DEAR MAYO CLINIC: What causes gout? I have had one attack and am not on treatment but am watching my diet. Is it possible that I won’t have additional attacks or need treatment for it, or is it likely to come back again?
ANSWER: Gout is a form of arthritis that happens when sharp particles, called urate crystals, build up in a joint, causing severe pain, tenderness and swelling. As in your situation, treatment usually is not recommended after just one attack. But gout can come back. Being careful about what you eat may help prevent another gout flare-up. If it does come back, medication is available that can effectively control gout.
The urate crystals that lead to gout form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances found naturally in your body, as well as in certain foods. Uric acid usually dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either makes too much uric acid or your kidneys flush out too little uric acid. When this happens, gout is often the result.
Certain foods and beverages have been shown to increase the risk of gout attacks, including those that are rich in fructose, such as fruit-flavored drinks, non-diet soda and many processed foods. Seafood, fatty fish and red meat also are associated with increased risk of gout.
Drinking alcohol, especially beer, is a significant gout risk factor. Studies have suggested that drinking two or more beers a day can double the risk of a gout attack. So limit the amount of alcohol you drink, or avoid it completely.
One of the most helpful things you can do to prevent gout attacks is to stay at a healthy body weight. Research has shown that excess weight is a major risk factor for developing gout. If you are overweight, losing weight can lower uric acid levels in your body and significantly reduce your risk of gout attacks.
When it comes to the specific diet you should follow, traditionally it was thought that reducing all foods that contain purines could substantially decrease the risk of gout flares. However, managing a low-purine diet can be quite cumbersome, and the success of such a diet in lowering blood uric acid levels is actually quite low. Even if you strictly follow a low-purine diet, the amount it can decrease your blood uric acid level is rarely enough to cure gout.
Instead, a lower-calorie diet — one that replaces refined carbohydrates with more complex carbohydrates, limits meat, and increases vegetables and fruit — often can be much more effective at reducing blood uric acid levels than a low-purine diet.
Specifically, if you want to lower your risk of gout, eat fruits, vegetables, whole grains and fat-free or low-fat milk products. Get your protein mainly from low-fat dairy products, which may have a protective effect against gout. Limit the amount of meat, fish and poultry you eat to no more than 4 to 6 ounces a day. Drink 8 to 16 cups — about 2 to 4 liters — of fluid daily, with at least half of that being water.
If you have another gout attack, your doctor may recommend that you take medications. A drug called colchicine or nonsteroidal anti-inflammatory drugs (NSAIDs) can be useful in reducing the symptoms of a gout attack. A group of drugs called xanthine oxidase inhibitors, including febuxostat and allopurinol, can help prevent future gout flare-ups. They work by causing the body to produce less uric acid.
These medications are often very effective in controlling gout. If you experience another episode of gout, talk to your doctor about your treatment options and which medications may be best for you. — Thomas Osborn, M.D., Rheumatology, Mayo Clinic, Rochester, Minn.