Gout: all you need to know
It’s a myth that only rich old men get gout. Find out how to ward off attacks, and the best things to eat and drink.
Image credit: Getty/Ika84
It’s a myth that only rich old men get gout. Find out how to ward off attacks, and the best things to eat and drink.
A type of arthritis, gout occurs when uric acid, a waste product in the blood, is not excreted in the normal way via urine (and faeces to a lesser extent).
Instead, the acid forms needle-like crystals that collect around joints, causing painful inflammation. “In some people, the kidneys or gut are unable to clear uric acid from their bodies efficiently,” says Professor Abhishek Abhishek, rheumatologist at the University of Nottingham and spokesperson for the charity Versus Arthritis.
Cases of gout have skyrocketed in the past four years, with the condition now affecting around 1.5 million people in the UK,
Some areas of the UK have been hit particularly badly – according to figures released by the NHS in 2024, Liverpool has seen a 960% increase, while cases in Dorset have gone up by 219%. But no one quite understands why.
Men are more than three times as likely to experience gout (oestrogen may have a protective effect), but after menopause any gender advantage is lost. Women are most likely to get gout between the ages of 65 and 69, according to one recent study.
For many years, gout was nicknamed the 'disease of kings' (King Henry VIII being possibly the most famous sufferer), but this is unfair and doesn’t paint the whole picture. While expansive diets and copious amounts of alcohol can be triggers, there are several seemingly healthy foods that can be just as risky for gout sufferers.
And anyway, genetics is more important. “The underlying problem in the majority of cases is genetic,” says Prof Abhishek. “The idea that gout is self-inflicted, caused by bad lifestyle choices, is not accurate – most often it is an inherited metabolic condition.”
Certain illnesses and medications also put people at a higher risk of gout. Chronic kidney disease is a leading cause, as the kidneys struggle to filter uric acid, while people with a body mass index above 25 are also more likely to develop it.
There is an associated risk for those who have high blood pressure, high cholesterol and diabetes. Paradoxically, medicines used to treat these conditions can increase uric acid in the blood. These include aspirin and diuretic medication for hypertension.
What we eat and drink can play a role not only in causing gout but in reducing the likelihood of further attacks. This is due to the presence of purines, a type of protein found in certain foods and drinks, which are broken down into uric acid in the body.
If you already suffer from gout, a diet high in purines will increase your risk of an attack fivefold, according to the UK Gout Society.
These foods are high in purines:
But most rheumatologists don’t recommend low-purine diets. “Banning food containing purines from your diet is difficult to adhere to and will only make a small difference to uric acid levels in the blood compared to medications,” says Prof Abhishek.
“It’s more important to have a balanced diet, which can include red meat and shellfish in moderation (once a week).”
Using analysis of some 400,000 people in the UK, the Biobank research group found that drinking alcohol – particularly beer and cider – can raise the risk of developing gout.
It was also discovered that men who drink five times a week have double the risk of those who drink once a week.
“Real ale contains a particular protein that turns into uric acid when metabolised,” explains Dr Kelsey Jordan, consultant rheumatologist at the Royal Sussex County Hospital and trustee director of the UK Gout Society.
Real ale includes dark beers (stout and ale) and IPAs (including craft beers). Lagers are fine as they don’t contain the same protein.
“Going on a long-haul flight and drinking alcohol on board rather than water can increase dehydration and precipitate a flare-up," says Dr Jordan. "This is because you have a more concentrated blood stream, meaning the uric acid level is much more concentrated.”
However, don’t quench your thirst with gallons of cola. “Fizzy drinks high in corn syrup can increase the risk of gout, too," explains Dr Jordan, "because the kidney prioritises excreting bad sugars like fructose over uric acid, leaving you with more urate in the blood.”
The big toe is the first area to be affected in 50% of people, and the pain can be excruciating.
“Many patients with first-time attacks present in A&E thinking that they’ve broken their foot,” says Dr Jordan. "Gout is one of the most painful things you can experience. In some cases, the skin goes red and peels off due to the acute and rapid inflammation.”
Pain can also occur in ankles, knees, fingers and wrists, and usually lasts for around two weeks if left untreated. After the first attack, 60-70% of people will have a further episode in the first year, according to Dr Jordan.
“If the disease remains untreated, it will often spread to the other foot, the ankle, the knee, and other joints and tissues, going from acute episodes to a background chronic inflammatory disease."
During a flare-up, Dr Jordan recommends taking an anti-inflammatory drug immediately. “You have a small window of opportunity for easing the pain,” she explains.
NICE guidelines recommend taking urate-lowering medication (most commonly the prescription drug allopurinol) two to four weeks after the gout episode has subsided. You remain on the medication indefinitely.
Annual blood tests should be carried out to determine what dose of the medication is needed to keep your uric acid levels below an acceptable threshold.
All dairy products contain a protein that helps the body to excrete uric acid. Consumption of dairy products was associated with a lower risk of gout in a data analysis study at Yale School of Medicine. Skimmed milk/low fat dairy in particular seems to lead to a reduction in blood urate levels.
A 20-year study involving some 47,000 men found that those taking a vitamin C supplement of 1,500mg a day had a 45% lower risk of gout than those who didn’t take any. The vitamin is thought to help the kidneys excrete uric acid.
A study in Japan found that uric acid levels in the blood waned with increasing coffee intake. This is thought to be due to a polyphenol, abundant in coffee, that has a similar uric acid-lowering mechanism to allopurinol.
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