Gout, or metabolic arthritis, was considered by Hippocrates “the disease of kings” because only wealthy people with rich diets got it. This was true until the early 20th century when cases went down because of improved knowledge about it.

But in the last 40 years, cases have gone up, mostly because now everyone can afford rich and sugar-filled treats. Gout affects 3 times as many men as women and an estimated 5.1 million people in the United States live with it.

It is caused by excess uric acid in the blood (hyperuricaemia) which leads to uric acid crystals collecting around the joints. There are a number of factors that contribute to the disease but consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout in men, finds a study published in BMJ.

Conventional dietary recommendations for gout have focused on the restriction of purines (found in high levels in meat and meat products, especially liver and kidney) and alcohol but with no restriction of sugar sweetened soft drinks.

So researchers in the US and Canada examined the relation between intake of sugar sweetened soft drinks and fructose and the risk of gout.

They followed over 46,000 men aged 40 years and over with no history of gout. The men completed regular questionnaires on their intake of more than 130 foods and beverages, including sugar sweetened soft drinks and diet soft drinks, over a period of 12 years. Different types of fruits and fruit juices (high in natural fructose) were also assessed.

At the start of the study, and every two years thereafter, information on weight, regular use of medications and medical conditions were also recorded. Gout was diagnosed according to American College of Rheumatology criteria.

During 12 years of follow-up, the researchers documented 755 newly diagnosed cases of gout.

The risk of gout increased with increasing intake of sugar sweetened soft drinks. The risk was significantly increased with an intake level of 5-6 servings per week and the risk was 85% higher among men who consumed two or more servings of sugar-sweetened soft drinks per day compared to those who consumed less than one serving per month.

These associations were independent of other risk factors for gout such as body mass index, age, diuretic use, high blood pressure, alcohol intake, and dietary factors.

Diet soft drinks were not associated with the risk of gout.

Fruit juice and fructose rich fruits (apples and oranges) were associated with a higher risk of gout. However, the authors stress that this finding needs to be balanced against the benefit of fruit and vegetable intake to prevent other chronic disorders like high blood pressure, coronary heart disease, stroke and certain types of cancer.

The findings provide evidence that consumption of sugar sweetened soft drinks and fructose is strongly associated with an increased risk of gout, say the authors. Furthermore, fructose rich fruits and fruit juices may also increase the risk. In contrast, diet soft drinks were not associated with the risk of gout.