If you are trying to lower your risk of gout or reduce your risk of painful attacks once you have it, one of your best defenses may be to achieve or maintain a healthy weight.
“Higher weight is associated with higher uric acid levels in the blood, which therefore increases gout risk,” says Tuhina Neogi, MD, PhD, associate professor of medicine at Boston University School of Medicine. Gout occurs when uric acid builds up in the body and then crystallizes in the joints, causing intense and often crippling pain, inflammation, stiffness and swelling.
In 1991, a study published in the Journal of the American Medical Association found that men who gained excessive amounts of weight in young adulthood were more likely to develop gout later in life, with the greatest risk occurring with the highest body mass index (BMI) at age 35.
“Because weight loss can be associated with a lowering of uric acid levels in the blood, it follows that the frequency of attacks should diminish if the serum urate levels fall and remain below the therapeutic target for a prolonged period of time,” says Dr. Neogi.
More recent research suggests that may be the case. In a 2010 study published in Rheumatology, researchers at Boston University School of Medicine analyzed data from a study that followed more than 12,000 men between the ages of 35 and 57 for seven years.
They discovered that compared to those with no weight change, those who significantly decreased their size – by about 22 pounds – had a four-fold increased chance of getting their uric acid to normal levels. Losing 10 to 20 pounds doubled the odds of achieving the recommended level, and a 2-pound weight loss was associated with an 11 percent increased chance of reaching that desired uric acid level.
“The more you lose, the higher chance of achieving that therapeutic target,” says Hyon Choi, MD, DrPH, professor of medicine, who led the study. Dr. Choi says while weight loss helped study participants achieve a widely accepted uric acid level of 6 mg/dl, which lessens gout risk, shedding pounds alone might not be enough for patients suffering from severe attacks.
“Weight loss cannot replace medicine in a severe gout patient. This won’t be sufficient as a replacement for a drug,” Dr. Choi says. “But this can be an adjunct. In conjunction with appropriate gout drugs, this can help. Maybe you can lower the medicine you need.”
Scott Zashin, MD, a rheumatologist with the University of Texas Southwestern Medical School and Presbyterian Hospital, both in Dallas, says that, ironically, losing weight could increase the risk of gout attacks short term.
“Any type of fluctuation in uric acid, whether it goes up because you drink a beer or goes down because you are on a medicine to lower it, can increase the risk that crystals will precipitate in the joint,” Dr. Zashin says.
If you are trying aggressively to lose weight, he recommends asking your doctor about prescribing an anti-inflammatory to prevent the kind of flares that can occur when someone’s uric acid levels go down.
Long term, however, he says it is good for people to know that they can try to control their gout on their own or lessen their need for medication. “It’s a good message – especially when you have all these medications coming out for gout,” Dr. Zashin says. “Let’s focus on things you can do so you don’t have to take medicine your whole life.”