Does Coffee Affect Gout?

'A Quick Readers Question From A Gout Sufferer'

Coffee is largely thought of as a help in the treatment of gout. But the evidence around gout, uric acid build up and hyperuricemia (which causes gout), is not so simple. We were asked the question “does coffee affect gout…and if so how?”

In this article, we examine the cases for and against.

Does Coffee Affect Gout… Checking The Evidence

Coffee is a staple in many people’s diet. It is a relatively healthy shot of caffeine that can help drive alertness and brain activity (and is much more healthy than the newer caffeine-filled energy drinks on the market).

However, hyperuricemia (the technical term for a uric acid build up) is known to be majorly affected by diet and smoking. Drinking caffeine drinks is often put in the same box, so it is not surprising that some people worry that coffee (even de-caffeinated) may be adding to their gout pain.

Indeed, eating too many high purine foods (such as shellfish or red meats), excessive alcohol consumption and even drinking sugary drinks are considered amongst the biggest triggers for the build-up of uric acid and ultimate formation of urate crystals that is gout.

Coffee beans in the shape of a heart and heart monitor

What Does The Evidence Say?

In one sense the evidence is pretty conclusive – does coffee affect gout? Absolutely yes, the evidence would seem to suggest that coffee does appear to affect gout. And, on balance, I think it is fair to say that coffee is actually good for gout.

However, some academics would still argue that the case for coffee’s role in controlling or reducing gout is actually not that clear cut at all.

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Does Coffee Affect Gout… Can It Help Prevent It?

Let’s start with the positives –

In a major review of all available literature published in the American Journal of Lifestyle Medicine, coffee was singled out as one of the items for specific review – further providing a positive answer to the initial question of ‘does coffee affect gout?’

Furthermore, the authors noted that…

“coffee consumption has been found to be associated with lowered serum uric acid level and hyperuricemia frequency”

Just a quick reminder for the non-academics reading this – hyperuricemia is just a long word used to describe a build of uric acid, the type of which is likely to be turned in to urate crystals (the urate crystals then forming around your joints and causing gout or ‘gouty arthritis’ if we are going to be really accurate).

Academic studies…

And for the academics reading this, the review cites two clinical trials in particular – one by choi et al in 2007 and one by kiyohara et al in the British journal of nutrition 

The first trial by Choi was particularly interesting because it showed not only a positive relationship between drinking coffee and uric acid levels, but also that the same levels were NOT significantly affected by tea.

This means that it is not the caffeine, but mostly likely all the other ingredients in the coffee that tempered uric acid levels and therefore hyperuricemia.

The belief is that coffee can lower your uric acid levels principally by increasing the rate at which your kidneys can excrete (get rid of) the acid.

Uric Acid Meter

If you remember, uric acid is produced by your body and then excreted through your kidneys. You can reduce chances of gout by either producing less acid or speeding up the rate that it leaves your body.

Produce too much or get rid of it too slowly and you get the uric acid build-up that is gout.

In the case of coffee, there seem to be clear benefits for the rate at which you excrete the uric acid.

However, the review also cited another potential benefit to consuming coffee – the possibility that coffee may actually stop the enzyme designed to break purines in the body (known as ‘xanthine oxidase’).

Purines = uric acid = hyperuricemia = (possible) gout

Knowing that purines (in fish and meat in particular) are a major source of uric acid production, this would then suggest that coffee also slows down the rate at which your body can produce uric acid.

This conclusion has been backed up by several other major reviews of recent literature, but in truth they are all relying on the same basic group of trials, so there is limited value in sharing the same conclusions.

It would appear though that coffee has something of a double whammy effect – both slowing down how fast your body turns purines into uric acid and increasing the rate at which your kidneys can get rid of the same gout inducing uric acid.

From this, a clear case can be made that the data is fairly clear – not only does coffee affect the likely build of gout by altering uric acid levels, but it does so in a positive manner, causing them to fall.

Does Coffee Affect Gout… Is It Really A Trigger For A Flare Up?

The case against coffee helping gout.

The argument against coffee is frankly rather pointless. By which I mean the case against coffee being effective in lowering the risk of gout is actually based on the fact that there is isn’t enough evidence to prove conclusively that there is a connection.

There is no actual evidence to suggest that coffee is harmful, but many of it’s critics point to the fact that other factors may have skewed the data towards the benefits of coffee.

A lovely cup of coffee

One often cited review by critics in the British Medical Journal  points out that the good links were not strong enough to be considered statistically significant, while another published in ‘Arthritis Research and Therapy’  suggested that genetic variations can alter the relationship between coffee and gout, skewing any positive data.

However, as both are merely speculating that the positive links to coffee may be more circumstantial than direct, without direct evidence, seems somewhat spurious.

If drinking coffee has somehow worked for patients with gout, then great – you’ve got nothing to lose in trying it and quite a lot to gain if it helps. Sometimes even scientists can overthink things.

The Final Word –

Whichever way you look at the relationship between coffee and gout, it would certainly seem that coffee has a positive effect.

Even an article in the ‘caffeine informer’ titled ‘caffeine may cause gout’, reaches the conclusion that actually the various studies available suggest a very positive link, not a negative one.

Yes, some of the data may not be as clear as we might like, but given the risks of drinking coffee are basically nil (other than possible caffeine addiction!), it would be fair to consider coffee on balance a help in preventing gout.

So to answer our member’s question – does coffee affect gout? Yes – and in a positive way.

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References –

1.Miki Kakutani-Hatayama, MD, PhD, Manabu Kadoya, MD, PhD, Hirokazu Okazaki, MD, PhD, Masafumi Kurajoh, MD, PhD, Takuhito Shoji, MD, PhD, Hidenori Koyama, MD, PhD, Zenta Tsutsumi, MD, PhD, Yuji Moriwaki, MD, PhD, Mitsuyoshi Namba, MD, PhD, and Tetsuya Yamamoto, MD, PhD (Sept 2015). Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. American Journal Of Lifestyle Medicine.
2. Hyon K. Choi, Gary Curhan. (May 2007). Coffee, Tea, And Caffeine Consumption And Serum Uric Acid Level: The Third National Health And Nutrition Examination Survey. American College Of Rheumatology.
3. C. Kiyohara, S. Kono, S. Honjo, I. Todoroki. (August 1999).Inverse Association Between Coffee Drinking And Serum Uric Acid Concentrations In Middle-Aged Japanese Males. British Journal Of Nutrition.
4. Yi Zhang, Tuo Yang, Chao Zeng, Jie Wei, Hui Li, Yi-lin Xiong, Ye Yang, Xiang Ding, and Guanghua Lei (July 2015). Is Coffee Consumption Associated With A Lower Risk Of Hyperuricaemia Or Gout? A Systematic Review And Meta-Analysis. BMJ Open.
5. Joseph Hutton, Tahzeeb Fatima, Tanya J. Major, Ruth Topless, Lisa K. Stamp, Tony R. Merriman & Nicola Dalbeth. (July 2018). Mediation Analysis To Understand Genetic Relationships Between Habitual Coffee Intake And Gout. Arthritis Research And Therapy.

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