Are carbonated beverages safe for patients with gout?

Carbonated Beverages for Gout Patients

Patients with gout should avoid artificially sweetened carbonated beverages and those containing high-fructose corn syrup, as these are associated with higher serum urate levels and increased gout risk. 1

Types of Carbonated Beverages and Their Effects

High-Fructose Corn Syrup Sweetened Beverages

• The 2020 American College of Rheumatology (ACR) guidelines conditionally recommend limiting high-fructose corn syrup intake for all gout patients, regardless of disease activity 1
• Ingestion of 1 gm of fructose/kg of body weight increases serum urate concentration by 1-2 mg/dl within 2 hours 1
• Sugar-sweetened beverages significantly increase gout risk:
  • For European Caucasians: OR of 6.89 for four drinks/day compared to zero 2
  • For Māori: OR of 5.19 for four drinks/day compared to zero 2
  • For Pacific Islanders: OR of 2.84 for four drinks/day compared to zero 2

Artificially Sweetened Carbonated Beverages

• National Health and Nutrition Examination Survey data showed artificially sweetened carbonated beverage consumption was associated with higher serum urate levels 1, 3
• The risk of hyperuricemia increases with greater consumption of sugar-sweetened soft drinks:
  • 34% increased risk with 0.5-0.9 servings/day
  • 51% increased risk with 1-3.9 servings/day
  • 82% increased risk with ≥4 servings/day 3

Diet Soft Drinks

• Diet soft drink consumption was not associated with serum urate levels or hyperuricemia in the National Health and Nutrition Examination Survey 3
• These may be a safer alternative for gout patients who desire carbonated beverages

BMI Considerations and Beverage Consumption

• BMI significantly modifies the relationship between sugar-sweetened beverage intake and gout risk 4
• Individuals with BMI ≥25 kg/m² show:
  • Stronger association between chronic SSB intake and increased serum urate
  • Higher risk of gout with SSB consumption
  • Different renal handling of uric acid after fructose consumption 4
• This suggests that avoiding sugar-sweetened carbonated beverages is particularly important for overweight/obese gout patients

Practical Recommendations for Gout Patients

1. Avoid beverages with high-fructose corn syrup - including most regular sodas and many sweetened carbonated drinks 1, 5
2. Limit artificially sweetened carbonated beverages - these are associated with higher serum urate levels 1
3. Consider diet soft drinks as a safer alternative if carbonation is desired 3
4. Be especially vigilant if overweight/obese - BMI ≥25 kg/m² increases susceptibility to urate-raising effects of sweetened beverages 4
5. Encourage alternative beverages:
   • Water
   • Low-fat or nonfat dairy products (which may actually help lower urate levels) 5

Additional Dietary Considerations for Gout Management

Beyond carbonated beverages, the ACR guidelines recommend:

• Limiting alcohol intake, especially beer 1
• Limiting purine-rich foods (organ meats, shellfish) 1, 5
• Weight loss for overweight/obese patients 1
• Avoiding vitamin C supplementation specifically for gout management 1

These dietary modifications should be implemented alongside appropriate pharmacologic management for optimal gout control and prevention of recurrent flares.