The Swallow Don’t Spit Guide to Wine and Gout

I write for you today with my left ankle swollen, in rotten pain, incapacitated. The result of my bringing home with me an unwanted souvenir from a month in South Africa. The scourge of the bon vivant and every hedonist’s unwanted but largely unavoidable co-conspirator – gout. Far from being taboo, living in whispered and knowing nods between the limping, Gout, the accumulation of purines and uric acid in the joints of our extremities is caused by living too good a life; gout, I will argue, should be worn as a hobble of honour. A defiant ouch,but eff, to the do-gooders and wowsers of the world who will look down upon you as some kind of degenerate who can’t pump the brakes on the good life even when it devastatingly affects our ability to move through the world. Right now, after a month of wine tasting and a particular last lunch of half a dozen giant oysters and the same amount of lobster tails, my ankle is so sore, so tender, that I can’t walk. I am crawling to the bathroom to pee –  often, because as you’re about to read, excess hydration and pissing like an alley cat is one of the surefire cures for gout. I am completely paralysed as a result of my own pleasure, and while it is devastating from the perspectives of mobility, socialising and my very very temporary forced abstention from imbibing Spanish wines after two months being separated from the various purple-hued objects of my affection, I find fondness in my pain and in my limp, because it reminds me of how damn well I lived, live and will continue to live, gout or no. 

 

And it is in that resignation to the inevitability of gout accompanying us throughout our gorgeously Dionysian lives that I’m going to give you a complete guide to wine and gout, living with gout, avoiding gout, treating gout, both hewn from extensive personal experience, medical expertise, with a fair shake of defiance, empowerment and a more than healthy swig of stupidity. Because look, the only way to avoid gout is to be either entirely abstinent from everything we hold dear – good wine and great food – or to treat them like frivolous “guilty pleasures” when instead they hold a proud and privileged perch atop Maslow’s pyramid of simply staying alive. This is fine for the average things in life, but rich foods and full bodied reds are designed to be indulged in. And so, here comes the Swallow Don’t Spit Wine complete guide to living with wine and gout and everything in between. 

What is Gout?

Gout is a pain that feels like you’ve been hit by a bus located entirely on your big toe, that comes out overnight without warning, usually on the back of some seriously good eating and drinking. But there’s more to it than that. 

How Gout Works: The Science Behind The Pain

Gout is a form of arthritis that is caused by uric acid buildup in our joints, generally at the extremities of our bodies. Uric acid is formed when our beloved (and frankly gorgeous) bodies break down purines from food and drink—particularly the rich, delicious, boozy indulgences we all love. Normally, the kidneys process uric acid and flush it out in urine, but when intake is excessive, or the body can’t clear it efficiently, trouble begins. However, excessive purine intake or inefficient uric acid elimination can lead to gout. When uric acid levels are too high, it crystallizes in the joints, causing swelling, heat, and unbearable pain, and this pain is acutely focused on very specific and essential parts of our bodies, like  the big toe joint (MTP joint), which is most commonly affected, but ankles, knees, and fingers can also suffer.

What Are Purines And Why Do We Even Need Them?

Purines are natural compounds found in all living things’ cells, and are essential for DNA and RNA production, and thus for life itself. They seem to accumulate more in things with higher cellular activity, like organ meats where you’ll find higher concentrations of nucleic acids and shellfish which metabolise nucleotides rapidly (I Googled that and don’t really know what it means either, but it’s just a fact baby). Purines are vital for cell growth and repair, energy production and brain function, so don’t avoid purines altogether unless you want to be an underdeveloped, low energy moron. But it’s when they break down to uric acid and then don’t flush through your piss, crystallize and then accumulate in your joints (usually at the colder extremities of your body, or where wear and tear helps them bond, like in my ankle). 

The Classic Gout Attack: What It Feels Like

Gout comes to you at night, seemingly out of nowhere, and usually after a good time. It will feel like you’ve injured yourself, but you will have no recollection of doing so (and sometimes your good time was such that you will doubt your lack of memory — maybe I did kick my toe last night. The pain will be throbbing, sometimes hot and your affected area will be red, hot, swollen and hypersensitive. You’ll feel it when rolling around your bed, potentially complaining about your hangover, or looking for that bedside glass of water that we always sleep next to (you better do this). Without treatment, the attack will last for a few days to a week and then go away, and if you haven’t had it diagnosed, or admitted to yourself that it’s most likely gout, you may think that it was a one off and unrelated to your wonderful lifestyle. But oh how wrong that will be.  

Why Is Gout Called The “Rich Man’s Disease”?

Because historically you only got gout if you overindulged in the finer things in life — that sadly until recently were the exclusive prevail of kings and aristocrats; if you’ve seen paintings of Henry VIII you might notice the swollen legs and that awkward stance enacted by someone whose joints feel like they’re on fire. Even until recently, meat and seafood wasn’t obtainable by the masses, and while booze bears an oversized burden for the onset of gout, it’s the purine rich foods — including unmercifully kale and tomatoes if you’re genetically unlucky — that do the heavy lifting. Let’s look deeper into the foods and drinks that causes gout (from her in on labelled the “Legends Disease”. 

What Causes Gout? (And Can Wine Make It Worse?)

In my case, gout has most recently been caused by (ranked in order of suspected culpability): six Western Cape oysters, six lobster tails also from the Western Cape, half a bottle of wooded South African Chardonnay, and then the 20 or so wine tastings that I did in the week prior to this attack, then the indulgent month spent in South Africa, then finally the indulgent entire life I’ve led since my teens. But is that the whole story? 

The Real Culprits: What Actually Causes Gout

As we know, gout is caused when our body breaks down purines and creates an excess of uric acid. Unfortunately for us, some of the best things in life are rich in purines, including fatty fish, red meat (particularly insides), shellfish, and some delicious vegetables. Here’s an incomplete list of the biggest culprits, starting at around 450 mgs of purines per 100 grams of food, right down to 6 mgs :

Anchovies, Beef kidney, Sardines, Beef liver, Mackerel, Herring, Mushrooms (shiitake, dried), Mussels, Scallops, Trout, Turkey, Veal, Chicken, Duck, Pork, Goose, Lamb, Rabbit, Crab, Lobster, Shrimp, Oysters, Clams, Octopus, Squid, Mushrooms (white, raw), Spinach, Asparagus, Cauliflower, Peas (green), Beans (navy), Beans (kidney), Beans (lima), Lentils, Soybeans, Tofu, Sunflower seeds, Peanuts, Almonds, Walnuts, Hazelnuts, Cashews, Pistachios, Chestnuts, Potatoes, Carrots, Broccoli, Cabbage, Lettuce, Tomatoes, Cucumbers, Zucchini, Eggplant, Bell peppers, Onions, Garlic, Apples, Oranges, Bananas, Grapes, Strawberries, Blueberries, Raspberries, Cherries, Pineapple, Mangoes, Peaches, Pears, Plums, Watermelon, Cantaloupe, Honeydew melon, Kiwi, Papaya, Avocado, Figs, Dates, Prunes, Raisins, Apricots.

But as they say, the poison comes with the dosage and most if not all of these foods are good for us in moderation – with benefits far outweighing the gout risks. Unfortunately genetics play a factor too, making  the safe dosage tough to pin down. Some people can wrap their beef kidneys in sardines eight days a week, while others might get triggered by muesli. So we guess that leaves wine and booze in the clear? Think again, pissy. 

Is Wine Really to Blame for Gout?

Yes it is, it really truly is, as much as I’d love to deny that simple fact. Alcohol slows the kidney’s ability to clear uric acid, making it more likely to crystalise in the joints, which is what makes it feel like Gerard Depardieu has hammered a nail into your big toe knuckle. AND some alcohol contains purines, especially beer with 6.5 mgs per 100 ml, while wine has less than 0.5 mgs making it on par with coffee and tea. 

And don’t believe the shysters and the hacks and the charlatans – there is no proof that organic, natural, or sulfite-free wines have less purines than the others, so like always when it comes to wine choose based on your preference, price point and the mood of the occasion.

But look, while a bottle of red wine contains the same amount of purines as a toothpick of anchovies or three dried apricots, it’s the booze’s effect on uric acid metabolism that gets us. 

Wine, The Kidneys And Breaking Down Uric Acid Metabolism

The problem with wine and gout isn’t the purines—it’s what alcohol does to your kidneys. Your body is constantly filtering and flushing out uric acid through urine, keeping levels in check. But when you drink alcohol, your kidneys have a priority shift: instead of dealing with uric acid, they focus on getting rid of the alcohol first. This means uric acid gets put on the back burner, levels spike, and those nasty little crystals start forming in your joints.

Red wine might not pack the purine punch of beer or organ meats, but it still slows down uric acid elimination. Plus, alcohol dehydrates you, which makes things even worse—less water, more uric acid buildup, more pain. So while it’s fun to argue that wine is “low in purines,” the reality is that it still increases your risk of a gout attack by messing with your body’s ability to clear uric acid.

The bottom line? If you’re prone to gout, hydration is your best friend. If you’re going to drink, alternate wine with water—not just to pace yourself, but to give your kidneys a fighting chance to do their job.

Other Risk Factors That Make Gout Worse

You might be tempted to think that gout is just the price we pay for living well—too much wine, too many oysters, too many indulgent meals with absolutely no regrets. But some unlucky bastards are destined for gout no matter what. Even if you drank herbal tea and lived on kale, you could still wake up one day with a big toe hotter than the surface of the sun. Here’s why:

Genetics: The Gout Lottery

Some people are just built for gout. If your ancestors spent their days feasting and guzzling wine, their genetic legacy may have blessed you with a body that hoards uric acid like a dragon sitting on a pile of gold. Even if you eat clean, your body might still struggle to clear uric acid efficiently, making you a prime target for the big toe curse.

Obesity & Metabolic Syndrome: Extra Weight, Extra Risk

Carrying extra kilos means higher uric acid levels and less efficient kidney function. Add in insulin resistance, and suddenly your body is even worse at flushing out uric acid. It’s a perfect storm for a gout attack. Plus, more weight means more pressure on those already screaming joints—a real kick in the swollen, throbbing nuts.

Dehydration: Gout Loves It When You’re Thirsty

Uric acid loves a dry environment, which is why not drinking enough water is one of the easiest ways to invite a gout attack straight into your bones. Less water means more concentrated uric acid, which means higher chances of crystal formation. If you’re drinking wine without water, you’re basically giving gout a VIP invitation.

Crash Diets & Fasting: The Painful Price of Rapid Weight Loss

Trying to drop weight fast? Your body doesn’t like that. When you burn fat quickly, uric acid floods your system, because your kidneys are too busy dealing with all the other metabolic chaos to clear it efficiently. The result? More uric acid, more crystals, more pain. Losing weight gradually is the way to go—unless you enjoy hobbling around like a pirate with a wooden leg.

Other Health Conditions: When Your Body’s Already Against You

If you’ve got high blood pressure, kidney disease, or diabetes, congratulations—you’ve unlocked extra gout risk. These conditions already mess with your kidney function, which means your uric acid clearance is slower than a drunk guy trying to find his way home at 4 AM. If you’re dealing with these issues, gout prevention needs to be on your radar, because once it starts, it never really f*cks off.

Verdict: Gout’s a Team Effort

Sure, booze and feasting play a role, but gout isn’t just about living large—it’s a perfect storm of bad luck, bad habits, and biology conspiring against you. Stay hydrated, keep an eye on your weight, and if your family tree is full of limping ancestors, well… at least you know what’s coming.

Can Wine Actually Help Prevent Gout? (Wishful Thinking, But Let’s Explore)

Wouldn’t it be brilliant if red wine actually helped with gout? If, instead of being a trigger, it somehow fought off the dreaded foot fire? If every glass of Tempranillo or Garnacha was actually medicine in disguise? Unfortunately, we’re not quite there yet—but there are some theories worth uncorking.

The Resveratrol Theory: Can Red Wine Fight Inflammation?

Red wine lovers cling to resveratrol the way we cling to our last glass of Rioja at closing time. It’s an antioxidant found in grape skins, and studies suggest it has anti-inflammatory properties. Since gout is basically a raging inflammatory reaction, some optimists believe resveratrol might help counteract the damage.

The problem? There’s no hard proof that the amount of resveratrol in wine is enough to make a difference. You’d probably need to drink bathtubs of the stuff – which we’re not adverse to – to see an effect, and at that point, you’re definitely making gout worse. Still, it’s nice to pretend that a good bottle of Priorat is a health supplement.

The Mediterranean Diet: Wine in Context

Some research suggests that drinking wine in moderation—specifically as part of a Mediterranean diet—doesn’t necessarily increase gout risk. This diet is full of olive oil, fish, nuts, legumes, and vegetables, all of which help keep inflammation in check. The thinking goes that if you’re eating well, drinking enough water, and living a balanced life, a bit of wine won’t send you straight into a flare-up.

Does that mean you should start swilling Albariño like a Mediterranean centenarian? Not exactly. But if you’re pairing it with lots of anti-inflammatory foods, you might not be rolling the dice as hard.

The Hydration Factor: Why Water Is Your Best Friend

If there’s one thing that separates wine drinkers from beer chuggers, it’s that we tend to drink water between glasses (or at least pretend to). Staying properly hydrated helps flush out uric acid, meaning your kidneys aren’t left high and dry while you sip on a silky Syrah.

Beer, on the other hand, is a diuretic, which means less water, more dehydration, and a fast track to gout hell. Spirits can be just as brutal, especially if you’re not balancing them with water. So while wine isn’t exactly medicinal, at least it’s not actively working against your hydration levels—if you’re drinking smart.

Verdict: Can Wine Help? Probably Not, But It’s Not the Worst Offender.

Wine won’t cure gout, but in the grand hierarchy of alcoholic sins, it’s less offensive than beer and hard liquor. If you hydrate, eat well, and don’t go overboard, you might just get away with it. And if anyone asks? You’re drinking for the resveratrol.

Living with Gout: Can You Still Enjoy Wine?

So now we’ve resigned to the fact that we’re probably going to get gout one day and that cutting out the wine isn’t going to deliver us from out gout-filled futures, but just make us miserable along the way. So let’s work out how we can minimise the flare-ups while not compromising our lifestyles. Because we’ve worked hard on creating these lifestyles and we deserve to live them to the fullest. 

The Art of Drinking Without Triggering Gout

We’re here to live well, not suffer. And while it’s true that booze and gout go hand in hand, that doesn’t mean we need to retire our wine glasses and take up knitting. The trick is minimizing the damage while still enjoying the ride.

Know Your Limits (Or Don’t, And Learn The Hard Way)

Let’s be honest—nobody really wants to hear “moderation” when it comes to wine. But if you’re prone to gout, learning your threshold is the difference between sipping a silky Tempranillo with dinner and hobbling around like an arthritic cowboy for a week.

How much is safe? There’s no universal number. Some people can throw back a bottle with no repercussions, while others will end up in a medieval torture scene after a single glass. The best approach? Start small and observe. If your body lets you get away with it, great. If not? At least you’ll know where the line is—right before you step over it.

Pacing It Out: No Need for a Gout Speedrun

Wine isn’t a sprint—it’s a marathon. If you blast through bottles in a single sitting, your body doesn’t have a chance to deal with the incoming uric acid onslaught. Spread it out. Sip it. Make an evening of it.

Also, take breaks between drinking days—because gout doesn’t just care about today, it’s keeping score over time. Give your kidneys a chance to catch up before you drown them in another round of reds.

Mixing It Up (No, Not With Low-Alcohol Wine)

Some people will try to push low-alcohol wines on you like it’s a gout-friendly solution. Let’s be clear: low-alcohol wine is a crime against pleasure. The answer isn’t stripping wine of what makes it great—it’s drinking like someone who respects their own lifestyle choices.

So instead of suffering through sad, watered-down wine, here’s how to actually mix things up:

• Drink water between glasses—not because we’re weak, but because it helps.
• Choose your battles—six beers in front of the tele every night? Maybe not. A crisp Albariño with lunch? Go for it.
• Be strategic with food pairings—because what you eat makes a difference (more on that next).

The One Rule You Can’t Ignore: Hydration

If you take nothing else from this, take this: water is your gout buffer. Uric acid builds up when your body is dehydrated, so if you’re drinking wine without drinking water, you’re basically setting a trap for yourself.

Wine + Water = Gout Prevention 101

For every glass of wine, there should be a glass of water somewhere nearby. This isn’t just hangover prevention, it’s basic kidney maintenance. Alcohol slows uric acid excretion, but water speeds it up.

Electrolytes & Hydration Hacks

Water is great, but sometimes you need to level up. Electrolytes—especially potassium and magnesium—help your body process uric acid more efficiently. Coconut water, mineral water, even a cheeky sports drink can help rebalance things after a night of indulgence.

Pee Often, Pee Proud

Your kidneys’ entire job is to filter out uric acid, and the only way they do that is by making you pee. So don’t hold it in—let those kidneys work their magic. If you’re not urinating like a well-hydrated racehorse, you’re not drinking enough water.

Food Pairings That Help (Or Hurt) Gout

A well-chosen cheese and charcuterie board can make or break your next gout attack. Get it right, and you’ve got a buffer against the uric acid spike. Get it wrong, and you’re mainlining purines straight into your bloodstream.

Gout-Friendly Snacks

The best snacks are low in purines but high in fat and protein to slow alcohol absorption. Think:

• Cheese (preferably hard cheeses like Manchego or Parmigiano)
• Nuts (almonds, walnuts, and cashews = safe, peanuts = risky)
• Vegetables (crunchy, fibrous, and won’t betray you)

What to Avoid

Seafood platters? Nope. Red meat in excess? Bad idea. Anything that combines high purines with alcohol? Dangerous territory. Avoid:

• Oysters, mussels, scallops, anchovies—the purine bombs of the sea.
• Processed meats—goodbye, chorizo (we’ll miss you).
• Sugary desserts—because fructose can also mess with uric acid levels.

Timing Matters

Drinking on an empty stomach is a rookie mistake. Not only does it increase alcohol absorption, but it also leaves your body defenseless against a purine spike. Eat before you drink, not just after, or you’ll pay for it later.

Supplements & Lifestyle Tweaks That Help

Wine might be here to stay, but that doesn’t mean we can’t stack the odds in our favor.

Cherry Juice & Vitamin C: Do They Actually Work?

Both have been hyped as natural gout fighters, and for once, the hype is kind of legit. Cherry juice has compounds that help lower uric acid, and Vitamin C helps your body flush it out faster. Do they cancel out a bottle of Rioja? No. But do they help nudge things in the right direction? Absolutely.

Exercise vs. Gout: Finding the Balance

• Too little movement = bad for circulation and kidney function.
• Too much intense exercise = uric acid spike from muscle breakdown.

The sweet spot? Regular, moderate exercise. Think long walks, strength training, and anything that doesn’t leave you collapsed in a heap.

Medications & Preventive Options

Some people need meds to keep uric acid levels in check—and if you’re getting frequent flare-ups, it might be time to have that chat with a doctor. Options include:

• Allopurinol (lowers uric acid production)
• Colchicine (helps manage flare-ups)
• NSAIDs (for pain relief when you inevitably ignore all this advice)

If you’re serious about keeping gout at bay, it’s worth exploring long-term solutions. But if you’re here to toe the line and drink smart, a few simple tweaks can go a long way.

Final Thought: Drink Like a Gout Veteran, Not a Rookie

We’ve accepted that wine and gout aren’t the best of friends, but we’ve also established that life without wine is not an option. So be smart. Hydrate, eat well, space it out, and know your body. If a gout attack comes for you anyway? At least you earned it.

You’ve Gotten an Inevitable Flare-Up. Here’s How to Treat Gout.

So, despite our best efforts to balance indulgence with caution, the dreaded gout flare-up has arrived in your toe and feels like a pair of sperm whales made of lava are mating inside of it. So let’s minimise the impact and get you back to dancing, or at least walking, as soon as possible. Firstly, you need to acknowledge that gout is inevitable if you live a certain way, and that everybody that you respect also has it. Once you’re at peace with this, we can work on helping you hang up the hobble and get back to strutting.

Getting a Diagnosis: Confirming That Your Foot Is Indeed Betraying You

Before we go necking NSAIDs and blaming last night’s Rioja, let’s make sure you actually have gout. Just because your big toe feels like it’s been run over by a medieval cart doesn’t mean gout is the only culprit—plenty of other conditions can cause joint pain. A proper diagnosis will save you from self-medicating for the wrong thing (or worse, ignoring something more serious).

Step 1: The Doctor’s Eyeball Test (And Some Questions)

• A good doctor can often tell it’s gout just by looking at it—the classic swollen, red, throbbing toe joint is hard to miss.
• But they’ll also ask about your lifestyle—do you drink? Eat rich food? Have a family history of gout-ridden ancestors limping through time?
• If they start nodding while you talk about wine, oysters, and bad decisions, you’re already halfway to a diagnosis.

Step 2: Blood Tests (Uric Acid Levels Aren’t Always Reliable)

• A uric acid blood test might be ordered—but here’s the catch: you can have high uric acid and no gout, or normal uric acid and still have gout.
• Context matters—which is why some doctors won’t rely solely on blood tests.

Step 3: The Needle Test (If They Really Want to Be Sure)

• If there’s any doubt, they might go full detective mode and extract joint fluid with a needle to check for actual uric acid crystals.
• Yes, it sounds horrifying. Yes, it involves a needle going into an already exquisitely painful joint.
• But if you want a 100% confirmed gout diagnosis, this is how they do it.

Step 4: Imaging Scans (Only If You’re Fancy or Confusing)

• In rare cases, they might use X-rays or ultrasounds to rule out other joint issues, like arthritis or an old injury you conveniently forgot about.

Once they confirm it’s gout, you can finally stop wondering if you just stubbed your toe really badly and move on to the fun part—figuring out how to treat it without giving up everything you love.

Medical Treatments: Prescription Warriors

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These are often the first line of defense. Medications like ibuprofen and naproxen can effectively reduce inflammation and alleviate pain. However, they come with potential side effects, especially for those with gastrointestinal issues, kidney problems, or heart conditions. Always consult with a healthcare provider before diving into the NSAID pool.​
2. Colchicine: This ancient remedy remains relevant. Colchicine can be particularly effective if taken at the onset of symptoms. But tread carefully; higher doses can lead to unpleasant gastrointestinal side effects.​
3. Corticosteroids: When NSAIDs and colchicine aren’t suitable, corticosteroids like prednisone step in. They can be administered orally or directly into the affected joint. Be mindful of potential side effects, such as mood swings and elevated blood sugar levels.

Over-the-Counter Allies

• NSAIDs: Over-the-counter options like ibuprofen are readily available. Remember to adhere to recommended dosages and consult a healthcare professional if you’re unsure.​
• Topical Ice Therapy: Applying ice packs to the inflamed joint can provide temporary relief by numbing the area and reducing swelling.​

Dietary and Lifestyle Adjustments: The Long Game

• Hydration: Keep those kidneys flushed by drinking plenty of water. Proper hydration aids in expelling excess uric acid from the body.​
• Dietary Choices: While we’ve previously delved into the relationship between diet and gout, it’s worth reiterating: reducing intake of high-purine foods (like certain seafood and red meats) can make a difference.​
• Alcohol Intake: Moderation is key. Certain alcoholic beverages, particularly beer and spirits, have been linked to an increased risk of gout flare-ups.​
• Weight Management: Maintaining a healthy weight can reduce the frequency and severity of gout attacks.​

Preventive Medications: The Guardians Against Future Flare-Ups

For those who experience frequent gout attacks, medications that lower uric acid levels, such as allopurinol or febuxostat, may be prescribed. These aren’t quick fixes but are intended for long-term management to prevent future flare-ups.​

In the grand tapestry of a life well-lived, a gout flare-up is but a minor snag. With the right combination of medical treatments and lifestyle adjustments, you can swiftly return to savoring the finer things—like that next exquisite glass of wine.

Conclusion: Everybody’s Got Gout And You Should Too

Because what better proof that you’ve lived a full and satisfying life, and done so in a way that shows your appreciation for pleasure. This is the bonvivants way and gout is simply a part of the territory. But we don’t want to romanticise it, because it bloody hurts and hobbling around isn’t a great look. So basically play it prudently, drink to the occasion, know what triggers you and if you plan on carrying on pack some preventative pills or some colchicine in your carry-on. 

And don’t believe the naysayers when they tell you that wine causes gout. It does not cause gout, not alone anyway, so drink in immoderation when it feels right to do so, and if you end up with a limp, well, sometimes we got to pay the price to play. Bottoms up!