Saturday, December 3, 2022

Can dehydration cause a gout flare-up?

Dehydration can lead to excess blood uric acid. That can cause urate crystals to deposit in joints and trigger gout attacks.

Executive Summary Video

Gout is a form of arthritis caused by too much uric acid in the blood. Uric acid is formed mainly from the breakdown of cells in the body, which is a part of normal living. The excess uric acid is eliminated by the kidneys through the urine. However, with age, this does not happen quickly enough in some people. The blood uric acid levels rise, leading to the deposition of urate crystals in many joints, especially the big toe. These sharp crystals are extremely painful, causing a gout attack.

While there are many factors that trigger a gout flare-up, the most obvious one is dehydration. With the loss of water from the blood, the uric acid levels in it rise, increasing the chances of crystal deposition.

One can reduce or prevent gout flare-ups by drinking a lot of water. At least two liters of water a day is recommended. The additional water not only dilutes the blood but also encourages the kidneys to flush out excess uric acid.

However, not all liquids are helpful for gout. Alcohol causes the kidneys to work more on getting rid of alcohol instead of uric acid. So their ability to filter uric acid reduces leading to a possible flare-up.

My Views

  1. Some alcohols such as beer, also contain compounds called purines that can increase uric acid levels in the blood. So drinking beer is a double-whammy for gout flare-ups.
  2. If one were to drink alcohol, one should at least avoid binge-drinking or drinking a lot of alcohol at one time.
  3. People debate which alcohols are safer for gout. However, one must remember that it is the alcohol content in the alcoholic drinks that leads kidneys to work less on excreting uric acid and more on eliminating alcohol. So all alcohols are risky for gout. Beer just turns out to be worse because it also contains purines that break down into uric acid.
  4. Don’t assume that all non-alcoholic drinks are useful in gout by helping with hydration. Drinks that are high in sugar or high-fructose corn syrup can cause a gout flare-up due to their high sugar content. According to a study, the gout flare-up risk increases significantly with an intake level of 5-6 servings per week of sugary drinks. The risk is 85% higher among men who consumed two or more servings of sugar-sweetened soft drinks per day.
  5. Fructose breaks down into uric acid upon consumption. So it logically follows that sweetned drinks would trigger gout attacks. In a similar vein, diet drinks that contain artificial sweeteners (but not sucrose or fructose) should not raise blood uric acid. This is indeed observed. So diet drinks are safe for gout.
  6. If one is taking medications such as diuretics that help eliminate water from the body, one may get increased uric acid levels causing a gout attack. Typically, diuretic medicines are given for blood pressure control or reduction in swelling (edema). In such cases, taking diuretics should be a higher priority and one must resort to other means of uric acid control that don’t rely on hydration.
  7. If a gout patient is likely to end up in a situation that can lead to dehydration, such as a sports event or an outdoor activity, the person must ensure adequate drinking water is handy.

For More Reading

First published on: 13th December 2021
Image credit: Anna Shvets on Pexels

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