Millions of Us Suffer From the 'Disease of Kings'

In early 16th century England, King Henry VIII liked to celebrate beheadings by eating a slab of beef...

Equipped with a large appetite, King Henry used food to flex his wealth and power. He'd host 14-course banquets, serving up a plethora of meats, sweets, and wine. Beasts of all realms – feathered, footed, or finned – made their way onto King Henry's table.

He rarely ate vegetables because they were inexpensive and considered peasant food. He even tried to impose laws – called sumptuary laws – dictating what foods people were allowed to eat, based on their social ranking.

Historians now believe King Henry's extravagant diet led him to experience a disease commonly known as gout... hence the nickname "the Disease of Kings."

But back then, King Henry's doctors thought gout was caused by unbalanced humors (blood, phlegm, yellow bile, and black bile) accumulating in a joint.

Treating gout meant applying a poultice – made of worms, pig bone marrow, and herbs, which were boiled with the body of a red-haired dog – to the affected area.

Thankfully, today we don't need red-haired dogs to treat gout...

Gout is considered a form of arthritis – a condition that causes inflammation in the joints. It's also considered one of the few arthritic conditions that's preventable and treatable. More than nine million Americans suffer from gout, which causes sudden, severe pain and swelling in the joints.

But gout has a stigma attached to it. As the "Disease of Kings," people assume it's always the result of overindulgence. But gout is actually much more complicated than that. Anyone can get gout, although some folks are more susceptible to it than others.

Aside from diet, common risk factors for gout include:

  • Family history.
  • Age and sex. Men are more likely than women (until menopause) to get it, and your risk increases with age.
  • Certain medical conditions – like high blood pressure, type 2 diabetes, obesity, metabolic syndrome, heart disease, and kidney disease.
  • Certain medications – like low-dose aspirin, thiazide diuretics, angiotensin-converting enzyme ("ACE") inhibitors, beta blockers, and anti-rejection drugs for people who've had an organ transplant.
  • A recent surgery, injury, or vaccination.

Gout usually occurs in just one joint at first, most often in a big toe. Other common areas are the smaller toes, ankles, and knees. But gout can happen in any joint, and overtime, flare ups may involve multiple joints at once.

Gout attacks come on suddenly and often at night, causing the affected joint to become swollen, red, and warm to the touch. Pain from a sudden gout attack typically peaks around 12 to 24 hours after it starts, and it can take a week or two for you to fully recover without treatment. Serious cases may require medication.

Gout happens when the body doesn't eliminate enough uric acid. Uric acid is an antioxidant that is made when our digestive enzymes break down organic compounds called purines, which our cells use to build DNA and RNA.

Uric acid is also a waste product in our blood that normally passes through our kidneys and exits the body when we urinate. But when uric acid levels build up, they eventually form needle-shaped crystals that embed into a joint and the tissues around it. Those crystals then rub against the soft lining of the joint – called the synovium – which causes inflammation, pain, and swelling.

Some foods high in purines contribute to gout when eaten often – like red meat, organ meat, certain fish, shellfish, foods and drinks sweetened with fructose, and grain alcohols.

But food isn't the only culprit...

Gout can be the result of an overproduction of uric acid in your body or an inability to get rid of the uric acid in your system efficiently entirely unrelated to your diet.

Some people experience gout once and never have it again. Others may experience flare ups several times each year.

If left untreated, gout can lead to more frequent attacks, eventually destroy your joint, and lead to other problems... like developing large, visible bumps under the skin called tophi (pronounced toe-fee), or even kidney stones.

Here are some common treatments for gout, which vary depending on your causes and symptoms:

  • Medicine to block uric acid production – like allopurinol and febuxostat.
  • Medicine to improve uric acid excretion – like probenecid.
  • Medicine to treat flare-ups and prevent attacks – like nonsteroidal anti-inflammatory drugs ("NSAIDs"), colchicine, and corticosteroids.

But these drugs all come with the potential for developing serious side effects (some of which we've written about before).

Eating low-purine foods and vitamin C are often recommended as preventative measures. However, when we looked into the research on these dietary practices, we found mixed reviews... Some studies say they help, others find the evidence lacking.

And some research suggests losing weight helps with gout, but we know that folks in a weight range that's considered healthy – and who shouldn't lose any weight – also experience gout.

Hopefully, continued research can shed more light on natural ways to effectively treat and prevent this uncomfortable disease.

But in the meantime, since gout is an inflammatory disease, keep doing what we've recommended for inflammation: get out and get moving every day, stop eating processed foods, and get plenty of antioxidants.

Simple exercises for your joints include yoga, walking, and some light resistance training. And antioxidant-rich foods include fresh fruits, veggies, and extra virgin olive oil.

What We're Reading...

Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
February 17, 2022