Despite what you may have heard, gout is not an archaic affliction, nor is it uncommon. These are just some of the many myths about gout that you may find on the internet when researching this particular form of arthritis. Yes, in ancient times gout was thought to only affect overweight men of means because of its association with eating indulgent foods and drinking excessive amounts of alcohol — a lifestyle that, in the past, could only be afforded to wealthy men.
But the truth is gout can affect just about anyone, and it’s more common than you may think. It’s estimated that nearly 4 percent —more than 9 million — Americans have this painful form of arthritis, according to the Gout Alliance.
If you’re not familiar, gout is a type of arthritis that occurs when your body produces too much urate, or uric acid. Your body makes uric acid when it breaks down purines, a natural substance found in the body and certain foods. Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. When there is too much uric acid in the body, either because your body produces too much of it or your kidneys don’t filter it out properly, sharp, needle-like urate crystals form in a joint or surrounding tissue. This leads to inflammation, swelling, and pain — in other words, a gout attack or flare.
So while you may think gout isn’t that serious (another myth that we’ll get into below), the Cleveland Clinic notes that, if left untreated, gout can lead to permanent joint damage. It is also associated with serious comorbid conditions such as heart disease and kidney disease. To keep that from happening, it’s important to educate yourself on gout and make sure it’s being treated properly. We spoke to a rheumatologist and a registered dietitian for National Kidney Foundation to help separate the gout fact from fiction.
Below, CreakyJoints clears up some common gout myths that can be harmful to patients, and even prevent proper diagnosis and treatment.
Myth: Gout is a man’s disease
Fact: Gout affects both men and women
Yes, gout is more common in younger men than in younger women, because women tend to have lower uric acid levels, according to the Mayo Clinic. After menopause, however, women’s uric acid levels approach those of men, and the rate of gout in men and women becomes a little more even. That’s why women who do develop gout tend to show signs and symptoms after menopause, whereas men are more likely to develop the condition earlier, usually between the ages of 30 and 50, Mayo Clinic notes.
However, even though gout is more common in older women than in younger women (and in older men than in younger men), keep in mind that you can get gout at any age. Check out our podcast The Gout Show, which features some stories of gout patients who were diagnosed in their 20s and 30s.
Myth: Only obese people get gout
Fact: People of all sizes can develop gout
Uric acid levels tend to be higher in people who are overweight, according to research published on The Rheumatologist, which can increase your risk of gout. But weight is not the only risk factor for gout, which means that people of all sizes could develop gout. The Cleveland Clinic notes that high blood pressure, diabetes, heart disease, and kidney disease can all increase your risk for gout. Genes play a big role as well. In fact, genetic factors might matter more than weight when it comes to risk of gout.
Myth: Gout only affects your big toe
Fact: Gout can impact your knees, elbows, and other joints
Your first gout attack often strikes at the joint at the base of the big toe, but gout can occur in any joint — most commonly the ankles, knees, elbows, wrists, and fingers. Additionally, as Robert Keenan, MD, a rheumatologist with Articularis Healthcare in Summerville, South Carolina, previously told CreakyJoints that, “gout tends to flare in areas that already have arthritis.”
Gout attacks are often a sudden burst of pain that feels like your joint is on fire. The affected joint will feel hot, swollen, and so tender that even the weight of a bedsheet may feel intolerable. The pain is likely to be the most intense within the first four to 12 hours after an attack begins, according to the Mayo Clinic.
After the pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints, especially if left untreated.
“As a general rule, gout works its way up the body,” Dr. Keenan said. “If it’s not treated, it works its way up from the big toe, through the ankle, to the knee, and then to the lower spine and so on.”
Myth: Although gout is painful, it isn’t that serious
Fact: Gout can lead to permanent damage joints and heart problems
Gout attacks can be extremely painful. Patients report difficulty sleeping or pain so severe it hurts to even tuck your toe into the bedsheets. Wearing shoes may seem impossible. But gout attacks tend to come and go, and gout may not cause many symptoms between attacks. This can cause gout patients to not fully understand the behind-the-scenes damage that gout can do your body between attacks.
There are several serious gout complications to be aware of. To start, gout that has become more progressive can cause clumps of urate crystals and inflammatory cells know as tophi to form under the skin. These nodules can erode the joints and surrounding skin and tissue, causing damage and eventual joint destruction.
Gout — or, more specifically, the high uric acid levels that cause gout — can also lead to kidney stones and kidney disease. “As we grow older, the kidneys can’t process as much uric acid,” Puja Khanna, MD, associate professor in the division of rheumatology, previously told CreakyJoints. This inability can cause uric acid to crystalize and form kidney stones, which are not only painful but harmful to the kidney.
Finally, several studies have found that inflammation from gout may also damage your heart. In one study published in The Journal of the American Heart Association, researchers assessed people being treated for coronary artery disease and found patients with gout had a 15 percent higher risk of either dying of cardiovascular disease or having a heart attack or stroke than patients who never developed gout.
All of these potential complications underscore the importance of getting gout properly diagnosed and treated with medication that keeps uric acid at a healthy level and prevents further attacks.
Myth: Gout disappears between attacks
Fact: Not having symptoms doesn’t mean your gout is gone for good
Gout attacks typically last one to two weeks and then subside. Some people can go months before getting another gout attack; others may get them more frequently. If gout is not properly treated — such as with taking medication to reduce uric acid levels — gout attacks can start to occur more frequently and affect more joints.
In between gouts attacks, you may have no painful symptoms and feel more or less fine. But your uric acid levels may still be high, which is why it’s important to stick to your treatment plan: “If you are on a uric acid-lowering drug, you have to continue to take it every day,” says Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Texas. “If you start and stop it, your uric acid fluctuates, and that’s the perfect setup for another gout flare.”
Myth: A poor diet causes gout
Fact: Food can play a role in gout, but it’s not as important as genetic and other factors
You’re more likely to develop gout if you have high levels of uric acid in your body, and your love of certain foods and drinks can raise that risk. Organ meats (like liver) and alcoholic beverages (particularly beer) are high in purines, chemicals that increase or promote high uric acid in the body. Red meat, shellfish, certain seafood (such as anchovies and sardines), and drinks high in fructose have the same effect.
However, it’s a common mistake to think that diet alone triggers gout and therefore, treating gout with diet changes alone can manage it. Research increasingly shows that gout is more influenced by genes and family history than diet. A 2018 study published in the journal BMJ found diet has much less influence on urate levels in your blood when compared to inherited genetic variants.
“Most people first experience a gout flare after habitually eating foods rich in purine and notice relief when limiting or eliminating these foods, so it is understandable why individuals would feel that food is the main reason why gout happens,” says Melissa Ann Prest, DCN, MS, RDN, spokesperson for the Academy of Nutrition and Dietetics.
It may be the case that in people who are genetically predisposed to gout, eating a lot of high-purine foods could trigger a gout attack. And minimizing your intake of these foods could help with your overall gout management. But most people with gout need to take medication to lower their uric acid levels; diet alone won’t help get them to a healthy level.
There is no single cause of gout. Your genes and family history, weight, your medical history, medications, and all play a part in developing gout. So, although that doesn’t mean you can all the steak you want, treating yourself occasionally won’t immediately lead to a gout attack.
Myth: You can manage gout with diet changes alone
Fact: Diet, in addition to medication and lifestyle changes, can help manage gout
Gout treatment aims to get your uric acid level to 6 mg/dL or lower to dissolve or prevent crystals, according to the American College of Rheumatology. Even with super rigid diet restrictions, most gout patients will only be able to lower their uric acid levels slightly — as little as 1.0 mg/dL, according to the Gout and Uric Acid Education Society.
Treatment for gout generally falls into two categories: Medications that help reduce pain and inflammation during a gout attack, and medications that help prevent future gout attacks by lowering uric acid levels. According to guidelines from the American College of Rheumatology, people with gout who get two or more attacks a year should be on medication to lower uric acid levels. People with gout tophi or evidence of joint damage from gout should also be taking uric acid-lowering medication.
In addition to medication, your doctor may also suggest a few lifestyle changes to reduce your risk of a gout attack and protect your joints. “Exercise, increasing your fluid intake, and losing weight are all helpful to lessen the wear and stress on your joints,” adds Dr. Prest.
Myth: High-acid foods lead to high uric acid levels
Fact: Purine-rich foods, not acidic foods, increase uric acid levels
You hear “acid” and assume acidic foods are linked uric acid, but the two don’t share that connection. In fact, ascorbic acid — also known as vitamin C — found in many citrus fruits can help decrease uric acid levels, explains Dr. Prest, who specializes in inflammation and renal nutrition.
Several studies support this claim. Most recently, a 2021 review published in the journal Nutrients in 2021 reported a correlation between high vitamin C intake and lower serum uric acid levels.
That said, studies have not found that vitamin C intake prevents the development of gout, or the severity or frequency of gout flares. So, while you may want to ask your doctor about incorporating vitamin C into your gout treatment plan, it should not be your only form of treatment. (But more on that later.)
Myth: You can’t eat meat if you have gout
Fact: You can eat meat and other high-purine foods in moderation
Dr. Prest says cutting back on purine-rich foods can help manage gout and may help reduce symptoms during a flare or gout attack. But you don’t have to eliminate red meat or other high-purine foods entirely — just limit your intake of them. Dr. Bose suggests you keep a food and symptom diary to help identify triggers. That way when you have a gout flare, you know which foods to cut back or avoid until your symptoms improve.
Myth: Milk and yogurt raise your uric acid levels
Fact: Dairy products can help lower uric acid levels
Where the misconception stems from is unclear, but what we do know is that people with gout do not need to avoid all dairy foods, as they are low in purines, according to Dr. Prest. Additionally, studies have shown that consuming low-fat milk, yogurt, and other dairy products reduces uric acid production and increases uric acid excretion from the body. For example, a 2011 study published in the journal Current Rheumatology Reports found that, “low-fat dairy intake has a moderate urate-lowering effect.”
Myth: Abstaining from alcohol prevents gout attacks
Fact: Quitting drinking can help reduce — not stop — flares
Not drinking alcohol excessively is good for your overall health, and “a positive step toward gout management,” says Dr. Bose, as alcohol molecules tend to increase uric acid levels. And research supports this. A 2018 review published in the Asia Pacific Journal of Clinical Nutrition Researchers analyzed 19 studies that evaluated dietary factors and risk of gout. The researchers found drinking alcohol to be positively correlated to high uric acid levels.
But abstaining from alcohol completely won’t cure or prevent gout from occurring, says Dr. Prest. If you are diagnosed with gout, you should limit beer, which is extremely high in purines, and other types of alcohol. Talk to your doctor to determine how much alcohol and what type is appropriate for you. And if you are having a gout flare, stick to water and tea.
Myth: Cherry juice can cure gout
Fact: This tart drink doesn’t prevent gout flares
It’s an often-recommended home remedy for gout: Sip on tart cherry juice to prevent attacks of gout. This is probably because vitamin C, which is found in cherry juice and cherries, may help reduce uric acid levels, as discussed earlier. But a 2020 study published in the journal Rheumatology found that drinking cherry juice doesn’t do much. No matter how much tart cherry juice the study participants with gout consumed, uric acid levels remained unchanged. In fact, drinking cherry juice sweetened with high-fructose corn syrup may contribute to or worsen a gout flare.
Learn More About Living with Gout
Check out The Gout Show, our podcast series hosted by gout patient Steve Clisby. Learn from gout patients and renowned doctors what living with gout is all about—and how to do it better. Listen to The Gout Show here.
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Interview with Melissa Ann Prest, DCN, MS, RDN, spokesperson for the Academy of Nutrition and Dietetics
Interview with Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Texas
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