Nicknamed “The Disease of Kings,” gout is too often thought of as a thing of the past. We imagine historical figures like Henry the VIII indulging in rich foods and wine, condemning themselves to future foot pain and swelling. However, it is not a disease of the past, any doctor will confirm that gout is as real a problem today as it was in the 16th century. Another misconception is that gout is brought about through overindulgence and rich living. This assumption is only partially correct.
What is Gout?
Gout is a rheumatic disease that is characterized by sudden and severe attacks of arthritic pain to the joints, most commonly the big toe, that is often accompanied by swelling, redness, chills, and fever.
It occurs when uric acid, a naturally occurring waste produced by the breakdown of purines in the kidneys, builds up and is deposited as crystals in joints or soft tissue resulting in inflammatory arthritis.
When balanced, uric acid acts as an antioxidant and helps prevent damage to our blood vessel linings. We need it to function and be healthy. It is when it becomes unbalanced, that gout becomes a potential problem.
There are a number of factors that can contribute to the development of gout. Yes, diet does have a hand in its development, but a uric acid imbalance can also be caused by genetic factors, age, medication, exposure to lead, high blood pressure, hyperthyroidism, and most prominently, renal insufficiency (poor kidney production).
Why are the kidneys so important? They are one of our eliminative organs, without which we wouldn’t be able to filter waste, like purines, produced naturally in our bodies.
What Are Purines?
Purines are an essential part of the structure of both plant and animal (including human) genes and are found in many foods at varying degrees. It is when our intake and/or personal tissue breakdown exceeds what our kidneys can handle that purines, converted to uric acid, become harmful.
When it comes to food, studies have shown that different sources of purines (plant, animal, dairy, etc) are metabolized differently, and therefore affect our uric acid levels in different ways. Meat and fish have been directly linked to the increased risk of gout, while vegetable sources seem not to make a difference and dairy may actually lower a person’s likelihood of developing the disease.
High Purine Foods (contain up to 1000 mg per 3.5oz serving):
- Animal Organs (liver, brain, kidneys, sweetbreads)
Moderate Purine Foods:
- Beef (veal)
The Four Stages of Gout
There are four stages in the progression of gout, however, at any point of attack, it can be incredibly painful and physically disabling.
1. Asymptomatic Hyperuricemia: elevated levels of uric acid with no noticeable symptoms.
2. Acute Gout/ Acute Gouty Arthritis: Uric acid crystals have been deposited in joint spaces leading to sudden onsets of pain, swelling, and possible nodule development at the affected joint. Stage two usually occurs at night and can be brought on by stress or alcohol and drug use, and clears up in approximately three to ten days.
3. Interval or Intercritical Gout: The period between acute attacks (#2) without noticeable symptoms.
4. Chronic Tophaceous Gout: Developed over an extended period of time (years), and not often reached if treated in one of the previous stages, permanent damage may have been done to the affected joints and kidneys. This stage is also associated with the possibility of ulcers with chalky powder or pus from within the skin nodules.
Luckily, gout in its early stages is treatable. After being diagnosed with gout through blood tests or joint fluid testing, doctors will recommend or prescribe general NSAIDs or corticosteroids (either oral or injectable) and diet modification to ease acute attacks of pain. If the condition has progressed in severity, and the NSAIDs and steroids are no longer working, colchicine, a natural toxin that inhibits mitosis, is given. When a patient’s condition persists over an extended period of time and is classified as chronic, medications like probenecid and pegloticase that help the body lower uric acid levels come into play.
Though we often think of Ben Franklin and Sir Isaac Newton as sufferers of the disease, we don’t have to look far to find modern examples.
In order to play the part of Mark David Chapman, John Lennon’s killer, in the movie Chapter 27, Jared Leto quickly gained 60 lbs. Because of the pace at which the weight was gained, Leto developed acute gout that reportedly put him in need of a wheelchair due to extreme pain in his feet. Other examples include sports stars like baseball’s David Wells and soccer’s Harry Kewell, who have spoken out about the disease and its debilitating effects.