Gout: What causes it, early warning signs and ways to lower flare-ups

Dr. Rhea Rogers explains the causes of gout, the warning signs to watch for, and practical everyday steps that may help reduce painful flare-ups.

Gout is common, painful and sometimes overlooked at first, but it can be treated.

Board-certified physician Dr. Rhea Rogers describes what gout is, what can trigger it and how to identify it early.

What gout is

Rogers said gout begins when uric acid builds up in the blood and crystals form in the joints and other tissues.

“It triggers a very inflammatory, painful response,” Rogers said.

The Centers for Disease Control and Prevention says gout is a painful form of arthritis that usually affects one joint at a time.

Many people picture gout as a red, throbbing big toe, also known as podagra, Rogers said.

Why the pain can be so severe

Gerontologist “Sam” Cradduck said her youngest daughter has had gout twice and compared the pain to a shard of glass. She said even walking near her daughter’s foot could hurt her.

Cradduck said the crystal itself is not what creates the pain.

“It’s not actually the crystal. It’s the immune system that’s coming after to attack that,” she said.

Rogers said the immune system sees the crystal as a foreign object.

What gout may indicate about overall health

Rogers said a buildup of uric acid can also point to a larger health issue.

“It really is telling you something else. It can be a very significant signal for underlying metabolic disease,” Rogers said.

She said many people with gout also have insulin resistance, diabetes or cardiovascular problems.

Rogers added that uric acid can also reduce nitric oxide, which helps arteries relax.

“It’s the same mechanism that’s involved with atherosclerosis, or hardening of the arteries,” Rogers said. “That’s why it’s so significant to recognize.”

Why men are affected more often than women

Rogers said men develop gout more often than women because of estradiol.

“Estradiol is protective,” Rogers said.

She said premenopausal women have that protection, while men do not have the same level of estradiol. Men do get some estradiol through the conversion of testosterone.

As men age, they often have less testosterone and more visceral fat, Rogers said.

The pattern changes for women after menopause.

“After menopause, when the estradiol drops, then that gap closes,” Rogers said.

Diet, lifestyle and when to get checked

Gout has long been called “the disease of kings,” aging well coach Katherine Ambrose said, and it has often been linked to rich foods and alcohol.

Aging expert Amy O’Rourke said the issue comes down to what you consume and how you care for your body.

She said her experience suggests men are less likely to seek treatment quickly than women. Her advice: if you have a husband, partner or brother, encourage him to see a doctor.

Rogers said some doctors treat patients with allopurinol.

“But that same mechanism of action of lowering uric acid with vitamin C, quercetin and luteolin, the three together, there’s some, products that have all three together that you take that will naturally lower the uric acid,” Rogers said.

As always, consult your health care provider for medical advice.

Rogers said sugary foods and sugary drinks are among the fastest ways to raise fructose, which can quickly increase insulin and cause the body to hold onto uric acid.

Learn more

Learn more about gout through Alliance for Gout Awareness.