Goutte et Alcool

Pourquoi l'alcool provoque-t-il autant de crises de goutte

Since most of my gout attacks have always occurred after I’ve had a few drinks in the past day or few days, we will begin our education by me explaining the relationship between gout and alcohol consumption. The bottom line fellow gout sufferer is that drinking more alcohol significantly increases the risk of triggering gout attacks and developing gout in an otherwise normal person. Now I was never an alcoholic but in my early twenties, I liked to go out on the weekend with friends and have a few drinks or even share a bottle of vodka for a friend’s birthday party. It was a very normal thing to do and I was like everybody else at the club, bar or pub, just having a good time with friends but the plain truth is that alcohol consumption increases uric acid levels and people with gout should probably avoid alcohol.

Alcohol enhances purine metabolism to produce more uric acid which can accumulate quickly. In addition, alcohol also stimulates the formation of lactate which reduces the kidneys’ ability to excrete uric acid. Beer is quite high in purines while other forms of alcohol promote purine production in the body which produce more uric acid. There’s no escaping the negative effects of alcohol when you have gout.

Une une étude menée en 1984 par le Journal de l'Association Médicale Canadienne, 24 patients with properly diagnosed gout according to the American Rheumatological Association criteria were matched with controls for age, weight and sex, and use of diuretic. Alcohol intake was determined by asking patients how much they drank on each occasion they were seen, over a five-year period. The results came out that patients with gout drank more excessively. Another study completed in 1994 by T.Nishimura et al. (43:745-748):

“Five healthy men who regularly consumed no alcohol, or less than 20 grams occasionally, and five health regular drinkers who consumed more than 60 grams of alcohol a day were given an oral alcohol load of 0.5 grams of ethanol per kg body weight. Blood samples were taken for up to four hours for measurement of xanthine and xanthine metabolites and for uric acid.

Résultats :

Avant la prise d'alcool, les concentrations d'acide urique et de xanthines étaient identiques chez les buveurs et les non-buveurs.

Chez les abstinents, l'ingestion d'alcool n'a eu aucun effet sur la concentration d'acide urique et de xanthines.

For regular drinkers, ingestion of alcohol resulted in prompt increases in xanthines (by 1.5 µmol/L for hypoxanthine and 5 µmol/L for xanthine) by 60 minutes. Uric acid also rose, by about 40 µmol/L, at 180 minutes.” 1

Dans une autre étude publiée en 2017 dans Arthritis Research & Therapy es chercheurs ont constaté que la consommation d'alcool altérait le risque de goutte par le biais du métabolisme du glucose et de l'apolipoprotéine. Les chercheurs ont conclu que la consommation d'alcool contribuait de manière causale à la goutte par le biais de la glycolyse et du métabolisme de l'apolipoprotéine.

Dans une autre étude, voyons ce qu'ils ont à dire sur la consommation d'alcool, en particulier la bière :

“In a étude publiée dans la revue médicale The Lancet ce printemps, des chercheurs ont suivi plus de 47 000 professionnels de la santé masculins sans antécédents de goutte pendant jusqu'à 12 ans. À la fin de l'étude, près de 2% des hommes avaient connu des crises de goutte. Les hommes qui buvaient le plus d'alcool chaque jour avaient deux fois plus de risque de développer le trouble que ceux qui ne buvaient pas. Les buveurs de bière ont augmenté leur risque de 50 % pour chaque portion quotidienne, tandis que ceux qui buvaient des spiritueux ont augmenté leur risque de 15 % pour chaque boisson. Les hommes qui buvaient du vin ne semblaient pas augmenter leur risque de goutte, bien que peu d'hommes aient bu plus de deux verres de vin par jour, donc ces résultats sont moins concluants.

The researchers believe beer consumption leads to gout because of its high purine content. Through the process of digestion, the purine compound breaks down to form uric acid. Normally, uric acid leaves the body through urine. But if the kidneys are unable to process all of the uric acid, levels in the blood become too high. The uric acid may then form crystal deposits in the joints. These deposits are the cause of gout. Beer was more likely to be associated with gout than spirits, and spirits in turn more than wine.” 2

So beer contains not only alcohol but it also contains purines! PURINES which are found in high protein foods and what your doctor first mentioned to you was the probable cause of your gout. Here’s a helpful article on 7 boissons qui peuvent augmenter votre risque de goutte et en particulier ce qu'il en est de la bière :

“Beer contains a large quantity of purines and has a strong association with gout attacks. One study estimated that patients who consumed a 12-ounce serving of beer daily were 1.5 times more likely to have gout compared to those without alcohol consumption,” says Dr. Sloane. Beer is especially bad for you if you tend to get gout symptoms because it is high in alcohol and brewer’s yeast, both of which may trigger gout pain.”

Also check out the other beverages we gout sufferers should try and avoid or at least limit their consumption like soft drinks which I’ll talk about in more detail in a future post:

“One large study found that just one sugar-sweetened drink per day doubled a woman’s risk of developing gout compared with women who had less than one sugar-sweetened drink per month. “Studies show that sugar-sweetened drinks and fruit juices are associated with an increased incidence of gout attacks.”

La goutte et la bière

Une chose que vous devez savoir, c'est que l'industrie de l'alcool n'est pas tenue de signaler les ingrédients sur les étiquettes et elle a fait pression pendant des années pour que cela reste ainsi afin de protéger ses recettes, mais surtout pour cacher les ingrédients qui sont simplement mauvais pour vous.

Par exemple, la bière Newcastle contient un colorant caramel fabriqué à partir d'ammoniac, qui est classé comme un cancérigène pouvant causer le cancer ! La bière Corona du Mexique contient du sirop de maïs génétiquement modifié, très similaire au sirop de maïs à haute teneur en fructose, ainsi que du propylène glycol. On dit que la bière Michelob Ultra contient un édulcorant génétiquement modifié, également appelé dextrose OGM. Ensuite, le roi des bières Budweiser a été trouvé pour contenir du maïs génétiquement modifié OGM, et l'autre bière populaire Miller Lite contient du maïs OGM et du sirop de maïs pour sucrer le goût, tout comme Coca-Cola et Pepsi le font, de même que les entreprises de boissons alcoolisées.

So you can understand why alcohol nowadays may be responsible for so many gout attacks around the world. Guinness beer which was one of my favorite beers due to its’ creamy smoothness, contains high fructose corn syrup but also fish bladder! Why did they do that? Beats me! I remember saying to myself after a few gout attacks, “I’ll only stick to Coors light beer from now on since it’s low on calories, has a light taste and doesn’t bloat you as much”, …well I sadly discovered later on that it too contains GMO corn syrup.

Alors, quelle quantité d'alcool est trop ?

Je vous suggérerais d'éviter complètement l'alcool, mais si vous ne pouvez pas vous en passer, il y a certaines limites que vous pouvez suivre. Une boisson de temps en temps est acceptable. Cette seule boisson vous mettra déjà à risque de 36% pour une crise de goutte récurrente. Une consommation élevée d'alcool signifie que vous buvez 12 boissons ou plus par semaine. Vous ne voulez pas être trop indulgent et vous rapprocher trop de cette plage.

Bien que je ne recommande pas de boire de la bière si vous souffrez de la goutte, si vous choisissez de boire un verre lors d'une soirée barbecue chez un ami et que vous envisagez d'en prendre un, alors envisagez une bière biologique brassée localement avec des ingrédients biologiques. Évitez les bières américaines car beaucoup d'entre elles contiennent des OGM. La bière Heineken serait mon premier choix ou une Amstel Light, mais ne buvez pas plus d'une bière.

Si vous avez développé la goutte à un jeune âge (avant 40 ans), vous devez être particulièrement prudent, car l'alcool peut être un déclencheur plus probable d'une crise de goutte. Dans une observationnelle étude, which followed 700 people, they found that those who developed gout before 40 were more likely to experience a gout attack triggered by alcohol compared to those who had gout after 40. This is probably because younger patients are more likely to drink beer than any other type of alcohol. 

Mais qu'en est-il du vin ?

Wine seems to be the lesser evil compared to all alcohols but that doesn’t mean you should go on a wine drinking spree. Wine is alcohol and it can still increase your risk although there have been some conflicting opinions on this. Some don’t seem to have a problem while others still experience a gout attack after having a couple but there is a consensus that all alcohols including wine must be avoided during a gout attack because they can worsen the flare.

Jusqu'à ce qu'il y ait plus de données, nous devrions simplement supposer que le vin est tout aussi mauvais que n'importe quel alcool et donc devrait être strictement limité dans la consommation.

If you just started taking gout medication, you need to be especially careful with your alcohol intake within the first six months since certain medications make you more vulnerable to gout attacks in the beginning.

Est-ce que l'arrêt de l'alcool éliminera ma goutte ?

It won’t, unfortunately. Eliminating it from your lifestyle is going to reduce your risk for gout attacks because you’ll need to do other things as well such as eat a healthy diet and stay active. In addition, you also need to be taking uric acid lowering medication. This is because gout has a strong genetic component, but it is also strongly influenced by lifestyle factors like diet, alcohol intake, body weight, kidney function and compliance of medication. This means that no matter how religiously you avoid alcohol, you’re still at risk for symptoms if you don’t control your uric acid.

En conclusion, je terminerai cette publication avec ce fait sur l'alcool :

“Alcohol does all kinds of things in the body, and we’re not fully aware of all its effects,” says James C. Garbutt, MD, professor of psychiatry at the University of North Carolina at Chapel Hill School of Medicine and a researcher at the university’s Bowles Center for Alcohol Studies. “It’s a pretty complicated little molecule.” 3

Yes, it is and I am a witness to it, yes you may get gout attacks triggered from purines or something else but I tend to get my attacks either the night of, after having a few drinks or having had a few drinks a couple of days before. It always gets me even after the last time several months ago in which I stopped my Allopurinol completely for about 3 months thinking I probably had this thing beat; whereby I had a couple of beers on a Saturday, then a beer with my meal at my mom’s place on Sunday and finally had another glass of wine with my supper on Tuesday. Then Wednesday night the gout attack followed on my right toe and was back at my local clinic getting a prescription for Colchicine.

Of course, alcohol shouldn’t be the only one thing you monitor. Though it’s on top of the list of things to watch out for, you should also avoid high purine foods, avoid getting dehydrated, and control your weight. A combination of all these things will help reduce your risk for experiencing a gout attack. 

So, watch your alcohol intake dear gout sufferer! Tread carefully!

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This article is for educational purposes only and should not replace medical advice. Patients should consult their physician for individual management.