Is Gout Hereditary? The Role of Family History and Lifestyle in a Gout Diagnosis

Historically, gout was considered the “rich man’s disease” and was associated with a diet laden in rich foods like meat and an excess consumption of alcohol. While research suggests diet plays an important role in controlling blood levels of uric acid, there is more about gout than just the food or alcohol you drink (if any). If gout isn’t solely caused by diet and lifestyle, could genetics be playing a larger role? 

The Origins of Gout

Gout, or gouty arthritis, is a painful condition caused by a buildup of uric acid in the blood. Swollen, painful joints, and collections of uric acid under the skin (tophi), can make living with the condition painful. The disease was named during the 5th century by Hippocrates, who coined the condition as “the unwalkable disease”. However, historians suggest that the first identification of gout occurred much earlier, in the year 2640 BC by the Egyptians. 

While the symptoms of gout have been recognized for thousands of years, the suspected cause has dramatically evolved. In the 14th-15th century, cases of gout were on the rise in the wealthy populations of royalty and noblemen in England. The suspected cause? Overindulgence of meaty feasts and alcohol.  

The diets of the mega-wealthy English folk were drastically different from the common man, whose diets consisted of smaller portions of lean proteins and carbohydrates. The wealthy also typically drank from lead goblets, and lead in the blood has also been associated with higher incidences of gout.  

It wasn’t until the 17th century that gout was suggested to have a genetic component. Today, we can identify specific genes that may be linked to the likelihood of developing the disease. This can help explain why so many people who do not have a diet rich in purines or drink alcohol can still develop gout, and develop it at a young age.  

How is Gout Hereditary?

The genes associated with gout are mainly a part of the renal-urate transport system. This transport system within the inner workings of the kidneys is responsible for removing urates (produced from purines) from the bloodstream. Typically, only a small portion of urates are removed from the body via urine. Most urates are reabsorbed, about 90% actually, and the renal-urate transport system dictates the extent of this reabsorption. 

Unsurprisingly, inheritable mutations in renal-urate transportation-specific genes have been shown to affect how well the body can reabsorb excess uric acid. Meaning, that if you inherit one of these “slow” transport genes, your body is unable to filter out as much uric acid as someone who inherited a “fast” or normal transport gene.  

Specifically, the genes ABCG2 and SLC2A9 (they affect uric acid excretion) have been linked to an increased risk of developing gout. Genetic testing for gout may be able to identify these specific genes, among others, that are linked to developing the disease. However, this testing is not widely available and does not change the way gout is treated if you develop gout. Also, genetic testing does not prove for certain that someone will develop gout, even if these genes are present. While genetics play a role in the likelihood of developing a disease, lifestyle choices and other environmental factors are more likely to influence the outcome.

Dr. Panico, Chief of Rheumatology at Summit emphasizes that you don’t have 100% control over a gout diagnosis.

“If you have a parent with gout, and think you may have gout yourself, there is nothing to be ashamed of,” says Dr. Panico, Chief of Rheumatology at Summit. “It is far more likely that you inherited the condition, just like you can inherit the color of your eyes or hair. We now have much more research to show that gout is not your fault.”  

Lifestyle Choices and Gout

It’s known that certain lifestyle choices increase the risk of developing gout. Being overweight, high alcohol consumption, purine-heavy diets, and usage of certain medications are all controllable factors linked to gout. Regardless of whether you have a family history of gout, there are ways you can lower your risk of developing the disease. 

“If you have a parent or relative with gout, it can be helpful to have a conversation with your medical team about how you can lower your risks of having severe gout. We are going to talk about diet and lifestyle choices, and controlling these things will help in every aspect of your health as well.”  

Obesity and Gout

Individuals who are overweight, especially those who carry weight around their abdomen, are at a higher risk of developing gout. According to the Arthritis Foundation, fat in the abdominal region is linked to the release of inflammatory chemicals that may potentially aid in triggering the disease.  

The pain associated with gout flares is a result of the body’s inflammatory response, so the increase of inflammation associated with abdominal fat can also worsen acute gout attacks. Dr. Panico states the importance of maintaining a healthy weight to help prevent gout.

“Obesity is one of the leading causes of gout that has a link to so many factors. By improving the quality of food you consume, you can decrease purine intake, the part of our diet that produces the most uric acid. And when you maintain a healthy weight, it is possible to decrease the risk of high blood pressure and diabetes, which also have a very strong link to gout.” 

Alcohol Consumption and Gout

Alcohol is processed through the liver, the same organ responsible for filtering out excess uric acid. Consuming too much alcohol can affect your liver’s ability to properly process that uric acid. Certain alcoholic drinks, especially beer, are also very high in purines and may lead to additional buildup of uric acid at high concentrations when consumed.  

Think about it like a rush of uric acid in your blood all at once. If your kidneys cannot keep up with getting rid of it, the uric acid has to go somewhere and can collect or deposit in your joints instead. 

Individuals with a family history of gout should be mindful of their alcohol consumption. Dr. Panico recommends to limit your alcohol consumption to no more than 1-2 drinks in a 24-hour period. Additionally, it’s best to opt for drinks lower in purines, like red wine.  

“When your body is exposed to a high amount of purines all at once, the filtration system often times cannot keep up. If one drink does not trigger a gout flare, that second or third drink may push your body over that edge. 

Diet and Gout

Diet has been shown to have an impact on gout symptoms. Diet is not the sole reason for developing gout, or having gout flares, but it contributes to the change in concentration of uric acid in the body that then leads to more gout attacks over time.  

When you consistently consume foods with high levels of purines, you deposit that uric acid into your “bank” so to speak. And when the uric acid level in your body increases past a certain point, that accumulation then leads to gout attacks. Examples of foods that contain the most purines include: 

  • Red meats, including lamb, bacon, and other game meats 
  • Certain seafoods, including anchovies, scallops, and sardines 
  • Highly processed foods, or foods high in sugar or high-fructose corn syrup 

Following a diet consisting primarily of fruits, vegetables, lean meats, healthy fats, and fiber-rich carbohydrates has been shown to minimize the risk of developing gout. Following dietary plans like the Mediterranean diet for gout may be beneficial in maintaining healthy uric acid levels in the body.   

However, if you already have gout and dramatically change your diet, the underlying reason your gout happened in the first place is still there: the genetics you inherited that predispose you to have gout. That is why there are so many layers to this disease, it is not a “one size fits all” treatment plan.  

Ultimately, there are ways you can mitigate the chances of developing gout, even if you have a genetic predisposition or family history. 

 If you are currently experiencing gout flares, our team of rheumatologists at Summit Rheumatology can work to lower uric acid levels through proper medication and lifestyle management. If you are treating gout and continue to experience flares despite medication, our team can still help you.   

Ready to schedule your appointment? Our team is currently accepting gout patients via virtual appointment, or in person at one of our several locations throughout Phoenix, Arizona. Give us a call at  (480) 494-2770 or send us a message to make an appointment. 

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