Gout is a form of inflammatory arthritis caused by a build-up of uric acid crystals in the joints. It affects around 1 in 40 people in the UK and is one of the most painful conditions you can experience. The good news is that it’s well understood and very manageable with the right approach.
What Causes Gout?
Your body produces uric acid when it breaks down purines — natural substances found in your body and in many foods. Normally, uric acid dissolves in your blood, passes through the kidneys, and leaves in your urine. But when your body produces too much or your kidneys don’t excrete enough, uric acid builds up and forms sharp, needle-like crystals in joints and surrounding tissue.
Key risk factors include:
- Diet — High-purine foods (red meat, organ meats, certain seafood) and drinks (beer, spirits, sugary drinks) increase uric acid production.
- Weight — Being overweight increases uric acid production and reduces kidney efficiency at removing it.
- Genetics — Family history plays a significant role. If your parents had gout, your risk is higher.
- Medical conditions — High blood pressure, diabetes, kidney disease, and metabolic syndrome all increase risk.
- Medications — Diuretics (water tablets), low-dose aspirin, and some immunosuppressants can raise uric acid levels.
- Age and sex — Men are more commonly affected, typically from age 30-50. Women’s risk increases after menopause.
Recognising a Gout Attack
Gout attacks typically come on suddenly, often at night. The big toe is the most common site (about 50% of first attacks), but gout can affect ankles, knees, wrists, fingers, and elbows. Symptoms include:
- Intense, sudden joint pain (often described as the worst pain imaginable)
- Swelling and redness around the joint
- The joint feels hot to the touch
- Even light pressure (such as a bedsheet) is unbearable
- Limited range of motion
Attacks typically peak within 12-24 hours and can last 3-10 days without treatment. With treatment, most attacks resolve within a few days.
Gout and Diet: What to Eat and Avoid
High purine foods to limit or avoid:
- Organ meats (liver, kidneys, sweetbreads)
- Red meat (beef, lamb, pork) in large quantities
- Certain seafood (anchovies, sardines, mussels, scallops, trout, mackerel)
- Beer and spirits (beer is particularly problematic due to brewer’s yeast)
- Sugary drinks and foods high in fructose
Foods that may help:
- Cherries and cherry juice (studies show they reduce flare frequency)
- Low-fat dairy products (milk, yoghurt — shown to lower uric acid)
- Vegetables (even high-purine veg like spinach and asparagus don’t seem to trigger gout)
- Complex carbohydrates (whole grains, fruits)
- Coffee (moderate consumption is associated with lower uric acid levels)
- Water — staying well hydrated helps kidneys flush uric acid. Aim for 2+ litres daily.
When to See a Doctor
If you suspect you have gout, see a GP. They can confirm the diagnosis with blood tests and joint fluid analysis. Left untreated, gout can lead to permanent joint damage, kidney stones, and tophi (hard lumps of uric acid under the skin). Long-term urate-lowering therapy (such as allopurinol) can prevent attacks entirely for most people — but it needs to be prescribed and monitored by a doctor.