Gout

What Causes Gout?

In order to deal properly with gout we need to understand and — if possible — remove the underlying causes and risk factors.  We need to ask: "What else is going on inside the body that might allow gout symptoms to develop?"

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Accurate diagnosis of the factors behind gout consists of three steps:

Step 1: List the Possible Causative Factors

Identify all disease conditions, lifestyle choices and environmental risk factors that can lead to gout symptoms.  Here are eight of many possibilities (more below):
  • Hypertension
  • CML Leukemia
  • A Weight Problem
  • Hemochromatosis
  • Lyme Disease*
  • Dehydration
  • Elevated Insulin Levels
  • Low Carbohydrate Diet Consequences
* symptoms can be very similar

Step 2: Build a Symptom Checklist

Identify all possible symptoms and risk factors of each possible cause, and check the ones that apply:
dizziness when standing up
poor mental clarity
weak appetite
adverse reaction to delayed meals
migrating arthritis
history of adult allergies
African ethnicity
tonsils/adenoids out before age 20
fatigue after slight exertion
allergies to certain foods
difficulty losing weight
high air pollution exposure
... and more than 80 others

Step 3: Rule Out or Confirm each Possible Cause

A differential diagnosis of your symptoms and risk factors finds the likely cause of gout symptoms:
Cause Probability Status
Low Carbohydrate Diet Consequences 93% Confirm
Dehydration 27% Unlikely
Hemochromatosis 22% Unlikely
CML Leukemia 2% Ruled out
A Weight Problem 0% Ruled out
Elevated Insulin Levels 0% Ruled out
Lyme Disease** 0% Ruled out
Hypertension 0% Ruled out
* This is a simple example to illustrate the process
** Symptoms can be very similar

Arriving at a Correct Diagnosis

The Analyst™ is our online diagnosis tool that learns all about you through a straightforward process of multi-level questioning, providing diagnosis at the end.

If you indicate joint problems, The Analyst™ will ask further questions including this one:
Have you suffered from Gout?
Possible responses:
→ Never had it / don't know
→ Probably had it/minor episode(s) now resolved
→ Major episode(s) now resolved
→ Current minor problem
→ Current severe problem
Based on your response to this question, which may indicate either history of gout or gout, The Analyst™ will consider possibilities such as:
Chronic Myelogenous Leukemia (CML)

One complication of CML is gout, caused by marrow hyperproliferation.

Chronic Renal Insufficiency

Patients with impaired renal function filter and excrete less uric acid and therefore become hyperuricemic.  Interestingly, patients with renal failure do not develop gout as frequently as expected, despite their high plasma urate levels.  The explanation for this phenomenon may be that they have not incurred sustained hyperuricemia levels long enough to develop gout.  Only 1% of renal failure patients develop gout but nearly 30% of patients with adult polycystic kidney disease do.

Dehydration

Gout can be caused by dehydration and the use of diuretics such as coffee or alcohol.

Effects of a Low Carbohydrate Diet

In March 2004, an article was published in the New England Journal of Medicine documenting the effect of meat intake on gout risk.  Harvard researchers followed almost 50,000 men for 12 years and found that "each additional daily serving of meat was associated with a 21% increase in the risk of gout." In fact, the Atkins Diet has been blamed directly for the rising incidence of this painful disease.  [The Observer, 18 January 2004]

Elevated Insulin Levels

Preliminary research suggests that insulin resistance may play a role in the development of gout.  Gout is strongly associated with the consequences of insulin resistance i.e. obesity, hypertension, hyperlipidemia and diabetes.

Hypertension (High Blood Pressure)

Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes.

Kidney Disease

Hyperuricemia is caused by a variety of means, one of which is abnormal kidney function.  In addition, for some individuals gout is a progressive, crippling chronic disease that eventually damages the kidneys.

Lyme Disease

Lyme disease is similar to gout and is sometimes misdiagnosed as such.

Problems Caused By Being Overweight

Gout is strongly associated with obesity, hypertension, hyperlipidemia and diabetes.

... and also rule out issues such as:
Multiple Sclerosis

It has been reported that MS (possibly associated with low uric acid) and gout (associated with high uric acid) are mutually exclusive.  A study of 20 million Medicare and Medicaid records found no overlap between MS and gout.

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