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Beer and Gout Update
This is an old discussion about beer and gout. But it still contains many relevant and interesting points. However, before you discuss alcohol, it is wise to read the facts about gout and beer:
I’m reviewing all my beer and gout articles. So, please share your questions, opinions, and experiences at Beer and Gout review.
Why worry about gout when you’re drinking beer? Also, for the latest gout discussions, you should read:
Hi everyone,just wondering how fellow gout sufferers handle the alcoholic problem associated with gout.I liked a pint or 6 at the weekends,but had to cut it out due to purines causing attacks all the time the day after. My gout level was very high 9 plus at times.I Had a good diet and not overweight and exercised weekly.I have recently changed to drinking lite beers or pilsners when I go out now and again and check my Uric acid readings before and after. Usually there isn’t a change which is good,but the minute I drink draught beers it soars up. Just wondering what others drink. I also take 300 mg allopurinol daily and drink pure black grape juice and lime juice and 8 glasses of water a day.I try to avoid colchicine as it upsets my stomach. My level in three weeks has come down from 9.5 to 7.2. Cheers Phil.
I used to drink 2 pints of stella every day but now I am brave if I have 2 in a week! I just love stella! I have tried everything and cannot with conviction really say which is the best option for me……
BUT – having kept a diary of all my consumption there is sometimes a link between attacks after I have had a stella (sometimes no effects after 2 and other times BANG after just one).
However – I find cider has not produced the same – so I tend now to drink cider rather than stella – not more than say 10 pints a week but my diary doesn’t show any relation to when I drink cider only and subsequent gout attacks (moderate intake).
Hope that helps?I love scotch(cue someone singing the bit from weatherman) When I finally accepted my diagnosis, I still had a bottle of my favorite peaty scotch lying around the house. It is still here for my wifes cousin when he comes to visit I am done drinking. From a western/allopathic medicine point of view alcohol lowers the effectiveness of allopurinol, in addition since the medication and any of the meds that deal with flair ups can directly effect the liver, and so does alcohol one should be as kind to their liver as possible. If anybody wants I can also go into the causes of gout from the point of view of traditional Chinese medicine (TCM) and how the body uses uric acid(western science perspective) to help explain this, but in the end quitting drinking is what is necessary, there is unfortunately a point of view that once allopurinol is at the right level one can go back to the lifestyle that kicked the disease off in the first place(barring really bad genetics). And that simply isn’t true.
so Dorian – thanks for depressing me!
I am certainly averse to quitting alcohol altogether – don’t get me wrong – when I get a bad gout attack it is BAD – and when I do get it bad I do abstain totally…..
but I really am hoping that when my acid levels have gone down that I can have more than ONE Stella a week.
If alcohol plays SUCH a big role in causing gout why do we bother getting acid levels down (I am talking about people who have linked alcohol to attacks rather than food/hereditary as main cause) – why not just stop drinking alcohol?
What I am trying to ask is this: if acid levels are down then surely moderate alcohol intake should be safe? Surely a few beers against hundreds of pills can’t be equal opposites? I am worried at how unfair it all is if it is a case of taking allopurinal everyday for months and months and then still get an attack when I occasionally have a few Stellas a week?Just read what I wrote…..not very clear…….
what I am trying to say is surely a few lagers cannot undo all the good work done by swallowing allopurinol for months…..Barry I am no expert and I am also a practitioner of Chinese medicine so I have my biases, however, your body is already telling you different. One of the things that is often neglected, is why do we have uric acid, one of the main reasons that we utilize uric acid is it is a antioxidant with powerful anti inflammatory properties, we produce more due to chronic inflammation, and since 90 % of gout sufferers are under excretors, and since a major reason the kidneys re-uptake uric acid is because of the inflammation, we should be looking at what causes our inflammation. Alcohol overall is very inflammatory, as are simple carbs, wheat, sugar, and many processed foods. The only person whose current research into gout and diet that I have read(besides keith here) that parallels what my research has found is(and whose books I am eagerly awaiting now) is rose scott the gout diet thepurine myth and the good bye to gout the new gout diet( don’t worry I have no business contacts with her so this is not a plug), which again parallels much of what keith has said here and what I have found. As a side note 10 pints of anything doesn’t sound like moderation to me(sorry to sound like such a dick)
also here is another thing to consider we already know that too much iron in our system(and that means iron that has not been processed by the cells) causes an increase in XO activity, one of the main trace elements that helps us process the iron is copper, which reduces as we age(it is linked to testosterone), guess what substance reduces the amount of copper in our body, yup mine and your friend alcohol. Jus found this in my research. Once again I know this news is a bummer, I treat patients all day(and if I followed my own advice I would never have been in this shitty situation to begin with, but I am getting out) and it always amazed me the number who would rather engage in their vices than get better (not me of course oh no not me I was somehow different from them), in fact usually if a patient is engaging in some addiction(not just drugs think over training, like ultra runners) and you point out they need to stop, that is the last time you see them. Listen this disease has been a blessing in some ways, one I have decided that longterm I will specialize in autoimmune and rheumatic conditions, two it forced me to make changes that even without the disease I needed to make, three since it is linked to metabolic syndrome my body could have easily told me I had went to far less gently, say a heart attack, stroke, or renal failure. Take this as an opportunity to change your life and really for the better. Perhaps with looking at the real causes of hyperuricemia you can actually live a gout free and medication free life. I am guessing you are in England(from the use of cider and pints) if so I may know someone for you to consult with.
Thanks Dorian for the comprehensive reply. As already said I don’t plan to stop alcohol altogether as I really enjoy a stella (just like I am not going to stop other “inflammatory, as are simple carbs, wheat, sugar, and many processed foods” altogether – I plan to learn how much I can tolerate – in fact I have been gout free for 2 weeks so decided to see what happened if I had 2 cans last night – absolute bliss – nectar – one good thing has come from all this – I really do savour the taste now and appreciate every drop!
No ill effects from last night’s stellas – so will give stella break for a week and “indulge” myself once a week with 2 cans and see what happens!
Thanks again – and good luck to you and all fellow afflicted.Thanks for the information.I also take pure lack cherry juice daily on e bay,natures own and this seems to help my gout.I take readings before I have a drink and readings the next day. I can tell if a attack is eminent as my big toe throbs like mad,my Uric acid reading before going out was 6.5 and after having 3 pints of cider and 2 lite beers was 6.5 the next day but when I went out and had 4 pints of draught bitter on pump it rose the next day to 8. So this is what seems to work for me, avoid at all costs any draught pulled beers on pumps or cask fermented beers especially real ales as much as I like them.chinese food is a no no too as recently this put my Uric acid levels up high too. More water and veg it is then. My level today is 7.1 at the weekend it was 6.5 more effort required, stopped my 300 mg Allpurinol I have been on for 4 weeks due to making me really drowsy etc is this a common side effect and would it have worn off. Cheers Phil
Hello Phil (and others of course) – when you say you take readings what exactly do you mean? I was under the impression that home kits were pretty much useless – maybe I have misunderstood what I have gleaned. Are you confident you have confidence in those readings and have you tested compared with ones taken at the same time by say the hospital?
I had 2 stellas last night (first 2 since 2 weeks ago) and so far am fine today. I also went for a blood test today – will get results on Friday. I have started drinking cider as for some twisted (or not) reason I feel that if cider vinegar is supposed to be good then cider itself isn’t too far different! Anyway cider (max 2 if I do indulge) has only been associated with one attack recently but after 2 pints that time I did also have a glass of red wine – 10 hours later the gout came! I am blaming the wine for tipping me over the edge. Otherwise I cannot put an attack down to cider alone when I have had my 2 pints. Unfortunately I cannot say that for stella which I am really really missing!Beer and gout discussion continues after this update notice…
Beer and Gout Update
This is an old discussion about beer and gout. But it still contains many relevant and interesting points. But, for the latest gout discussions, you should read:
However, before you join those discussions, it is wise to read the facts about gout and beer:
I’m reviewing all my beer and gout articles. So, please share your questions, opinions, and experiences at Beer and Gout review.
Why worry about gout when you’re drinking beer?
There’s a few ‘sub-plots’ running through this thread. That’s nice, but as Phil started it, I want to give my take on his issues relating to beer and gout.
In your first post, Phil, you indicate that draught beers raise your uric acid levels, but other drinks do not. First I would say that you need to be able to retest this several times to be sure it isn’t a coincidence. For accurate testing, you have to keep everything the same apart from changing beer to something else. This is actually very hard to do in practice. It’s why I gave up with my meter – apart from the cost of test strips. I found I was trying to justify results rather than focus on gathering accurate data.
I think if you do find conclusively that uric acid rises with beer, then it’s best to avoid it.
To me, the bigger issue is that your uric acid level is simply not low enough. Every gout sufferer needs to be below 5mg/dL, except those who have other illnesses that might make 6 the upper limit. During the first few months of uric acid lowering treatment it makes sense to aim much lower – i.e 2 or 3 mg/dL. That way, the uric acid crystals that have built up over several years will dissolve faster. Whilst they exist, I believe they can easily confuse any attempt to measure uric acid levels accurately.
If I’d been good enough to answer you earlier, I would have recommended getting your allopurinol dose increased for six months to a year, until you get stable results and no gout flares. Then you can start experimenting to see which drinks, or other foods, allow you to reduce your allopurinol dose the most.
Unfortunately, I’m late answering, and now you’ve added more information that disturbs me. It sounds like you are trying to avoid allopurinol altogether, and rely on diet changes. Now, I’m not saying that you cannot do that, but it’s not an easy path.
I’m not sure what to suggest next.
If drowsiness is a problem, has it been constant throughout the time you took it? Unfortunately, my early allopurinol experience was accompanied by recovery from an accident, so I put drowsiness down to that and other meds. It might have been a side-effect. I can’t be sure, but I do know that I did not feel any drowsiness after a few weeks. Sorry to be vague, but I never associated drowsiness with allopurinol. If it did happen, it soon passed.
Another thought on that is that, when you first start lowering uric acid, you are starting a recovery process from a disease that’s been eating away at you for years. In those circumstances a little tiredness might be expected. Certainly, with any other disease, you would be expected to take extra rest during your recovery period.
All of this is why I advocate starting with a plan. That should include target uric acid levels over the next 12 months. The plan needs appraisals every so often to review targets, and change doses, or even switch treatments.
As I say, I’m not sure what to suggest next. I want to help you get your uric acid under control, but I’m not sure how I can help you best. What’s most important to you now, Phil?
My 2 cents.
I too realy enjoy beer, wine and scotch in moderation with the occasional weekend of overdoing it. I have suffered from gout for many years and after my last REALLY bad flareup earlier this year and having read all the good advice on this site, I decided to get on Allopurinol. I abstained from all alcohol and once my Uric acid level got to below 5mg/dL I slowly started drinking alcohol again. I am now drinking the same as before and knock on wood have not had any major flare ups just a couple of really minor ones at the beginning which I believe we’re due to the old crystals being flushed out of my system.
Excessive alcohol, sugar, sodium, saturated fats etc. are bad for your health regardless if you have gout or not. However, I truly believe that if you get and keep your Uric Acid under control, you should be able to eat and drink as you please within moderation.
Again, just my 2 cents.
Cheers,
RonHello Ron – tha’s good news – the type I want to hear! I too am hoping this is what my situation will eventually become. I was really getting fed up with the idea that even though I take allopurinol I ALSO have to stop drinking altogether. My view is if people keep telling me it is the booze that causes the gout and that I must stop boozing altogether to avoid gout then why I am bothering to take allopurinol too??!! I am hoping the allopurinol regime will eventually let me have a Stella or two a night without fearing a gout attack. Thanks.
Barry, I’d like to echo what Ron say’s about the freedom you get with food and drink once allopurinol has done it’s first job of helping you get rid of old crystals. I notice on your profile, you’re at 287 μmol/L for your uric acid. That’s 4.8 mg/dL, so you’re well on your way to recovery.
Shouldn’t be long now before you can relax and enjoy.
I like Ron’s statement:
“Excessive alcohol, sugar, sodium, saturated fats etc. are bad for your health regardless if you have gout or not. However, I truly believe that if you get and keep your Uric Acid under control, you should be able to eat and drink as you please within moderation. ”Moderation is always good for gout, but it’s important to recognize general health benefits as well. Once I controlled my gout, I found it empowered me to make healthier choices generally. I can still enjoy myself with the occasional drinking session, or blow-out meal. But most of the time I eat healthier, cos I don’t want to be gout-free only to get other health issues. I’m still working on shedding a few more pounds (obviously not hard enough!), but I’m hoping the worst of obesity is in my past now.
I had a few pints and a nice meal on Saturday. The 34″ waist jeans still fit. The 40″ ones that were getting tight last year are in the bin. 🙂
Yes Keith – my acid levels come down quite nicely – Doc started me off on 100mg a day and then increased to 200mg (allopurinol) when not enough progress made – still on 200mg and it seems to be doing the trick. I too don’t plan to go overboard with the booze and go back to my previous consumption, which was possibly too much from all points of view – health and gout – I still am a bit wary of wine and lager but seems cider (max 2 pints when I do indulge) is ok – so far anyway – been brave the last 2 weeks and have had about 10 pints a week and probably won’t go higher – but I certainly do savour every drop whereas before I tended to guzzle!
I spoke too soon! still not over-indulging but also not taking as many nights off the booze as I have been recently – and BANG – my knee in beeeg gout pain on Wednesday night – still sore and feeling very woozy after starting the colchicine! Just thought I’d let others know that the idea of sticking exclusively to cider is not going as it looked like it was – pity – as I was stating to miss my Stella less and less – now I am going to miss my cider!
That’s a shame Barry, when everything was going so well.
A big problem with gout is that so many different things can cause an attack. Alcohol might be a factor, but I can’t see how type of drink will make a difference. In fact, there’s no way to tell if the gout flare is alcohol related or caused by other common factors such as food, temperature, falling uric acid or something else.
The only thing that is certain is that, with uric acid safely below 5, attacks will get less frequent, less widespread, and less intense. The lower you go, the faster that happens, but gout attacks remain a risk until most existing uric acid crystals dissolve.
Barry,
If I understand your previous posts you’ve been on Allopurinol for slightly over six months going from 100mg to 200mg. From what I’ve read it can take well over a year for all your old uric acid crystals to dissolve.
So, don’t despair eventually there will be no more flareups as long as you stay on the Allopurinol.
Ron
Thanks Ron and Keith for input.
I keep getting told about “old” crystals causing flare-ups and once these have dissolved (once uric acid levels are in safe zone for a while) then these flare-ups should stop. What I cannot get to grips with is where do this old crystals lurk before they decide to cause a problem? Logc tells me that a flare up is caused by a crystal being formed (due to indulgence,temperature etc) and that these crystals form in joints – hence the problems.
IF there are “old” crystals in my blood stream or wherever anyway, why aren’t they causing me problems – can crystals exist without causing problems? Is it these combining factors that cause the old crystals to decide they are going to go for a joint? – whereas before the factors kick in they lurk elsewhere and don’t cause problems?
I know it is a combination of things but surely bottom line is: crystals at joints cause the gout problem.
I took a chance last night – went for a curry with a mate I hadn’t seen for ages and had 2 ciders and 2 glasses of wine and touch wood – so far OK.
Thanks again.Hi Barry,
I think it’s a good question that you’re asking.
I had a toe that was swollen and odd looking for a couple of years. It caused no pain unless i squeezed it, which of course I avoided. I didn’t know it was gout because even when i had the odd gout attack every year or more, it wasn’t the toe that was painful but somewhere else. Then, this year, i got an attack and the toe erupted with tophi. 3 months on it still hasn’t healed though is much better as my levels (on 200mg Allpurinol) have dropped below 5.
And here is my idea as to what the “old” crystals are.
Correct me anybody if it seems wrong, please.There is some kind of tipping point and uric acid builds up, you have an attack or “acute gouty arthritis” that goes away as you have expelled some uric acid. The crystals are still in your joints waiting to build to the tipping point. When the next stage hits – the “chronic tophaceous gout”, the tipping point has been reached in several joints and it’s a big blast that is hard to shake. As the Allopurinol starts reducing the uric acid, the tipping point is reduced and so the flares occur.
Why the tipping point might be reduced by Alo, I don’t know. You would think if it lowered the level that the “old” crystals would just hang around waiting like they were before – I think that is the gist of your question, Barry.
So, my question out there is, if Alopurinol lowers production of uric acid, why don’t the crystals hang around until it is raised again?
Because if the lowering of the level creates flares, does that mean before an attack (pre- Alo) our levels were dropping, sparking an attack?Seems a mystery, the whole damn thing.
Tim“Seems a mystery, the whole damn thing.”
Absolutely spot on Tim. Every day the experts are finding new explanations for different aspects of gout. The only truth that bears out is my last response to Barry:
“The only thing that is certain is that, with uric acid safely below 5, attacks will get less frequent, less widespread, and less intense. The lower you go, the faster that happens, but gout attacks remain a risk until most existing uric acid crystals dissolve.”But Barry’s new question is fascinating (at least to me):
“where do this old crystals lurk before they decide to cause a problem?”When we experience a gout attack, it’s our immune system telling us there’s a problem. We’re not supposed to have non-human matter floating round our bodies. Our white blood cells hide the crystals by engulfing them. They die in the process, but the invader is hidden.
Now, that stops our immune system sending out inflammation signals. The pain goes away, but the problem doesn’t. Without stopping the uric acid excess, we just get more of the same. In advanced gout, we can see this as tophi start to burst through our skin. But we don’t see the smaller deposits, or the deposits hidden deep within our bodies. I don’t fully understand the next part of the process, but as deposits grow, they harden. Tophi become solid lumps, so it seems like there’s some sort of calcification process. Anyway, there’s more to the lumps than pure uric acid crystals. Crystals are engulfed in white blood cells, and this hardens into something more.
If you did not treat the excess uric acid, or didn’t treat it well enough, uric acid crystals would continue to form, and at random, these cause gout attacks. I say “at random” because the theme of this thread is beer causing gout attacks, but not other alcoholic drinks. I don’t believe that to be the case. I do believe that alcohol can play a part in the gout problem, but it is one of many factors, so attacks will never correspond directly to alcohol drinking.
If you do get uric acid below 6, through allopurinol or any other means, then uric acid crystals start to dissolve. This is based on the equilibrium laws of inorganic chemistry, but there are confounding factors:
1. As uric acid crystals dissolve into the blood, they raise blood uric acid until it is excreted by the kidneys. In some cases, this might trigger new crystals to form. Adequate hydration is vital, but some gout patients with low excretion rates are best advised to support allopurinol with an uricosuric. If you’re reluctant to add more meds, then there are dietary ways to encourage this.
2. Some of the crystals will be isolated from the bloodstream by the aforementioned coating of white blood cells that have built up and hardened. We’ve had a few reports from long term allopurinol users who have experienced flares after years of no gout symptoms. My best guess in this situation is that a long-hidden cluster of uric acid crystals has suddenly started to dissolve. In any event, this explains why gout attacks appear at random for a few months after you start uric acid treatment.I hope that answers Barry’s question. As for Tim’s ‘tipping point,’ I don’t think it’s that straightforward. There is certainly a tipping point as far as our immune system is concerned. I don’t think anyone knows what it is, but a single uric acid crystal is unlikely to trigger the massive inflammatory response that we experience as a gout attack. So, how many uric acid crystals does it take trigger the attack? I’ve never seen any research that explains this, but I’d love to hear from anyone that knows. One important thing to bear in mind about the ‘tipping point’ is that it only relates to uric acid crystals that the immune system can identify. That means new crystals forming when uric acid is high. It also means old crystals that are partially dissolved to the point where the dead cells that hid them fall away.
There are a few mysterious unknowns that can make gout management very complicated. However, basic understanding of the immune system makes it a little bit less of a mystery.
Keith,
What a detailed and in depth answer. I’m always learning something new about gout on this site.
One thing you didn’t mention that you have before is how FFA’s (Free Fatty Acids) may actually cause the gout flare up while high purine foods and beverages increase uric acid which is the fuel.
Perhaps this is one more piece in the puzzle as to why Barry experienced another attack ?
Beer and gout discussion continues after this update notice…
Beer and Gout Update
This is an old discussion about beer and gout. But it still contains many relevant and interesting points. But, for the latest gout discussions, you should read:
However, before you join those discussions, it is wise to read the facts about gout and beer:
I’m reviewing all my beer and gout articles. So, please share your questions, opinions, and experiences at Beer and Gout review.
Why worry about gout when you’re drinking beer?
Thanks Ron,
I think you are right in saying “one more piece of the puzzle”
There are so many things that can trigger an attack, and I believe they are often very individual. For instance, @susan-lewis-suselew wrote recently about lack of common redness with and only minor swelling with her gout. Her immune response might be different from most, but I’ve no idea how we can measure that.
It seems that, as soon as we learn something new about gout, we uncover more mysteries.
Many doctors are still stuck with “one size fits all” gout treatment plans. But leading rheumatologists emphasize individual treatment plans for each gout patient.
Thanks gents for comments – I have been away for a few days and ignored e-mails etc! I will read your input carefully a bit later and comment – thanks
Thought I’d give an update. I can’t say whether it is down to the allopurinol or not but I haven’t had an attack for 5 weeks (touch wood!) despite having 2 cans (sometimes pints if I am at the pub) of cider a night. Before I started taking allopurinol I could go for months without an attack even with drinnking much more so I cannot rule out anything really. But – just thought I’d let you all know that perhaps cider is the way to go? I miss my Stella but did get convinced that strong lagers were blamed for high purines. My rationalisation that cider could be OK was down to the old wives tale that cider vinegar was good – and surely cider can’t be too different from cider vinegar! Well, I believe it anyway!
Great update Barry. I was going to take you to task for not supplying latest uric acid test results. But, who cares – an update is an update 🙂
You are a fine example of a good gout patient. Find your own way to deal with the gout pain. And never take your eye off safe uric acid numbers.
It’s 3 and a half months since you started here, and we’ve had some great discussions. Is that over six months on the allopurinol now? I always see six months as a milestone in gout. In my opinion, once you’ve gone six months with uric acid under 300 μmol/L, and not had a gout flare, you’re pretty much ‘cured’. You say 5 weeks without an attack, and I’m hoping it’s the first 5 weeks of your Gout Freedom!
Anyway, Wednesday is my weekend, so it’s off to the pub to meet my Mum for lunch. I’ll be raising a glass to your continuing improvement, Barry. I’ll also be toasting all the other gout sufferers who make my GoutPal project so fulfilling for me.
Cheers!
Keith,
That’s an interesting comment you make about being on Allopurinol for 6 months and no gout flare means your pretty well cured. I’ve been on Allo for almost 8 months and no flare ups so that makes me feel real good !
I’m back to exercising and playing sports like I used to and I’m still enjoying my beer & wine and occasional scotch. My next visit with the doctor is the beginning of December so I’ll post my uric acid acid levels once I get them.
If I am indeed “cured” I owe a wealth of gratitude to you and this site for steering me in the right direction and giving me support I needed to get on the right track to beating gout.
Barry, I hope that your flare ups are behind you and you can start enjoying your Stella’s again !
Cheers,
RonHi Ron and Keith
yes – been on the allopurinol now for 30 weeks (firstly at 100mg a day and latterly at 200mg). I do sincerely hope and want to believe it is the fact that my acid levels have gone down (287 micromols at last test in August) that is to be attributed and not just how it has worked in the past – ie I could go months without an attack before I started on allopurinol – very random. I am due for another blood test on 13th Oct and will let you know the results.
Thank you for your interest and comments and I wish you well!Ron, I’m blown away by your comments. It’s great of you to take time to let us all know about your progress.
It’s a wonderful feeling for all gout sufferers to know that our gout is improving. It’s a wonderful feeling for me to be part of that.
Barry, the apparent randomness of gout attacks can be confusing and confounding. I can’t tell you the number of bad days I’ve had in the past, wondering what I’ve done to deserve another gout flare. I’m certain you’ll soon be looking back on recent months as the time you found Gout Freedom. I know that’s an optimistic hope at the moment. But, I can’t wait for your test results to confirm that you’re continuing to control uric acid.
Thanks guys for a really optimistic start to October 🙂
Thanks for all the replies,as mentioned previously I am ok drinking a couple of lite beers preferably German and pilsners also a couple of original ciders .The minute I touch any draught beer that’s when the gout flare up starts so I permanently avoid my much loved draught bitters now completely. Cheers Phil
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