Gout is not just the "rich man's disease" you might think it is

Think gout is just a “rich man’s disease” caused by too much beer and red meat? Not quite. While diet can be a factor, the truth is more complex.

“Gout is a metabolic disorder that results from elevated uric acid levels in the blood,” explains Michael Cassetta, DO, a rheumatologist with Hartford HealthCare Medical Group. “When uric acid builds up, it can form painful crystals in the joints, leading to inflammation and severe pain.”But what actually triggers these excruciating flare-ups? Dr. Cassetta breaks down five common causes — and how you can keep gout under control.

1. Too much uric acid

At its core, gout is a result of high uric acid levels. But those levels can rise for several reasons – including genetics, diet and certain medications.“Some commonly used medications, especially diuretics, can raise uric acid levels,” explains Dr. Cassetta. “The higher your uric acid, the more likely you are to experience gout attacks.”

And gout isn’t just a joint problem – it’s linked to kidney stones, soft tissue masses called tophi, and even cardiovascular disease.

2. A diet high in purines

Uric acid is produced when the body breaks down purines, a type of amino acid found in many foods. “Because humans lack the enzyme uricase, which breaks down uric acid, certain foods can cause sudden spikes,” says Dr. Cassetta.

“Foods rich in purines – like red meat, organ meats and shellfish such as scallops, shrimp and lobster – can trigger acute gout attacks in people who are susceptible.”

3. Genetics

For some, gout runs in the family. Especially in men.

“A subset of people have a genetic defect that affects how their kidneys process uric acid,” explains Dr. Cassetta. “Instead of excreting it effectively, their bodies retain too much, leading to elevated levels and a higher risk of gout.”

If male relatives in your family have a history of gout, your risk may be higher, and symptoms can start at a younger age.

4. Obesity and weight gain

Carrying extra weight doesn’t just strain your joints. It can also increase your risk of gout. “Obesity is associated with metabolic syndrome, which includes conditions like diabetes, high cholesterol, and hypertension,” says Dr. Cassetta. “People with obesity tend to have higher levels of uric acid, which increases their risk of gout attacks.”

5. Dehydration

Not drinking enough water? Your uric acid levels might spike. “When you’re dehydrated, your kidneys don’t flush out uric acid as effectively,” says Dr. Cassetta. “This can lead to acute gout attacks and even kidney stones.” Read more