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What Causes High Uric Acid Levels That Can Lead to Gout?

The short answer from a rheumatologist

Closeup of a foot with gout, including swollen, crooked toes and damaged toenails

Q: I understand that high levels of uric acid lead to gout. What causes uric acid to be too high?

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A: There’s a common misunderstanding that gout is caused by overindulging in foods high in purines, such as red meat, seafood and alcohol. This is because purines break down to uric acid, which is the substance that at high levels in the body can lead to gout. But it’s not that simple.

In fact, a recent study found that genetics was far more likely to be responsible for variations in uric acid levels than food. High-purine foods raise uric acid levels only a very small amount.

Some, but not all, people with high uric acid levels develop gout. Gout occurs when excess uric acid leaves the bloodstream and settles in other parts of the body, particularly joints. The uric acid may form needle-shaped crystals. These periodically trigger a gout attack, which is marked by swelling, redness and pain in the joint.

The exact cause of gout is still not entirely understood, especially because not everyone with high uric acid levels develops. Even though the food you eat probably doesn’t cause gout, it’s still a good idea to eat a healthy diet, which may help cut down on gout attacks.

— Rheumatologist Chad Deal, MD

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