Gout is often seen as a lifestyle-driven condition, and with good reason. Dr. Colin Race explains:

Diets rich in red meat and seafood, alcohol consumption (especially beer and spirits), being overweight, having high blood pressure or metabolic syndrome, and certain medications like diuretics and low-dose aspirin are all well-known triggers for elevated uric acid levels and gout. Kidney function also plays a major role—when the kidneys struggle to clear uric acid effectively, it builds up in the bloodstream, setting the stage for painful gout flares. While genetics can contribute to how the body processes uric acid, for most people, it’s the combination of lifestyle, kidney function, and environmental factors that drives the condition.

One environmental factor that often flies under the radar is chronic exposure to toxic heavy metals, particularly lead. Lead exposure is a well-established, though frequently overlooked, contributor to gout. Even at levels considered acceptable by current safety standards, lead can harm the kidneys in a very specific way—by damaging the tiny structures in the proximal tubules that help eliminate uric acid from the body. This impairment promotes uric acid buildup, which, over time, can lead to gout.

Lead accumulates in the body over a lifetime of exposure. It gets stored in the bones and can be slowly released back into the bloodstream for years, meaning that damage can continue long after exposure has stopped. This has been clearly demonstrated in studies of both occupational and environmental exposure, and the relationship to gout is maintained even when traditional risk factors like kidney disease or medication use are accounted for.

Cadmium and arsenic are another two other heavy metals with emerging evidence linking them to higher uric acid levels and increased gout risk. While the connection isn’t as well documented as it is for lead, these metals are also nephrotoxic—they can harm the kidneys in similar ways and likely interfere with uric acid elimination.

So what does all this mean if you’re living with gout or struggling with unexplained flares? It means that looking deeper could matter. If your lifestyle and lab results don’t fully explain your gout, it may be time to assess for toxic metal exposure. Blood or urine tests can provide insight, and in some cases, addressing heavy metal burden—through chelation therapy or simply reducing ongoing exposure—can improve uric acid handling. Importantly, even low levels of exposure, ones that wouldn’t raise any flags on routine screening, can still disrupt kidney function enough to increase gout risk. Gout isn’t just about what you eat or drink—it’s also about the environmental triggers you’ve been exposed to.