Diet sodas, like diet coke, are generally viewed as healthier alternatives to regular sugary sodas. But are diet sodas really safe to drink with gout? Could diet coke, for example, actually cause even more gout attacks than regular coke? Read on to discover why you may wish to avoid both regular and diet sodas with gout.
Diet Coke and Gout
Gout is a type of arthritis whose root cause is high levels of uric acid circulating in the bloodstream, a condition called hyperuricemia. If not properly addressed, the continuous buildup of uric acid can lead to the deposition of microscopic uric acid crystals in joints and associated tissue. This happens in the joint at the base of the big toe the majority of times, but it can occur in any joint, for example, wrists, knees, elbows, fingers, etc.
It’s the body’s natural inflammatory response to these crystals that causes the classic gout symptoms: redness, swelling, inflammation, stiffness, warm to the touch, and severe pain.
Uric acid is a byproduct of purine metabolism. Purines are chemical compounds that exist in the cells of all living things, including we humans, animals, sea creatures, and plants.
Generally speaking, the highest concentrations of purines are to be found in high-protein foods. All organ meats and wild game, some red meat, and some seafoods (like certain oily fish and shellfish) are high in purines; plants generally less so. Some alcoholic beverages, particularly beer, can be high in purines too.
However, there’s a more pertinent gout risk factor when considering possible links between regular sodas and gout, and that’s sugar, particularly in the form of fructose…
Fructose and Gout
Fructose is a natural, simple sugar often called ‘fruit sugar’ because it’s primarily found in fruit, although it’s also to be found in vegetables, sugar beets, sugar cane, and honey.
Several studies have shown that fructose, especially commercially produced high-fructose corn syrup (HFCS), can also raise uric acid levels in the blood. HFCS is the added sweetener of choice in many sugary sodas and soft drinks.
Some energy drinks and sports drinks can also contain large amounts of fructose; often appearing as sucrose (glucose and fructose combined) in the list of ingredients.
And, unbelievably, even some fruit juices, such as orange juice, can contain added fructose.
But setting aside, for one moment, the link between fructose and an increased risk of gout, studies have also associated sugary drinks with weight gain, type-2 diabetes, and heart disease.
Which is why people are ditching their regular soda and turning to diet sodas with artificial sweeteners, like diet coke for example. And, of course, many of these will have gout too.
So, since diet sodas, like diet coke, don’t contain fructose are they safe to drink with gout? Or can the artificial sweeteners or other chemicals used in them increase the risk of gout attacks too?
Can Diet Coke Cause Gout Attacks?
Evidence from a large study by Choi and Curhan, published in 2008, shows that sugary drinks lead to a higher risk of gout attacks but diet soft drinks don’t. They concluded that:
“Prospective data suggest that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men…Diet soft drinks were not associated with the risk of gout.” (My emphasis.)
So on the face of it, and purely in terms of gout risk factors, it would seem that it’s best to replace sugary drinks with diet coke or other diet sodas.
This doesn’t mean that diet coke and other diet sodas will actually reduce the amount of uric acid in your body. Rather it just means that there would be a lower risk of gout flares compared to the risk if you stay with regular coke or other sugary sodas.
However, gout sufferers (on forums etc.) share conflicting results; some saying they stopped having gout attacks after changing to diet coke from regular coke, but others saying that their gout only started after changing to diet coke!
The problem with such anecdotal ‘evidence,’ and why it can’t be relied upon, is that there are many underlying reasons for raised uric acid levels. For example, we know that some of the most important underlying causes of high uric acid are:
- being overweight
- regular and excessive alcohol consumption
- high-purine diet
- family history of gout / arthritis
- hypertension (high blood pressure)
- some medications
- some medical conditions
- high levels of fats (lipids) in the bloodstream.
These would have to be’ filtered out’ in order to come to a conclusion about one particular cause or trigger, for example diet coke. Scientific studies normally account for these.
But many of those sharing their stories are likely to be unaware of the underlying factor(s) that could have caused the change and are blaming diet coke when, in fact, the change to diet coke was purely coincidental.
That being said, even if we follow the science and accept that diet coke and other diet sodas don’t increase the risk of gout, there is at least one reason why you may wish to consider avoiding them as well…
Aspartame and Other Artificial Sweeteners
Diet coke contains aspartame, the world’s most utilized non-calorific artificial sweetener, in general use in diet soda and food preparations since the 1980’s.
And, although it has been passed by various governing bodies worldwide as being ‘safe’, there’s still a huge debate going on about possible health problems arising from its consumption, such as weight gain, epilepsy, stroke, dementia, brain tumors, cancer, and other health issues.
Some independent studies do show an ‘association’ between diet soft drinks and these sorts of health problems. What they haven’t been able to show is a direct causal effect, in other words, that diet soda is to blame. As a result their authors invariably call for longer, more in-depth, clinical trials.
But, although nothing has been proved scientifically as yet, it’s still something to seriously consider, especially given that we don’t need to drink sodas at all.
So, given the uncertainty, perhaps the best option would be to avoid, not just sugary sodas (a given), but also diet coke and similar non-calorific sweetener drinks.
Why not replace that can of soda with water, mineral water, sparkling water/seltzer, flavored seltzer (check there’s no calories, added sugars or artificial sweeteners), or simply water with a slice of lemon?
But, if you find it very difficult to completely banish diet soda / diet coke from your life then, at the very least, try to reduce your consumption over time to one or two cans a day.