The Role that Genetics Plays in Gout

The Role that Genetics Plays in Gout

July 13, 2020

If you’ve been diagnosed with gout, you may feel uncomfortable or embarrassed, thanks to outdated ideas about what causes it. Gout is sometimes called “the disease of kings” because people wrongly think the condition stems from indulging in rich foods and drinking too much alcohol.

Diet does play a role in gout. But turns out, it isn’t the only — or even the main — factor. The genetic hand you’re dealt plays a much bigger role in whether you get gout.

 

What Causes High Uric Acid Levels

Gout is caused by high amounts of uric acid in the blood. Your uric acid levels are the result of how much your body makes minus how much it excretes. Only 10 percent of people with gout produce too much uric acid; a full 90 percent don’t excrete enough. When that happens, the acid crystalizes in the blood, accumulates in the joints, and causes intense discomfort.

Just last year, researchers identified 183 different locations on genes that are strongly associated with high levels of uric acid in the blood. If your body is genetically inefficient at excreting uric acid, you’re more prone to developing gout than the average person.

 

How Gout Discriminates

For more proof that gout is largely genetic, just look at who gets it.

Some of the groups with the highest incidence of gout include the Hmong of Southeast Asia, the Māori of New Zealand, and Pacific Islanders., If gout were mainly a dietary problem, we would expect the diets of these peoples to be rich in organ meats, red meat, wild game, shellfish, soda, and alcohol — all the things people with gout are told to avoid.

But that’s not the case. These cultures’ dietary traditions emphasize fruits, vegetables, rice, and starchy tubers — not the classic problematic gout foods. When Polynesians move to New Zealand and stop eating their traditional diet, though, their rates of gout skyrocket.

Importantly, people of all economic classes get gout. But contrary to the stereotype, it seems lower-income folks may be more prone to it.,

 

The Role of Diet in Gout

Diet is part of the gout picture, but mainly as a trigger. If you don’t have the genetic propensity for gout, you could eat as much meat and drink as much booze as you wanted, and you still wouldn’t get it.

On the flip side, some people whose diets are healthy can end up with gout if they have even a little of these foods and beverages. It’s similar to celiac disease. Gluten is the trigger, but genetics is the cause.

 

Your Genes Are Not Your Destiny

When it comes to the genetic part of the gout equation, it’s not as simple as merely having a gene or not having it. They can be turned on or off, like a light switch.

Scientists think the presence of certain genes accounts for 35 percent of the variations in people’s blood levels of uric acid, but how active the genes are explains another 23 percent. Diet, on the other hand, is only responsible for just over 3 percent!

 

What to Do

If you have gout, you can’t change your genes. But you can help keep your uric acid levels under control with some simple changes, including staying hydrated and identifying and avoiding your personal triggers.

 

References

1 Ragab G, et al. Gout: an old disease in new perspective—a review. J Adv Res. 2017;8(5):495-511.

2 John Hopkins University Bloomberg School of Public Health. Large genome-wide association study illuminates genetic risk factors for gout: Analysis of DNA from nearly half million people should speed efforts to develop gout screening tests, treatments. ScienceDaily. 2019 Oct 7. https://www.sciencedaily.com/releases/2019/10/191007113335.htm

3 Dalberth N, Merriman TR, Stamp LK. Gout. Lancet. 2016;388(10055):2039-52.

4 Winndard D, et al. National prevalence of gout derived from administrative health data in Aotearoa, New Zealand. Rheumatology. 2012;51(5):901-09.

5 Mintz L. Gout isn’t the disease of medieval kings. I was diagnosed in my 20s and it changed my life. The Telegraph. 2018 Oct 15. https://www.telegraph.co.uk/health-fitness/nutrition/diet/gout-isnt-just-disease-medieval-kings-diagnosed-20s-changed

6 Sigurdardottir V, et al. Low education level as a predictor of gout in Western Sweden. Ann Rheum Dis. 2016;75(Suppl 2):1187.3-88.

7 Bowen-Davies Z, et al. Gout severity, socioeconomic status, and work absence: a cross-sectional study in primary care. Arthritis Care Res. 2018;70(12):1822-28.

8 Can epigenetics switch off gout? Arthritis National Research Foundation. 2017 Jun 9. https://curearthritis.org/epigenetics-gout/

9 Can epigenetics switch off gout? 2017 Jun 9.