Gout is a painful inflammatory condition caused by the formation of uric acid crystals in the joints. Also known as gouty arthritis, this condition can occur suddenly and most often begins in the big toe.
Uric acid is a compound created as your body breaks down purines, which are found in your body and the food you eat. High levels of uric acid cause gout crystals to form, which then build up in the joints. This leads to the onset of pain and inflammation. People with gout experience periods where their symptoms worsen, which is known as a gout attack.
Gout occurs in between 1% and 4% of the world’s population, though in some countries it has a higher prevalence of closer to 10%. This condition affects over 3% of adults in the United States. Gout occurs in men more often than women.
Someone is at risk of developing gout if they have a high serum uric acid level, which can lead to a condition called hyperuricemia. This causes the creation of monosodium urate (MSU) crystals. When there are too many MSU crystals in the body, they build up in joints, fluids, and tissues, which is what causes gout and its associated side effects. It’s important to note, though, that hyperuricemia does not always cause gout.
A buildup of MSU crystals can be caused by the body’s inability to excrete uric acid through urine. People are more likely to have gout when their kidneys aren’t functioning properly, because the kidneys are responsible for 60% to 70% of the body’s total uric acid excretion.
Uric Acid Excretion
There are a number of reasons why a person doesn’t excrete enough uric acid through urine. Certain genetic defects and illnesses can hinder uric acid elimination and cause the body to reabsorb too much uric acid. These conditions include juvenile hyperuricemic nephropathy (medullary cystic kidney disease) and chronic kidney disease.
Uric Acid Production
In addition to negatively affecting uric acid excretion, genetic defects are also responsible for the production of too much uric acid. Additionally, certain treatments like chemotherapy can increase purines as the treatment kills the tumor cells and causes the breakdown of the purines in those cells.
Purines occur in the body naturally and cannot be avoided; however, you can limit your intake of purines through proper dietary choices. Certain foods are also high in purines, which can lead to high uric acid levels or cause an overproduction of uric acid.
Alcohol has also been shown to increase the risk of a gout attack. Specifically, alcohol consumption even in moderate amounts can contribute to gout, and anyone predisposed to gout should avoid drinking.
People genetically predisposed to gout can still prevent gout attacks from occurring by making certain lifestyle changes.
For people with only mildly elevated uric acid levels, dietary changes may be all that’s needed to prevent gout.
Avoiding and limiting foods that are high in purines can greatly reduce the risk of gout. These include:
- Some kinds of fish and shellfish, including anchovies, sardines, mussels, scallops, trout, and tuna
- Red meat like beef, pork, and lamb
- Organ meat like liver, kidney, and sweetbread
Foods to consume that are low in purine and can lower gout risk include:
- Fresh fruits and vegetables
- Low-fat dairy products
- Potatoes, rice, bread, and pasta
- Poultry, in moderation
- Eggs, in moderation
Research has shown that eating nutritionally well-designed food, such as vegetables and dairy products, causes urine alkalinization, which promotes uric acid excretion.
Limit Alcohol Intake
Alcohol is high in purines, which is why it contributes to gout. Some people say that only grain alcohols like beer contribute to gout attacks, while others believe it is triggered by wine. However, research has shown that all types of alcohol can pose an equal risk to the development of gout.
All alcohol consumption increases the risk of gout, even if it’s one drink, and the risk of gout increases with each drink consumed. Therefore, having one drink is still better than having two or three.
Losing weight can potentially reduce the risk of gout because it reduces a person’s average serum uric acid levels. Moreover, weight loss from both bariatric surgery and dietary changes resulted in positive outcomes for people at risk of gout. However, the evidence supporting the role that weight loss plays in reducing uric acid levels is of low to moderate quality, so more studies are needed to show the benefit of weight loss for gout.
For some people, stress can trigger gout attacks. That’s because high levels of stress and anxiety are associated with increased uric acid levels. Taking action to manage your stress can also support a more calm state of mind and reduce the inflammation associated with stress.
Diaphragmatic breathing is a breathing technique that involves a steady inhale while expanding the belly and a long exhale while bringing the belly in. Yoga and meditation have also been shown to reduce stress and make it easier to manage daily challenges.
Water plays a vital role in preventing gout attacks because it helps flush uric acid from the body and prevent a buildup of crystals. Research has shown that exercise-induced sweating reduces uric acid excretion and leads to increased uric acid levels in the body. This suggests that dehydration can increase serum uric acid level and is a risk factor for a gout attack.
In another study, adequate water consumption in a 24-hour period prior to a gout flare-up was associated with a 46% decrease in recurrent gout attacks. It is therefore important to stay hydrated. Try to drink eight 8-ounce glasses of water per day for optimum hydration.
Certain drugs can help prevent a gout flare-up. For example, allopurinol (Alloprim) is a drug that restricts the breakdown of purines, which reduces serum uric acid levels. Allopurinol belongs to a class of medications called xanthine oxidase inhibitors, and it works by reducing the production of uric acid in the body.
Febuxostat is another xanthine oxidase inhibitor that can be used to prevent gout attacks in people who were not successfully treated with or cannot take allopurinol. However, this medication is much stronger compared with allopurinol and comes with a warning of increased risk of heart-related death.
Allopurinol and febuxostat are used to prevent gout attacks, not to treat them once they occur.
A Word From Verywell
People with genetic predispositions for gout cannot avoid the condition entirely, but gout attacks can be greatly reduced by making dietary and lifestyle changes. They can help you manage your condition and alleviate the painful symptoms of gout. Changes like maintaining a healthy weight and eating nutritious foods can also boost your overall health and prevent other problems such as heart disease. Talk to your healthcare provider about getting help for gout and before pursuing any medications.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Ragab G, Elshahaly M, Bardin T. Gout: an old disease in new perspective - a review. J Adv Res. 2017 Sep;8(5):495-511. doi:10.1016/j.jare.2017.04.008
Roddy E, Choi HK. Epidemiology of gout. Rheum Dis Clin North Am. 2014 May;40(2):155-75. doi:10.1016/j.rdc.2014.01.001
Evans PL, Prior JA, Belcher J, Hay CA, Mallen CD, Roddy E. Gender-specific risk factors for gout: a systematic review of cohort studies. Adv Rheumatol. 2019 Jun 24;59(1):24. doi:10.1186/s42358-019-0067-7(Video) Best & Worst Foods to Eat with Gout | Reduce Risk of Gout Attacks and Hyperuricemia
Bobulescu IA, Moe OW. Renal transport of uric acid: evolving concepts and uncertainties. Adv Chronic Kidney Dis. 2012 Nov;19(6):358-71. doi:10.1053/j.ackd.2012.07.009
Hande KR, Hixson CV, Chabner BA. Postchemotherapy purine excretion in lymphoma patients receiving allopurinol. Cancer Res. 1981 Jun;41(6):2273-9
Peixoto RD, Cossetti R, Lim H, Cheung WY, Kennecke H. Acute gout episodes during treatment with capecitabine: a case report. Gastrointest Cancer Res. 2014 Mar;7(2):59-60.
Neogi T, Chen C, Niu J, Chaisson C, Hunter DJ, Zhang Y. Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. Am J Med. 2014 Apr;127(4):311-8. doi:10.1016/j.amjmed.2013.12.019
Kanbara A, Hakoda M, Seyama I. Urine alkalization facilitates uric acid excretion. Nutr J. 2010 Oct 19;9:45. doi:10.1186/1475-2891-9-45
Nielsen SM, Bartels EM, Henriksen M, Wæhrens EE, Gudbergsen H, Bliddal H, Astrup A, Knop FK, Carmona L, Taylor WJ, Singh JA, Perez-Ruiz F, Kristensen LE, Christensen R. Weight loss for overweight and obese individuals with gout: a systematic review of longitudinal studies. Ann Rheum Dis. 2017 Nov;76(11):1870-1882. doi:10.1136/annrheumdis-2017-211472
Kakutani-Hatayama M, Kadoya M, Okazaki H, Kurajoh M, Shoji T, Koyama H, Tsutsumi Z, Moriwaki Y, Namba M, Yamamoto T. Nonpharmacological management of gout and hyperuricemia: hints for better lifestyle. Am J Lifestyle Med. 2015 Sep 2;11(4):321-329. doi:10.1177/1559827615601973
Ma X, Yue ZQ, Gong ZQ, Zhang H, Duan NY, Shi YT, Wei GX, Li YF. The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Front Psychol. 2017 Jun 6;8:874. doi: 10.3389/fpsyg.2017.00874
Maddux RE, Daukantaité D, Tellhed U. The effects of yoga on stress and psychological health among employees: an 8- and 16-week intervention study. Anxiety Stress Coping. 2018 Mar;31(2):121-134. doi:10.1080/10615806.2017.1405261
Seth R, Kydd AS, Buchbinder R, Bombardier C, Edwards CJ. Allopurinol for chronic gout. Cochrane Database Syst Rev. 2014 Oct 14;(10):CD006077. doi:10.1002/14651858.CD006077.pub3
By Michelle Polizzi
Michelle Polizzi is a freelance writer and certified yoga instructor who creates research-based health and wellness content for leading brands and publications.
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