What Is Gout? Causes, Symptoms, Uric Acid Levels, Diet & Lifestyle Explained

What comes to mind when you hear the word “gout”?

You may picture sudden, severe pain in the big toe, or think of it as a condition associated with beer and foods high in purines.

It is true that sudden pain at the base of the big toe is one of the most typical signs of gout. However, gout is not simply caused by “drinking too much beer” or “eating too many high-purine foods.”

Behind gout is the balance between uric acid produced in the body and the uric acid that is removed from the body.

Body weight, alcohol consumption, eating habits, kidney function, genetic factors and some medicines can also influence uric acid levels.

In this article, we explain what gout is, how uric acid levels can become elevated, how hyperuricemia differs from gout, common symptoms and affected joints, testing and treatment, and everyday considerations such as diet, alcohol, hydration and exercise. The aim is to provide the basic information worth knowing about gout and uric acid in an easy-to-follow way.

What Is Gout? Uric Acid and How Gout Attacks Occur

Gout is a condition in which urate crystals can accumulate in joints and trigger intense inflammation.

To understand gout, it helps to first understand uric acid.

Uric acid is a substance produced when purines found in the body and in foods are broken down.

Despite its name, uric acid is not found only in urine. It also circulates in the blood. Uric acid produced in the body travels through the bloodstream and is mainly removed through the kidneys and excreted in urine. Some is also eliminated through the intestines.

Normally, the amount of uric acid produced and the amount removed from the body remain in balance.

When this balance is disrupted and uric acid levels remain high, some uric acid may no longer remain fully dissolved and can form urate crystals that accumulate in joints and other tissues.

When the immune system reacts to these crystals inside a joint, sudden inflammation and severe pain can occur. This is known as a gout attack.

High uric acid levels do not always cause noticeable symptoms. For this reason, hyperuricemia is sometimes first discovered through a routine health check.

Why Do Uric Acid Levels Rise? Hyperuricemia and Related Risks

A condition in which the level of uric acid in the blood is high is known as hyperuricemia.

In Japan, hyperuricemia is defined as a serum uric acid level of more than 7.0 mg/dL, regardless of sex.

Hyperuricemia often causes no noticeable symptoms, so it can be easy to think that it is “just a slightly high number.”

However, when uric acid levels remain elevated, urate crystals are more likely to form. This can be associated not only with gout but also with urinary stones and kidney-related problems.

There Is More Than One Reason Uric Acid Levels Can Rise

Broadly speaking, uric acid levels can rise because too much uric acid is produced, too little is excreted, or a combination of both.

A variety of factors involving both the body and everyday lifestyle can contribute.

This means that simply saying, “My uric acid is high because I ate too many high-purine foods,” can be an oversimplification.

Diet, body weight, alcohol intake, kidney function and individual differences all need to be considered together.

Why Is Gout More Common in Men? Can Women Get It Too?

Hyperuricemia and gout are more common in men than in women.

The Japanese Society of Nephrology reports that hyperuricemia is found in approximately 20–30% of adult men and a few percent of women.

One reason women tend to have lower uric acid levels is related to the influence of female hormones.

However, this does not mean that women cannot develop gout. Uric acid levels tend to rise after menopause as female hormone levels decline, so gout and hyperuricemia are also relevant to women.

Regardless of sex, if a health check shows that your uric acid level is high, it is worth taking a closer look at the result.

Symptoms of a Gout Attack and Commonly Affected Joints

The typical symptoms of a gout attack are sudden severe joint pain, swelling, redness and warmth.

A joint may begin to hurt intensely even when you were feeling completely normal beforehand.

The most well-known location is the joint at the base of the big toe.

The pain can become strong enough to make wearing shoes difficult, and even light contact from bedding may feel uncomfortable. Symptoms can intensify over a relatively short period of time.

Gout does not occur only in the big toe.

However, gout is not the only condition that can cause a joint to suddenly become red, swollen and extremely painful.

Other conditions, including infectious arthritis and arthritis caused by calcium pyrophosphate crystals, sometimes referred to as pseudogout, can produce similar symptoms.

If you experience severe joint pain or swelling for the first time, joint pain accompanied by fever, or particularly intense symptoms, avoid self-diagnosis and seek medical attention.

What Can Trigger a Gout Attack?

Even when urate crystals are present in a joint, severe pain does not necessarily continue all the time.

A gout attack can begin suddenly.

Possible triggers vary from person to person, but factors such as dehydration, heavy alcohol consumption, overeating, illness or surgery, and very intense exercise may be involved.

Rapid changes in blood uric acid levels can also be associated with gout attacks.

For this reason, it is not always accurate to attribute an attack to one event immediately beforehand, such as eating a high-purine food the previous day.

If the Pain Goes Away, Is Everything Fine?

The pain of a gout attack may gradually improve with time.

That can make it tempting to think, “The pain is gone, so the problem is over.” However, the disappearance of pain does not necessarily mean that the underlying uric acid problem has been resolved.

If hyperuricemia continues and gout attacks recur, urate crystals can accumulate under the skin and form tophi, and the effects on the joints may become more significant.

Hyperuricemia is also associated with urinary stones and kidney problems.

People with hyperuricemia may also have obesity, high blood pressure, abnormal blood lipid levels or high blood glucose. It can therefore be useful to look at your overall health-check results rather than focusing only on uric acid.

Testing and Diagnosis: Is Uric Acid Level Enough to Diagnose Gout?

It may seem that gout can be diagnosed simply by checking uric acid levels, but a uric acid result alone is not enough to confirm gout.

A doctor will consider how the pain began, whether the joint is swollen or red, and whether similar attacks have happened before.

Blood Tests for Uric Acid

A blood test can measure serum uric acid levels.

Hyperuricemia is an important background factor in gout, but many people with high uric acid levels have never experienced a gout attack.

Conversely, serum uric acid is not always elevated during an acute gout attack.

For that reason, a single blood-test result should not be used to decide on your own whether you do or do not have gout. Symptoms and other test findings are considered together.

Checking Joint Fluid for Urate Crystals

When necessary, fluid may be taken from a swollen joint and examined under a microscope for urate crystals.

Finding urate crystals in joint fluid provides important evidence when diagnosing gout.

Depending on the symptoms and circumstances, imaging tests such as ultrasound or X-rays may also be used as part of the assessment.

Gout Treatment: Managing an Attack and Managing Uric Acid Are Different

Gout treatment can broadly be divided into treatment of the inflammation and pain during an acute attack and long-term management of uric acid levels.

During an Acute Gout Attack

Depending on the individual, medicines such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids may be used to reduce inflammation and pain during an acute gout attack.

The most appropriate medicine depends on factors such as kidney function, other medical conditions and medicines already being taken.

Do not add over-the-counter pain medicines or change the dose of prescribed medicines on your own. Speak with a doctor or pharmacist.

Managing Uric Acid Between Attacks

For people who experience repeated gout attacks, treatment to manage serum uric acid over the longer term may be considered.

Different medicines can reduce the production of uric acid or help the body remove it, and the choice depends on the individual’s health and circumstances.

One point worth remembering is that treatment should not be stopped simply because the pain has disappeared.

If you are already taking medicine to lower uric acid and experience a gout attack, do not stop, increase or decrease your medicine without medical advice. Follow the instructions of the doctor who prescribed it.

Alongside medical treatment, eating habits, alcohol consumption, body weight, hydration and physical activity may also need to be reviewed.

However, lifestyle changes are not necessarily a substitute for medical treatment. If you have experienced a gout attack or have been diagnosed with hyperuricemia, speak with a healthcare professional about the approach that is appropriate for you.

Diet and Alcohol: It Is Not Just About Purines

When reading about gout, one word appears again and again: purines.

This can make it seem as though simply avoiding high-purine foods is enough.

However, purines are only one part of the picture when thinking about uric acid levels.

Overeating, body weight, alcohol, sugary drinks and the overall balance of the diet are also worth considering.

What Are Purines? You Do Not Need to Avoid Them Completely

Purines naturally exist in our bodies and are involved in processes such as cell turnover.

They are also found in food, and when they are broken down in the body, uric acid is produced.

Foods that are commonly known to contain relatively high amounts of purines include:

This does not mean that every food containing purines must be completely avoided.

Rather than severely restricting individual foods, it is more practical to avoid frequently eating large amounts of very high-purine foods while paying attention to the amount and overall balance of your meals.

Uric acid is not produced only from purines obtained through food. It is also produced through normal metabolism inside the body.

For this reason, focusing only on purines can cause other relevant factors, such as body weight and alcohol intake, to be overlooked.

Focus on the Overall Diet, Not Only on What to Avoid

Being told that you have hyperuricemia does not necessarily mean that you need to place extreme restrictions on your diet.

A more balanced approach is to include a variety of foods such as vegetables, fruit, legumes and grains rather than focusing heavily on one particular food or food group.

Do Not Forget About Sugary Drinks

Alcohol tends to receive most of the attention when gout is discussed, but soft drinks and juices containing large amounts of sugar are also worth considering.

Regularly consuming large amounts of sugary drinks can contribute to excess energy intake and weight gain.

For everyday hydration, water and unsweetened tea can be useful choices.

Is Switching from Beer to Shochu Enough?

A common belief about gout is that “beer is high in purines, so switching to shochu solves the problem.”

It is not quite that simple.

Beer can contain purines, but the relationship between alcohol and uric acid is not determined by purine content alone.

Alcohol itself can affect uric acid levels.

Therefore, a drink labelled low-purine or purine-free does not mean that it can be consumed without considering uric acid levels.

The same principle applies to spirits such as shochu and whisky, which contain little or no purine.

The appropriate approach to alcohol varies depending on age, sex, body size, medical conditions and medicines.

If you are receiving treatment for hyperuricemia or gout, discuss alcohol consumption with your doctor or another healthcare professional.

Hydration, Body Weight, Exercise and Other Lifestyle Considerations

When thinking about uric acid, everyday factors such as hydration, body weight and physical activity are also relevant.

Hydration: There Is No Single “2 Litres for Everyone” Rule

Uric acid is mainly removed from the body through the kidneys and urine, and dehydration can cause blood uric acid levels to rise.

It is especially worth paying attention to fluids on hot days, during exercise and whenever you are sweating heavily.

However, there is no need to assume that everyone must drink more than two litres of water every day.

Fluid requirements vary according to body size, temperature, activity level and overall health.

Some people with heart or kidney conditions may also have specific medical instructions regarding fluid intake.

Body Weight: Aim for Sustainable Changes Rather Than Rapid Weight Loss

Hyperuricemia is sometimes seen together with obesity and metabolic syndrome.

For people with obesity, improving eating habits and increasing appropriate physical activity while working toward healthier weight management can also support overall health.

However, severe food restriction or trying to lose a large amount of weight very quickly is best avoided.

Rather than aiming simply to “eat less,” think about reducing overeating and creating eating and exercise habits that can be maintained over time.

Exercise: More Intense Is Not Always Better

Regular movement is useful for body-weight management and general health.

However, very intense exercise and short bursts of anaerobic activity can temporarily raise serum uric acid levels.

If you are not normally active, there is no need to suddenly begin high-intensity training.

Moderate aerobic exercise such as walking, adjusted to your fitness and health, can be an easier place to start.

However, there is no need to force yourself to exercise while a joint is severely painful during a gout attack.

If you are having an attack or are receiving treatment for another condition, ask your doctor about when and how to exercise safely.

Be Aware of Dehydration in Saunas and Hot Weather

Saunas and hot outdoor conditions can cause you to sweat more than usual.

If heavy sweating leads to inadequate fluid intake, the amount of water in the body decreases and the concentration of uric acid in the blood may rise.

There is no need for everyone to avoid saunas completely, but if your uric acid level is high, try to avoid becoming dehydrated in situations where you sweat heavily.

What If a Health Check Shows High Uric Acid?

Hyperuricemia often causes no noticeable symptoms.

This means that a routine health check may be the first time you become aware that your uric acid level is high.

It can be tempting to ignore the result because you feel well and have no pain.

If your uric acid level is reported as high, take another look at the result and consider it together with your overall health information.

Hyperuricemia may occur together with obesity, high blood pressure, abnormal blood lipid levels or high blood glucose.

Rather than looking at uric acid in isolation, reviewing your health-check results as a whole can provide a better picture of your overall health.

When to Seek Medical Advice

Consider speaking with a healthcare professional in situations such as the following:

In particular, avoid assuming that a severe joint pain occurring for the first time “must be gout.”

Some conditions that resemble gout require prompt diagnosis and treatment.

Summary: Start by Knowing Your Uric Acid Level

Gout is a condition in which urate crystals accumulate in joints and trigger inflammation, leading to severe pain and swelling.

Hyperuricemia is an important underlying factor, but it is not accurate to think of gout simply as “a disease caused by eating too many high-purine foods.”

Uric acid levels can be influenced by many factors, including genetics, body weight, diet, alcohol intake, kidney function, hydration and certain medicines.

A gout attack can appear suddenly as severe pain. However, the elevated uric acid level behind it may have been present for some time without noticeable symptoms.

Rather than waiting until something hurts, checking your health results and paying attention to everyday habits can be a useful first step in understanding your own health.

Instead of focusing only on food, alcohol or purines, look at your overall lifestyle and start with changes that feel realistic and sustainable.