Gout was once seen as a rich man’s disease because it was associated with overindulgence in food and drink (think of gluttonous Henry VIII of England) and because more men than women develop it.
But gout strikes both sexes and people in all walks of life. It’s estimated that eight million Americans have gout (including 10 percent of people over 65) and that its incidence has nearly tripled in the past 25 years. That’s not surprising, since gout is linked to obesity, which is also on the rise.
A buildup of uric acid
Recognized since the time of Hippocrates, gout is a form of inflammatory arthritis. It commonly results from an excess of uric acid, a waste product formed from the breakdown of nitrogen compounds called purines, which are found naturally in the body and certain foods.
As uric acid builds up in the blood—either because too much is made or, more typically, too little is excreted by the kidneys—it can form crystal deposits in joints and other body parts. The body sees these crystals as foreign invaders and releases inflammatory substances that make the area hot, red, swollen and extremely tender.
Gout most commonly affects joints—notably the ankles, feet, knees, wrists, elbows and hands—with most first attacks occurring in the big toe. Sometimes there is fever. Inflammation often subsides in a few days, but a severe attack can last a few weeks.
Men are more susceptible to gout at younger ages because their blood levels of uric acid typically begin to rise after puberty. But women catch up after menopause. Gout seems to have a genetic component. Certain medications (such as aspirin, diuretics and high-dose niacin), alcohol (especially large amounts), surgery, physical trauma and perhaps even hot weather (because of dehydration) may increase uric acid levels and trigger gout. Recent research suggests that even modestly elevated blood levels of lead increase the risk of high uric acid levels and gout.
The impact of diet is debatable, but studies have generally linked gout to high intakes of meat and seafood, which are rich in purines, but not to purine-rich plant foods such as peas, beans, lentils, spinach, mushrooms and cauliflower or total protein intake. Dairy may reduce the risk of developing gout and/or having flare-ups.
Elevated uric acid in the blood and gout itself are linked to an increased risk of hypertension, perhaps because uric acid impairs the ability of blood vessels to dilate, contributes to kidney disease and/or activates hormones that can boost blood pressure. Thus, certain drugs used to lower uric acid may improve blood vessel function and reduce blood pressure. Research has also linked high uric acid to coronary artery disease.