Can coffee increase uric acid levels?

Coffee Does Not Increase Uric Acid—It Lowers It

Coffee consumption is associated with lower serum uric acid levels and reduced risk of hyperuricemia and gout, not increased levels. 1, 2

Guideline Recommendations

The 2016 EULAR (European League Against Rheumatism) guidelines explicitly recommend encouraging coffee consumption as part of lifestyle modifications for patients with hyperuricemia or gout. 1 This recommendation appears alongside advice to avoid sugar-sweetened beverages and alcohol, positioning coffee as a beneficial dietary component rather than a risk factor. 1

The 2012 American College of Rheumatology guidelines do not specifically address coffee but focus on limiting purine-rich foods, alcohol, and high-fructose beverages while encouraging low-fat dairy products. 1 Notably, coffee is not listed among substances to limit or avoid. 1

Research Evidence on Coffee's Uric Acid-Lowering Effect

Magnitude of Effect

The most comprehensive evidence comes from a 2016 systematic review and meta-analysis of 175,310 subjects demonstrating that coffee significantly lowers serum uric acid levels. 3 The effect shows important gender differences:

• Men: 1-3 cups/day produces measurable uric acid reduction 3
• Women: 4-6 cups/day needed for equivalent effect 3

A nationally representative US study (NHANES III) with 14,758 participants found that consuming 4-5 cups daily lowered serum uric acid by 0.26 mg/dL, while ≥6 cups daily lowered it by 0.43 mg/dL compared to non-drinkers. 4 The multivariate odds ratio for hyperuricemia with ≥6 cups daily was 0.57, representing a 43% risk reduction. 4

Mechanism: Not Caffeine-Dependent

The uric acid-lowering effect is mediated by components of coffee other than caffeine. 4 This is evidenced by:

• Decaffeinated coffee shows a modest inverse association with serum uric acid 4
• Pure caffeine intake from all sources shows no association with uric acid levels 4
• Tea consumption (which contains caffeine) does not lower uric acid 4

Gout Risk Reduction

Coffee intake of ≥1 cup/day is significantly associated with reduced gout risk, with a dose-response relationship showing greater protection with higher intake in both genders. 3

Clinical Application Algorithm

For patients with hyperuricemia or gout:

1. Encourage regular coffee consumption (not tea) as part of comprehensive lifestyle modifications 1, 2
2. Target 4-6 cups daily for optimal uric acid-lowering effect, recognizing women may need higher intake than men 3
3. Decaffeinated coffee is acceptable for patients who cannot tolerate caffeine, as the benefit is not caffeine-dependent 4
4. Do not substitute tea for coffee, as tea lacks the uric acid-lowering properties 4

Important Caveats

While coffee lowers uric acid, diet and lifestyle measures alone provide therapeutically insufficient serum urate-lowering effects (typically only 10-18% reduction) for most patients with sustained hyperuricemia substantially above 7 mg/dL. 1 Coffee should be viewed as an adjunctive measure, not a replacement for pharmacologic urate-lowering therapy when indicated. 1

The recommendation to encourage coffee consumption must be balanced against individual contraindications (e.g., arrhythmias, anxiety disorders, gastroesophageal reflux) that are unrelated to uric acid management. 2