The Link Between Obesity and Gout

Senior man with gout
Peter Dazeley

Obesity is now known to be a risk factor for the development of a number of chronic illnesses, including diabetes, cardiovascular disease, obstructive sleep apnea, and many forms of cancer, among others. But did you know that obesity is also an important risk factor for gout?

What Is Gout?

Gout is a condition that is characterized by crystal deposits within joint fluid and other tissues, causing painful, recurrent flares as well as tissue damage.

One of its primary features is the presence of high levels of uric acid in the blood; these high uric acid levels contribute to the crystal formation (known formally as monosodium urate monohydrate crystals) that causes so much of the pain of gouty arthritis.

Obesity as a Risk Factor for Gout

There are several recognized risk factors for gout, and obesity is one of them. While other risk factors, such as age and sex (men are at higher risk), are not considered modifiable, obesity and diet are two risk factors that can be changed, and doing so can help reduce the risk of gout.

In the Health Professionals Follow-up Study reported in the Archives of Internal Medicine in 2005, over 47,000 men were followed over 12 years, and the risk for gout was found to increase as body mass index (BMI) increased. The good news from this study was that a weight loss of at least 10 pounds was associated with a 39 percent reduction in the risk for gout.

In another study reported in the journal Urolithiasis in 2016, the authors found that, even in people consuming a Mediterranean diet, the rates of both gout and Type 2 diabetes were higher in those who had overweight and obesity.

In addition to gout, it should be noted, obesity has been recognized as a risk factor for another, more common form of arthritis: osteoarthritis, the kind that often develops with age as a result of wear and tear on the joints.

However, obesity puts added stress on major joints, particularly the knees, which bear the brunt of added weight, and this can cause osteoarthritis to develop earlier and to be more painful and more difficult to manage. Losing weight can thus be greatly beneficial in both forms of arthritis.

Similar Dietary Risks

It may also be the case that cravings that result in high dietary fat intake can be the cause of both gout and obesity. This is what French researchers found in the NutriNet-Santé study reported in the International Journal of Behavioral Nutrition and Physical Activity in 2016. With nearly 25,000 French adults participating in this study, researchers were able to assess dietary preferences and habits over a five-year timeframe and found that, in both men and women, a sensory liking for dietary fat was associated with an increased risk of obesity.

Consider another food source that has been repeatedly linked to obesity: sugared beverages. Of all the dietary causes of obesity, consumption of added sugar tops the list.

Many experts have noted how the increased intake of sugar-sweetened beverages in the United States has paralleled the rise in obesity rates. And there have been ever-increasing amounts of sugar added to the American diet over the past several decades; nowhere is this more apparent than in sugared beverages such as sodas, fruit juices, and energy drinks.

As it turns out, consumption of high-fructose-containing foods and beverages has also been recognized as a risk factor for the development of gout. In fact, according to a review article published in the Annals of Internal Medicine in 2016, “fructose is the only carbohydrate known to directly increase serum urate levels,” which are, as noted before, a hallmark of gout.

Thus, limiting or eliminating intake of sugared beverages and high-fructose-containing foods (which includes many packaged and processed snacks, candies, desserts, and even entrees) will not only aid in the prevention of obesity but will also help reduce the risk for gout.

Being able to avoid such added sugars, though, requires knowing how and where to look for them. Because food manufacturers have found many different methods and sources by which to add sugar to foods ranging from ketchup to cereal to soft drinks, it can be difficult to identify added sugar in the ingredients lists on food labels. However, by knowing many of the names that indicate a sugared or sugar-derived ingredient, you can be an informed consumer and opt for the products without added sugar.

The most common names for added sugar include any ingredient ending in “-ose”--such as maltose, dextrose, sucrose, fructose, lactose—as well as high fructose corn syrup, molasses, honey, cane sugar, corn sweetener, evaporated cane juice, raw sugar, syrup, and fruit juice concentrates.

Further, according to the American Heart Association (AHA), in addition to the soft drinks, fruit drinks, candy, and desserts mentioned above, the following are also major (and unexpected) dietary sources of added sugars in the United States: cereals and sweetened yogurt. So always be sure to check that nutrition label as well as the ingredients list.

In addition to fructose, another very well-known source of dietary indiscretion that increases the risk for gout and gout flares is the intake of high-purine-containing foods. These include several animal sources, ranging from red meat such as beef, lamb, and pork, to organ meats like liver and kidney, to high-purine-containing seafood such as sardines, anchovies, and shellfish. This category even includes meat extracts like gravy and broth.

Perhaps not surprisingly, many of these processed meats have been connected to a host of other diseases, obesity among them. Probably most strikingly, processed meats have been declared carcinogenic by the International Agency for Research on Cancer (IARC), a part of the World Health Organization (WHO), which has stated that such processed meats as hot dogs, sausages, jerky, and the like definitely can cause colorectal cancer (also an obesity-related disease). The IARC has also stated that red meat in general “probably” causes cancers such as colon, pancreatic, and prostate cancer.

Note that fresh, low-mercury-containing seafood such as sardines and anchovies have not been declared carcinogenic and are not included in that cancer-causing processed- and red-meat category; in fact, they are an important part of many healthy, Mediterranean-style diets. However, if you have gout or are at risk for developing gout, they are unfortunately in the category of foods that have a high-purine content and can contribute to gout flares.

Finally, alcohol consumption is also a dietary risk factor for developing gout and gout flares. Excess alcohol consumption has been associated with an increased risk for obesity as well.

Losing Weight Can Help

Studies have shown that weight loss can help in reducing the risk for gout and for treating the high uric acid levels that are the root cause of gout.

In the MRFIT Study (Multiple Risk Factor Intervention Trial) reported in the journal Rheumatology in 2010, people who lost at least 10 pounds were nearly four times more likely to achieve lower bloodstream uric acid levels than were those without any weight loss. On the opposite end of the spectrum, those who gained 10 pounds or more were 65 percent less likely to achieve healthier uric acid levels.

Losing weight is not always easy, but keep in mind that just a little weight loss can go a long way. Research has found that losing just 5 percent to 10 percent of excess weight can result in a dramatic reduction in the risk for obesity-related illnesses like gout. And getting daily exercise, regardless of associated weight loss, has far-reaching health benefits.

How Do You Know if You Have Gout?

If you have obesity or overweight, you may be wondering how you can tell if you have gout. The main symptoms of gout are what are known as gout flares, which are episodes of joint pain that come on suddenly and without warning, with maximum pain that occurs usually within 24 hours.

The joint or joints involved in a gout flare will typically be swollen, red, warm to the touch, and extremely painful, to the point that even clothing or a bedsheet touching the skin around the joint can elicit pain. The base of the big toe is a joint commonly affected by gout. Less commonly, you may have a fever in combination with the joint signs and symptoms.

If you experience such symptoms, see your clinician immediately, as making the final diagnosis may require analyzing a sample of the joint fluid and checking bloodstream uric acid levels.

Making the correct diagnosis is important for guiding the kinds of medications you will receive for treatment, both for management of your current painful episode as well as for prevention of further episodes.

Sources:

Choi HK, Atkinson K, Karlson EW, Curhan G. Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the Health Professionals Follow-up Study. Arch Intern Med. 2005;165:742-748.

Lampure A, Castetbon K, Deglaire A, et al. Associations between liking for fat, sweet or salt and obesity risk in French adults: a prospective cohort study. Int J Behav Nutr Phys Act. 2016;13(1):74.

Neogi T. In the clinic: gout. Ann Int Med. 2016;165(1):ITC1-ITC16.

Trinchieri A, Croppi E, Montanari E. Obesity and urolithiasis: evidence of regional influences. Urolithiasis. 2016 Aug 3. [Epub ahead of print]

Zhu Y, Zhang Y, Choi HK. The serum urate-lowering impact of weight loss among men with a high cardiovascular risk profile: the Multiple Risk Factor Intervention Trial. Rheumatology (Oxford). 2010;49:2391-2399.

Continue Reading