Can gout be prevented?



Can gout be prevented? 1

To many people, gout seems like a disease of the past. Cartoons from 200 years ago depicted it as a condition afflicting the wealthy (“the disease of kings”), whose gluttonous consumption of food and drink was thought to bring on the attacks of debilitating arthritis.

All these years later, much about gout is still misunderstood. Shame, derision, and the belief that the gout sufferer deserves the condition linger. And rather than being a disease of the past, gout is quite common — and rates are rising. Estimates suggest gout affects nearly 4% of the adult population in the US, an increase from prior decades. And it’s not a disease limited to the well-to-do; it affects people of all economic classes.

The most likely explanations for the rising rates of gout are an aging population and excess weight. Both are major risk factors for the disease. The expanding waistline of the average American probably plays a bigger role than age, since overweight and obesity have increased more rapidly than the average age of Americans in recent decades.

A study of gout suggests ways to avoid it

Even though research has identified some preventable risk factors for gout, the impact of modifying them is uncertain. Now a new study published in JAMA Network Open has found that more than three-quarters of gout cases affecting men might be completely avoidable. And since gout affects men more often than women, this finding is notable.

The researchers analyzed data from nearly 45,000 men who completed detailed surveys about their health, habits, and medications every two years for 25 years. Comparing those who developed gout (nearly 4%) with those who did not, four factors were identified as protective:

  • normal body mass index (BMI), a measure of weight and height (see calculator)
  • no alcohol consumption
  • no use of a diuretic medication (a drug that increases urination, commonly used to treat high blood pressure and other conditions)
  • following a DASH-style diet, a heart-healthy diet originally developed to counter high blood pressure.

The analysis suggested that 69% of all cases of gout in men could be avoided with these four measures. Most of this benefit applied to men who were not obese. Obese men (BMI of 30 or higher) saw little benefit. According to the researchers, this suggests losing excess weight is necessary to reap benefit from the other three protective factors.

As with all research, this study has limitations. For example, the analysis relied heavily on self-reporting, which can be inaccurate. This included information about diet, alcohol consumption, medication use, and even the diagnosis of gout. And it’s possible that other, unmeasured contributors to the risk of gout (such as genetic factors) could have contributed to the findings. The study participants were all male health professionals (dentists, optometrists, osteopaths, pharmacists, podiatrists, and veterinarians), and 91% were white, so the findings may not apply to all persons at risk for gout.

In the real world, is this study a game-changer?

While the findings could be seen as game-changing, we don’t know how much impact they’ll actually have. For example, if every household in the country received this information, how many people would switch to the DASH diet and stick with it? How many people who usually drink alcohol would give it up? And how many overweight and obese individuals would manage to achieve and maintain a normal BMI?

As for diuretic use, doctors often prescribe diuretics, such as hydrochlorothiazide or furosemide, for people with high blood pressure and other health conditions. The risk of future gout is unlikely to alter this. However, there are many alternative medications available to lower blood pressure. So if gout is diagnosed in a person taking a diuretic, switching to a different drug is worth considering.

The bottom line

The idea that a painful and sometimes disabling condition like gout can be prevented without medications is certainly appealing. But knowing how to prevent gout and actually preventing it are two different things. At the very least, this new research adds one more reason to adopt a healthy diet, moderate alcohol intake, and maintain a healthy weight: not only might this improve your health overall, but you may also save yourself from gout.

Follow me on Twitter @RobShmerling

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