Triggers for Gout: Why Attacks Happen and How to Avoid Them

Gout is a common type of arthritis that can affect any joint, most often the big toe. Gout typically occurs in periods of no symptoms and periods of symptoms. When symptoms are present, it is known as a flare or attack. Gout flares can come with pain, swelling, redness, and difficulty moving the joint and typically last one to two weeks. There's a wide range of things that can trigger a gout flare: from food to medications to dehydration.¹

Common Triggers of Gout Flares

Gout is caused by high levels of uric acid in the body. Uric acid is created when the body breaks down purines, which are chemicals found naturally in the body and in some food. Uric acid is typically broken down and discharged through urine. When not properly gotten rid of, excess uric acid turns into needle-shaped crystals in the joints, which cause gout flares.¹

There are certain things that are well-known triggers of gout flares. And because the triggers can largely be avoided, it's important to know what they are when trying to prevent or manage gout pain.²

Certain Meat and Seafood

Many purine-rich foods can raise the levels of uric acid in the body, in turn increasing the risk of a gout attack. Foods with higher levels of purine include³'⁴:

• Red meat, such as beef, lamb, and pork
• Organ meat, such as liver and kidney
• Some kinds of seafood
  • Anchovies
  • Sardines
  • Mussels
  • Scallops
  • Trout
  • Tuna

Not all purine-rich foods appear to raise your uric acid levels or risk of gout, though. Vegetables like peas, beans, lentils, asparagus, spinach, and mushrooms are rich in purine but—when eaten in moderate amounts—do not seem to have an effect on gout risk.⁵

Alcohol

Drinking beer, wine, and liquor is known to raise the levels of uric acid in the blood. The more alcohol you drink, the greater the risk of a gout attack.

But one study found that even moderate alcohol consumption may increase the risk of gout attack among men. In fact, the male participants who had up to two drinks in a 24-hour period had a 36% higher risk of a gout flare than those who didn't have any alcohol in that same time period. On the other hand, one drink in a 24-hour period did not significantly increase the risk.⁶

Limiting consumption of alcohol might help prevent flares.

Drinks and Food High in Fructose

Fructose, a type of sugar, is the only sugar that raises uric acid levels in the body. Drinks high in fructose, like fruit juices and sweetened soft drinks, have been shown to increase the levels of uric acid in the blood.⁵

The consumption of foods high in fructose, such as cookies and candy, have also been linked to an increased risk of gout flares. Avoiding or limiting these high-sugar drinks and food might help reduce the risk of a gout attack.⁴

A Higher Body Mass Index

Being overweight or having obesity is associated with the initial development of gout. There is a link between a higher body mass index (BMI) and higher levels of uric acid.⁵ The connection can continue to play a role even after you've already developed gout.

If you are in the overweight or obese BMI categories, losing weight through diet and exercise may be a way to bring down uric acid levels and prevent future flares.⁷

Surprising Triggers of Gout

While certain food, drinks, and lifestyle factors are well-known triggers of gout attacks, there are other gout triggers that should also be considered.

Stress

The exact relationship still needs to be determined, but research suggests that stress can cause an increase in uric acid levels in the blood. To help avoid gout flares, researchers suggest that people with gout try to avoid stress or take steps to reduce stress.⁵

Aspirin

Low-dose aspirin can increase uric acid levels in the blood and sometimes nearly double the risk of gout flare. One study found that the risk of gout attack increases after two days of taking low-dose aspirin. The lower the dose, the greater the association.⁸

But low-dose aspirin is often used in the prevention of cardiovascular disease. So even though it might trigger gout flares, it is not recommended that you stop or change the use of your low-dose aspirin if you are taking it to protect yourself against heart attack or stroke. Instead, you can address other gout triggers that might be in your life, such as your consumption of alcohol and red meat.⁹

Dehydration

Dehydration can lead to higher levels of uric acid due to a decrease in urination and, thus, elimination of uric acid.

To lower the risk of a gout attack, people with gout should drink plenty of water on a daily basis. If exercising or spending time in hotter environments, such as a sauna, it's important to drink extra amounts of water.⁵

Temperature Changes

The weather can have an effect on gout. High temperatures and low humidity each increases the risk of a gout attack. The combination of hot and dry weather can especially trigger a gout flare. Extremely high humidity can also increase gout flare risk but to a lesser extent.¹⁰

The exact reasoning behind the associations is not yet fully understood, but one theory is that dehydration plays a part. People with gout should stay hydrated to try to prevent weather-related gout flare when in hot or dry environments.¹⁰

Summary

Common triggers for gout flare, such as red meat, alcohol, and high-sugar drinks should be limited or avoided to help reduce the risk of a gout flare. Other gout triggers, such as aspirin, stress, or the weather should also be taken into consideration when figuring out how to prevent and manage flares.

Not everyone with gout will be affected by every trigger. To determine which factors trigger a gout attack for you, take note of what you consumed or what activities you took part in before the gout flared up. By keeping a journal of these factors, you might be able to recognize a pattern in your gout flares.

A healthcare provider may also help you identify triggers and help prevent future flares. If you are experiencing a flare, talk to a healthcare provider about treatment options, which may include nonsteroidal anti-inflammatory drugs, like ibuprofen (Advil), or prescription medications to manage pain.³

Sources:

1. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Gout.
2. Abhishek A, Roddy E, Doherty M. Gout – a guide for the general and acute physicians. Clin Med (Lond). 2017;17(1):54-59. doi:10.7861/clinmedicine.17-1-54.
3. Centers for Disease Control and Prevention. Gout.
4. Agency for Healthcare Research and Quality. Managing Gout.
5. Kakutani-Hatayama M, Kadoya M, Okazaki H, et al. Nonpharmacological Management of Gout and Hyperuricemia: Hints for Better Lifestyle. Am J Lifestyle Med. 2017;11(4):321-329. doi:10.1177/1559827615601973.
6. 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):311-318. doi:10.1016/j.amjmed.2013.12.019
7. Arthritis Foundation. How Fat Affects Gout.
8. Zhang Y, Neogi T, Chen C, Chaisson C, Hunter DJ, Choi H. Low-dose aspirin use and recurrent gout attacks. Ann Rheum Dis. 2014;73(2):385–390. doi:10.1136/annrheumdis-2012-202589.
9. American College of Rheumatology. Gout.
10. Neogi T, Chen C, Niu J, et al. Relation of Temperature and Humidity to the Risk of Recurrent Gout Attacks. Am J Epidemiol. 2014; 180(4):372–377. doi:10.1093/aje/kwu147.