If you have gout, you’re likely familiar with the debilitating pain and swelling that accompanies flare-ups. These flare-ups can strike with little to no warning and can last for days to weeks. Thankfully, some simple lifestyle and dietary modifications can help reduce the frequency and duration of painful gout flare-ups. Keep reading to learn more about the causes and risk factors of gout, as well as some strategies for preventing future gout attacks.
What is gout?
Gout is a type of inflammatory arthritis that causes pain, redness, and swelling in your joints, particularly in your big toes. Gout flares are intermittent and can last for one to two weeks before resolving. They occur when high levels of urate (uric acid) build up in the blood, a condition known as hyperuricemia, prompting the body to form needle-shaped crystals in the affected joint or joints. (12)
High levels of uric acid build up when the body makes too much uric acid or is unable to efficiently eliminate uric acid though the urination. Although high levels of serum uric acid is indicative of gout, many individuals may have high serum uric acid without ever developing the condition. (12)
In addition to the joints, gout may also affect bursae, the cushion-like sacs between bones and soft tissues, and tendon sheaths, the membranes that surround tendons. The high uric acid levels associated with gout may also contribute to kidney stones and may lead to kidney damage. (12)
Gout flare-ups most often present with pain, swelling, and redness of the affected joint(s). Signs and symptoms of gout include:
- Sensitivity to pressure
- Severe, sharp pain
- Tenderness (5)
What causes gout?
Gout is typically caused by a buildup of uric acid levels in your bloodstream. Uric acid is a waste product of substances known as purines, which are components of nucleic acid, an essential building block of the body. (9) Certain modifiable and non-modifiable factors may leave you more susceptible to developing gout. Risk factors for gout include:
- Alcohol consumption
- Chronic kidney disease
- Consumption of high-fructose corn syrup (found in soda and other sugar-sweetened beverages)
- Family history of gout
- High blood pressure
- High urate levels
- High-purine diet
- Increasing age
- Metabolic syndrome
- Obesity or being overweight
- Sex (men are more likely to develop gout) (12)
Furthermore, some medications may increase your risk of developing gout, including:
- Diuretics (blood pressure medication)
- Low-dose aspirin
- Niacin, when taken in large amounts
- Cyclosporine (immunosuppressant used by individuals who have certain autoimmune diseases or have received organ transplants) (12)
Did you know? Gout is more common in men than women and is the most common form of inflammatory joint disease among men aged 40 years and older. (1)
4 stages of gout
Gout is a disease that has several stages of progressive severity. The types of gout are outlined below.
1. Asymptomatic hyperuricemia
Asymptomatic hyperuricemia occurs in individuals who have abnormally high serum uric acid levels without outward symptoms of gout such as gouty arthritis or kidney stones. Having asymptomatic hyperuricemia can predispose you to gout and kidney stones. As a precautionary measure, your practitioner may recommend modifications to your diet or lifestyle to address any underlying causes of your hyperuricemia. (1)
2. Acute gout
Acute gout is a sudden onset of pain, redness, swelling, and limited range of motion of the joint. Approximately 90% of first attacks of acute gout occur in a single joint, and over 50% of cases occur in the first joint of the big toe, a condition known as podagra. Although less common, the initial joint affected by acute gout may involve the instep (top of the foot), ankle, knee, wrist, and fingers. (1)
Did you know? Many individuals with gout go months or even years without a flare-up; however, when gout is left unmanaged, attacks may last longer and occur more frequently. (4)
3. Intercritical gout
Intercritical gout describes the symptoms-free stage following recovery from acute gout. It’s common for practitioners to assess the secondary causes of hyperuricemia and recommend diet and lifestyle modifications during this stage. Your practitioner may also reassess any medications (e.g., diuretics) you’re taking that may worsen your symptoms.
If you’re a patient, do not make changes to your medication or supplement regimen unless advised by a healthcare practitioner. (1)
4. Chronic tophaceous gout
Chronic tophaceous gout, which occurs when gout is poorly managed or left untreated, is the most debilitating and painful type of gout. At this stage, the joints and kidneys may be permanently damaged. The time between the initial gout attack and chronic tophaceous gout can vary, with the average being 11.6 years. (1)
How to prevent gout and how to improve symptoms
1. Minimize purines from your diet
Foods high in purines are known to raise serum uric acid levels, which can cause a gout attack. Specifically, studies have shown that animal sources of purines, such as red meats, are most likely to trigger a gout attack. (18) Dietary sources of purines include:
- Alcoholic beverages (e.g., beer, wine, liquor)
- Fish and seafood
- Meat extracts and gravies
- Organ meats (18)
Purines are also found in some plant-based foods, such as asparagus, beans, legumes, mushrooms, oats, and spinach; however, these foods have lower amounts of purines and are less likely to cause a gout flare-up. (18)
2. Follow a Mediterranean diet
Following a healthy diet, similar to the Mediterranean diet, may help prevent or mitigate symptoms of gout. The Mediterranean diet is rich in vitamins, minerals, and antioxidants thanks to its abundance of fruits, vegetables, nuts, seeds, whole grains, and legumes. (16) This health promoting dietary pattern is also naturally low in purines, which can help reduce serum uric acid by up to 15%, according to some studies. (16)
3. Consume foods and beverages that may help decrease uric acid levels
Some foods and beverages are known to reduce uric acid serum levels, which may help manage symptoms of gout. Foods for gout include:
- Celery (3)
- Cherries (10)
- Green tea extract (8)
- Low-fat dairy products (15)
- Nuts and seeds (7)
Did you know? According to a study of 633 individuals with recurrent gout attacks, those who ate a ½ cup serving (approximately ten to 12 cherries) for two days had a 35% reduced risk of a subsequent gout flare-up compared to those who did not consume cherries. (19)
4. Reduce alcohol
Research demonstrates that there is a significant dose-response relationship between alcohol consumption and occurrence of gout attacks, meaning that the more alcohol you consume, the greater your risk of experiencing recurrent gout flare-ups. One study noted that your risk of having recurrent gout attacks is 1.36 times higher when consuming one to two alcoholic beverages, and 1.5 times higher when consuming two to four alcoholic beverages compared to no alcohol consumption in a 24-hour period. (14)
5. Stay hydrated
Dehydration has been shown to increase serum uric acid levels, thus triggering symptoms of gout. Stay hydrated by drinking plenty of water throughout the day and increasing your water intake particularly during and after exercise or excessive perspiration. (10) One study noted that consumption of 1250 mL to 2000 mL (42 to 67 fl oz) of water per day can help decrease recurrent gout attacks. (13)
6. Exercise regularly
Being physically active has been shown to reduce the risk of developing gout. In one study involving male runners, the risk of gout was 16 times higher for men with a body mass index (BMI) above 27.5 kg/m2 (overweight) than a BMI of under 20 kg/m2 (healthy). (17) Another study published in 2020 concluded that individuals with gout who engage in regular moderate physical activity have significantly fewer gout flare-ups per year as well as reduced C-reactive protein (CRP) levels (a marker of inflammation) and lower pain scores compared to individuals who are not physically active. (6)
During symptom-free periods, engage in various forms of low to moderate exercise such as walking, cycling, swimming, and weight lifting. (6)
7. Rest your joints
When a gout flare-up hits, it’s best to rest the affected joints. Keep the affected areas elevated using a pillow or footstool to help reduce pressure and alleviate pain. (2) Applying a cold pack to the affected joints can also help reduce pain associated with gout. (11)
8. Consider vitamin C supplementation
Research demonstrates that supplemental vitamin C is associated with reduced occurrences of hyperuricemia. It’s believed that vitamin C reduces the amount of serum uric acid by improving excretion of uric acid and increasing glomerular filtration rate, the rate at which the kidneys remove waste and excess fluid from the blood. (10)
The bottom line
Gout is a painful inflammatory condition affecting one or more joints, particularly in the big toes. Prevent gout attacks before they start by eating a healthy diet, minimizing high-purine foods such as meat and seafood, drinking plenty of water each day, and staying active. If you’re a patient with gout, speak to your integrative healthcare practitioner for guidance and a tailored treatment plan.
- American Family Physician. (1999). Gout and hyperuricemia. https://www.aafp.org/afp/1999/0215/p925.html
- Coburn, B. W., & Mikuls, T. R. (2016). Treatment Options for Acute Gout. Federal practitioner:for the health care professionals of the VA, DoD, and PHS, 33(1), 35–40.
- Dolati, K., Rakhshandeh, H., Golestani, M., Forouzanfar, F., Sadeghnia, R., & Sadeghnia, H. R. (2018). Inhibitory effects of Apium graveolens on xanthine oxidase activity and serum uric acid levels in hyperuricemic mice. Preventive Nutrition and Food Science, 23(2), 127–133.
- Howren, A., Cox, S. M., Shojania, K., Rai, S. K., Choi, H. K., & de Vera, M. A. (2018). How patients with gout become engaged in disease management: A constructivist grounded theory study. Arthritis Research & Therapy, 20(1), 110. https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC5984761/
- InformedHealth.org . Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Gout: Overview. 2015 Mar 11 . https://www.ncbi.nlm.nih.gov/books/NBK284934/
- Jablonski, K., Young, N. A., Henry, C., Caution, K., Kalyanasundaram, A., Okafor, I., Harb, P., Schwarz, E., Consiglio, P., Cirimotich, C. M., Bratasz, A., Sarkar, A., Amer, A. O., Jarjour, W. N., & Schlesinger, N. (2020). Physical activity prevents acute inflammation in a gout model by downregulation of TLR2 on circulating neutrophils as well as inhibition of serum CXCL1 and is associated with decreased pain and inflammation in gout patients. PLoS ONE, 15(10), e0237520.
- Jakše, Jakše, Pajek, & Pajek. (2019). Uric acid and Plant-Based nutrition. Nutrients, 11(8), 1736.
- Jatuworapruk, K., Srichairatanakool, S., Ounjaijean, S., Kasitanon, N., Wangkaew, S., & Louthrenoo, W. (2014). Effects of green tea extract on serum uric acid and urate clearance in healthy individuals. JCR: Journal of Clinical Rheumatology, 20(6), 310–313.
- Johnson, R. J., Lanaspa, M. A., & Gaucher, E. A. (2011). Uric acid: A danger signal from the RNA world that may have a role in the epidemic of obesity, metabolic syndrome, and cardiorenal disease: Evolutionary considerations. Seminars in Nephrology, 31(5), 394–399.
- Kakutani-Hatayama, M., Kadoya, M., Okazaki, H., Kurajoh, M., Shoji, T., Koyama, H., Tsutsumi, Z., Moriwaki, Y., Namba, M., & Yamamoto, T. (2015). Nonpharmacological management of gout and hyperuricemia: Hints for better lifestyle. American Journal of Lifestyle Medicine, 11(4), 321–329.
- Khanna, D., Khanna, P. P., Fitzgerald, J. D., Singh, M. K., Bae, S., Neogi, T., Pillinger, M. H., Merill, J., Lee, S., Prakash, S., Kaldas, M., Gogia, M., Perez-Ruiz, F., Taylor, W., Lioté, F., Choi, H., Singh, J. A., Dalbeth, N., Kaplan, S., . . . Terkeltaub, R. (2012). 2012 American College of rheumatology guidelines for management of gout. Part 2: Therapy and antiinflammatory prophylaxis of acute gouty arthritis. Arthritis Care & Research, 64(10), 1447–1461.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2021, July 1). Gout. https://www.niams.nih.gov/health-topics/gout
- Neogi, T., Chen, C., Chaisson, C., & Hunter, D. J. (2009). Drinking water can reduce the risk of recurrent gout attacks. Arthritis & Rheumatology, 60, S762.
- Neogi, T., Chen, C., Niu, J., Chaisson, C., Hunter, D. J., & Zhang, Y. (2014). Alcohol quantity and type on risk of recurrent gout attacks: An internet-based case-crossover study. The American Journal of Medicine, 127(4), 311–318.
- Roddy, E., & Choi, H. K. (2014). Epidemiology of gout. Rheumatic Disease Clinics of North America, 40(2), 155–175.
- Stamostergiou, J., Theodoridis, X., Ganochoriti, V., Bogdanos, D., & Sakkas, L. (2018). The role of the Mediterranean diet in hyperuricemia and gout. Mediterranean Journal of Rheumatology, 29(1), 21–25.
- Williams, P. T. (2008). Effects of diet, physical activity and performance, and body weight on incident gout in ostensibly healthy, vigorously active men. The American Journal of Clinical Nutrition, 87(5), 1480–1487.
- Zhang, Y., Chen, C., Choi, H., Chaisson, C., Hunter, D., Niu, J., & Neogi, T. (2012). Purine-rich foods intake and recurrent gout attacks. Annals of the Rheumatic Diseases, 71(9), 1448–1453.
- Zhang, Y., Neogi, T., Chen, C., Chaisson, C., Hunter, D. J., & Choi, H. K. (2012). Cherry consumption and decreased risk of recurrent gout attacks. Arthritis & Rheumatism, 64(12), 4004–4011.