Gout starts when uric acid builds up in your blood and forms crystals in your joints
Gout is caused by a substance called uric acid that your body produces when it breaks down purines — compounds found in certain foods and drinks, and also made naturally by your cells. Normally your kidneys filter uric acid out through urine. But when you have too much uric acid in your blood, or your kidneys cannot filter it fast enough, crystals form in your joints. These needle-shaped crystals trigger an intense inflammatory response — your immune system treats them as a threat, flooding the area with white blood cells and inflammatory chemicals. That is what causes the sudden, severe pain, swelling, and redness of a gout attack.
The big toe is the most common target, though gout can strike any joint. The reason the big toe is vulnerable is partly mechanical: it bears weight with every step, and the joint is cooler than the rest of your body. Uric acid crystals form more easily in cooler areas, and the constant motion of walking can shake the crystals loose and trigger an attack.
Key Takeaways
- Gout happens when uric acid builds up in your blood and forms crystals inside a joint, triggering sudden pain and swelling.
- Your kidneys normally filter uric acid out of your body, but if they work slowly or you produce too much, crystals can form.
- Certain foods and drinks — red meat, organ meats, seafood, alcohol, and sugary drinks — raise uric acid levels and increase your risk.
- Some people's bodies are genetically prone to gout, and men are more likely to develop it than women.
- Obesity, high blood pressure, kidney disease, and certain medications can all make gout more likely.
How your kidneys' filtering speed affects uric acid levels
Your kidneys are responsible for removing uric acid from your bloodstream and sending it out as waste in your urine. But not everyone's kidneys work at the same pace. Some people have kidneys that naturally filter uric acid more slowly than average — this is often inherited, meaning it runs in families. If your kidneys are slow to clear uric acid, it accumulates in your blood even if you eat a normal diet.
Other people produce more uric acid than average because of how their bodies break down purines. Again, this tendency often runs in families. The combination matters: if you have both slow kidney filtering and high uric acid production, your risk of gout is much higher than someone with just one of these traits.
Foods and drinks that raise uric acid
Purines are found in many common foods, and eating them increases the uric acid your body has to filter. Red meat, organ meats (liver, kidney, tongue), and certain seafood — especially anchovies, sardines, mussels, and scallops — are high in purines. Poultry has moderate amounts. Vegetables contain purines too, but research shows they do not raise gout risk the way meat and seafood do.
Alcohol is a major trigger, particularly beer. Alcohol slows your kidneys' ability to filter uric acid, so it raises levels in two ways: by adding purines and by making your kidneys work less efficiently. Sugary drinks — especially those sweetened with high-fructose corn syrup — also increase uric acid. Regular soda, fruit juice, and sweetened iced tea can all contribute to attacks.
Medical conditions and medications that increase gout risk
Several health conditions make gout more likely. Obesity raises uric acid levels because excess body weight increases the amount of purines your body produces. High blood pressure and kidney disease both interfere with how efficiently your kidneys filter uric acid. Diabetes and metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and excess body fat — also increase risk.
Certain medications can trigger gout as a side effect. Diuretics (water pills) used for high blood pressure or heart disease slow uric acid filtering. Low-dose aspirin, taken for heart protection, has the same effect. Chemotherapy drugs used to treat cancer can cause a sudden spike in uric acid when cancer cells die and release their contents. If you take any of these medications and develop gout, your doctor may be able to switch you to an alternative.
Why men are more likely to develop gout than women
Gout is two to three times more common in men than in women. Part of the reason is biological: men naturally have higher uric acid levels than women. Estrogen, the hormone that women produce in higher amounts before menopause, helps kidneys filter uric acid more efficiently. After menopause, when estrogen levels drop, women's gout risk rises.
Men also tend to drink more alcohol and eat more red meat on average, both of which raise uric acid. Age matters too — gout typically starts in men in their 40s and 50s, though it can occur earlier. Women usually develop gout later, often after menopause.
How dehydration and sudden weight loss trigger attacks
Dehydration concentrates uric acid in your blood because there is less fluid to dilute it. When you are dehydrated, your kidneys also hold onto more water to maintain hydration, which means they filter uric acid less efficiently. This is why gout attacks sometimes happen after a night of heavy drinking — alcohol dehydrates you while also raising uric acid levels.
Rapid weight loss can also trigger an attack, even though losing weight is generally good for gout prevention. When you lose weight quickly, your body breaks down tissue faster, releasing more purines into your bloodstream. Crash diets and fasting are common culprits. Gradual weight loss over weeks and months does not carry the same risk.
Injury and stress as gout triggers
A physical injury to a joint — even a minor one — can sometimes trigger a gout attack in that spot. This happens because the injury causes inflammation, which can shake loose uric acid crystals that were already present. Similarly, surgery or intense physical exertion can bring on an attack.
Emotional stress and illness also trigger gout in some people. The exact mechanism is not fully understood, but stress hormones and the inflammation that comes with infection or illness both seem to play a role. If you notice gout attacks cluster around stressful periods or times when you are sick, that pattern is real and worth mentioning to your doctor.
Frequently Asked Questions
Can you get gout if no one in your family has it?
Yes. While genetics play a role — about 20 percent of people with gout have a family history — you can develop gout without any family connection. Diet, weight, alcohol use, and certain medications can all cause gout even if your relatives never had it. Conversely, having a family history does not mean you will definitely develop gout.
Does eating too much fruit cause gout?
Most fruits are safe, but fructose — a natural sugar in fruit — can raise uric acid levels. Dried fruits and fruit juices are more concentrated sources of fructose than whole fruit. If you have gout, whole fruits are generally fine, but limiting juice and dried fruit is a reasonable precaution.
Can gout be caused by something other than diet?
Yes. Genetics, kidney function, medications, obesity, high blood pressure, and other medical conditions all cause gout independent of what you eat. Some people develop gout despite eating well because their kidneys filter uric acid slowly or their body produces excess amounts. Diet is one piece, not the whole picture.
Does coffee cause gout?
No. Research shows that coffee actually lowers uric acid levels slightly. Tea and coffee are safe to drink if you have gout. The concern is with sugary drinks — regular soda and sweetened iced tea — not with coffee or unsweetened tea itself.
Why did I get gout suddenly if I have not changed my diet?
A sudden first attack often happens because uric acid has been building up silently for years. You may have crossed a threshold where crystals finally formed. Alternatively, a recent change you did not notice — starting a new medication, gaining weight, drinking more alcohol, or becoming dehydrated — can tip the balance. Illness and stress can also trigger an attack even without dietary changes.