Knowing Your Gout Triggers

Specific gout triggers may increase the risk of a flare-up and symptoms, such as painful, inflamed joints. Alcohol, dehydration, purine-rich foods (like organ meat), foods with high-fructose corn syrup, stress, and other factors may contribute to gout attacks in some people, though not everyone can determine a connection.¹

This article discusses potential gout triggers, how to identify your triggers, and how to minimize their impact on your life.

Gout Triggers to Stay Ahead Of

A variety of factors may trigger gout symptoms. Some people notice that certain factors directly impact their lives, while other factors increase the risk of flare-ups.

Although scientists don’t fully understand what triggers a gout flare, high levels of uric acid (a waste product in your blood) are known to contribute. At high levels, uric acid is more likely to crystalize in the joint and cause pain.²

Some factors that may trigger a gout flare also increase uric acid levels.  

Alcohol and Dehydration

Alcohol is one of the most common gout triggers.³

One study reported that people with gout who had consumed one to two servings of alcohol had a 36% increased risk of flare within the next 24 hours compared to those who had not consumed any alcohol. They had a 51% increased risk if they had greater than two servings.⁴

Historically, scientists believed that hard liquor had more significant risks compared to wine and that beer seemed to have the most significant risk of all.⁵ Recent studies have found that alcohol type may not matter. However, the evidence is inconclusive.⁴

Alcohol is also a problem because it increases the risk of dehydration. Dehydration is another potential trigger for gout attacks, whether it comes from excess alcohol, poor water intake, excess sweating, vomiting, or other causes.⁶

Purine-Rich Foods

Eating foods high in purines may increase the risk of gout flares. Purines are a standard component of your DNA (polymer that carries genetic information) and are broken down into uric acid. In general, animal foods are some of the richest sources of purines.⁶ Examples include:

• Meat: Some of the highest sources of purines are organ meat (e.g., sweetbreads or chicken liver), red meat, processed meats (e.g., cold cuts), and some cuts of poultry.⁵
• Seafood: Specific types of seafood are also high in purines, including anchovies, trout, tuna, salmon, sardines, and shellfish. Canned, dried, or processed seafood also tend to have more purines.⁵

Nuts, beans, and vegetables contain relatively high amounts of purines, though they don't typically trigger flares.⁷

Foods or Drinks High in Fructose

Sugary foods or beverages, especially those high in fructose, may trigger gout symptoms. Eating extra sugar of any type can worsen inflammation, and fructose, in particular, can increase uric acid levels and the risk of gout.⁸

Fructose is found naturally in honey, agave, and many fruits. High-fructose corn syrup, used in many processed foods and sugary drinks, is particularly high in fructose. For example, it's often found in products such as:

• Baked goods
• Peanut butter
• Snack foods
• Soda
• Sports or energy drinks

While whole fruits contain some fructose, most people with gout don't don't experience flare-ups after consuming fruit.⁵

Although dietary recommendations for gout have traditionally focused on lowering dietary intake of purines from animal sources, eating a diet too high in carbohydrates, especially simple carbohydrates like white bread and pasta, might also increase flare risk.⁹

Stress

Bodily stress can trigger gout. For example, gout flares may be more likely to occur after surgery, illness, unusual physical exertion, excessively warm or cold weather, or emotional stress. Crash dieting, which also stresses the body, is another potential trigger.⁵

Medications

Some medications might trigger a gout flare, especially when you first start to use them. Some examples include:⁷

• Certain diuretics like Lasix (furosemide)
• Low dose aspirin
• Some immunosuppressant drugs, like Gengraf (cyclosporine)

Urate-Lowering Drugs and Gout Flare

Paradoxically, medications used to prevent future gout flares—urate-lowering drugs, such as Zyloprim (allopurinol)—can temporarily increase the risk of flare. Your healthcare provider may prescribe an additional medication to help prevent this, like colchicine, low-dose corticosteroids, or a nonsteroidal anti-inflammatory drug (NSAID) like Advil or Motrin (ibuprofen).⁷

Medical Comorbidities

Although they can’t exactly be considered gout triggers, certain health conditions are more common in people with gout, and vice versa. Called comorbidities, with gout these include high blood pressure (hypertension), cardiovascular disease, and chronic kidney disease.⁶

Having these conditions does not directly lead to increased risk of flares, but some conditions, like chronic kidney disease, may increase the risk of getting gout and having future flares.¹⁰ People with diseases that increase cell turnover—like psoriasis, in which the life cycle of skin cells is greatly increased—are also at an increased risk for gout.¹¹

Risk Factors

Other factors also increase the risk of gout. For example, it’s more common in older individuals (over 65), people assigned male at birth, and people carrying more significant amounts of adipose (fat) tissue. Having variants of specific genes also seems to increase risk.¹

How to Identify Your Gout Triggers

Identifying your triggers can be tricky. Researchers don’t fully understand why different factors might trigger a gout flare. Some factors may increase your risk of flare, but not immediately, so it’s harder to identify. Something might also increase your risk, but not in a way you can easily notice.

Gout triggers are individual; for example, purine-rich foods and alcohol increase the risk of a gout flare in some people. However, not everyone with gout experiences a flare immediately after consuming purine-rich foods or alcohol.

One study found that only 38% of people with gout had specifically noticed something that seemed to trigger their flares.⁶ Others just hadn’t observed any connections.

Although it’s an imperfect method, you may want to keep a symptom diary to help identify your potential flares. Write down the foods you eat—especially common trigger foods like purine- or sugar-rich foods—and the amount and type of alcohol you consume.

Also note any unusual circumstances, like illness, added stress, or medication changes. Comparing this information to when you have flares might help you identify gout trigger patterns.

Even if you don’t find any patterns, it’s still a good idea to minimize factors that increase the risk of gout flares generally, like excess alcohol and purine-rich foods.

Gout Triggers and Flares: What Helps

Although you may not be able to prevent all future gout flares, you can do some things to reduce your risk.⁷

• Limit alcohol: If you choose to drink, wine may be a better choice than beer.
• Stay hydrated: Drink lots of water, especially if you lose fluids for any reason, such as excessive sweating or illness.
• Decrease high-purine foods: Eat a diet emphasizing vegetables, plant proteins (e.g., beans and tofu), and whole grains. Meat can be a part of your diet, but limit your portion size and number of servings. Avoid any specific foods that you find trigger your flares.
• Limit foods high in sugar: Avoid processed foods when you can, especially limit foods and drinks with high fructose corn syrup.
• Stay active and manage stress: Pursuing hobbies, spending time with loved ones, practicing spirituality, and spending time in nature may all help reduce stress.
• Consider medications: Talk to your healthcare provider about urate-lowering medications.
• Manage other health conditions: Ask whether any of your medications might increase your flare risk.

Summary

Not everyone notices the same gout triggers. Alcohol, dehydration, purine-rich foods (like organ meat), high-fructose foods, medications, and stress can all be triggers, but you might notice others.

Keeping a symptom diary might help you identify yours. Limiting alcohol, making dietary changes, and staying physically active may all help you prevent flares. It can also help to talk to a healthcare provider about medication.

Sources:

1. MacFarlane LA, Kim SC. Gout: a review of nonmodifiable and modifiable risk factors. Rheum Dis Clin North Am. 2014;40(4):581-604. doi:10.1016/j.rdc.2014.07.002
2. Georgel PT, Georgel P. Where epigenetics meets food intake: Their interaction in the development/severity of gout and therapeutic perspectives. Front Immunol. 2021;12:752359. doi:10.3389/fimmu.2021.752359
3. Abhishek A, Valdes AM, Jenkins W, Zhang W, Doherty M. Triggers of acute attacks of gout, does age of gout onset matter? a primary care based cross-sectional study. PLoS One. 2017;12(10):e0186096. doi:10.1371/journal.pone.0186096
4. Neogi T, Chen C, Niu J, Chaisson C, Hunter DJ, Zhang Y. Alcohol quantity and type on risk of recurrent gout attacks: an internet-based case-crossover study. Am J Med. 2014;127(4):311-8. doi:10.1016/j.amjmed.2013.12.019
5. Helget LN, Mikuls TR. Environmental triggers of hyperuricemia and gout. Rheum Dis Clin North Am. 2022;48(4):891-906. doi:10.1016/j.rdc.2022.06.009
6. Danve A, Sehra ST, Neogi T. Role of diet in hyperuricemia and gout. Best Pract Res Clin Rheumatol. 2021;35(4):101723. doi:10.1016/j.berh.2021.101723
7. Hainer BL, Matheson E, Wilkes RT. Diagnosis, treatment, and prevention of gout. Am Fam Physician. 2014;90(12):831-836.
8. Jamnik J, Rehman S, Blanco Mejia S, et al. Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies. BMJ Open. 2016;6(10):e013191. doi:10.1136/bmjopen-2016-013191
9. Juraschek SP, McAdams-Demarco M, Gelber AC, Sacks FM, Appel LJ, White KJ, Miller ER 3rd. Effects of lowering glycemic index of dietary carbohydrate on plasma uric acid levels: the OmniCarb randomized clinical trial. Arthritis Rheumatol. 2016;68(5):1281-9. doi:10.1002/art.39527
10. Johnson RJ, Sanchez Lozada LG, Lanaspa MA, Piani F, Borghi C. Uric acid and chronic kidney disease: Still more to do. Kidney Int Rep. 2022;8(2):229-239. doi:10.1016/j.ekir.2022.11.016
11. Wei JC, Chang YJ, Wang YH, Yeh CJ. The risk of gout in patients with psoriasis: a population-based cohort study in Taiwan. Clin Epidemiol. 2022;14:265-273. doi:10.2147/CLEP.S346128=.

Important Notice: This article was originally published at www.verywellhealth.com by Ruth Jessen Hickman, MD where all credits are due. Medically reviewed by Anita C. Chandrasekaran, MD.

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