Drinking Pains: Beer and Gout

Beer and Health by | Jul 2015 | Issue #102

Illustration by Nolan Pelletier

Barry Fairfield, a retired bicycle-shop owner, homebrewer and classic-rock musician, is a self-proclaimed IPA man. Or, he was. Now he’s more of a German-style Pilsner guy. But it wasn’t a palate change that prompted Fairfield’s beer-style switch. It was gout.

“My first attack happened about a year and a half ago, and it hit me just as bad as you can get it,” says Fairfield, 73, of Fort Lauderdale, Fla. “It’s this incredibly severe, burning pain in the joint of your big toe. You can’t touch it. You can’t walk on it. It is just unbearable.”

More than 8 million Americans suffer from gout, according to the American College of Rheumatology, about 4 percent of the US population. It’s a form of arthritis that causes swelling, redness and acute pain in joints, most commonly the big toes and ankles but occasionally knees, elbows, shoulders and knuckles.

When the agony subsided the day after his initial attack, Fairfield turned first to the internet, then to his doctor, to figure out how to manage the condition. Both confirmed his IPA-loving fears: He’d have to change his four-beer-a-day lifestyle if he wanted to avoid more frequent attacks.

Beer has long been associated as a gout trigger due to its relatively high levels of purine, an organic compound that, among other functions, helps form the base of human DNA. The body metabolizes purine into uric acid, which dissolves into the bloodstream and is passed through the kidneys.

But in gout sufferers, the uric acid doesn’t dissolve and pass; it crystallizes into microscopic lancelets that crowd around the joints. “These crystals look just like needles, and they literally pierce through the walls of white blood cells, which signals for more cells to come to the rescue, and now you have this cascade of inflammation and a full-on attack,” explains Dr. Mark Jaffe, a rheumatologist in Pembroke Pines, Fla.

Beer drinking doesn’t necessarily lead to gout, Jaffe says, noting that family history, genetics and overall health play a bigger role than diet in how our bodies handle purines and uric acid. But beer and other high-purine foods and drinks do affect those susceptible to gout attacks.

“You may not get gout by drinking too much beer,” Jaffe says. “But if you have gout and drink beer, you will definitely experience attacks.”

Beer gets the bulk of its purine content from brewer’s yeast, which has about three times the purines as baker’s yeast. Other relatively high-purine foods include organ meats like sweetbreads and liver, red meat, pork, poultry, fish and seafood. So what’s safe for a gout sufferer? “Dairy and vegetables,” Jaffe says. He adds that gout can be controlled through diet for most people who experience one or two attacks a year. More frequent attacks can be treated with medicine.

The medicine route is the one Cris Morgan, a brewer at Boulevard Brewing Co. in Kansas City, Mo., has taken for most of his seven-year battle with gout.

“For a while, I stopped drinking beer or having any alcohol, stopped eating animal-based proteins. I was a sober vegetarian brewer, which kind of sucked,” Morgan says. “It never got to a point where I considered changing careers. I love my job enough to be like, ‘I’m going to find a way to live with this.’ So I started taking medicine every day, and I’m fine. I can drink beer. I can eat meat. I just don’t go crazy with it.”

According to Jaffe, the bulk of gout sufferers are men in their 40s and older, although post-menopausal women are susceptible. Still, it can affect people outside those groups, like Morgan (who experienced his first attack in his mid-30s) and Penny Watson, a Boston writer who was diagnosed with gout at age 38. Watson says she found that shellfish and her beloved Magic Hat #9 triggered her flareups, to the point that she stopped drinking beer entirely—for a while.

It “seriously broke my heart, because I love beer,” she says. Watson has since eased some beer back into her life; light ales and lagers consumed in moderation don’t seem to trigger symptoms. “I have noticed that if I drink really heavy beers, the gout is worse.”

Jaffe recommends zero alcohol consumption for his gout patients (spirits and wine also are high in purines), especially those trying to manage the condition without prescription drugs. He says most are quick to oblige. “Three of the most painful things humans can experience are childbirth, passing a kidney stone and having a gout attack,” he argues. “And as you get older, and the attacks become more frequent, the pain becomes more severe, if you can believe it.”

Fairfield wasn’t quite ready to give up beer altogether. While he found that some beers were surefire triggers to his gout attacks—anything bottle-conditioned, unpasteurized or unfiltered tended to be the biggest offenders, perhaps due to residual yeast—his body seemed to react OK to the Pilsners he discovered when visiting Germany.

“I used to be one of those guys who pooh-poohed Pilsners because the mainstream ones in the US didn’t really have the flavor I was looking for,” Fairfield says. “But the German ones, even some of the craft ones being brewed now in America, are actually very good. And I can have one with my meal, one later in my studio when I’m working on music, and that seems to work for me. I haven’t had a flareup in several months now.”