This page about gout triggers was last reviewed, or updated, on 11 February 2015.
Gout triggers are the immediate conditions that cause gout flare ups but every gout flare up isn't necessarily caused by them. And you may have your own, including foods that bring on attacks for you but not others. Finding out what are your triggers is a significant task - long term gout sufferers get to learn them. But many are very common.
Hyperuricemia can remain in the body for 20-30 years before the first gout attack. This is unusual and remains as mysterious as an unexamined planet, but certain immediate causes are known.
If you have gout, make sure you understand all these triggering conditions below, to help avoid another attack. If you don't have gout be aware of these gout triggers because you may have excessive uric acid in your body. If there is a common factor in most of them, it is any event or substance that causes a rapid change in blood (serum) uric acid, including uric acid lowering drugs.
Will you pull a gout trigger and spark a flare ? Read these !
Alcohol and high purine foods binges The best known immediate cause of gout, but possibly not the one that causes the most flare ups, is over consumption of alcohol and high purine foods. Alcohol especially is a major immediate cause of gout for three reasons. It is a major source of purines; it stimulates the liver to breakdown purines and so produce more uric acid; and it undermines the kidney’s ability to remove uric acid. Purines are the precursors (building blocks) of uric acid. (See the purines section for more about purines and uric acid - click on the Purines/Uric Acid Nav Bar button left). Such binges can cause rapid change of blood uric acid levels and be a gout trigger.
Cold weather is another.You can’t avoid winter unless you are able to move to a warmer climate, but you can be extra gout aware during this time. Wear warm clothes including gloves and woolen (or extra) socks. Gout is most likely to start in one of the big toes. And the fingers are where gout attacks may last longest and be the most difficult to control. Both the feet and the fingers are the coldest part of the body, the furthest from the heart. Avoid being outside during cold weather as much as possible.
Very hot and humid weather can also trigger gout flare ups, probably because it causes dehydration. Make sure you drink plenty of water in very hot weather, and if you live in a hot and humid climate.
Stress An overstressed lifestyle.
Medications Some drugs can cause hyperuricemia which as you now know may lead to gout. Leading medications that can do this are diuretics and immune system suppressors. And of course medications that lower uric acid such as Krystexxa (pegloticase), febuxostat, allopurinol, probenecid and others.
For low dose aspirin - see below.
Illness or maladies such as kidney diseases, (less uric acid is excreted), heart disease, high blood pressure, high serum levels of cholesterol, insulin resistance and diabetes.
Surgery including organ transplants.
Joint injuries from another cause. e.g. a broken bone, a heavy bruise or a sprain. And note that gout is attracted to body joints where an injury has happened in the past. If you suspect gout, ask yourself "has this spot been injured before?" It's quite common.
Fast Weight loss on a crash diet may increase your uric acid level and therefore can be a gout trigger.
Too much exercise
Niacin and gout (aka Nicotinic acid), Vitamin B3, but only in large doses. The amount of this very interesting and versatile vitamin in multivitamin formulas, usually about 20 mg, is highly unlikely to be a gout trigger. Neither is an intake of up to 50 mg daily. But if you were to take more than a gram daily, that would be a different matter.
The late Dr.Robert Atkins (the Atkins diet) reported in his Vita-Nutrient Solution that high niacin doses of 3 grams and more caused uric acid elevations.
Low dose aspirin Low dose aspirin has long been regarded as a gout trigger, and as a medication that may worsen a gout attack. A study published in January 2013 (1) concluded that the odds of a gout attack rose 81% in 724 participants who took an aspirin dose of 325 mg or lower for two days. And the lower the dose, the greater the chances. To counter this effect, Allopurinol was used successfully.
Chlorella is loaded with nutrients and very high in protein, but in Japanese scientific research it has been also been found to be exceptionally high in purines. too. Avoid. So too spirulina, but not as high as chlorella.
Environmental factors such as exposure to lead and possibly to molybdenum. Working in a cold environment without wrapping up well.
Obesity The larger your body, the more uric acid it has to excrete. And obesity is a major cause of the illnesses and the maladies listed above, and these can trigger gout. There is no doubt about the link between obesity and gout, as true today as it was 200 years ago.
Footwear If you suffer from gout, or are close to your first attack, poorly fitting shoes could trigger an attack. Gout sufferers have reported this.
Why does gout so often attack a big toe first? And how can you use this knowledge to help stave off a gout flare up? Visit our page about big toe gout.
(1) Zhang Y., Neogi T., Chen C, Chaiusson Cm Hunter D.J., Choi H. Low-dose aspirin use and recurrent gout attacks. Annals of the Rheumatic Diseases doi: 10.1136/annrheumdis-2012-202589. Epub 2013 Jan 23.