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Why Does Beer Raise Uric Acid? What Science Knows About Gout and Alcohol-Free Beer

By Carlos Uhart M.

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Beer is the alcoholic drink most strongly associated with high uric acid and gout. In a study that followed more than 47,000 men for 12 years, each daily beer was associated with a 49% higher risk of developing gout, more than spirits and considerably more than wine.

Person holding their foot in pain at the big toe joint, the typical symptom of gout
Gout causes pain and swelling, especially in the big toe

The explanation lies in a combination of factors. Beer provides purines, which the body converts into uric acid, and it also contains alcohol, which raises uric acid production as well.

This article summarizes what studies and medical guidelines say about beer and uric acid, how many purines each type of beer contains and what is known about alcohol-free beer. It is not a substitute for consulting your doctor or rheumatologist.

What is uric acid and when does it turn into gout?

Uric acid is the end product of the breakdown of purines, molecules that the body makes and that also come from the diet. When its blood concentration exceeds 6.8 mg/dl, the point at which it stops dissolving, monosodium urate crystals can form in the joints.

These crystals are what cause gout, a form of arthritis marked by attacks of intense pain and inflammation. According to the Global Burden of Disease study, 55.8 million people worldwide had gout in 2020, with a prevalence 3.26 times higher in men than in women, and 95.8 million cases are projected by 2050.

Why does beer raise uric acid more than wine?

A study published in The Lancet in 2004 followed 47,150 health professionals without gout for 12 years. During that time, 730 new cases were recorded.

Each daily serving of beer, 12 ounces or about 355 milliliters, was associated with a 49% higher risk of developing gout. A daily serving of spirits was associated with a 15% higher risk, and wine showed no significant increase.

The same team analyzed serum uric acid in 14,809 people from the US National Health and Nutrition Examination Survey. Each daily serving of beer was associated with 0.46 mg/dl higher uric acid, each serving of spirits with 0.29 mg/dl, and wine was not associated with a significant difference.

The table summarizes both comparisons.

Drink (per daily serving)Risk of developing goutDifference in uric acid
Beer49% higher+0.46 mg/dl
Spirits15% higher+0.29 mg/dl
WineNo significant increaseNo significant difference

Where does the effect of beer come from?

Beer acts through two pathways at once. It provides purines, mainly guanosine, which according to a 1984 British study is probably the most readily absorbed dietary purine, and it provides ethanol.

Ethanol increases uric acid production by speeding up the breakdown of adenine nucleotides, according to a study of six patients with gout published in The New England Journal of Medicine in 1982. According to a 2014 study, with acute excessive intake, the lactate generated by alcohol also reduces the kidneys’ excretion of uric acid.

Whether purines or ethanol matter more is still unresolved. One Japanese study attributes the rise mainly to purines, another mainly to alcohol and a third considers alcohol a relevant factor in habitual heavy drinkers, all with groups of 5 to 13 volunteers.

How many purines are in a beer?

An analysis of beers sold in Japan measured between 5.21 and 9.76 milligrams of purines per 100 milliliters in six regular beers. Beer-like beverages and low-purine beers ranged from 0.13 to 3.6 milligrams.

Based on these values, a can of 350 milliliters provides between 18 and 34 milligrams of purines, depending on the type of beer.

[math]350 \times \dfrac{9.76}{100}[/math]

[math]= 34.2 \text{ mg}[/math]

The only stout in the study had 12.02 milligrams per 100 milliliters, more than any of the regular beers, and a single sample cannot be generalized to all dark beers. Another Japanese study found that some local and low-alcohol beers had about 2.5 times more purines than a regular beer.

The table shows the measured values by type of drink.

DrinkPurines (mg/100 ml)Per 350 ml can
Regular beer (six brands)5.21 to 9.7618.2 to 34.2 mg
Stout (one brand)12.0242.1 mg
Beer-like and low-purine beverages0.13 to 3.60.46 to 12.6 mg

Does alcohol-free beer also raise uric acid?

We have not found any clinical study that measured the effect of a commercial alcohol-free beer on uric acid. The closest evidence is a 2002 Japanese experiment with five volunteers that compared a regular beer with the same beer freeze-dried, that is, without ethanol.

The regular beer raised plasma uric acid by 6.5% at 30 minutes and the ethanol-free version by 4.4%. The authors concluded that the purines in beer played a major role in that rise.

Another 2002 study tested a beer with 28% fewer purines and observed a rise almost identical to that of regular beer. Reducing purines alone, therefore, does not guarantee a smaller effect.

The Spanish Society of Rheumatology sums it up in its guide for patients with gout.

Beer is perhaps the most harmful, not only because of its alcohol content but in itself, because of its high purine content, so its consumption should be limited even in alcohol-free versions.

Anyone with gout should talk to their doctor before drinking alcohol-free beer regularly, because it has not been shown to be harmless for uric acid.

If I already have gout, can wine also trigger attacks?

Yes. A 2014 study of 724 people with gout compared what they had drunk in the 24 hours before an attack with what they drank at other times.

Having more than one to two alcoholic drinks was associated with 36% higher odds of an attack, and more than two to four drinks with 51% higher odds. More than one to two glasses of wine was associated with 2.38 times higher odds of an attack, and more than two to four beers with 75% higher odds.

Moderate wine consumption, then, was not associated with developing gout in the Choi study, and it can still trigger attacks in people who already have it, just like beer and spirits. In every case, the risk grows with the amount consumed.

What do medical guidelines recommend?

In its 2020 guideline, the American College of Rheumatology recommends that people with gout limit their alcohol intake. It is a conditional recommendation based on evidence of low quality.

For patients on treatment, the same guideline strongly recommends keeping uric acid below 6 mg/dl.

The European League Against Rheumatism (EULAR) sets the same target of below 6 mg/dl, and below 5 mg/dl in severe gout. The UK’s National Health Service advises people with gout not to exceed 14 units of alcohol per week.

If alcohol has become hard to control, there are strategies with scientific support to stop drinking beer. In any case, managing uric acid and medication is a matter for your doctor.

Frequently asked questions (FAQ)

1. How much does one beer raise uric acid?

In an analysis of 14,809 people in the United States, each daily beer was associated with 0.46 mg/dl higher serum uric acid. This is a difference between drinkers in a population survey, and the American College of Rheumatology guideline cites a rise of 0.16 mg/dl per unit of beer.

2. Is beer worse than wine for gout?

For developing gout, yes, because in a study of men moderate wine consumption showed no significant increase in risk. People who already have gout should keep in mind that wine can also trigger attacks.

3. Can I drink alcohol-free beer if I have high uric acid?

There are no clinical studies with commercial alcohol-free beer, and in one experiment ethanol-free beer also raised uric acid. The Spanish Society of Rheumatology advises limiting it, so it is best to discuss it with your doctor.

4. Which beer has the fewest purines?

In a Japanese analysis, beer-like and low-purine beverages had between 0.13 and 3.6 mg per 100 ml, compared with 5.21 to 9.76 mg in regular beers. A beer with fewer purines does not guarantee a smaller effect, because alcohol also raises uric acid.

5. At what uric acid level does gout appear?

Above 6.8 mg/dl, uric acid can form crystals in the joints. Guidelines set a treatment target of keeping it below 6 mg/dl.

Bibliography

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Author Carlos Uhart M.

Founder and director at The Beer Times™. Certified Beer Server Cicerone©, BJCP Beer Judge, and beer sommelier. Author of 'Practical Guide to Beer Tasting', 'Cooking and Mixology with Beer', and four other books on pairing and beer culture.

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