What Causes Gout?
Uric Acid, Urate Crystals, and Why It's Rarely Just One Thing
Gout develops when urate crystals build up in and around a joint, usually against a background of raised uric acid — but why uric acid rises, and why only some people with high levels ever develop gout, is more complicated than "eating the wrong food."
The Quick Answer
Gout happens when monosodium urate crystals form in and around a joint and trigger inflammation. These crystals can develop once uric acid in the blood has stayed high enough for long enough — most often because the kidneys aren't clearing it efficiently, though the body can also produce more than usual.
Diet can influence uric acid, but it's rarely the whole story. Genetics, kidney function, body weight, certain health conditions and some medicines all play a part — and not everyone with high uric acid goes on to develop gout at all.
Uric Acid
A natural waste product from purine breakdown. Problems start when levels in the blood stay too high for too long.
Urate Crystals
When uric acid is high enough for long enough, sharp, needle-like crystals can form in and around a joint.
Your Body's Handling
Most cases come down to the kidneys not clearing enough uric acid, rather than the body making too much.
Multiple Risk Factors
Genetics, weight, health conditions, medicines and diet can all raise the odds — rarely just one thing alone.
The Cause of Gout, Step By Step
Gout isn't caused by a single event — it's usually the endpoint of a process that can build quietly for years before the first attack. Here's the chain, from ordinary body chemistry to a painful joint.
Purines Are Broken Down
Purines are natural compounds found in your own cells and in some foods. As your body repairs and renews itself, and digests food, it breaks purines down into uric acid.
Uric Acid Is Produced
This is a normal, everyday process — everyone produces uric acid. The question is what happens to it next.
Uric Acid Should Be Removed
Normally, the kidneys filter most uric acid out of the blood and into urine, with a smaller amount removed via the gut.
Levels Can Become Elevated
If the kidneys clear too little, or the body produces more than usual, uric acid can build up in the blood — a state called hyperuricaemia.
Urate Crystals Can Form
When uric acid stays high enough for long enough, it can form sharp, needle-like urate crystals in and around a joint.
The Immune System Reacts
The body treats these crystals as a threat and mounts an inflammatory response — producing the sudden pain, swelling and heat of a gout attack.
What Is Uric Acid?
Uric acid is a waste product your body makes when it breaks down purines — natural compounds found in your own cells as well as in some foods and drinks. Roughly three-quarters of the uric acid in your blood comes from your body's own ordinary cell turnover, and only around a quarter comes directly from what you eat.
Uric acid normally dissolves in the blood and travels to the kidneys, where most of it is filtered out and passed in urine, with a smaller amount removed via the gut. Problems tend to start not because uric acid itself is harmful at every level, but because production and removal can fall out of balance, allowing levels to climb higher than the body can comfortably manage. See our uric acid levels chart for typical ranges and treatment targets. EaseGout has a dedicated guide to uric acid and gout for anyone who wants to go deeper on this relationship.
Why Does Uric Acid Become High?
There are two broad ways uric acid can build up: the kidneys removing too little, or the body producing too much. In most people with gout, it's the first — the kidneys aren't clearing uric acid as efficiently as they could, so it gradually accumulates in the blood. Overproduction happens too, and a small number of rare inherited conditions cause it directly, but under-excretion is the more common pattern by far.
This is one of the most useful things to understand about gout: for most people, it isn't really about producing "too much" uric acid from what they eat. It's about the body not clearing uric acid out efficiently enough — which is exactly why diet alone often isn't the full explanation.
The Role Of The Kidneys
Your kidneys are responsible for filtering most of the uric acid out of your blood. When they're working efficiently, this keeps blood levels within a normal range. When kidney function is reduced — whether from age, chronic kidney disease, dehydration, certain medicines or genetics — uric acid can be reabsorbed rather than excreted, and levels rise.
This is part of why gout and kidney disease are often seen together, though having gout doesn't mean you have kidney disease, and having kidney disease doesn't mean you'll develop gout. If you have an existing kidney condition, any changes to fluid intake or medication should be guided by your own doctor rather than general advice.
Is Gout Hereditary?
Genetics play a real role. Family history is one of the most common contributors to gout, and researchers have identified genes — including SLC2A9 and ABCG2 — that influence how efficiently the kidneys and gut handle uric acid. Inheriting certain variants of these genes can make it harder for your body to clear uric acid, regardless of diet.
That said, having gout in the family doesn't make it inevitable. Genetics is one contributor among several, and plenty of people with a strong family history never develop gout, just as plenty of people with no family history at all do.
Body Weight & Metabolic Health
Being overweight is a recognised risk factor for gout — extra body weight is associated with higher uric acid production and can make it harder for the kidneys to clear it efficiently. Gout is also commonly seen alongside metabolic factors such as high blood pressure, high cholesterol and insulin resistance, which is why a doctor may look at overall metabolic health rather than uric acid in isolation.
This isn't a reason for blame, and it isn't a reason to pursue rapid weight loss either. Crash dieting and very low-calorie diets can temporarily raise uric acid and have been linked to triggering flares, so gradual, sustainable change is generally a safer approach than an aggressive overhaul. Where weight management is relevant, it works best as one part of a broader plan agreed with a doctor.
Health Conditions Associated With Gout
Gout rarely occurs in isolation. It's commonly seen alongside chronic kidney disease, high blood pressure, high cholesterol and diabetes, and less commonly alongside conditions that increase cell turnover, such as psoriasis, or certain blood disorders and their treatments.
Having one of these conditions doesn't mean you'll develop gout, and having gout doesn't mean you have any of them — but the overlap is well recognised, which is one reason a doctor assessing gout will often look at your broader health picture rather than the joint alone.
Medicines That Can Affect Gout Risk
Some medicines can raise uric acid levels or increase gout risk as a side effect. Commonly recognised examples include diuretics ("water tablets"), some blood pressure medicines, low-dose aspirin, and certain immunosuppressants such as ciclosporin, which is well documented to raise uric acid in people who take it after an organ transplant.
Do not stop or change a prescribed medicine because of gout without discussing it with the clinician who prescribed it. These medicines are often treating something more immediately serious than gout, and their benefits can outweigh the gout risk. If you're concerned a medicine you take might be contributing, ask your doctor or pharmacist whether an alternative is appropriate — don't make the change yourself.
Does Food Cause Gout?
Diet can contribute to gout, but food is rarely the whole explanation. Some foods — particularly red meat, organ meats and shellfish — are higher in purines, and eating a lot of them can push uric acid higher. But it's worth remembering that around three-quarters of the uric acid in your blood comes from your own body's processes, not from what you ate.
That means how efficiently your kidneys clear uric acid, your genetics, your weight and any medicines you take can matter just as much as, or more than, diet alone. Two people can eat almost identically and end up with very different uric acid levels, simply because their bodies handle it differently.
None of this makes diet irrelevant — it remains one of the most practical, changeable factors, and sensible dietary patterns genuinely help many people manage gout. It just isn't a moral test, and it isn't the full picture. EaseGout's Diet guide, Foods to Avoid guide and Low Purine Foods guide go into this in much more practical detail.
Alcohol, Sugar & Dehydration
Alcohol. Alcohol, and beer in particular, is a well-established contributor to raised uric acid and gout attacks — beer contains purines directly and can also affect how the kidneys handle uric acid, while spirits and wine appear to carry somewhat less risk, though drinking any alcohol to excess can still contribute. EaseGout's dedicated guide to alcohol and gout covers this in full.
Sugary drinks & fructose. Sugar-sweetened drinks — particularly those containing high-fructose corn syrup — can raise uric acid relatively quickly, because of how fructose is broken down in the body. This is different from whole fruit, which contains fibre, antioxidants and other beneficial compounds alongside its natural sugars, so ordinary fruit doesn't need to be avoided on this basis. EaseGout's guide to the best fruit for gout has more on this distinction.
Dehydration. Dehydration is better thought of as a trigger for an individual attack than an underlying cause of gout itself. When fluid levels drop, uric acid in the blood can become more concentrated, which may be enough to tip someone who already has a build-up of urate crystals into an acute flare. Staying sensibly hydrated is a reasonable general habit, though there's no need to force unusually large amounts of water. EaseGout's guide to hydration and gout covers this in more detail.
Cause vs Trigger — Why It's Not The Same Thing
It's worth being clear about the difference between what causes gout in the first place, and what triggers a particular attack.
The Underlying Cause
The underlying cause of gout is long-term hyperuricaemia — uric acid that has stayed high for long enough to allow urate crystals to form in and around a joint. That build-up typically happens gradually, often over years, shaped by the factors covered on this page: kidney function, genetics, weight, health conditions, medicines and diet.
The Trigger
A trigger is the specific thing that seems to set off a particular attack once those crystals are already present — a heavy drinking session, a bout of dehydration, an illness, an unusually large meal, or physical trauma or surgery are all recognised triggers. The trigger didn't create the underlying gout overnight; it disturbed a situation that had usually been building for a long time already.
Why Does Gout Often Start In The Big Toe?
The joint at the base of the big toe is the single most common first site for a gout attack. One widely discussed explanation is temperature: this joint tends to run slightly cooler than joints closer to the centre of the body, and cooler conditions are thought to make it easier for urate crystals to form. Everyday wear and pressure on the joint may also play a role.
It's worth saying these mechanisms aren't settled with complete certainty, and the big toe is common rather than universal — gout regularly starts elsewhere too, including less typical sites such as the elbow. EaseGout's guide to gout symptoms covers where an attack can strike in more detail.
High Uric Acid Without Gout
Why doesn't everyone with high uric acid get gout? Having hyperuricaemia raises the conditions under which urate crystals can form, but it doesn't guarantee they will, and it doesn't guarantee symptoms even if crystals are present. A large share of people with persistently elevated uric acid never go on to develop symptomatic gout — many live for years with a high reading and no symptoms at all. It helps to keep three things distinct: hyperuricaemia (a high blood level), urate crystal deposition (crystals actually forming in tissue), and symptomatic gout (an inflammatory attack). One can exist without the others.
Can you get gout if you eat healthily? Yes. Because diet is only one contributor among several, someone with careful eating habits can still develop gout if their genetics, kidney function, weight, health conditions or medicines push their uric acid up regardless. This isn't a reason to dismiss the value of a healthy, gout-friendly diet — it remains genuinely useful for managing gout once it's present — but a gout diagnosis in someone who eats well isn't a contradiction, and it isn't something to feel ashamed of.
What Can You Actually Influence?
After so many contributing factors, it helps to separate what's realistically within your control from what isn't.
- Genetics and family history
- Age and biological sex — men and post-menopausal women carry higher risk
- Some existing health conditions
- Body weight, changed gradually and sustainably
- Alcohol intake, especially beer
- Sugary drinks
- Everyday hydration
- Reviewing medicines with your doctor
- Taking a prescribed urate-lowering treatment consistently, if you have one
For many people with established gout, lifestyle changes alone aren't enough to stop attacks — medical management, including urate-lowering medication where a doctor prescribes it, is often what actually keeps uric acid controlled long-term. Lifestyle changes work best alongside that, not as a replacement for it. Our Living With Gout guide covers this long-term picture in more detail.
Myths About What Causes Gout
"Gout only happens to people who eat richly."
Diet is one contributor among several. Genetics, kidney function, weight and certain medicines all play a part too — plenty of careful eaters develop gout.
"If you don't drink, you can't get gout."
Alcohol raises risk, but plenty of people who drink little or not at all still develop gout through other contributing factors.
"If I eat healthily, I can't get gout."
A healthy diet lowers risk but doesn't eliminate it. Genetics, kidney function and other factors can still lead to gout regardless of diet.
"A high blood test result means I definitely have gout."
Many people have high uric acid for years without ever developing gout symptoms. Hyperuricaemia raises risk; it isn't the same as having gout.
"Gout is inherited, so nothing I do makes a difference."
Genetics plays a real role, but weight, alcohol, hydration and medicines can still meaningfully affect uric acid and attack frequency.
"I ate one big meal and now I have gout."
A single meal can trigger an attack if urate crystals are already present, but it doesn't create the underlying condition overnight — that usually builds up over a much longer period.
Frequently Asked Questions
What is the main cause of gout?
Gout is caused by urate crystals forming in and around a joint after uric acid has stayed high in the blood for long enough — usually because the kidneys aren't clearing it efficiently, sometimes because the body produces more than usual.
What causes uric acid to become high?
Most often, the kidneys not clearing uric acid efficiently enough; less often, the body producing more than usual. Genetics, weight, certain health conditions, some medicines, alcohol and diet can all contribute.
Why do urate crystals form?
When uric acid in the blood stays high enough for long enough, it can no longer stay fully dissolved and can form needle-like crystals in and around a joint, which the immune system then reacts to.
Is gout hereditary?
Genetics plays a real role, including specific genes that affect how the kidneys handle uric acid. Family history increases risk but doesn't make gout inevitable.
Does kidney function affect gout?
Yes. The kidneys clear most uric acid from the blood, so reduced kidney function is one of the most common reasons uric acid builds up.
What foods cause gout?
No single food causes gout on its own. Purine-rich foods like red meat, organ meats and shellfish can raise uric acid, but most uric acid comes from the body's own processes rather than diet.
Does alcohol cause gout?
Alcohol, especially beer, is a well-established contributor to raised uric acid and gout attacks, though it's rarely the only factor involved.
Can dehydration cause gout?
Dehydration is better understood as a trigger for an individual attack than an underlying cause — it can concentrate uric acid in the blood if crystals are already present.
Can medicines cause gout?
Yes, some can, including certain diuretics, some blood pressure medicines, low-dose aspirin and some immunosuppressants. Never stop a prescribed medicine without talking to your doctor first.
Can you get gout if you eat healthily?
Yes. Diet is only one contributor, so genetics, kidney function, weight and other factors can lead to gout even with a healthy diet.
Why do some people have high uric acid but never develop gout?
Having high uric acid raises the conditions for crystals to form, but it doesn't guarantee they will, or that symptoms will follow. Many people live for years with elevated uric acid and no symptoms at all.
This guide is for general educational purposes and explains the factors that can contribute to gout — it can't determine the exact cause of gout in any individual case. If you have concerns about your own risk, medicines or diagnosis, please speak with your own doctor rather than relying on this page alone.