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.
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By Beth Levine
Updated on October 12, 2018

For many, the term "gout" immediately evokes an image of historical excess—a "disease of kings" linked to lavish indulgence and sedentary lifestyles. This enduring stereotype, however, carries a significant and often detrimental stigma, painting gout as a self-inflicted condition. Such misconceptions can lead individuals to avoid seeking crucial medical help, as they may feel embarrassed or believe their symptoms don't align with this narrow, outdated perception. Challenging these preconceived notions is vital to encourage proactive engagement with healthcare and ensure affected individuals receive the appropriate diagnosis and comprehensive treatment necessary for effective management of this debilitating condition.

Recent scientific inquiry is actively dismantling these long-held assumptions about gout's origins. For instance, research published in August 2015 in Clinical Rheumatology revealed a common inclination among patients to treat gout symptoms as they arise, rather than adopting a consistent, preventative approach. This reactive strategy, unfortunately, carries dire consequences. Untreated gout leads to more frequent and prolonged attacks, and can cause irreversible joint damage. Furthermore, it significantly heightens the risk of developing serious comorbidities such as kidney disease or kidney stones, underscoring the critical need for proactive, long-term management.

A pivotal new study, published in the BMJ on October 10, 2018, presents compelling evidence that genetic predisposition plays a far more significant role in gout development than dietary habits. This groundbreaking finding shifts the focus from purely lifestyle-centric explanations to a recognition of underlying genetic factors. As Edward Roddy, MD, a coauthor of the Clinical Rheumatology study and honorary consultant rheumatologist at Keele University, states, "The study from New Zealand is an important step to try to correct these societal misconceptions that gout is caused by dietary habits." He reassures that high urate levels, the direct cause of gout, are primarily influenced by genes, countering the misconception of self-infliction.

To provide essential background, gout is a painful form of inflammatory arthritis. It is characterized by hot, swollen, and stiff joints, resulting from the accumulation of uric acid in the body, which then forms sharp, needle-like urate crystals. While famously associated with the big toe, gout can affect a wide range of joints, including the ankles, heels, knees, wrists, fingers, and elbows. According to MedlinePlus, this condition is notably more prevalent among men, particularly those over 40 years of age, though it can manifest in any individual regardless of gender or age.

Historically, the perception that diet is the main cause of gout has posed a significant obstacle to seeking appropriate gout treatment. Many individuals, influenced by stigma, delay or avoid medical consultation due to shame or a belief they don't fit the stereotypical profile. Tony R. Merriman, PhD, a professor of biochemistry at the University of Otago and a key author of the study, clarifies this misunderstanding. He acknowledges that diet can trigger gout attacks in those already having urate crystals but emphasizes that "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.” This distinction is crucial for effective patient education and care.

The New Zealand study provided compelling evidence that genetics play a substantially larger role in the development of gout than dietary factors. Researchers from the University of Otago meticulously compared dietary information from a large, diverse cohort of 8,414 men and 8,346 women. All participants were over 18, of European ancestry, and drawn from five established U.S. cohort studies. Crucially, none had a gout diagnosis nor were they taking urate-lowering or diuretic drugs. This rigorous methodology allowed the researchers to precisely analyze genetic profiles alongside urate levels, providing a clear picture of the influence of each factor in a healthy, unmedicated population, thereby strengthening the validity of their conclusions regarding genetic predisposition.

The study's findings regarding diet's direct impact on urate levels were particularly insightful, revealing its minimal influence compared to genetic factors. The research team identified certain foods associated with very slight increases in urate levels: beer, liquor, wine, potatoes, poultry, soft drinks, and various meats. Conversely, foods such as eggs, peanuts, cold cereal, skimmed milk, cheese, brown bread, margarine, and non-citrus fruits showed a marginal correlation with reduced urate levels. However, these changes were exceedingly small, accounting for less than a 1 percent variation. This indicates that while diet may have some influence, its direct effect on systemic urate levels is negligible.

The stark contrast in influence between diet and genetics on urate levels was a central revelation of the study. Dr. Merriman elaborated on this disparity, noting, “When we compared the dietary scores to the overall genetics of people, the effect was very different.” He underscored that diet alone proved to be an ineffective means of maintaining low urate levels. In the general population, genetic history accounted for a substantial nearly 24 percent of the variations observed in urate levels. This contrasts dramatically with diet, which contributed a mere fraction of this variation. Dr. Merriman concluded that "Genetics explained in the general population a nearly 100-fold increased variance in urate levels than did diet,” solidifying the predominant role of genetic predisposition.

Effective gout management necessitates a comprehensive approach, addressing both the long-term prevention of disease progression and the immediate relief of acute attacks. The cornerstone of prevention involves maintaining consistently low urate levels to preclude crystal formation and joint damage. Your healthcare provider will determine the most appropriate strategy for your individual needs, often prescribing urate-lowering medications such as Allopurinol, Febuxostat, Lesinurad, Pegloticase, or Probenecid. As Tanya Major, PhD, a coauthor of the study, asserts, "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."

In addition to preventative measures, effective strategies for managing an acute gout attack are crucial for patient comfort and minimizing joint inflammation. During a flare-up, medications like Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are commonly used to rapidly reduce pain and swelling. Supportive home care also plays a vital role: applying ice and elevating the affected joint can provide substantial relief. It is also imperative to stay well-hydrated, specifically with water, while assiduously avoiding alcohol and sugary beverages, which can exacerbate symptoms. Resting the inflamed joint is essential. Should the flare-up not subside promptly, or if symptoms worsen, it is critical to consult your doctor for further guidance.

It is crucial to emphasize that these findings do not constitute a license for unrestricted eating. While diet's influence on the underlying cause of gout (high urate levels) is minimal, maintaining a healthy, balanced diet remains paramount for overall health and well-being. A nutritious diet supports weight management, reduces inflammation, and positively impacts various bodily systems. Such dietary prudence can indirectly benefit gout management and lessen the risk of other health issues, including those related to cardiovascular health. For instance, RELATED:****Sleep Apnea Increases the Risk for Gout, Study Suggests highlights the interconnectedness of systemic health and gout risk, reinforcing the value of holistic health practices.

Despite the primary genetic component of gout, the anecdotal link between specific foods and acute gout flares has been observed for centuries. Patients frequently report that attacks occur following the consumption of particular foods. However, this relationship is often inconsistent and highly individualized; what triggers a flare in one person may not affect another, and even for the same individual, triggers can vary. As Dr. Major noted, “We don’t really know how these foods relate to flares.” This indicates that while certain foods might act as triggers for those already predisposed to gout, the precise mechanisms are yet to be fully understood, representing an area ripe for further scientific exploration.

Original article: https://www.everydayhealth.com/gout/genetics-not-diet-likely-cause-gout/