To some, gout is an ailment commonly mentioned in historical texts and a lot less commonly in daily life. To others, it's a fact of life, something they contend with and have to handle on a routine basis. It's a surprisingly complex illness, with many factors and triggers to consider, so let's learn about it and how you can help control it.
Table of Contents
What is Gout?
Gout is the common name for a specific form of inflammatory arthritis that affects the joints. It causes brief but extreme swelling in joints, often specific joints, including toes, ankles, knees, fingers, wrists, and elbows.
Gout comes and goes rapidly, but the pain and stiffness can linger even after the primary symptoms fade.
What Causes Gout?
When you eat and drink, your body takes in a wide range of different nutrients, both good and bad. Certain chemicals in your diet, called purines, can be counted among that list. Purines are a chemical compound the body uses to build DNA and RNA and are commonly found in meat products.
Purines are important to our health. In addition to their use in creating and repairing DNA and RNA, they are also used in metabolic processes to provide energy, and they help regulate enzymatic activity throughout the body.
When your body breaks down purines, the resulting byproducts include uric acid. Uric acid then builds up in your blood and is filtered out by your kidneys as part of their operation. Uric acid is then excreted in urine. Under normal circumstances, your body is able to handle the filtration just fine, so uric acid never builds up, and you go about your life just fine.
Sometimes, though, this balance is broken. Maybe your body breaks down purines too quickly, or there are too many of them in your diet. Alternatively, maybe your kidneys can't handle and filter the amount your body is producing. Either way, uric acid builds up in your blood, causing a condition called hyperuricemia.
On its own, hyperuricemia is very common, with as many as one in five people having it to some degree. Often, it doesn't cause any problems, but if it's maintained over the long term or is bad enough, the uric acid in your blood can form crystals. These crystals are small but sharp and jagged. They also clump together to form larger and larger masses.
Two primary illnesses result from this build-up, and it depends on where the crystals accumulate. If they end up caught in your joints and cause pain, inflammation, and swelling, it's gout. As much as 5% of the people in the United States are estimated to have gout. If the crystals make their way to the kidneys but get stuck and build up there, the resulting immensely painful condition is a kidney stone.
Neither of these conditions are guaranteed with hyperuricemia, but they're both common enough to be widely known today.
What Are the Symptoms of Gout?
The primary symptoms of gout are a sudden onset – often developing overnight and becoming abundantly obvious in the morning – of significant swelling, intense pain, stiffness, tenderness, and warmth in a joint. The most common first location for gout is the big toe, but it can crop up in nearly any joint in the body.
Gout flares, also known as gout attacks, come on quickly and can linger with severe pain for 4-12 hours. After that, lingering pain, stiffness, redness, and inflammation can stick around for days to weeks.
Who is At Risk of Developing Gout?
Anyone can develop gout. However, people with certain risk factors are much more at risk of developing gout than others.
These people include:
- Genetically male individuals are three times more likely than females to develop gout.
- Females are more likely to develop gout after menopause.
- People with obesity are at greater risk.
- People with congestive heart failure are at greater risk.
- People with diabetes are at greater risk.
- People with high blood pressure are at greater risk.
- People with kidney disease are at greater risk.
- People with blood cancers are at greater risk.
- People who regularly drink alcohol are at greater risk.
- People who consume protein in excess are at greater risk.
Additionally, people who take immunosuppressants or diuretic medications are at greater risk, as these can impact kidney function.
What Foods Can Trigger Gout?
Gout is caused by uric acid building up in the blood, and uric acid is created through the breakdown of purines, which are found in your diet. This leads us to the obvious question: which foods are high in purines and, thus, can trigger a gout attack?
First, we have to consider why gout occurs. Is it as simple as eating too many purines, or is there another mechanism at play?
According to a significant systemic review from 2022 of gout symptoms, management, and dietary control, there are several factors involved beyond simple purine consumption. Consuming foods high in purines is one factor, but gout is also impacted by high dietary fat, high sugar, and even gut microbiome changes can all play a role. Dietary modification is effective at controlling gout, but it's not as simple as just reducing foods high in purines; you have to consider other factors as well.
In broad strokes, the best dietary change is emphasizing a low-fat, low-carb, primarily plant-based diet that maintains nutritional balance and moderation in all things. Fortunately, this is in line with most recommendations for a healthy diet, absent other specific concerns.
The areas of highest concern, according to a meta-analysis published in 2018, are:
- Red Meat
- Seafoods
- Alcohol
- Fructose
Interestingly, high-purine foods from vegetable sources (rather than animal sources) were not associated with hyperuricemia, nor were dairy products, soy foods, or coffee.
It's also worth looking at specific foods more closely, which was done in a 2022 analysis of a wide range of studies.
Alcohol
Alcohol intake has been historically associated with gout in anecdotal reports, but until recently, relatively little information about it was studied.
Recent studies did find some interesting facts:
- Beer seems to have the highest increase in risk of gout, followed by spirits.
- Wine seems to have the least risk of gout, but was not free of risk.
- Those experiencing gout flares were more resistant to drug-based treatment if they consumed alcohol regularly.
That final fact may, however, be more related to noncompliance than to an effect of the alcohol itself.
Fructose
Sugar, in general, is often attributed as a factor in gout. So far, however, very few studies have been conducted into sugar.
One small study looked at fructose and found that intake of high fructose corn syrup had both an immediate and a long-term increase in serum urate.
Protein
One of the largest studies on hyperuricemia and gout evaluated a study group of 47,150 men over the course of 12 years. During that time, 730 confirmed new cases of gout were observed. This study found that higher consumption of purine-rich protein sources from animals – specifically red meat and seafood – was associated with a higher risk of gout, whereas consumption of purine-rich vegetables was not.
This might indicate that purine alone is not wholly responsible for gout but that other risk factors from animal protein may be relevant. Further study is necessary to evaluate the truth of the matter.
Foods that Might Reduce the Risk of Gout
While examining foods to see if they're worth cutting out of your diet is a good place to start, it's also possible that some foods might be able to reduce the risk of gout when you consume them regularly. Some areas that studies investigated found a few potential options.
Coffee, Tea, and Caffeine Intake
Another area of concern evaluated in these studies was caffeine and caffeinated beverage intake. The most interesting result was that people who consumed 4, 5, and 6+ cups of coffee per day had lower serum urate levels than those who drank less. Coffee seems to have an inverse association with serum urate levels, while tea had no association at all, at least in one Japanese study.
Another interesting finding was that decaf coffee was also inversely associated with gout and gout flare-ups.
Of note is that caffeine, as a chemical molecule, has a similar chemical structure to allopurinol, one of the primary medications for gout. There's no firm understanding as to whether or not caffeine has an impact, however, and the fact that coffee does seem to decrease gout risk while tea does not would indicate that the molecule responsible is not caffeine, which is shared between both.
Cherries and Cherry Juice Concentrate
Another interesting result was that cherries, with their antioxidant effects, might have a benefit in reducing inflammation related to gout, and could possibly have an impact on reducing uric acid in the blood.
A small trial of 26 individuals without gout found that tart cherry juice reduced serum urate by 19.2%. Unfortunately, another study of 50 patients with gout found no significant impact of cherry juice. A slightly larger study involving 633 people found a 35% lower risk of gout flares when cherries were consumed, but this was a very short, two-day study.
Broadly, while cherries may be promising, more evidence is needed to draw any firm conclusions.
Tempering Expectations
There's a lot to consider with dietary control over gout. It's proven that, broadly speaking, adjusting your diet can help reduce the incidence and severity of gout flare-ups in people who already have gout, and that maintaining a healthy diet can help reduce the risk of developing gout.
However, any specifics need to be tempered by three main considerations.
The first is that relatively few studies have been performed that conclusively prove significant impacts. Essentially, only two large studies have been performed, and they echo common wisdom: reduce red meat and alcohol intake, reduce sugar intake, and maintain a healthy diet and weight. Beyond that, nothing is as simple as "eat less beef, have less gout."
The second is that many studies into "gout" are not actually directly studying gout; they tend to study hyperuricemia instead. While people who have gout by definition have hyperuricemia, the opposite is not true; many, many people have hyperuricemia and never develop gout or even any symptoms at all.
The biggest concern is that dietary changes alone are not enough to control gout if you've already experienced it before and thus "have gout" as opposed to having hyperuricemia. While dietary changes are still recommended, it's not necessarily possible to completely control gout through diet alone. Medication such as allopurinol is likely still necessary.
The third is that there's actually relatively little data about the purine content of specific foods. In response to increasing concerns about gout, the USDA did produce a large report, both into purine itself and the four main components of purines, adenine, guanine, hypoxanthine, and xanthine, but even this data set is relatively small.
At the end of the day, my broad recommendations still stand.
- Strive to maintain a healthy diet, with all things in moderation.
- Cut back on the primary causes of obesity and disease, including red meat and refined sugar.
- If you experience symptoms of any acute illness, and especially something like gout, consult with your doctor right away. Gout is very painful and, while it's not immediately life-threatening, it needs to be controlled.
Whatever steps you take, always make sure you're in contact with a medical professional to ensure you aren't developing, at risk of developing, or at risk of worsening any illnesses. When it comes to gout, diet is key, and medications as prescribed by your doctor are essential.
Sources:
- Cleveland Clinic – Gout and the Low Purine Diet: https://my.clevelandclinic.org/health/treatments/22548-gout-low-purine-diet
- NHS Gout: https://www.nhs.uk/conditions/gout/
- Mayo Clinic Gout Overview: https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897
- Cleveland Clinic Gout Overview: https://my.clevelandclinic.org/health/diseases/4755-gout
- Cleveland Clinic Hyperuricemia Overview: https://my.clevelandclinic.org/health/diseases/17808-hyperuricemia-high-uric-acid-level
- Purine – National Cancer Institute: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/purine
- National Institutes of Health – Special Component Databases – Choline, Fluoride, Iodine, Purines, and Other Compounds: https://ods.od.nih.gov/Research/specialdatabases.aspx#purines
- Gout and Diet: A Comprehensive Review of Mechanisms and Management: https://pmc.ncbi.nlm.nih.gov/articles/PMC9459802/
- The Association between Purine-Rich Food Intake and Hyperuricemia: A Cross-Sectional Study in Chinese Adult Residents: https://pmc.ncbi.nlm.nih.gov/articles/PMC7765492/
- Dietary factors and risk of gout and hyperuricemia: a meta-analysis and systematic review: https://pubmed.ncbi.nlm.nih.gov/30485934/
- Role of Diet in Hyperuricemia and Gout: https://pmc.ncbi.nlm.nih.gov/articles/PMC8678356/
