Can your morning coffee prevent gout?

Coffee is drunk in huge quantities across the globe. Around one billion people drink two billion cups of the stuff every day. Sixty-four percent of Americans consume coffee daily, a rate slightly higher for women than men. Britons spend £1 billion every year on coffee. Finland has the highest consumption at 12.2kg per person per year, with Sweden and Norway not far behind. In the USA, that figure is 4.5kg, and in the UK, 2.8kg per year.

Quite apart from getting us going in the morning, coffee has been touted as having a variety of health benefits. Studies suggest it protects against type 2 diabetes, Parkinson’s disease, Alzheimer’s disease, adult leukaemia, liver and mouth cancer, cirrhosis, death from cardiovascular disease and kidney stones. Coffee also reduces the risk of gout.

It has been repeatedly demonstrated that drinking coffee reduces the risk of gout. A coffee drinker is 25% less likely to develop gout than someone who doesn’t drink coffee. There’s a clear dose-response, too: the more coffee you drink, the less likely you are to develop gout. Each cup of coffee drops your risk of gout by about 15%, so those drinking six cups a day have just 40% the chance of non-coffee drinkers for developing gout. Their risk is more than halved.

How does coffee protect us from gout?

Studies have shown conflicting results on whether drinking coffee lowers blood uric acid levels. It is urate crystals that cause the effects of gout. Some studies have suggested that it does, especially in women, whilst others show no effect. When you combine all the studies, a so-called meta-analysis, it looks as though coffee’s protective effect is not through the lowering of uric acid levels.

One potential explanation is that caffeine is responsible. Caffeine appears to block the action of xanthine oxidase, the enzyme that produces uric acid. This is how allopurinol works – the medicine most commonly given to reduce urate levels in people with gout. However, whilst in women, there is a correlation between the amount of caffeine ingested and the level of uric acid in the blood, there is no such relationship in men. Not only that, protection from gout is also seen with decaffeinated coffee, though admittedly to a lesser extent. This suggests that if caffeine does help prevent gout, it is certainly not the end of the story.

Figuring out how coffee protects against gout may not be easy: coffee contains more than 1000 chemical compounds. One of those, the antioxidant chlorogenic acid, also blocks the uric acid-producing enzyme xanthine oxidase, and so may be involved in coffee’s anti-gout action. Several compounds are likely involved.

How effective your coffee is will also depend on how you like to drink it. Dairy products are known to lower the risk of gout, so a latte may be better than an Americano. But, be careful what you put in it: sugar will raise your uric acid level and reduce the benefits of the coffee.

What do our genes have to say?

Delve into the genetics of gout and coffee drinking, and things become fiendishly intertwined. Yes, you read that correctly; there are genetic aspects to coffee drinking. There are genes that affect how efficiently you break down caffeine; the faster you metabolise caffeine, the more likely you are to drink more and stronger coffee. There are genes that affect how much of a mental buzz you get from caffeine – those who feel a greater psychological reward are more likely to be regular drinkers. There’s even a gene that determines how much you like the taste.

Four genes determine the level of urate in the body and thus the risk of gout. And here’s the kicker: all four of those genes are associated with a lower rate of coffee drinking. Think about that for a minute. The very people who would benefit from drinking coffee because they are at risk of gout, are genetically programmed not to drink it. Is that unfair or what?

Is there a downside to drinking more coffee?

Now we know that coffee reduces the risk of gout, could there be any disadvantages to drinking lots of coffee? Well, it turns out there are risks as well as benefits. Isn’t that always the way? A high coffee intake appears to increase the risk of lung and throat cancer in smokers, miscarriage and pre-term birth, childhood leukaemia, rheumatoid arthritis, osteoarthritis and lymphoma.

As with most things in life, we must weigh up the pros and cons, but it may be helpful to reflect on the fact that when all the studies on coffee are put together, drinking coffee results in a 10-20% reduction in death rates from all causes after taking out the effects of smoking. That doesn’t mean you won’t die; it means that there were 10-20% fewer deaths amongst coffee drinkers for the follow-up period of the studies. The effect appears to be greatest at three to four cups of coffee daily.

What should you do differently?

The evidence is clear: drinking about four cups of coffee a day protects you against developing gout. Frustratingly, we don’t know whether drinking coffee reduces the frequency of gout flare-ups in someone who already has gout. It’s not unreasonable to think that coffee will reduce flare-ups, but it has never been investigated.

• If you are pregnant or a smoker, you need to carefully weigh up the risks and benefits before intentionally increasing your coffee intake. You may want to talk to your doctor.
• For most other people, the benefits of drinking three or four cups of coffee a day are thought to outweigh any potential risks.
• Since coffee can increase urine production, you should compensate by drinking other fluids. Dehydration increases your risk of a gout flare-up, whilst a liquid intake of 2.2 litres for women and 3 litres for men has been shown to decrease uric acid levels significantly, and hence the risk of an attack.

If you found this information useful, please have a look at The Gout & Pseudogout Handbook which is packed with similar information.

The Pocket Doctor Handbooks are designed to give you the knowledge and facts you need to talk confidently with your doctor to ensure you get the best treatment.