Genetics, Not Diet, Is the Likely Cause of Gout
A new study challenges the perception that gout is the result of gluttony and overindulgence in food and drink.
By Beth Levine
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October 12, 2019
What’s the first thing that comes to mind when you hear the word gout? When most people think of gout, they picture a stout old Englishman, sitting by a fire with his foot up after yet another round of gluttony and excess. This “disease of kings” stereotype and stigma have led too many people to avoid seeking meaningful help.
Did We Get Gout All Wrong? New Research Debunks Beliefs
Research published in August 2015 in Clinical Rheumatology showed that people prefer to treat gout symptoms as they occur rather than plan a lifetime prevention approach. Bad idea: If gout isn’t treated, each attack will last longer, you will have more attacks, and you may eventually suffer irreversible joint damage. You will also be at higher risk for kidney disease or kidney stones. A study published in theBMJ published on October 10, 2019 posits that genetics (family history) may play a more important role in the disease development than diet.
RELATED:Sleep Apnea Increases the Risk for Gout, Study Suggests
Gouty Arthritis Is Not a Result of Dietary Habits, Research Suggests
“The study from New Zealand is an important step to try to correct these societal misconceptions that gout is caused by dietary habits. People with gout should be reassured that high urate levels are influenced more by genes than by diet, countering the widespread misconception that gout is a self-inflicted disease,” comments Edward Roddy, MD, a coauthor of theClinical Rheumatologystudy, a reader in rheumatology and an honorary consultant rheumatologist at the Research Institute for Primary Care and Health Sciences at Keele University, in Staffordshire, England.
Gout Is a Painful Form of Inflammatory Arthritis
First, some background: Gout is a form of arthritis involving hot, swollen, stiff joints caused by the buildup of uric acid, which forms painful needle-like urate crystals. It will often appear in the big toe but can also affect ankles, heels, knees, wrists, fingers, and elbows. It is more prevalent in men older than 40, according to MedlinePlus.
New Study Helps Removes Gout Stigma, an Obstacle to Treatment
Up until now, it’s been believed that diet was the main driver of the disease. Many people don’t go for gout treatment because they believe that they don’t fit the stereotype or they are too ashamed to seek it. “Diet is a well-established trigger of gout attacks in people who already have urate crystals in their joints. Because individual foods associate with small changes in urate levels, this has led to an incorrect belief that levels of urate can be managed by diet,” says one of the study's authors, Tony R. Merriman, PhD, a professor in the department of biochemistry at the University of Otago, Dunedin, New Zealand.
RELATED:Rheumatoid Arthritis and Gout: What’s the Difference?
Genetic Factors Influence Gout Disease Development
This study shows that genetics play a bigger role in disease development than diet. The researchers from University of Otago, Dunedin, New Zealand, compared dietary information from 8,414 men and 8,346 women older than 18 and of European ancestry from five U.S. cohort studies. Participants did not have gout, and were not taking urate-lowering or diuretic drugs. In these studies, researchers looked at genetic profiles and urate levels.
Diet Affected Gout Disease in Study Participants Only Minimally
The team found that certain foods did minimally affect urate levels:
- Foods that raise urate levels: beer, liquor, wine, potatoes, poultry, soft drinks, and meat
- Foods that reduce urate levels: eggs, peanuts, cold cereal, skimmed milk, cheese, brown bread, margarine, and non-citrus fruits.
But the increases and decreases were very small — less than 1 percent variation. Genetic history, on the other hand, was responsible for nearly 24 percent of variations in urate levels.
“When we compared the dietary scores to the overall genetics of people, the effect was very different,” Dr. Merriman explains. “Diet was not an effective way of keeping urate levels down. The effect of genetics was much greater," he adds. “Genetics explained in the general population a nearly 100-fold increased variance in urate levels than did diet.”
The Best Ways to Treat Gout and Gout Symptoms
Treatment is done on two levels:
Prevention of Gout
In order to maintain low urate levels to prevent attacks and disease progression, your healthcare provider may prescribe the following medications:
“Taking urate-lowering drugs has been shown to be very effective because this treats the underlying cause of gout rather than focusing on preventing a symptom,” says another of the study's coauthors, Tanya Major, PhD.
Dealing With a Gout Attack
A Balanced Diet Is Still Important for Overall Health
Sorry, this is not a hall pass to the all-you-can-eat buffet! While diet may have very little influence on the underlying cause of gout (you have to have high urate to get gout), you still should aim to eat a healthy diet.
RELATED:Treat-to-Target Therapy Improves Gout Outcomes
The Role of Trigger Foods in Gout Flare-Ups Is Not Understood
“Gout has been linked to diet for centuries because flares often occur after eating particular foods. It varies a lot between individuals which foods will cause a flare, and it can be inconsistent in an individual as well. We don’t really know how these foods relate to flares,” says Dr. Major.
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