 million people in the United States suffer from gout.4 This number is expected to increase further as risk factors such as drinking continue to remain unchanged. So how much does alcohol contribute to the development of gout?
Studies have linked alcohol consumption to an increased risk of gout.
In a study published in JAMA Network Open,5 British researchers have established that alcohol is a known risk factor for gout. From there, they tried to quantify how many drinks you would need to drink to increase your risk of gout.
The researchers selected men and women aged 37 to 73 from the UK Biobank, which included 502,411 participants. This database excluded participants who self-reported poor health, those who had ever had a gout episode (including those taking gout medication), and those who had reduced their drinking due to their ongoing illness. After exclusions, the final test population was determined to be 401,128.6
From there, we created two categories: Male (179,828) and Female (221,300). All participants were asked to classify their status into three options: never, former, and current drinking. Current drinkers were asked to list the types of alcoholic beverages they drink (e.g. beer, wine, etc.) and what they consume in an average week.7
After the analysis, the researchers noted that after follow-up there were 5,278 cases of gout: 4,096 in men and 1,182 in women. The researchers also added that among men, current drinkers had a 69 percent higher risk of developing gout compared to those who never drank alcohol. Interestingly, this association was not found among women.8,9
Although the study did not address the mechanism by which alcohol causes gout, it theorizes that the type of drink, rather than biological differences between men and women, influences gout risk.
“In this prospective cohort study, which carefully considered potential confounding and reverse causality, consumption of several specific alcoholic beverages was associated with a higher risk of gout in both men and women.
“The observed gender differences in the association between total alcohol consumption and gout incidence may be due to differences in the types of alcohol consumption between men and women rather than biological differences.”
How alcohol consumption can cause gout
Purines are naturally occurring substances in the body and are used to make DNA and RNA. Studies have shown that about two-thirds of the purines circulating in the body are endogenous, with the remainder coming from exogenous sources such as food or alcohol. When purines are metabolized, the final byproduct is uric acid, which is eliminated through urination.10
Uric acid itself is not bad. In fact, uric acid plays a role in protecting your health. According to one study, uric acid “contributes approximately 60% of plasma antioxidant activity and maintains the stability of blood pressure and antioxidant stress.”11
Under normal conditions, uric acid levels in the blood range from 2.5 to 7.0 mg/dL in men and 1.5 to 6.00 mg/dL in women.12 However, it becomes a problem when the body produces more uric acid than it can eliminate, which causes crystals to form in the blood plasma and deposit in joints and soft tissues, causing gout.13 And again, one of the biggest causes is drinking.
Going back to the JAMA Network Open study, there are two ways in which alcohol consumption affects uric acid production that progresses to gout: frequency of consumption and type of alcoholic beverage. Researchers from the JAMA Network Open study noted:14
“Among people who currently drink alcohol… drinking more frequently was associated with a significantly higher risk of gout in men and a slightly increased risk in women. Regardless of gender, several specific alcoholic beverages, especially beer and Consuming more cider was associated with a higher risk of gout…
Among current drinkers, men who drank more than five times a week had about twice the risk of developing gout compared to men who drank less than once a week. “For female drinkers, the positive association between drinking frequency and gout incidence was only seen after adjusting for body mass index (BMI), especially after further accounting for potential reverse causality.”
As you can see, beer consumption appeared to be the biggest contributor to elevated uric acid levels, a finding echoed in other studies. In 2021 Review15 Published in Molecules, beer increased serum acidity more than whiskey or soju in just one hour.
Exercise — A Healthy Way to Manage Uric Acid Levels
The best way to avoid the harmful effects of alcohol on your health is to not drink it in the first place. However, if you have been drinking for quite some time and want to better manage your uric acid levels and prevent gout attacks, exercise is recommended. That’s because exercise has multi-system benefits.
According to one study16 People who weigh more than the normal reference range generally have higher uric acid levels, according to a study published in the Indonesian Journal of Global Health Research. This is because visceral fat and fatty tissue produce uric acid as a by-product.
research on the contrary17 It has been shown that when you begin regular exercise of low or moderate intensity, your body begins to produce an anti-inflammatory effect that reduces the pathological response caused by uric acid crystals.
You might be wondering why we only do low- and moderate-intensity exercise. This is because high-intensity exercise causes lactic acid to accumulate in the body. When this happens, your body retains more uric acid, which it wants to lower in the first place.18
A study published in 2021 noted that improving uric acid levels “helps reduce the risk of chronic diseases such as high blood pressure, obesity, diabetes, and insulin resistance.”19
I’m a passionate advocate for moderate-intensity exercise, and I explain why in more detail in this interview with cardiologist Dr. James O’Keefe. In his research, he noted that at moderate intensity, the body experiences dose-dependent reductions in mortality, diabetes, depression, high blood pressure, osteoporosis, and sarcopenia.
Moreover, O’Keefe found that long-term, high-intensity exercise provided no further benefit to those who did it. If you need further information, please read my article covering his research. Here we also provide examples of moderate intensity exercises you can do.
Oxalates cause an inflammatory response similar to gout
For years I had suffered from mysterious rashes, and I believed that sweating out the toxins in an infrared sauna three times a week might help. Despite our best efforts, the problem persisted. I eventually learned that I had developed a condition called oxalate dermatitis due to oxalates lodged in my skin.
Oxalates are natural compounds found in many foods, including leafy greens and seeds. It is also called a dicarboxylic acid because it is made up of two carbon dioxide molecules. The problem with oxalate is that under certain conditions it can lose a proton, leaving a negative charge that binds to positively charged ions such as calcium.
When oxalate combines with calcium, it forms oxalate crystals, which are insoluble and usually accumulate in the kidneys. In my case, my kidney function was impaired and it deposited on my skin.
So what do oxalate crystals have to do with gout? They work similarly to uric acid crystals. As previously mentioned, when the body produces uric acid faster than it can get rid of it, uric acid crystals begin to build up in the joints, causing gout.
While looking for a solution to my oxalate problem, I discovered citrate to be an effective tool. Citrate salts, made of calcium, potassium, or magnesium, bind to oxalates in the skin when applied topically. Because the process of oxalate accumulation is similar to the uric acid formation process in gout, it is thought that applying citrate salts to joints may provide similar relief from gout symptoms.
Interestingly, past studies have suggested a link between uric acid levels and oxalate formation. Excessive uric acid excretion can lead to the formation of calcium oxalate kidney stones because calcium salts remove mucopolysaccharide, a sugar molecule that inhibits stone formation.20
Therefore, to protect your health, a two-pronged approach is ideal: reduce alcohol intake to lower uric acid levels while also reducing your oxalate load. The most logical starting point is to avoid foods high in oxalate, such as:
- spinach – Typically, it contains 600 to 800 mg of oxalate per 100 g.
- Almond — Contains approximately 122mg per 100g. I also generally recommend avoiding nuts. That’s because nuts contain linoleic acid, a toxin that destroys mitochondrial health.
- Peanut Butter – It generally contains about 140mg per 100g.
- sweet potato – Contains approximately 30mg per 100g.
- Figs — Contains approximately 40mg per 100g.
Other strategies to help lower uric acid levels
Exercise is not the only strategy that can help lower uric acid levels into a healthy range. Here are some other recommendations you may want to try:
• Avoid processed sugar — According to a study published in Frontiers in Nutrition, fructose consumption stimulates the pathway that produces uric acid from amino acid precursors.21 Although the exact process has not been confirmed, several observations have been made. Obstetrician and gynecologist Dr. Liji Thomas explains:22
“After absorption, fructose is absorbed by the liver and converted to fructose-1-phosphate, which causes a decrease in ATP levels. The resulting increase in AMP means that if there is no phosphate available for phosphorylation, it is converted to IMP instead.
This can eventually enter the uric acid synthesis pathway. As fructose intake increases and ATP levels decrease, purine nucleotide production increases and uric acid increases, which may lead to side effects.
Another possible pathway is fructose-induced decreased insulin sensitivity due to peripheral fat accumulation, which may result in decreased uric acid excretion.”
To protect your health, avoid all forms of ultra-processed foods and drinks that contain refined sugars, especially high-fructose corn syrup. In addition to stimulating uric acid production, refined sugar is harmful to your health in other ways.
Examples include the production of endotoxins in the gut that destroy mitochondrial function, tooth decay, and heart disease. For more information about the dangers of fructose, read my article “Can Eating Refined Carbohydrates Make You Look Less Attractive?”
• Consider taking quercetin — People who experience gout take a variety of medications to lower uric acid levels and pain. However, these medications often have side effects and contraindications that make gout more difficult to manage. That is, according to a 2022 study:23 Quercetin’s antioxidant, anti-inflammatory, and antihyperuricemic effects suggest that it offers a way to relieve gout without the use of drugs.
According to information gathered by researchers, quercetin helps reduce uric acid production “by inhibiting glycolytic enzymes and increasing urate excretion by regulating renal urate transporters.” Moreover, quercetin inhibits the activity of adenosine, a key enzyme of purine metabolism in aortic endothelial cells.
Another way quercetin helps reduce production is by reducing the downstream process of fructose metabolism, which, as mentioned earlier, is another way the body produces uric acid.24
Quercetin is found in a variety of foods, including green leafy vegetables, broccoli, apples, onions, green tea, red grapes, and strawberries. Quercetin is also available as a supplement. It is a zinc ionophore, so taking it with zinc has a synergistic effect on immune function.25
