Gout causes are often ignored by gout patients and physicians alike.
There is focus on treating gout symptoms, and what seems to me, an obsession with diet. However, gout causes are often overlooked, or you might get some obvious references to weight or diet control.
It is important to understand gout causes. Because it is your best chance of curing gout. I know I have said elsewhere that gout cannot be cured – only controlled. That is true for primary gout, but if another problem is causing secondary gout, then controlling that first problem may cure gout.
Before I look at different gout causes, I need to make an important distinction.
Gout Causes Or Causes Of Gout Flares
Many people talk about causes of gout flares, or gout triggers.
There is only one cause of a gout flare, with two reasons why it happens. A gout flare is a reaction to uric acid crystals in the body. It is an inflammatory process where our immune system reacts with uric acid crystals. This is what leads to the most common gout symptoms, with swollen joints. The reaction will subside naturally as white blood cells encase uric acid crystals. This normally takes less than a week, though additional exposure to more crystals can give a succession of gout flares that feels like one long episode. The white blood cells form a sheath round uric acid crystals that hides them from our immune system.
The two reasons for our immune reaction to uric acid crystals are:
- New crystals forming when uric acid levels are above the saturation point
- Partially dissolved crystals lose the sheath when uric acid levels fall below the saturation point
Saturation point varies with temperature, pH, and other factors affecting crystallization. For practical purposes, 5 or below is safe, up to 6.5 is increasingly risky, and over 6.5 is dangerous.
Though these triggers are important, particularly when we consider treatment, they do not explain the underlying gout causes. Also, they focus on short periods of time when gout flares are causing pain and discomfort. The real danger lies in the progressive spread of uric acid crystals throughout the body that leads to permanent joint damage (osteoarthritis) and damage to all soft tissues, including kidney failure.
Types Of Gout Causes
We have seen that gout flares are a direct result of exposure to uric acid crystals. These crystals are a result of excess uric acid, but what are the gout causes that lead to excess uric acid (hyperuricemia)?
First, we should recognize that there are different reasons for hyperuricemia. It used to be considered that you were either an over-producer or an under-excreter. We can see from Gout Causes: 3 Types Not 2, that we should now consider:
- Kidney Under-excreter – as before, medically known as renal under excretion
- Non-kidney Under-excreter – where excretion outside the kidney, mainly through the gut, is impaired, medically known as extrarenal under excretion
- Over-Producer – previously this included Non-kidney Under-excreters, medically known as urate over production
More importantly, we must distinguish genetic causes from acquired causes.
Genetic Gout Causes
Genetics affects all three types of gout causes. According to Merriman and Dalbeth in “The genetic basis of hyperuricaemia and gout,” it can also affect your propensity to form uric acid crystals, and the start of the immune response that leads to a gout flare.
The genetic aspect of gout is well known. The gout causes report I referred to indicates at least 75% for the specific genetic disorder investigated, so other inherited problems could make this higher. It is common enough to make many of the popular obsessions with gout diet ridiculous.
Though this has to be considered on an individual basis, we also know that some racial groups are more susceptible to gout than others. You must consider your own family history, though this can be difficult since medical science in the past has not always been applied well enough to diagnose gout correctly. Indeed, there is still a poor record of gout diagnosis today.
Genetics is never simple, but if you know that your parents, siblings, or other close family members have gout, there is a strong chance that your gout causes are genetic. That is no excuse to ignore diet completely, but you must be aware that all you can do is to eat healthy, nutritionally balanced meals. An obsession with purines will not change your parents.
Acquired Gout Causes
As I have mentioned diet, I will explain that it is possible to acquire gout through bad diet. Diet includes exercise and all aspects of your lifestyle besides food and drink. Obesity, starvation, and dehydration can all cause gout. Related to this is malnutrition where you have a very limited menu which deprives your body of essential nutrients whilst producing an excess of others. If a bad diet is the only factor affecting your gout, then adopting healthy eating with moderate exercise will cure your gout.
I am in the process of compiling a comprehensive list of other acquired gout causes. I would appreciate your help with this, so if you are aware of acquired gout causes that are not on my list, please let me know using the gout symptoms and causes forum.
Gout causes that are acquired, also known as secondary gout causes are:
- Kidney disease
- Leukemia, lymphoma, or hemoglobin disorders
- Medical conditions that cause rapid weight change (increase or decrease)
- Medications for other health conditions
- Exposure to lead and other metal salts
Some of these are temporary in nature. So they will resolve naturally. Where they are permanent, e.g. medications for other health problems, then you can often find an alternative.
Please note that removing acquired causes of gout may cure your gout, but only when existing deposits of uric acid crystals are significantly reduced. This may take several months. Or even years. But you can hasten the process with temporary treatment to lower uric acid.
Gout Causes: Next Steps
To try to understand your own personal gout causes, you should discuss your history with your doctor, and possibly arrange further tests to determine your uric acid excretion rate. If you are being treated for other health problems, see drug based gout causes. That list may not be complete, so check your specific medicines with your doctor or pharmacist, or ask on the gout forums.
If your gout causes are not obvious, you do not need to worry. Gout symptoms are easy to control, and early treatment avoids serious long-term health problems. The most important action is to get uric acid down to 5mg/dL (0.30mmol/L) as soon as possible, so please do not delay that by worrying about what caused your gout.
You can also use the gout forums to share any questions, experiences, or opinions in the gout causes discussion.
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