Adding pounds raises uric acid levels and increases risk for
flares.
Painful gout attacks are caused by an excess of uric acid in the
body that leads to the buildup of flare-triggering uric acid crystals around
joints. The more you weigh, the less efficient your body is at removing uric
acid, says Hyon Choi, MD, PhD, professor of medicine and director of the Gout
and Crystal Arthropathy Center at Harvard Medical School in Boston.
Carrying extra weight slows down the removal of uric acid by the
kidneys. Elevated levels of this acid are the primary culprit in the
development of gout and its disabling attacks.
“There’s a very tight association between excess weight and the
risk of developing gout and gout flares. It’s a dose-response relationship,
meaning the more you weigh, the higher your risk, and the more likely you are
to have recurrent attacks,” Dr. Choi says.
Insulin resistance, a state in which insulin levels remain
abnormally high because the body has reduced sensitivity to the hormone, is
likely the major player in the increased risk of gout linked to body fat.
More Fat, More Uric Acid
When people are overweight or obese, their bodies produce more
insulin. “Higher levels of insulin circulating throughout the body inhibit uric
acid elimination by the kidneys. This excess uric acid can lead to gout and
gout attacks,” says Dr. Choi.
Because uric acid level is dynamic, like blood pressure, many
factors can move it up or down, says rheumatologist Puja Khanna, MD, MPH,
assistant professor of medicine at the University of Michigan in Ann Arbor.
“Stress, dehydration and certain medications, such as diuretics,
can cause a jump in uric acid, as can weight gain,” she says. “One study found
that just gaining 10 pounds over four months was associated with an increased
incidence of gout.”
Belly Fat and Gout Risk
Numbers like overall weight and body mass index (BMI) may not
tell the whole story, according to recent research looking at gout and visceral
fat – the fat that builds up inside the abdomen. Too much visceral fat is
linked to insulin resistance and development of type 2 diabetes – and gout.
A 2015 Arthritis Research &
Therapy study found that people who were not obese as measured
by BMI, but who had high levels of visceral fat, were more likely to have gout
than their smaller-bellied counterparts (47.4% versus 27.3%). Gout patients
with normal BMIs but high abdominal fat were also more likely than people
without it (31.7% versus 13.2%) to have metabolic syndrome. The cluster of
factors that make up this syndrome, which include abnormal cholesterol levels
and high blood sugar, together increase the risk of heart disease, stroke and
diabetes more than any one factor alone.
“Gout is not just an arthritis, but also a metabolic disease in
which the primary metabolic problem is high uric acid,” says Dr. Khanna. “Like
obesity and diabetes, high uric acid is a direct risk factor for cardiovascular
disease and cardiac events.”
Gout is Long-Term Disease
Another common misunderstanding about gout, she says, is that
while attacks may make the condition seem like something that comes and goes,
it is a chronic disease.
“Keeping uric acid low to prevent flares and reduce future
complications requires long-term treatment with uric acid-lowering therapy,”
she says. “Lifestyle changes can also edge down uric acid levels, and should be
seen as an additional treatment – but not a replacement – to medication.”
Lifestyle Changes
Improving diet, including avoiding sugary soda, exercising and
keeping your weight closer to a healthy number can help lower uric acid. Drs.
Khanna and Choi also note that these lifestyle changes lower the risk factors
for heart disease, stroke and diabetes that are common among people with gout.
A 2015 European study of 3,079 gout patients, for example, found 68% had high
blood pressure, 59% had high cholesterol and 24.2% had type 2 diabetes.
“The goal of gout management is to stop both attacks of gout and
its complications,” says Dr. Khanna. “This requires uric acid-lowering
medication, but weight loss can help. For example, one small trial found
patients with gout who lost about sixteen pounds dropped uric acid levels about
three points.”
Dr. Choi, who says diet and lifestyle changes are cornerstones
of his gout management plan, advises choosing sustainable diets that are shown
to improve cardiovascular and metabolic risk factors, such as the DASH (dietary
approach to stop hypertension) diet and those plans modeled on Mediterranean eating patterns.
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