9 Surprising Triggers of Gout Pain

Gout is an excruciatingly painful form of arthritis that often affects the feet.

Dietary factors, such as red meat and alcohol, can trigger gout pain. However, medications and medical conditions can be a problem too, says Kenneth G. Saag, MD, a rheumatologist at the University of Alabama at Birmingham.

"Non-food items are the major risk factors for developing gout," he says. Here are nine such triggers, which could be causing your gout pain.

Aspirin drives up the amount of uric acid in your blood. At high enough levels, uric acid deposits in joints (especially in the big toe and fingers) and forms the razor-sharp crystals responsible for gout.

If you take low-dose aspirin to reduce your risk of heart disease, don’t skip your daily pill for fear of gout. Instead try to avoid other gout risk factors (such as

food triggers). If your uric acid levels are still high, medications can help reduce them, Dr. Saag says.

For occasional pain, acetaminophen (Tylenol) or ibuprofen (Advil) might be better for the gout-prone.

Diuretics help reduce blood pressure by flushing water and salt from the body. At the same time, they block the excretion of uric acid from the kidneys, which can allow uric acid to accumulate to gout-causing levels.

Although switching to a different blood-pressure drug may help, some people get the best results with a diuretic, Dr. Saag says.

In those cases, combining diuretics with medications that slow the body’s production of uric acid, such as allopurinol (Lopurin) or febuxostat (Uloric), can help. "Quite a few people take both," Dr. Saag says.

Dehydration can have many ill health effects, and gout is one of them.

"Dehydration can increase the blood uric acid concentration, and in susceptible individuals such an increase can contribute to a gout attack," says Theodore Vanitallie, MD, professor emeritus of medicine at Columbia University College of Physicians and Surgeons in New York.

Aim to drink around eight cups of water a day, Dr. Vanitallie says, especially if you have already had a gout attack or have other risk factors.

It’s not enough just to limit those food items that are particularly bad for gout, such as meat, alcohol, and sugary drinks.

Research suggests that obesity itself ups gout risk by both stimulating the body to make more uric acid and blocking uric acid excretion.

Maintaining a healthy weight is an important step toward keeping uric acid levels under control.

If you want to get both your weight and uric acid levels down to within a healthy range, forget about crash dieting.

"Trying to lose weight by fasting can put you at risk of gout attack," Dr. Vanitallie says.

The main reason is because when you fast the level of ketones in your body increases, and ketones compete with uric acid for excretion, Dr. Vanitallie explains.

An increased risk of gout can be an unwelcome consequence of menopause. This is because estrogen, a hormone that helps the kidneys excrete uric acid, dips during and after menopause. (This protective effect of estrogen is probably also the reason premenopausal women are less likely to get gout than men.)

After menopause you should be careful to avoid other gout risk factors. Some studies suggest that you can help keep gout at bay by consuming coffee, cherries, and vitamin C.

A minor injury like bumping your big toe can do more than just smart for a few minutes.

Injured joints seem to make better spots for uric acid to collect, and can lead to a gout attack that can last for weeks. "A traumatic event can start a small inflammatory response, which may then precipitate a gout attack in that joint," Dr. Vanittalie says.

Osteoarthritis, which is the wearing down of joint-cushioning cartilage as we age, is also associated with gout. Take this as another reason to try to avoid jamming a toe or finger, twisting an ankle, or putting repetitive stress on a joint.

Although there haven’t been studies looking at the effect of shoes on gout risk, wearing uncomfortable shoes is rarely a smart health move.

"That combination of having high uric acid, being predisposed to gout, and wearing shoes that are hurting your feet, that could do it," Dr. Vanitallie says.

Women should opt for shoes with a lower heel to reduce stress on the toes, or limit time wearing stilettos.

Unfortunately one factor that has a big impact on gout risk is something you can’t control. About 20% of people with gout have a family history of the condition.

If you do, be aware of other risk factors, especially as you age. (Men in their mid-40s are at the highest risk of gout; post-menopausal women are at increasing risk as they age.)

Avoid other risk factors and gout-triggering foods to help prevent this painful type of arthritis.