Instant Genius - Why gout is on the rise, and how to lower your risk

Episode Date: March 27, 2026

If you were to mention the term gout, the chances are that most of us would think of the gluttonous sovereigns of yesteryear who ended up with the condition after years of gorging on rich foods and drinking fortified wines. But the fact is, cases of gout have been climbing significantly over the past few decades. So, what’s behind this increase and what measures can we all take to help us avoid this painful condition? In this episode, we’re joined by Dr Daniel Baumgardt, a GP and lecturer in health and life sciences at the University of Bristol, to talk about what happens in our bodies when we suffer from gout. He tells us how gout is caused by jagged acidic crystals forming in and around joints, how, far from only affecting the elderly, it’s beginning to affect more and more people in their 20s and 30s, and how suffering from an acute gout attack could be a warning sign that your cardiovascular system is also in poor health. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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commissioning editor, the BBC Science Focus. If you were to mention the term gout, the chances are that most of us would think of the gluttonous sovereigns of yesteryear, who ended up with a condition after years gorging on rich foods and drinking fortified wines. But the fact is, cases of gout have been climbing significantly over the past few decades. So what's behind this increase and what measures can we all take to help us avoid this painful condition? In this episode, we're joined by Dr Daniel Baumgart. a GP and lecturer in health and life sciences at the University of Bristol

to talk about what happens in our bodies when we suffer from gout. He tells us how gout is caused by jagged acidic crystals forming in and around joints, how, far from only affecting the elderly, it's beginning to affect more and more people in their 20s and 30s, and how suffering from an acute gout attack could be a warning sign that your cardiovascular system is also in poor health. So today we're talking about gout. So I think this is something that's really misunderstood, maybe even underdiagnosed.

And, you know, we can get on to all these questions later. But first off, you know, what exactly is it? What are we talking about? So gout is a specialised sort of form of joint inflammation, which is associated with crystals. If you were to take a sample of the fluid off from a joint that's been inflamed with gout, then what you'll see if you look under the microscope and lots and lots of little spiny crystals and they cause lots of inflammation

and they can cause really, really severe symptoms. Lots of patients with gout describe it as the worst pain they've ever felt. And considering that I've seen quite a few patients as a GP complaining of different pains, I think the ones that come in with gout really, really do stand out. Yeah, so let's have a look at what sort of joints does it affect then? Because I think a lot of people will have seen

like the old-fashioned illustrations of the inflamed toe, etc. Absolutely. So there's this old classic image of a little sort of devil with wings and horns biting into what looks like this really, really inflamed toe. That's the classic picture that's associated with it. And actually, we tend to find that most people with gout, around about 50 to 70% of them, get big toe inflammation first of all.

Now that could be for a lot of reasons. We think potentially it's because the toe's a bit cooler, causing the crystals to precipitate out a bit more easily. it could be that it's an area that becomes a little bit more dehydrated and the circulation is a little bit slower, but in most cases it's that big toe. So you're talking about these crystals. So what I've heard about is something called uric acid. Yeah, absolutely. That's the main culprit. Uric acid is something that's naturally within our bloodstream and it's excreted from the kidneys. And sometimes what happens is uric acid builds up and it's the old sort of chemistry lesson.

And as soon as something gets to too higher level, it starts to precipitate out and form crystals. And I said it's these crystals that cause the inflammation. Yeah. So how common is it? Because unfortunately, I think a lot of people think of it is it sort of an old-fashioned condition, which just isn't the case if you look into it. No, no, no, no. And I think it's becoming more common as well because typically it affects men much more frequently than women. It's around a ratio of about 4 to 5% more likely or more common in men than it is women.

Perhaps that's considered to be the fact that women have estrogen in greater levels and there might be a protective effect associated with it, but also perhaps that men are more prone to the lifestyle implications which make it more common too. But yeah, it is more common. And it's becoming more common in younger people as well. So how does gout differ from rheumatoid arthritis? So gout is the crystal form and there's another type called pseudo gout as well, which is a different sort of form of crystals. But they're managed in more or less the same way.

But with regard to other conditions, osteoarthritis, for instance, is degeneration in the joint and wear and tear that we see as we get older from us being on our feet, wearing those joints out doing physical activity. Rumatoid arthritis is immunological. So it's an autoimmune condition where the body attacks its own tissue. issues. And as we've seen with gout, gout can impact your cardiovascular health and it can impact your an increase of risk of developing a stroke. Rumatoid arthritis is exactly the same. Rheumatoid arthritis, everybody thinks it's just the joints, but it's a whole body disease. It's autoimmune attack of the lungs and the heart and even the eyes and things like that. So I think one thing that I encourage patients to think about when they think about the joint

health is it's not just your joints. It can impact other parts of your body as well. And I think that's one thing that patients sometimes aren't aware of and it's good to educate them about. So let's have a look at some of the courses there. You mentioned these lifestyle things. Yeah. So there's a lot of things because wasn't it called the disease of kings? Yeah. A bit back because associated with excessive drinking of rich fortified wines such as port and eating sort of organ meats and really rich foods and things. You know, so is there really truth in that? Yeah, it's got a really very rich and resonant history. So it dates back as far as the Egyptians and the Greeks. Hippocrates was someone who turned around and told it the, I believe it was the unwalkable disease because, as I said, it was affecting the big toe and it was so, so severe and painful that people could barely put their foot on the floor. And we attempted to associate it in the times of Henry VIII and Queen Anne with that excess of what was good living. So lots and lots of poor, lots of. Lots of. of sort of sweet meats and liver and offal and stuff like that. And that's what's translated into

modern day gout history as well, sort of like the modern day picture of it. Although I would say that people are sort of not eating awful as much these days, but for people who do like offal, it is particularly high in the compound which can cause gout. Yeah. You mentioned their Queen Anne. He was quite, quite famous in fiction, such as is the film the favourite, if people have seen that. As person who suffered with Gout themselves. And there's all sorts of all sorts of things of this. And, you know, other movies and other literature that people have tried to do. And it's really fascinating. So can you talk us through some of these and like how they worked and how they didn't? Yeah, of course. I think favourite is an absolutely fantastic film and it sort of portrays

Queen Anne in a rather sort of miserable and grotesque way, sort of sitting, sitting down, not doing an awful lot other than eating lobster and cake and sandwiches and drinking. drinking hot chocolate and feeling sorry for herself. And I think part of that, if you look back in the annals of history, I think part of that perhaps was true. She lost a husband. She lost many, many children because they believe she also had an immunological disorder that caused recurrent miscarriages.

But also, she was afflicted with gout. And within about 10 minutes of the film starting, the maids are calling up the stairs, going, oh, come and get some beef. I need to apply some beef to the Queen's poor gouty limbs to try and suffer. And actually I think that that was, part of it, I think, is dramatic effect and perhaps misinterpreting history a little bit. Almost certainly, they would have used sort of strips of meat or something like that in order to sort of, but almost as like a cold compress to bring things down. But if you look back in the actual history of what her quack doctors actually did to the poor woman, they smothered her feet in goose fat and used herbal extracts, probably used leeches as well to extract blood from her. I think they've even even got to the stage of shaving her head completely bare as well.

And then the poor woman died aged in her late 40s, again, which she was afflicted with heart disease and had a stroke, which incapacitated her at a later day. So again, it's a sad state of her affairs, but again, documents the historical impact between gout and cardiovascular health too. You're great of protecting your data, but lots of places could still expose you to identity theft. I thought it was safe. If that happens, LifeLock gives you a U.S.-based restoration agent

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So what role does that play in this? There's very much a genetic background to it. So actually it's in my family. So in my family history, my great-grandmother had gout, which sort of flared up from time to time and then uncles and aunts as well. So there is very, very much a genetic and family component associated with it too, associated with disorders of metabolism and stuff like that, which can cause uric acid to form in higher concentrations in the bloodstream. Yeah, so you've mentioned that you see some patients that are suffering from this. I think there is still a bit of kind of embarrassment surrounding Gout due to these associations. You know, is that something you've found? Yeah, I think so. And another thing as well

is that we are seeing more and more younger patients with it. I mean, you most, you know, people who do or have heard of Gavitt in the past are usually associated with people who are older. And so if you're in that sort of 15 to 40 age category and you've noticed that you've got a pain in your big toe, It's something that you usually seek treatments about, and often people are quite astonished to find out that it could beak out. And we're seeing more people in their 20s and 30s with it. And it is, as I said, it is so severely painful. We sometimes find that people come in having had a really awful night's sleep because they can't even bear the bedclothes to be touching their foot. It's, you know, even a light bed sheet on top.

What do we know about some sort of early warning signs, you know? So obviously that's what perhaps you call an acute flare-up, or so that's what perhaps you call an acute flare-up, or so that's a little. thing like that? Yeah, absolutely. Gout occurs in sort of two main forms, really. There's an acute form, which comes along really, really quickly. And then there's a more chronic form where you can get attacks which come and go. And goutes as well, one of the fascinating things that happens with it is sometimes, as well as being in the joints, the uric acid precipitates out and forms crystal deposits which you can actually see underneath the skin. So sometimes it can occur on the elbows, and sometimes it can occur actually in your ears as well. You can get sort of deposits, and they're called tophi.

And when you, again, have a look at them and sample them, they look like chalk, because the crystals have precipitated out to make this chalky deposit. And some people, that's what we call tofacia scouts, where you can see it underneath the skin, not just in the joints. So having said that, you know, is there a test that we can do to see? Like, oh, something's wrong with my toe or, like, maybe I've noticed these toe-fite crystals or something collecting around somewhere in my body, you know, could, if I go to a GP, you know, is there a sort of, gold standard test. Yeah. Well, normally we would start off with examination, so we'd have a look and examine the joints and see if they were red or hot or swoon at all. That's our big thing. We don't see tophae as frequently, but we can certainly have a look for those around the elbows or the ears. The first thing that I would do with the patient that I was concerned about gout,

is send them away for a blood test. And the blood test that we look for is effectively the uric acid or urate levels within the bloodstream. If they're high, a high likelihood that it is going to be gout. So we talked about these acute flare-ups, which, you know, personally, I've had friends that have experienced Galp before, and they've said exactly what you said is incredibly painful. You can't even put a sheet on it. So can it actually cause sort of long-term damage to the joint that it's in? If left untreated, then absolutely it can do. So if you have persistently high uric acid levels in the bloodstream that causes a sort of a more progressive and persistent form of going. what it can cause is erosion to the inside of the bones. So normally in sort of the acute setting, we might not see any changes in the bones, but over longer periods of time, what you'll then see on sort of an x-ray is that the bone will start to erode around the edges.

So it can cause some quite nasty deformities and some really horrible problems later on in life if it's left untreated. So say we've received a diagnosis for our GP or, you know, arthritis specialist or whatever. you know, what's the next step? What treatments are available? So the treatment we usually think of a sort of twofold. In fact, it could go further than that. But what we want to do, first of all, is to dampen the inflammation down and get the patient feeling much better again. Now, in the acute setting, there's lots of different medications that we can use. So one of them might just be an anti-inflammatory, which is prescribable from the GP. And the other thing that we can use as well is something called

Colchicine, which is actually as old as the hills. It's actually derived from crocone. bulbs. So it's from the morning crocus bulb. And actually that's got a really interesting history as well because it goes back ages and ages. They used to use tinctures and crocus derived medicines years and years ago, almost 2,000 years ago, to treat gout and inflammation. And it has an anti-inflammatory effect. It can cause problems. So colchicine can cause quite nasty vomiting and quite explosive diarrhea. So it's not, it's, you pick your poisons, I think, in life. But it can be really, really useful in the acute setting to help some patients and dampen down the inflammation. And the big first target is getting that inflammation under control.

And it's not just medications, staying off of it, staying off the joint, not putting it to the floor and giving it some, the standard rice to rest, ice, compress and elevate. And that can really help as well. How about sort of other lifestyle things? I don't know, like staying hydrated and things like that. Yeah, that can be really helpful as well. So sometimes again, dehydration can worsen things along. So if you drink lots of fluid, that can really, really help. And that can help sort of reduce the concentration of uric acid within the bloodstream. Avoiding alcohol. So alcohol, as we've seen before, you know, those people who used to drink port and sort of really sort of heavier, alcohol naturally dehydrates you. And it also increases the amount of purines and uric acid within the system. So again, that's a, that's important thing to avoid avoiding alcohol. And then with, to food. Now, this is a topic all of itself. So with lots of foods, it's wise to avoid things which

are high in purines. Now, purines in our bloodstream are compounds which we naturally break down into uric acid. But they're important. They're involved in DNA and RNA and cellular activity. But they can be very high in certain foodstuffs. And the food stuffs, a rule of thumb is think about what would someone really posh, someone like a king or a lord eat? So things like oily fish, things like rose and caviar caviar's really high in purines and things like game so game things like venison and pheasants and stuff like that or high so if you think of that what would king henry the eighth or queen ham have on their table those sorts of things best to avoid which actually in the modern day diet we probably see less and less these days yeah one thing that i've i've heard that contain purines is things like shellfish

yeah absolutely yes so shellfish is again things like lobster or crabs so a massive plate of Sweden mare and stuff like that. Again, we've seen some patients go away to France. I've seen some patients go away to France and eat seafood every single day and then come back for the first time having precipitated gout because they've had a glut of too many good things. It's rarer, I would say, but occasionally you do get a case of it come along. So let's have a look at another like really fascinating new area of this research, which is some of the comorbidities that are associated with gout. I think this is really, you know, not saying anyone that is struggling with gout isn't in enough pain enough, but you know, we've got other sort of associated

conditions that it can be maybe an indicator of or something like, can you talk us through that? Yeah, absolutely. So with regards to sort of comorbidities that we do see it more in patients who are obese. And that's because in obesity, you have a higher turnover of cells and the higher turnover of cells in the body basically makes more purines, which we've seen before the compounds which we then turn into uric acid. Patients who've got kidney problems, we often find that as well, is that their kidneys are much less effective at clearing uric acid in the bloodstream and getting it out into the urine. We do associate as well with some patients who are on certain medications, so patients who are on water tablets, diuretics to help treat fluid retention, that can

lack and worse than the effects as well. And we do see it in patients who have cancer. So unfortunately, it can be associated with cancer like leukemia and other cancers. And also patients who have quite rare metabolic diseases as well. So do we know what the association is there? So say if somebody is, because I've heard, you know, different things like cardiovascular risk and things like that. Like you mentioned somebody who is perhaps obese or overweight and things like. So do we know what this sort of? association is there? Is one a sign of the other? You know, can we, you know, if we do have gout, for

example, should we get cardiovascular checkup? Yeah, and I think that's a really important thing. It is a really complex and quite diverse picture because patients who typically you see with gout, as I said, are usually overweight, and they usually, as a result of being overweight, have cardiovascular risk factors because the more overweight you are, the higher cholesterol, the more sedentary a lifestyle, or higher or richer diet is typically associated with higher cardiovascular risk. And for many, many years, we always associated the fact that if you had gout, it was more likely that you had that metabolic syndrome. You were more at risk of developing cardiovascular disease.

But what we've developed over the last couple of years and is much more newer evidence, is the fact that higher levels of uric acid, higher levels of uric acid within the bloodstream, can increase the risk of developing a heart attack or a stroke. Do we know how that works? Yeah, so it's the uric acid in the bloodstream can affect the lining of the blood vessels. It makes them more likely of being dysfunctional, causing the vessels to become stiff, and also for them to start laying down fatty deposits in them,

which make it more likely that the artery is going to be narrowed. So that increases the risk of developing a heart attack or indeed stroke. The other thing as well is that it can sometimes increase the risk of developing a blood clot, which we know is one of the main risks of developing, again, a heart attack if a blood clot gets stuck within a narrow blood vessel in the heart, or indeed one of the ones in the brain, which causes a stroke. So what about sort of long-term medical treatments then? Because a lot of things like this, people say like aspirin or statins, etc.

Is that all part of this package? I think the main thing with the first episode of Gout is it should prompt some follow up with your GP afterwards. So once you've gotten over that stage of the pain's gone down, we've given you some treatments and you've rested and elevated, it puts mice on it, and got hopefully better within a couple of weeks, is that you go back to have the next, to examine the next stage of the process, which is thinking about your lifestyle and thinking about risk further down the line. Because cardiovascular risk is one of them. So we need to think about assessing for cardiovascular risk,

is your blood pressure too high, is your cholesterol too high? Have you got undiagnosed diabetes and high blood sugars that might be fueling the process as well? The other thing is, we want to want to stop it from coming back. Because once you've got gout, unfortunately, there is the risk of it coming back and causing another flare further down the line. And there's medications we can do, we used to help that too. So why does it persist? Is that because these, like you talked about earlier, these crystals don't break down? Yeah. And they can sort of proliferate and they become sort of more widespread and in different joints. We usually say, I said it's that big toe. That's the one where it starts. But again, you can get gout in other structures as well. You could always get it in

any of the large joints, you could get it in your shoulder or your elbows too. And if it continues, as I said, it can erode the bone and it can impact your cardiovascular function, as we've seen. But luckily, there are medications. So there's a medication, I don't know if you've ever heard of it called allopurinol. Oh, I have actually. Yeah, but can you explain that to our listeners? Yeah, of course. So allopurinol is a medication that you would normally start after that acute flare of gout had cleared. The problem is if you start it too soon after the first flare of gout or a flare, is that it can actually cause another one further down the line. What its action is, is it lowers the uric acid levels in your bloodstream, and in doing so stops the crystals from forming the

first place, but if there are any existing crystals, it can cause them to break down, and in doing so trigger more inflammation and another flare. But it can be really, really useful, and lots of patients who we've seen with gout for the first time, we consider, actually, is it a good idea to think about starting a monolapurinol to prevent this risk of developing in the future? And potentially lend itself as well to better heart health. Yeah, so we've talked about an awful lot there. So do you have a sort of by way of summary, a sort of cheat sheet for someone listening? It thinks, oh, you know, possibly, possibly I'm starting to see signs of gout.

Can we summarise, like, how could I spot it? and then, you know, what action should I take? Well, as I said, I think with anything, with any joint pain, if you've got a joint that's red or hot or swollen or painful, is that you really ought to get it checked out by a doctor. Because it might be gout, and in lots of instances, we get patients and we make a positive diagnosis, and we can do something with it. But at the same time, the other things that can happen

is that there are other rheumatological disorders that can cause redness, pain, heat and swelling. and they also need to be worked up and treated, often in different ways using different medications. But in some instances, they can be quite dangerous. So one of the main causes for concern that we have with gout is that actually it's not gout, this red, hot, swollen joint, but it can be an infection inside the joint. It's what we call septic arthritis. And sometimes you can actually get bacteria, which inflame a joint, and it makes it red, hot, swollen,

and some patients, it's not gout at all. It's actually an infected joint, and that can make patients very poor. very quickly. Thank you for listening to this episode of Instant Genius, brought to you from the team behind BBC Science Focus. That was Dr Daniel Baumgart. If you liked what you just heard, then please do consider subscribing to Instant Genius

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