Caffeine and Gout
First, let’s take a quick look at what caffeine actually is, where it comes from, and its health implications. Then we’ll look at how caffeine may or may not interact with your gout.
What is Caffeine?
Caffeine — a naturally occurring plant-based chemical — is the world’s most widely used psychostimulant drug, mostly consumed in the form of coffee. To give you an idea, some other psychostimulant drugs are d-amphetamine, methamphetamine and cocaine.
So, yes, caffeine’s actually a drug! Scientific name: 1, 3, 7‐trimethylxanthine.
And, as well as in coffee, it’s also found in tea, cocoa, chocolate, soft drinks, energy drinks, energy bars, and even in snacks like jelly beans, marshmallows, and many more.
The following plants are some of the main sources of caffeine:
- yerba mate
…with some estimates of as many as 60 to 100 different plants having caffeine.
Caffeine’s a natural defense mechanism for these plants since it’s toxic to insects and other pests.
Being a psychostimulant drug, caffeine affects the central nervous system (which includes the brain) causing a boost in energy, alertness, focus, and mood. It also helps to offset tiredness.
Caffeine’s used in some prescription and over-the-counter (OTC) medications to help overcome things like drowsiness and tiredness.
It’s also used to help improve the speed and effectiveness of certain drugs, such as those for headaches and migraines.
It can also be found in antihistamines to help counteract the drowsiness that antihistamines can cause.
And it’s sometimes used to help treat conditions such as ADHD (attention deficit-hyperactivity disorder), gallbladder disease, and asthma, although evidence for it’s efficacy is somewhat lacking.
It’s widely used, too, in some weightloss pills to help boost metabolism and burn fat.
Although low to moderate amounts of daily caffeine pose no particular problems for the majority of us, too much caffeine can have some adverse, even dangerous, consequences.
Some side effects of taking-in too much caffeine are:
- high blood pressure
- adrenal gland impairment
- increased heart rate
- increased urination
- digestive problems
- rhabdomyolysis (damaged-muscle breakdown)
- addiction / dependency
So how much is “too much”?
According to the Mayo Clinic website:
Up to 400 milligrams (mg) of caffeine a day appears to be safe for most healthy adults. That’s roughly the amount of caffeine in four cups of brewed coffee, 10 cans of cola or two “energy shot” drinks. Keep in mind that the actual caffeine content in beverages varies widely, especially among energy drinks.
So if you’re drinking more than 4 cups of coffee per day, that’s too much.
It also goes on to say that people have different sensitivities to caffeine. Some are more sensitive to caffeine than others and can suffer one or more side effects even with relatively low amounts of caffeine.
How sensitive are you? Do you feel a bit agitated after your second cup of the day?
Does Caffeine Make Gout Worse?
Well, there may be some good news for gout sufferers. Several studies suggest that caffeine, in and of itself, may not be linked to a higher risk of either incident (first time) gout or recurring gout.
In fact, at least one study, published in 2007, found quite the opposite: an inverse association between long-term coffee consumption and serum uric acid. In other words, the study found that blood uric acid levels decreased with increased coffee intake.
And remember, gout is caused by higher-than-normal uric acid levels in the bloodstream so this, and similar studies, suggest that coffee may actually reduce the risk of gout (incident and recurring), not increase it.
However, the study couldn’t find an association with tea or with total caffeine consumption (all sources). But it did find an association with decaffeinated coffee.
So it seems that other components in coffee may be responsible for lowering uric acid, not the caffeine. Exactly what or how this works is unknown, although there are some theories.
For example, coffee contains chlorogenic acid, a polyphenol that studies show may help improve insulin sensitivity and reduce glucose levels. This is interesting in our context because a study has linked improved insulin sensitivity to increased uric acid excretion which, of course, can then lead to a reduction in blood uric acid and a lower gout risk.
Also, other studies suggest that chlorogenic acid helps to inhibit iron absorption in the body which, since iron overload is a risk factor for gout, reduces the risk of gout.
So where does all this leave us?
Studies have shown that caffeine may not make your gout worse. But it may not make it any better either. So, in terms of gout, caffeine seems to be neutral.
Remember, though, that caffeine is mostly consumed in the form of coffee and we’ve seen that increased coffee consumption may lower uric acid levels (due to components other than the caffeine).
But here’s the thing, don’t think by suddenly going from 1 cup of coffee per day to 3 or more cups per day you’re going to lower your gout risk overnight. On the contrary, at least one study has found that rapidly changing your coffee habit may actually increase your risk of a gout attack, not lower it.
Well, according to the study authors, the explanation is in the difference between ‘habitual’ and ‘occasional’ coffee drinkers.
Although the study did establish a link between increased coffee intake and increased gout risk, this was only observed in occasional drinkers, i.e. those who usually drank less than 2 cups per day.
But in habitual drinkers — those who usually drank 2 or more cups of coffee every day — their increased coffee consumption didn’t raise the risk of a gout attack.
The main difference between this study and the previous one is that the previous one measured long-term coffee consumption whilst this study measured the outcome of a rapid (24 hour) increase in coffee consumption.
Occasional drinkers in this latter study, who abruptly went from 1 cup of coffee a day to 3 or more within 24 hours, experienced an increased risk of a gout attack.
This is my personal take on it…
The former study (along with others) linked long-term coffee consumption with a reduction in uric acid and a lower risk of gout. So we know that coffee is capable of reducing uric acid.
So the latter study also would have seen a reduction in uric acid except that, in this case, it was a sudden drop brought on by a very abrupt, significant increase in coffee intake among occasional drinkers.
Now, this is where it gets interesting: we know from experience that a sudden reduction in blood uric acid (as would have occurred in the latter study) can actually trigger a gout attack in someone with gout. This is totally counterintuitive, but it does happen, although the experts aren’t exactly sure why.
For example, we see this happening in people with gout who crash diet. We even see it in newly diagnosed gout patients who start taking urate-lowering drugs like allopurinol. Both can have the effect of accelerating uric acid reduction resulting in a new gout attack or an increase in the severity and/or length of an existing one.
So the studies seem to indicate that whilst long-term coffee consumption may benefit people with gout, abrupt increases can be harmful in the short term.
Overall, then, we’ve learned that:
- caffeine is the world’s most widely used psychostimulant drug.
- it’s used in some prescription and OTC medicines, and dietary supplements.
- too much caffeine can have some adverse, even dangerous, side effects.
- 4 cups of coffee, or 2 energy drinks, or 10 cans of cola a day is “too much.”
- caffeine is probably gout-neutral so shouldn’t make your gout worse.
- long-term coffee consumption may actually reduce the risk of gout.
- other ingredients in coffee probably reduce the risk of gout, not caffeine.
- a sudden increase in coffee consumption can actually trigger a gout attack.