Old Fashioned

The Old Fashioned is a classic cocktail built on three core ingredients: a distilled spirit (typically bourbon or rye whiskey), sugar (usually a sugar cube or simple syrup), and aromatic bitters, often finished with an orange peel or cherry. Each component presents a distinct challenge for people with gout.

Why it's risky

Alcohol — especially spirits and beer — is one of the strongest dietary triggers for gout. Whiskey increases uric acid production in the body and simultaneously impairs the kidneys' ability to excrete uric acid, leading to a rapid rise in serum urate levels. Even a single drink can precipitate a flare in susceptible individuals, and regular consumption of spirits is associated with a significantly higher risk of gout attacks.

The added sugar compounds the problem. Sucrose (table sugar) is broken down into glucose and fructose, and fructose metabolism directly stimulates uric acid generation. A sugar cube or syrup in an Old Fashioned adds a concentrated, fast-absorbing dose of fructose that can spike uric acid soon after drinking.

Practical guidance

For those managing gout, it is best to avoid the Old Fashioned entirely. If you choose to drink, limit spirits to no more than one serving and pair with plenty of water. Better alternatives include a non-alcoholic "zero-proof" Old Fashioned made with flavored bitters, citrus, and a sugar substitute — or simply sparkling water with lemon. Never drink during an active flare, as alcohol and sugar will prolong recovery.