Aching Joints, Spiking Sugar: The Hidden Connection Between Gout, Diabetes, and Metabolic Health
An Expert Interview with Endocrinologist Dr. Chhaya Makhija and Rheumatologist Dr. Pamela Kammen
By Dr. Chhaya Makhija
Board-Certified Endocrinologist & Lifestyle Medicine Specialist
When pain is more than joint deep: a story that repeats itself
Let me begin with the story of one of my patients—we’ll call him Daniel. He’s a 46-year-old tech executive who arrived at my clinic feeling drained, frustrated, and discouraged. His job was demanding, his sleep was poor, and he was dealing with painful gout attacks that came out of nowhere. More than once, he found himself unable to walk for days. At the same time, he was juggling type 2 diabetes, increasing weight, and rising blood pressure.
He looked at me one day and said:
"Dr. Makhija, I can’t lead my team or be present at home when I’m constantly exhausted, in pain, or stressed about my health."
This is not a rare story. It’s becoming a pattern among high-performing individuals. And it’s why I sat down with Dr. Pamela Kammen, a trusted rheumatologist, to have a much-needed conversation about the systemic nature of gout and how it intersects with diabetes and chronic inflammation.
Gout Is Not Just About Joints
The first myth we wanted to bust is that gout is merely an orthopedic or musculoskeletal issue. As Dr. Kammen puts it:
“Gout is not just a joint disease—it’s a systemic inflammatory condition.”
Gout occurs when uric acid crystals accumulate in the body—typically in joints, but also in the kidneys and soft tissues. These sharp, jagged crystals are highly inflammatory and can result in kidney stones and irreversible joint damage. What many don’t realize is that high uric acid levels—also called hyperuricemia—may be silently damaging the body even before any joint pain arises.
"You don’t have to be in pain for uric acid to be doing harm," says Dr. Kammen. “Elevated levels can quietly lead to long-term complications like kidney disease and cardiovascular issues.”
The metabolic storm: How diabetes and gout are linked
The connection between gout and diabetes runs deep, through the common thread of insulin resistance. When insulin levels are chronically elevated—often from dietary imbalances, poor sleep, or stress—it impairs the kidneys' ability to excrete uric acid, resulting in its accumulation.
As I explained during the interview:
“Insulin resistance decreases uric acid excretion through the kidneys, which raises the risk for gout. I see this frequently in patients whose A1c and fasting insulin are elevated—but the gout is what brings them into the clinic.”
Dr. Kammen further added:
“In response to obesity, the body produces more insulin, and that elevated insulin interferes with the kidney’s ability to eliminate uric acid. The result is this slow buildup that eventually manifests as painful flares.”
This makes gout not only a diagnostic red flag but also an opportunity to intervene early in metabolic decline.
The triggers you might be missing
We asked Dr. Kammen to share the most common triggers for a gout flare, and her answer surprised even some of our viewers.
“It’s not just red meat and alcohol,” she noted. “It’s dehydration, crash dieting, and even sudden weight loss that can shift uric acid levels and trigger a flare.”
I often see this when patients begin new diets—especially ketogenic or very low-carb regimens—without hydration and medical guidance. Their intentions are good, but their results can be painful. One steakhouse meal or a few days of intense fasting can be all it takes.
Gout as a signal of systemic inflammation
This is where the conversation turned to the bigger picture. Gout is inflammatory. So is diabetes. So is cardiovascular disease. These conditions don’t operate in isolation.
"We’ve seen from diseases like rheumatoid arthritis and lupus that systemic inflammation increases risk of vascular disease," Dr. Kammen explained. "The same applies to gout—it’s part of a larger metabolic and inflammatory storm."
Left unmanaged, gout can cause severe joint damage, kidney stones, and even chronic kidney disease. But the good news? There are lifestyle and medical strategies that can help.
Lifestyle: The first line of defense
Lifestyle medicine is at the heart of how I practice, and gout prevention is no different. Dr. Kammen and I both agreed that targeted lifestyle shifts can significantly lower uric acid levels and prevent future flares.
Here are our top recommendations:
Reduce intake of purine-rich foods such as red meat, pork, and shellfish
Avoid fructose-sweetened beverages like soda and many commercial fruit juices
Increase hydration to support kidney function
Lose weight gradually—avoid extreme diets or fasting
Limit alcohol, especially beer
“It’s not about perfection,” I often tell patients. “It’s about consistency in supporting your metabolic system as a whole.”
When to consider medication
For many patients, lifestyle changes alone may not be enough. That’s where medications come in. During an acute flare, the goal is to reduce inflammation. NSAIDs, colchicine, or corticosteroids are typically used.
Long-term, the goal shifts to lowering uric acid levels. “Allopurinol is usually the first-line option for prevention,” Dr. Kammen shared. “But it’s not used during a flare—starting it then can actually worsen symptoms.”
Patients with kidney disease or those who don’t respond to allopurinol may be prescribed febuxostat. However, medication choices must be made carefully and tailored to each individual’s health profile.
Patient education = Empowerment
If there’s one takeaway from our conversation, it’s this: knowledge is power.
“I always encourage my patients to understand why their gout is happening,” Dr. Kammen said. “Because once they do, it becomes easier to make the changes we recommend—and stick with them.”
Understanding gout as part of a broader metabolic and inflammatory picture allows us to treat not just the pain, but the root cause.
Final thoughts: This Isn’t Just About Gout
When a patient walks into my clinic with gout, I see more than joint pain—I see a warning signal. It tells me to evaluate insulin resistance, cardiovascular risk, kidney function, and systemic inflammation. Gout is a clue that the whole body needs attention, not just the toe.
If you or a loved one is dealing with gout, don’t ignore the deeper story it’s telling. This interview is a great place to start.
Watch the full Interview on YouTube
If you found this helpful, I invite you to watch the entire expert interview with Dr. Pamela Kammen on my YouTube channel @chhayamakhijamd. This conversation is part of my ongoing mission to educate and empower patients with evidence-based knowledge about endocrine health, chronic disease prevention, and integrative care.
Whether you’re dealing with gout, insulin resistance, type 2 diabetes, or simply trying to understand how your body works better—this video offers real insight from two specialists who are passionate about root-cause medicine and long-term wellness.
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