Causes and Risk Factors of Gout

How Diet, Alcohol, and Obesity Contribute to Your Risk

African American woman slicing vegetables
JGI/Jamie Grill / Getty Images

Gout is a form of arthritis characterized by sudden, severe attacks of pain and inflammation in the joints, most often the big toe. While certain factors can predispose you to the disease, such as genetics or chronic kidney disease, others like diet, alcohol, and obesity can contribute just as profoundly.

By and large, people will generally experience their first attack between the ages of 30 and 50.

While men are more likely to have gout than women, the risk in women can significantly increase after menopause.

Dietary Causes

Unlike other forms of arthritis, gout is caused by abnormalities in body metabolism rather than the immune system. The risk of the gout is related to multiple factors—genetic, medical, and lifestyle—that together contribute to a rise in uric acid levels in the blood, a condition we refer to as hyperuricemia.

The foods we eat play a significant role in the development of gout symptoms. This is due in large part to an organic compound found in many foods called purine. When consumed, purine is broken by the body and converted into the waste product, uric acid. Under normal circumstances, it would be filtered out of the blood by the kidneys and expelled of the body through urine

If this doesn't happen and the uric acid begins to accumulate, it can form crystallized deposits in a joint and lead to a gout attack.

Certain foods and beverages are common triggers for this. Among them:

  • High-purine foods are considered a major risk factor for gout. These include foods like organ meats, bacon, veal, and certain types of seafood
  • Beer is especially problematic as it is made with brewer's yeast, an ingredient with an extremely high purine content. Alcohol, in general, is off-limits as it actively stimulates uric acid levels production.
  • High-fructose beverages, including sodas and sweetened fruit drinks, can cause hyperuricemia as the concentrated sugars impair the excretion of uric acid from the kidneys.

Genetic Causes

Genetics can play a significant role in your risk of gout. Hereditary hyperuricemia is one such example, caused by SLC2A9 and SLC22A12 mutations that lead to the impaired renal (kidney) function. When this happens, the kidneys are far less able to filter uric acid or reabsorb the uric acid crystals from the blood.

The inability to maintain equilibrium between how much uric acid is produced and how much is expelled with ultimately lead to hyperuricemia.

Other genetic disorders linked to gout include:

  • Hereditary fructose intolerance
  • Kelley-Seegmiller syndrome
  • Lesh-Nyhan syndrome
  • Medullary cystic kidney disease

Medical Causes

There are certain medical conditions that can predispose you to gout. Many of these carry the same risk factors as gout, namely being overweight, eating rich foods, and drinking too much alcohol.

Others directly or indirectly affect renal function or are characterized by an abnormal inflammatory response.

Some of the more common medical risk factors include:

  • Chronic kidney disease
  • Congestive heart failure

Other medical events are known to trigger a gout attack, including a traumatic joint injury, an infection, a recent surgery, and a crash diet (the latter of which can increase uric acid concentrations due to the rapid decrease of body volume).

Medication Causes

Certain medications are associated with hyperuricemia either because they have a diuretic effect (increasing the concentration of uric acid) or impair renal function. The most common culprits include:

  • Aminophylline (use to treat chronic bronchitis)
  • Cyclosporine (an immune-suppressive drug)
  • Ethambutol (used to treat tuberculosis)
  • Lasix (furosemide)
  • Levodopa (used to treat Parkinson's disease)
  • Low-dose aspirin (used to decrease heart attack risk)
  • Niacin (vitamin B3)
  • Thiazide diuretics (used to treat high blood pressure or heart disease)

Lifestyle Risk Factors

The choices you make in life play as much of a role in your risk of gout as the factors you can't control, such age or gender. They may not entirely erase your risk, but they can affect how frequently and severely you experience an attack.

Obesity

Chief among these concerns is obesity. On its own, excessive body weight slows the removal of uric acid from the body. And, the more you weigh, the greater this impairment will be.

Insulin resistance is one of the driving forces behind this dynamic. If you are overweight or obese, your body produces more insulin. Higher levels of insulin lead to greater renal impairment leads to higher levels of uric acid.

A 2015 study also found a direct correlation between a person's waistline and his or her risk of gout. According to the researchers, among people with gout, those with higher volumes of abdominal fat have a 47.4 percent risk of an attack compared to those with normal waistlines who have a 27.3 percent risk. This is irrespective of the person's body mass index (BMI), suggesting that the more fat we visibly carry, the greater our risk of symptoms.

Other Factors

From health management perspective, many of same factors associated with chronic diseases such as type 2 diabetes and cardiovascular disease are linked to gout. These include:

Sources:

Hanier, B; Matheson, E. and Wilke, T. "Diagnosis, Treatment, and Prevention of Gout." Am Fam Physician. 2014; 90(12):831-836.

Richette, P. and Barden, T. " Gout." Lancet. 2010; 375(9711):318-28. DOI: 10.1016/S0140-6736(09)60883-7.

Roughley, M.; Belcher, J.; Mallen, C. et al. "Gout and risk of chronic kidney disease and nephrolithiasis: meta-analysis of observational studies." Arthritis Res Ther. 2015; 17(1):90. DOI: 10.1186/s13075-015-0610-9.