Does too much wine cause gout? Ask Decanter

There has been talk of a resurgence for this ‘disease of kings’ in the UK, but how accurate is the popular idea that drinking wine causes gout?

Gout cases in England rose by 153% between 2010-11 and 2017-18, reported The Times newspaper in January this year. Health officials were concerned enough to be considering new guidelines, it said.

This so-called ‘disease of kings’ has long been associated in the popular imagination with a lifestyle of gastronomic excess, and not least a diet high in wine. It is reported to have afflicted high-profile figures, from Henry VIII to Sir Isaac Newton.

While no one would wish to make light of gout, which is a form of inflammatory arthritis that can be extremely painful, is the historical association between the disease and wine an accurate one?

The answer is, unsurprisingly, not a straight yes or no.

Recent research published in the British Medical Journal has indicated that genetic factors might be much more important in causing gout than originally thought.

Professor Tony Merriman, who helped to lead that research, told Decanter.com that it is important to remember that gout is a two-stage process.

In simple terms, the first stage involves elevated uric acid levels in the blood, which leads to the formation of urate crystals in the joints.

In the second stage, gout becomes evident when the body’s immune system reacts to the presence of the crystals.

‘Diet is very important in triggering gout attacks in step 2,’ said professor Merriman, a gout specialist at the department of biochemistry at the University of Otago in New Zealand.

‘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.