A look at the ingredient list of drinks will show that many contain fructose syrup – which contains a lot of fructose. And although drinks such as sugary sodas and orange juice do not contain purines, the abundance of fructose in them can increase serum uric acid levels and induce gout, experts say. Gout is an inflammatory joint lesion caused by the disruption of purine metabolism in the body, resulting in the crystallization of uric acid in tissues and joints, and was once considered a male-only disease. In recent years, however, it has been found that about 5% of older women over the age of 70 suffer from gout. Between 1977 and 1996, the incidence of gout in the United States rose from 16 per 100,000 to 42 per 100,000, a trend that coincided with a dramatic increase in soft drink and fructose consumption. A study conducted by Hyon Choi et al. at Boston Medical School, USA, with a 22-year follow-up period (1984-2006), showed that consumption of fructose-rich beverages such as sugary sodas and orange juice increased blood uric acid concentrations and increased the risk of gout in women. They selected 78,906 women from the American Nurses’ Health Study database and used a food questionnaire to collect the subjects’ daily fructose intake and analyze its relationship with the development of gout. A total of 778 new cases of gout were diagnosed during a 22-year follow-up period. They found that excessive consumption of sugary beverages increased the risk of gout. Women who consumed one sugary soda per day had a 74% increased risk of developing gout and those who consumed two or more servings per day had a 139% increased risk of developing gout compared to those who consumed less than one sugary soda in a 1-month period. Similarly, excessive intake of orange juice was associated with the development of gout. Women who consumed one and two or more servings of orange juice per day had a 41% and 142% increased risk of developing gout, respectively. In addition, when stratified by fructose intake, women in the top quintile (>6.6% of total daily energy) had a 1.62 times greater risk of gout than women in the bottom quintile (<3.7% of total daily energy). Consumption of sugar-free soft drinks, on the other hand, does not increase the risk of gout. In humans, fructose raises blood uric acid levels by promoting the degradation of ATP to adenosine monophosphate (a precursor of uric acid). The process of fructose phosphorylation in the liver requires the participation of ATP, and excessive phosphate consumption limits the conversion of ADP to ATP, which is then converted to uric acid during enzymatic digestion. As a result, plasma uric acid levels increased significantly within a short period of time after excessive fructose intake. The researchers also noted that in addition to these effects, fructose can cause hyperinsulinemia and promote insulin resistance. This effect is not present with the intake of glucose or other simple sugars. Therefore, the importance of reducing fructose intake, especially for women of advanced age with metabolic disorders such as hyperuricemia, cannot be overstated.