Nutritional Epidemiology

Does Fruit Juice Cause Gout?

Max Carmody, MSc

Fruit juice doesn’t “cause” gout, but many epidemiological studies have shown that it increases the risk of gout. One study showed that people who consume 2 glasses of fruit juice a day were 81% more likely to get gout compared with people who drank no fruit juice on average.

What is Gout?

Gout is a form of inflammatory arthritis that is quite common. It usually affects one joint, such as the big toe especially. However, it can affect other joints too, such as the ankles or knees. Sometimes the symptoms flare and get worse, and sometimes they get better. A flare can start suddenly and last for days or weeks. Gout is caused by a condition called hyperuricemia. This happens when there is too much uric acid in the body. The body makes uric acid when it breaks down these purines, purines are found in your body and the foods you eat. When there is an abundance of uric acid in the body, uric acid crystals can build up in joints, tissues, and fluids within the body.

What are the Risk Factors for Gout?

There are a variety of factors which can put you more at risk for hyperuricemia, the cause of gout. Being male, or being obese, are major risk factors. Some health conditions such as diabetes or hypertension can increase the risk of developing gout. Using medications like diuretics is another factor. Then there are the risk factors related to diet and what you ingest, drinking alcohol, eating or drinking foods high in fructose, or having a diet high in purines, which are found in foods like red meat and many types of seafood.

Does Fruit Juice Cause Gout?

As an epidemiologist by trade, I’ve looked at a variety of different original epidemiological studies to find out if fruit juice raises your risk of gout. A relatively new prospective cohort study (A study that follows over time a set of individuals who differ by the key factors under study) has found that “a high intake of naturally occurring fructose increased the risk of developing gout, consuming two or more glasses of fruit juice each day increased the risk by 81%”, so people who were consuming two glasses of fruit juice a day were 81% more likely to develop gout than people who were very similar otherwise, but consumed no fruit juice. Even beyond fruit juice, in this study eating other types of fruit, an apple or an orange a day, increased the risk by 64%.

In a review of three studies, all put together in one study in the form of a systematic review, fruit juice showed a statistically significant and considerable adverse association with gout. People who drank fruit juice were generally 77% more likely to experience gout than people who did not.

In another prospective cohort study that followed 46,393 men with no history of gout when the study began, 755 incidents of gout were confirmed at the end of the 12 years. I just say this so you get a little bit of a better idea how a prospective cohort study works. At the end of the study, there is no exact figure listed, but total fruit juice, and also apples and oranges which are fruits high in fructose, were associated with a higher risk of gout.

Fructose and Fruit Juice

All fruit, fruit juices, and smoothies contain a naturally occurring sugar called fructose. Fruit juice contains added sugar (although fruits don’t). Added sugars are sugars and syrups added to foods or beverages when they are processed or prepared. We already found out in one of the earlier sections that consuming fructose is a risk factor for gout. It is generally considered to be safe to eat fructose in moderation, however as we’ve seen above, it does have the potential to contribute to certain specific conditions.

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