Gout: From Famous Kings to Average Americans
Gout, a painful type of arthritis, isn’t a glamorous disease. But because its triggers include eating rich foods like seafood and steak and drinking alcohol, it has long been linked to wealth and fame.
Now, this ancient condition is on the rise again in the United States. Its debilitating effects remain the same—but the causes and, fortunately, the treatments have evolved with time.
Gout’s storied past reaches back to somewhere around the year A. D. 30. A Roman medical writer named Aulus Cornelius Celsus recognized many of its features, including its link to alcohol. He prescribed a session of bloodletting, followed by a year of refraining from wine and drinking donkey’s milk instead.
During the Roman Empire, the surgeon Galen described gout as the imbalanced discharge of the four humors into the joints. The disease gets its name from the Latin term for “drop”— gutta—which he used to describe the drops of discharge.
More recently, the condition was common among royalty who overindulged in food and drink. They were often awakened after a night of debauchery by podagra, a painful gout attack in the big toe. This led to gout’s nickname, the “disease of kings.”
Through the years, gout has affected many well-known scientists, philosophers, and leaders. The list includes Sir Isaac Newton, Thomas Jefferson, John Calvin, Charles Darwin, and Karl Marx.
King Henry VIII, who ruled England from 1509 to 1547, was said to celebrate beheadings with a side of beef, an indulgence that may have brought on his gout attacks. When he was 74, founding father and humorous scribe Benjamin Franklin famously wrote a dialogue between himself and his gout.
In 1726, British physician Richard Blackmore called gout “the grievous Calamity of the Great, the Rich and the most Easy in their Circumstances." Portraits in this era demonstrated a person’s high status by depicting him lying down, bandaged feet raised on a stool.
Today, although some famous and wealthy people do have gout, the disease has spread throughout the social classes. The number of new cases nearly tripled between the 1970s and the 1990s. Today, about 3 million U.S. adults have gout—and more than 6 million have experienced it at some point in their lives. Men typically develop gout earlier in life compared to women.
In part, doctors say, our modern lifestyle is to blame. Obesity is a risk factor for the condition, as is rapid weight loss of the type encouraged by fad diets. Recent studies have found that sugar-sweetened beverages, including soda and fruit juice, may increase the risk.
We now know that gout is caused not by humors but by a buildup of uric acid. This substance is formed when your body breaks down the DNA building blocks known as adenine and guanine, which are types of purines. Not everyone with elevated uric acid gets gout. Affected individuals develop crystals of monosodium urate (MSU) throughout the body, and that leads to gout. To reduce your risk of developing gout or triggering an attack, skip the soda and eat less of these foods, all high in purines:
Dried beans and peas
Fish such as anchovies, herring, and mackerel
Organ meats, including liver, kidneys, and brain
The pain of gout is significant; appropriate diagnosis can provide significant relief—and there are other reasons to diagnose it as well. A recent study in the journal Rheumatology suggests that people with gout may have a higher risk of cardiovascular disease and even death. People with gout may also be at higher risk of kidney disease. It is recommended by the American College of Rheumatology that health care providers should check cardiovascular and renal (kidney) health in people suffering from gout. Researchers are looking into whether treatment of gout by lowering uric acid levels can help prevent heart and kidney disease.