Confirming the wisdom of ages, researchers have found that drinking alcohol - particularly beer - can more than double a man's risk of developing gout.
One of humankind's most ancient diseases, the painful joint condition is the leading cause of arthritis in men. It is less common in women, occurring only after menopause.
The connection to drinking has been believed for centuries, but a study published this week in The Lancet medical journal verifies it for the first time and found that even light indulgence increases the risk.
The study found that beer was the worst choice for gout, followed by spirits. It concluded that moderate wine drinking did not appear to be a problem, but experts said there were too few men in the study who drank a lot of wine to be sure that wine is a safer alternative.
In the study, conducted by scientists at Massachusetts General, Brigham and Women's Hospital, and Harvard's medical and public health schools in Boston, researchers followed 47,150 men with no history of gout for 12 years.
When the study ended in 1998, 730 men, or nearly 2 percent, had developed gout. The higher the daily alcohol consumption, the more likely gout was to develop, and the disease was more than twice as likely to occur in men who drank the most alcohol compared with those who drank none.
The strongest link was with beer - each daily serving increased the risk by 50 percent.
For spirits, the chance of developing gout increased by 15 percent with each extra drink daily.
There appeared to be no increased risk among wine drinkers, but there were only 18 men in the study who drank more than two glasses of wine a day.
Dr. Hyon Choi, a rheumatologist at Massachusetts General Hospital who led the study, said he could not rule out the possibility that heavy wine drinking could be problematic.
Gout is caused by too much uric acid in the blood. The acid forms crystal deposits in joints, particularly in the big toe, feet and ankles.
Uric acid levels are raised by foods and drinks containing a compound called purine. Digestion breaks purine down into uric acid. Beer is particularly high in purine.
"It's often said that we have drugs that are so powerful in the treatment of this disease that dietary management is probably not all that important ... But modification of diet is one of the ways in which you can reduce the risk of developing gout in the first place,'' said Dr. John Klippel, president of the Arthritis Foundation.
"There are very few forms of arthritis that you can seriously talk about proven ways of preventing the disease,'' said Klippel, who was not connected with the research.
Gout causes sometimes-excruciating episodes of pain in feet and joints. Severe cases can cause major disability or kidney failure.
Curtailing alcohol consumption is already recommended for people who suffer from the disease.