It has long been known that obesity can raise the levels of uric acid in the blood and may increase the risk of gout. Now a study shows that the reverse is also true – losing weight lowers uric acid levels and may reduce gout risk.

“Now you know if you keep your weight down and keep your uric acid down, maybe you can get off the medicine and reduce gout attacks,” says lead researcher Hyon Choi, MD, DrPH, a professor of medicine at Boston University School of Medicine.

Gout is a type of arthritis that occurs when uric acid builds up in the body and then crystallizes in the joints causing intense and often crippling pain, inflammation, stiffness and swelling. It’s estimated that three million people suffer from the condition, which affects more men than women. 

Obesity and diabetes are often associated with gout. Genetic factors and diet also play a role in triggering the condition.

In a study published in Rheumatology, researchers parsed data from a study that followed more than 12,000 men between the ages of 35 and 57 for seven years. 

In analyzing the data, Dr. Choi discovered that compared to those with no weight change, those who significantly decreased their size – by about 22 pounds – had a four-fold increased chance of getting their uric acid to normal levels. Losing 10 to 20 pounds doubled the odds of achieving the recommended level, and a 2-pound weight loss was associated with an 11 percent increased chance of reaching that desired uric acid level.

“The more you lose, the higher chance of achieving that therapeutic target,” Dr. Choi explains.

Dr. Choi says while weight loss helped study participants achieve a widely accepted uric acid level of 6 mg/dl, which lessens gout risk, shedding pounds alone might not be enough for patients suffering from severe attacks.
 

“Weight loss can not replace medicine in a severe gout patient. This won’t be sufficient as a replacement for a drug,” Dr. Choi says. “But this can be an adjunct. In conjunction with appropriate gout drugs, this can help. Maybe you can lower the medicine you need.”

Dr. Choi says he knows losing weight isn’t easy, but he thinks this study highlights yet another reason why it should be an important goal for gout patients.

“Gout patients have so much comorbidity. About 70 percent have hypertension, so lowering weight would lower that,” he says. “A lot of people have diabetes. All these things are associated with gout. So trying to lose weight is a no brainer.”

Scott Zashin, MD, a rheumatologist with the University of Texas Southwestern Medical School and Presbyterian Hospital, both in Dallas, says that this is a good study and that the findings are interesting and important. But he says patients do need to realize that if they try to lose weight to improve their gout, they could actually increase their risk of a gout attack in the short term.

“Any type of fluctuation in uric acid whether it goes up because you drink a beer or goes down because you are on a medicine to lower it, can increase the risk that crystals will precipitate in the joint,” Dr. Zashin says.

He says that’s why when he treats people for gout that are trying to aggressively lose weight, he also prescribes an anti-inflammatory to prevent the kind of flares that can occur when someone’s uric acid levels go down.

“When someone loses weight, theoretically their uric acid is declining and they are at a higher risk of attack,” Dr. Zashin says. “So that needs to be kept in mind with individuals losing weight that they could have some attacks.”

But he says it is good for people to know that they can try to control their gout on their own or lessen their need for medication – especially in the long term.

“It’s a good message – especially when you have all these medications coming out for gout,” Dr. Zashin says. “Let’s focus on things you can do so you don’t have to take medicine your whole life.”