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Frank Bruni Has The Gout
March 22, 2012 3:37 PM   Subscribe

Frank Bruni (previously) announced in his blog column today that he has recently been diagnosed with gout. The New York Times' restaurant critic for years, he links his condition to a predisposition combined with his personal habits and his professional experiences with alcohol and fatty meats. He chronicled his food writing in his memoir Born Round. The American College of Rheumatology, PubMed, and The Mayo Clinic all provide factsheets on gout. Bruni wonders, "Why must it take something like [gout] for so many of us to pivot in a healthier direction?"
posted by knile (67 comments total) 5 users marked this as a favorite

 
Gout, the Ailment of Kings, Now Affects the Middle Class -- NYT, 2009
posted by dhartung at 3:43 PM on March 22, 2012 [1 favorite]


It's okay soon we'll be floating brains in jars and we won't have to bother with all ts crap anymore.
posted by The Whelk at 3:45 PM on March 22, 2012 [7 favorites]


Really interesting, thanks for posting. In a way, you feel worse for him because he has access to the finest food the world has to offer, and he now so often has to say no. On the other hand, he got to experience all the gluttony there is to experience; I'm sure there are people who get gout that have eaten nothing nearly that exciting.

The hardest part, in fact, has been not ordering a cocktail or wine, because I know how crucial alcohol is to a restaurant’s profit and to a server’s income, and I worry that I and my San Pellegrino (or, worse, my free tap water) are taking up valuable dining-room real estate and server time and patience. So I sometimes ask and pay for a cocktail or glass of wine and then just leave it be

That's generous. I don't think I'd ever do that. Tap water for me, please, and keep it coming!
posted by ThePinkSuperhero at 3:49 PM on March 22, 2012 [5 favorites]


That is like saying, "Why does it take something like lung cancer for so many of us to stop smoking?" The info is all out there.
posted by weapons-grade pandemonium at 3:50 PM on March 22, 2012 [4 favorites]


I haven't enjoyed a New York literatus comeuppance like this since David Denby complained that his underpants chafed and his Firefox was running too slowly.
posted by R. Schlock at 3:54 PM on March 22, 2012 [5 favorites]


I could see an Eloi/Morlock like divide between recurrent 19th century deseases in the form of gout for the rich and antibiotic resistant tuberculosis for the poor...
posted by Artw at 4:02 PM on March 22, 2012 [2 favorites]


That is like saying, "Why does it take something like lung cancer for so many of us to stop smoking?" The info is all out there.

It's not so cut and dried with gout (or type 2 diabeetus or gall bladder issues).

Of course, even when it is as cut and dried as it is for certainly family members and a close friend who actually have freakin' gout and they still refuse to change their ways, well I guess that's what it means to have a first-world problem.
posted by Lesser Shrew at 4:02 PM on March 22, 2012


The problem with gout is that is usually is not a constant reminder - you have a flare-up at 26, and then go another 26 years before you get another not-so-gentle foot-stabbing reminder. There are also too many ways around it; a daily dose of dark cherry juice, or just avoiding one food group, like pork. Or one variety of alcohol, like vodka.

It is certainly a disease of proportion. The worse you behave, the more, and more often you have to pay. If you even rein it in a little, you'll usually live symptom-free. High purine foods and dark beers and good scotch are tough to say goodbye to, but compared to other things people have to live with, it's like nothing. Your pain lasts a week, and then it goes away until you make it come back.
posted by halfbuckaroo at 4:15 PM on March 22, 2012 [3 favorites]


The episode of King of the Hill where Bobby gets gout is AWESOME.
posted by the young rope-rider at 4:22 PM on March 22, 2012 [10 favorites]


Does he get to wear a big comedy bandage on his foot that inevitablelty will have things dropped on it, caught in car doors, attacked by small dogs etc...?
posted by fearfulsymmetry at 4:24 PM on March 22, 2012 [3 favorites]


As a devout foodie, these stories make me so angry. Restaurant food is notoriously biased against the very concept of a balanced diet. When was the last time you ordered an entree that came with a decent serving of greens? It's so obvious there is a vicious cycle happening in restaurant culture when it comes to usage of meat, and too much inertia and not enough innovation to get out of the trap any time soon.

Many enlightened haute cuisine chefs actually prefer to cook with vegetables. Unfortunately people on average don't desire vegetarian; they want meat and they want it for all sorts of irrational reasons. Meat is a crowd-pleaser, so it's easy to order just that and be done with. Especially in a social setting, people tend to confusing cost with value, and so if you're taking out a friend or business acquaintance and feel obliged to host them you'll order the usual stuff, i.e. meat. We pass on these habits to our children, and the cycle continues. These implicit attitudes are what makes the consumer relationship so exploitable. And so back at the ranch, restaurants feel they can't do a thing about this because they have a bottom line to manage.

This overconsumption has to do with neither meat's biological/satiety properties, nor its traditional practices of enjoyment, and everything to do with modern social excess and a misoptimized industry as a consequence of competitive capitalism.

The other day we were sitting in a sushi restaurant and I mentioned to my fellow foodie friend that I often like to cook beans for meals. She wrinkled her nose. Come on 21st century.
posted by polymodus at 4:32 PM on March 22, 2012 [14 favorites]


I really enjoyed that piece. Thanks. My friend at 28 (I am also 28) told me a few months ago that he had gout. He said this after we ate steaks and were sipping on some great gimlets though...

I do eat too much red meat and drink so maybe I'll find out what the kings of yore knew. Luckily, quorn mycoprotein chicken nuggets are pretty damn good and I'm cutting out a lot of meat by eating those if I have a craving. Ze soy nuggets do nothink.
posted by OnTheLastCastle at 4:33 PM on March 22, 2012


Anecdata point: For some people, including myself, this is all backward.

By 2005 I was having gout attacks every month or two and they were bad enough to nearly immobilize me for a few days at a time. I also had hemorrhoids and dermatitis and weighed over 220 lb. I had tried all kinds of diets, both calorie restricting for the weight and cutting various foods for the gout, and nothing worked.

In late 2005 my mother was diagnosed with Type II diabetes and I got suspicious, so for new year's day 2006 I got myself a glucose meter and found that my fasting glucose was 110 mg/dl. A lot of doctors would shrug at that and say come back next year, but I decided to eat a Snickers bar and see what happened -- and what happened was it went to 200.

That's not supposed to happen. I stopped eating anything that made it happen. I went through about 300 test strips in the first quarter of 2006 eliminating foods that jolted my sugar levels. That basically required me to eliminate pasta, potatoes, and bread from my diet, as well as more obvious things like sweets and juice. (In fact, pasta an potatoes are much worse for me than a piece of cake.) At first there were some cravings but after a few weeks they magically went away.

After a few months a few more things magically went away: About 40 pounds of fat, my hemorrhoids, and my gout. I had also quit alcohol as part of the experiment but took it back up to the happy discovery that it made not difference whatsoever in my readings.

A few years later I had a wisdom tooth out, and my oral surgeon prescribed a course of 12 dexamethasone anti-infalmmatories for me. After the third pill my fasting glucose was the highest I'd ever seen, 160. I didn't take the rest and gradually my levels fell, not to what they'd been before, but to reasonable levels.

But I was drinking. Later when I took one of my periodic dry-out periods, the gout returned, and with a vengeance; it wouldn't pass, jumping from joint to joint. Finally, seeing no other cause for this attack, I went back to the liquor store and it abated. I shrugged and went on.

Later I decided to try again, and this time I was also on one of my periodic glucose spot-check tests. Fasting glucose, by day, after teetotaling: 95, 105, 120, 135, 150, 165. I went back to the liquor store.

To this day I have to drink a little more than a 750 ml bottle of wine, or equivalent, to keep my sugar at bay. This appears to be an entirely predictable side effect of alcohol metabolism if you actually read the effects of alcohol without plumbing them for moral panic fodder. All drugs are toxins and all toxins are drugs -- and alcohol is definitely both.

I bring this up whenever it comes up because low fat does not work for a lot of people, low calorie doesn't work, and alcohol absinence doesn't work, because the high-carb diet (with god knows how much HFCS) is ubiquitous and diabetes is an epidemic and I think that's much more likely to be any individual person's problem. And it's really not hard to find out; a few hours of quality time with a meter and half a dozen test strips will tell the tale conclusively. In the fullness of time I've alerted at least a dozen people who turned out to have a problem either developed or emerging very similar to mine.

At this point quitting alcohol is about the worst thing I could do for myself health wise. I'd happily switch to another drug with less side effects if one existed, but none do. (I've tried metformin. Didn't do shit. None of the others are even theoretically promising.) Every minute of your day your blood glucose is over 140 is a moment of chronic poisoning. You may endure such insults for decades, but one day your body will not be able to keep up. The fact that one of the primary targets of this poisoning is your pancreas and your ability to control blood sugar levels really doesn't help.

I now have a gout attack every year or two, usually because I've let my diet slip. I should really test continuously but it gets expensive, and what I'm doing isn't covered by my insurance.
posted by localroger at 4:33 PM on March 22, 2012 [26 favorites]


fortunately people on average don't desire vegetarian; they want meat and they want it for all sorts of irrational reasons.

Mmmmm.... meat...

DIY sous-vide cooking: cookinga perfect steak
posted by Artw at 4:40 PM on March 22, 2012 [1 favorite]


Does he get to wear a big comedy bandage on his foot that inevitablelty will have things dropped on it, caught in car doors, attacked by small dogs etc...?


KING OF THE HILL SPOILERS WARNING




His dad thinks it's a manly football injury and parades him around and is horrified to find out it's gout from eating lots of sweetmeats and giblets and such at the local deli.
posted by the young rope-rider at 4:43 PM on March 22, 2012 [1 favorite]


Many enlightened haute cuisine chefs actually prefer to cook with vegetables.

A lot of the chefs I hear from in the media recently are all about meat, like they won't even have a vegetarian option on the menu. Also, charcuterie, offal, game, etc. are hot right now. Of course these might not be enlightened chefs so much as local rock star "foodie" chefs.
posted by Pruitt-Igoe at 4:52 PM on March 22, 2012 [3 favorites]


that is the weirdest coincidence, i just named my new band "Frank Bruni's Gout". hope the dude doesn't sue.
posted by facetious at 4:57 PM on March 22, 2012


localroger, I think Frank Bruni's experience may be a bit different from yours, as he didn't have gout until some years after he had lost a ton of weight (IIRC ca. 100 pounds) via diet and exercise. He also has a history of bulimia and compulsive over-exercising (per his memoir, I'm not outing him). There's probably a lot of stuff going on in his metabolism given his weight swings and his history of disordered eating and disordered exercise, even apart from the unusual food regime of a full-time restaurant critic.
posted by Sidhedevil at 5:13 PM on March 22, 2012


Sidhedevil, you're probably right. Why I forwarned my post with "anecdata." But I do think there needs to be a pushback against the knee-jerk assumptions of the low-fat, low-calorie, anti-alcohol moral panic brigade. People who just skim aren't gonna get the special features.

Combining low-fat with bulimia and compulsive over-exercise seems to me to be a particular recipe for disaster; one thing I've noticed in myself is that hydration is a noticeable factor. (I have to be especially careful how I get my alcohol dose because of this.) There are lots of ways to overstress your liver, and alcohol is only one data point there.
posted by localroger at 5:22 PM on March 22, 2012 [1 favorite]


But I do think there needs to be a pushback against the knee-jerk assumptions of the low-fat, low-calorie, anti-alcohol moral panic brigade. People who just skim aren't gonna get the special features.

I couldn't agree more!

I also think that many of the people who aren't familiar with Bruni are assuming that he's fat (because, you know, restaurant critic with gout). Which he isn't. Gout is in fact not related to body mass at all, either causally or correlationally.
posted by Sidhedevil at 5:36 PM on March 22, 2012 [1 favorite]


Gout's not just a disease of the well-off, either. Gout and kidney stones run in my family, but I had no idea I was prone to gout until I had my first attack at the age of thirty-one while unemployed. I was eating a lot of cheap grocery-store hummus that summer, and as it turns out, chickpeas are pretty high in purines, which increase your uric acid levels and can trigger a gout attack.

I had no health insurance, of course, so I spent a miserable week and a half gulping down near-toxic levels of ibuprofen and gritting my teeth so hard that I lost a couple of layers of enamel. (Someone once asked me what gout feels like. I told her to imagine that there is a small and sadistic gnome perched on your foot, and every couple of minutes he thinks it'd be a dandy idea to HAMMER A RED-HOT FUCKING RAILROAD SPIKE INTO THE BASE OF YOUR BIG TOE.)

The usual treatment is almost as bad, if nowhere near as painful. It involves large initial doses of a corticosteroid like prednisone, tapering off gradually over three or four days. This takes care of the initial swelling and some of the pain, but it can mess with your immune system--you're not supposed to take it if you have, say, an existing fungal infection.

Along with the steroid, you're also given colchicine, a toxic alkaloid that inhibits mitosis and motility in white blood cells, preventing further inflammation by keeping white blood cells from reproducing and migrating to the site of the gout and triggering the inflammatory response. However, this (as you might imagine) also interferes with the immune system, so you have to be very, very careful when you're taking your medication. Fortunately, the whole course only lasts a few days, but I still managed to get a raging stomach infection during my third (and so far, final) attack a few years ago.

Along with the usual prevention--cutting down on meat and alcohol, getting plenty of water to flush out the system, and so on--there are medications like allopurinol that interfere with the production of uric acid in the body. I'm technically supposed to be on allopurinol right now, but I'm trying to control it with diet and fluid intake as much as possible, though.
posted by Mr. Bad Example at 6:38 PM on March 22, 2012 [1 favorite]


Yeah, my uncle who's always appeared to be really fit, has always watched his food intake, and has always been a runner has been battling gout for a while. Some people are just hamstrung by genetic predisposition.
posted by padraigin at 7:23 PM on March 22, 2012


Yep I don't get triggered by what I eat at all. dehydration and some sort of minor injury below my ankles and bam - flare. Fortunately I able to control it really well via vigilant hydration and icing my feet down if I feel any sort of twinge at all. My grandfather had it from his late 20's and my mom got it in her 40's. I made it to 29.
posted by JPD at 7:40 PM on March 22, 2012


Time to start reviewing vegan restaurants, Mr. Bruni...
posted by Renoroc at 8:04 PM on March 22, 2012


In two of my classes (I'm a couple of months away from a masters in nutrition) we were taught that fructose consumption can worsen gout due to the fact that uric acid is a breakdown product of fructose metabolism. I've also read confirmation of this in various studies that were not on gout but were discussing the presence of uric acid in the blood after consuming fructose. (For instance, uric acid is a powerful antioxidant, and some were criticizing that eating, say, and apple raises the antioxidant capacity of the blood not because of an antioxidant in the apple, but because of all of the fructose going to uric acid). We all brought this up recently in our clinical class when we covered gout and fructose wasn't mentioned. The response -- "Well, I know what you're talking about but it's not really standard of care.. the research isn't conclusive yet." And we're all saying, "but gout is linked increased type 2 diabetes.. which is linked to increase fructose intake.. so the connection is pretty obvious." So, I don't know anyone with gout to do the experiment for me, but if you're looking for something to try, avoiding fructose should reduce one source of uric acid. Is it more significant than avoiding purines? I have no idea.
posted by antinomia at 8:11 PM on March 22, 2012 [3 favorites]


JPD, interesting about the dehydration. We're told to counsel patients with gout to have 3 liters of water a day (12 cups), which I thought sounded excessive -- won't you just spend the whole day peeing? But it's supposed to help flush the uric acid out of your system, and I guess from your experience you really do want to avoid dehydration.
posted by antinomia at 8:15 PM on March 22, 2012 [1 favorite]


So that guy from Game of Thrones just needed rabbit food and all his wine replaced with water.

Man, I'd be so down for being Court Medical Charlatan for that guy.

Although given how much of the guy's body is covered with gout problem areas... it'd probably take a while for all those uric acid crystals to re-dissolve. I wonder if I would be hung for not curing him after X days.
posted by Slackermagee at 8:36 PM on March 22, 2012 [1 favorite]


According to this, Mr. Bruni can eat as much pudding as he desires!

Now, to look up a few of NY's noted pudding bars, on his behalf.
posted by Danf at 8:44 PM on March 22, 2012


To follow on Antinomia's comments about fructose, it looks like Gary Taubes (Good Calories, Bad Calories) also believes that fructose is the root of the problem (GCBC "missing chapter" posted on Tim Ferriss's blog.
posted by sevenyearlurk at 8:46 PM on March 22, 2012 [1 favorite]


A lot of the chefs I hear from in the media recently are all about meat, like they won't even have a vegetarian option on the menu. Also, charcuterie, offal, game, etc. are hot right now. Of course these might not be enlightened chefs so much as local rock star "foodie" chefs.

Yes, but the trend is to use less meat, but more expensive locally-raised small farm meat and to use stocks/animal fat in cooking vegetables, which is what makes a place like Momofuku vegetarian-unfriendly. I eat at nice restaurants and eat very little actual meat. For example, spot the "meat" in this dish at El Ideas in Chicago. The "meat" in this dish is pretty dispersed among all these lovely plants in the form of slivers and juices. Maybe Bruni is eating at steakhouses or something, but at a lot of noveau cuisine places (influenced most by El Bulli perhaps, you can see how little meat was in the El Bulli tribute meal I ate at Next), you aren't eating hunks of meat and in fact those really can ruin the pacing of a meal and the delicate flavors of the very expensive plants in use.
posted by melissam at 9:27 PM on March 22, 2012


(Someone once asked me what gout feels like. I told her to imagine that there is a small and sadistic gnome perched on your foot, and every couple of minutes he thinks it'd be a dandy idea to HAMMER A RED-HOT FUCKING RAILROAD SPIKE INTO THE BASE OF YOUR BIG TOE.)

I liken it to having tiny little diamonds embedded in your joints, which isn't far from what it is. The uric acid builds up into crystals in your joints. Bending & especially putting pressure on them becomes impossible. It's quite excruciating, some of the worst pain I've ever felt. And at night it throbs even when there's no pressure. Yeah, not fun at all.
posted by scalefree at 9:28 PM on March 22, 2012


My 'fun' with gout happened while I was really really really poor. Disease Of Kings me arse! Thank God there was a cherry tree in the yard. I keep some form of cherries on hand to this day. Oh I wasn't 40 yet when it hit.
posted by Katjusa Roquette at 12:13 AM on March 23, 2012


I'm going to pull up the articles when I have time, but most of the recent stuff I've read on Gout (Taubes included.) seems to link it more to our standard crappy American processed food diet than with meat specifically. More of a epiphenomenon of high glucose, metabolic syndrome, prediabetes etc.

Kind of like how we're starting to realize that Heart Disease has a lot more to do with inflammation than cholesterol.

Obviously there are exceptions to this, but it's worth mentioning. Let's not pretend this is a meat/vegetarian thing. It's probably more of a dietary imbalance thing. It's just as easy to get gout from a vegan diet as it is from a meat-based diet.

I'll try to post some articles when I get back.
posted by Telf at 12:31 AM on March 23, 2012


Let's not pretend this is a meat/vegetarian thing.

Well, let's not pretend we know what people are mistaken about. The key question posed in the article is:

"Why must it take something like [gout] for so many of us to pivot in a healthier direction?"

If Bruni is completely mistaken in bringing up the role of meat in his article, fine. But clearly he's not even merely looking at gout as a purely medical problem. The issue is being looked at from different perspectives, that's all.
posted by polymodus at 1:07 AM on March 23, 2012


The dietary position on gout is pretty complex, and you can't really equate a good diet for gout with a good diet generally. It's true that eating a lot of red meat and drinking brandy is bad for your gout, but so are broccoli and asparagus. Oily fish is good in a normal diet, but not for gout. And so on.

It is true that not being overweight is both good generally and one of the better things you can do to help your gout; but it is tiresome when people assume, quite erroneously, that gout is basically a punishment for not being a vegetarian.
posted by Segundus at 2:38 AM on March 23, 2012 [2 favorites]


it is tiresome when people assume, quite erroneously, that gout is basically a punishment for not being a vegetarian.

I find that beans (black, kidney, garbanzos and cannellini) are some of the biggest triggers for me. Most of the dietary recommendations for meat say to avoid "long-cooked" meats, and organ meats, not meat in general.
posted by halfbuckaroo at 3:29 AM on March 23, 2012


Frank Bruni gets Gout
Paula Deen gets Diabetes

This pattern makes me confident that Rick Santorum will be diagnosed with Mouth Cancer by end of the decade.
posted by DigDoug at 5:31 AM on March 23, 2012


The other day we were sitting in a sushi restaurant and I mentioned to my fellow foodie friend that I often like to cook beans for meals. She wrinkled her nose

She ain't no foodie.

Besides, doesn't she realize that (take it away, Shelly!)
posted by IndigoJones at 5:41 AM on March 23, 2012


As a devout foodie, these stories make me so angry. Restaurant food is notoriously biased against the very concept of a balanced diet. When was the last time you ordered an entree that came with a decent serving of greens?

My dad got it from home cooking. He bonded with one of our neighbors over the fact that they were both Polish and both foodies, and every Easter they'd team up and throw an immense, lavish, all-day traditional Polish Easter feast, which called for three solid days of cooking. And of course, the cooking involved a lot of tasting-as-they-went, as well as drinking-of-krupnik-liqueur (and, oddly, dancing-to-Talking-Heads). The menu usually called for a ton of cream, butter, pork, liver, etc.

And it was shortly after one of these Easters that Dad got gout. Apparently when he told the doctor just what he'd been eating that Easter, the doctor just gave him this look like, "well, no wonder."

I think the following year, their concession to being more healthy was to add a green salad.
posted by EmpressCallipygos at 6:00 AM on March 23, 2012


That is like saying, "Why does it take something like lung cancer for so many of us to stop smoking?" The info is all out there.

I have gout. Not eating shellfish, processed meats, or drinking beer doesn't prevent flare-ups. So for snide attitudes like this to simply dismiss my condition as a character flaw (instead of the genetic problem it is) is fucking rude and offensive. I avoid just about all the "gouty" foods and I still have to take two different medications to prevent flare-ups daily.

So back off.
posted by Edison Carter at 6:04 AM on March 23, 2012 [10 favorites]


"Why did God make all the bad stuff so tasty?"
- Homer Simpson
posted by prepmonkey at 6:09 AM on March 23, 2012


I'm amazed by the lack of awareness of what Gout is. Luckily I'm not a sufferer, but I know/am related to a few people who are and I was talking to someone recently about it and they looked at me like I'd made the condition up. Seriously, they thought I was crazy. It's not like it's that uncommon...
posted by ob at 7:37 AM on March 23, 2012


Dude, you have gout because you over indulged for your body. To pretend it is some genetic weakness has a limit.
posted by bystander at 7:41 AM on March 23, 2012


Dude, you have gout because you over indulged for your body. To pretend it is some genetic weakness has a limit.

You're full of shit. It is a genetic condition, and nothing I do prevents flare-ups, short of medication. The doctors who treat me and have diagnosed this were the people who told me this information.

But, no, keep fucking talking.
posted by Edison Carter at 8:02 AM on March 23, 2012 [3 favorites]


Let's see:

High-purine foods:
Anchovies.
Roe (fish eggs).
Fish such as herring and mackerel.
Sardines.
Scallops and mussels.
Game meats, like goose, duck, and partridge.
Organ meats: brains, heart, kidney, liver, and sweetbreads.
Meat extracts.
Mincemeat.
Broth, bouillon, and consomme.
Gravy.
Yeast (baker's and brewer's) taken in the form of a supplement.


Nope. i don't eat any of this. So why the flare-ups?

God's will, right?
posted by Edison Carter at 8:12 AM on March 23, 2012 [1 favorite]


To pretend it is some genetic weakness has a limit.

It is a genetic condition. I mean, yeah, Frank Bruni was told he had the genetic predisposition and didn't attempt to remediate his diet and exercise habits preventatively, so maybe you can say he was a bit foolhardy, but WTF with bashing Edison Carter, about whose life experience you know absolutely nothing except that he is experiencing gout, based on your uneducated preconceptions?
posted by Sidhedevil at 8:12 AM on March 23, 2012


The New Puritanism of seeing illness as a moral weakness is one of the shittiest things I encounter in modern society. Everyone who thinks it's appropriate to indulge in this nonsense needs to take a long jump into a ball pit filled with hedgehogs.
posted by Sidhedevil at 8:13 AM on March 23, 2012 [6 favorites]


Dude, you have gout because you over indulged for your body. To pretend it is some genetic weakness has a limit.

What happened in the '50s is that they discovered they could knock a huge chunk of mortality due to cardiovascular diseases and cancers if they could get people to stop smoking. It worked, and worked incredibly well.

Now, since then, folks are inclined to see health as a result of virtuous choices - if you follow the prescribed ablutions, you will live to be a hundred and eleventy. There is some truth to this.

The problem comes when people assume that serious medical conditions must always arise because of something the sufferer did - their suffering is just punishment for not living virtuously. That is so much baloney.

My mother in law works in a pulmonologist's office. The most common patient reaction to the news a they have lung cancer is, "But I don't smoke!"

Prevention is a very small part of a much larger picture, and is often misused for some seriously repugnant social behavior.
posted by Slap*Happy at 8:15 AM on March 23, 2012 [1 favorite]


Bill Hicks' comments on his own smoking are appropriate. Breaking News: you all are going to die!
posted by bukvich at 8:22 AM on March 23, 2012


Dude, you have gout because you over indulged for your body. To pretend it is some genetic weakness has a limit.

Seconding Edison Carter's "full of shit". You know what I was doing during my most recent attack a few years ago? I was eating pretty healthily and working on a section of my MFA program that included four hours of yoga a week on top of six to eight hours of pretty strenuous stage combat. I was in the best shape I'd been in years, but I took a misaimed rapier to the hand and all of a sudden there was a uric acid crystal party in my right index finger for a week or so.

This last Christmas season, when I was admittedly a massive glutton and did nothing but eat tons of meat and drink metric assloads of wine while being way more sedentary than I should? Not even a twinge, even though I'm not taking the allopurinol that I should.

Sometimes people just don't metabolize things properly, and not every condition like gout is a call to moral judgement.
posted by Mr. Bad Example at 8:22 AM on March 23, 2012


Actually, let me break it down further:

High-purine foods:
Anchovies.


Never eat them. I don't even eat Caesar salad dressing, which often contains anchovies.

Roe (fish eggs).

Never.

Fish such as herring and mackerel.

Don't know if I've ever had these.

Sardines.

Never.

Scallops and mussels.

I've had a few scallops over the years. Had some for my birthday (which was the 12th of this month). Didn't have a flare-up. I've never had a flare-up after eating scallops.

Never eaten mussels.

Game meats, like goose, duck, and partridge.

Never.

Organ meats: brains, heart, kidney, liver, and sweetbreads.

jesus, no.

Meat extracts.

I don't eat meat extracts as I know them.

Mincemeat.

Never.

Broth, bouillon, and consomme.

I've had broth/bouillion in the past, but very rarely.

Gravy.

Rarely.

Yeast (baker's and brewer's) taken in the form of a supplement.

Never.
posted by Edison Carter at 8:22 AM on March 23, 2012


Sometimes people just don't metabolize things properly, and not every condition like gout is a call to moral judgement.
posted by Mr. Bad Example at 11:22 AM on March 23 [+] [!]


I would agree with you, but for your user name. ;-)
posted by Edison Carter at 8:23 AM on March 23, 2012 [1 favorite]


Quorn has been noted as having a significant purine level, also.
posted by Skwirl at 8:35 AM on March 23, 2012


I'll continue to avoid that, then.

The one food that my doctor has indicated may be a contributing factor is high fructose corn syrup. Since it's a good idea to cut that down anyway, I've been working on eliminating it from my diet altogether.
posted by Edison Carter at 8:40 AM on March 23, 2012


The article asks readers to share their related problems and solutions. In that spirit:

My doctor recently told me that my GGT levels were way too high, probably as the result of over-consumption of alcohol. He told me that he wanted me to go on an alcohol cessation programme. I told him that I didn't think that was the right solution for me, either personally or culturally, and asked him to give me a year to get things under control.

Four years ago, I started homebrewing. It is now my main hobby, and one of the pillars of my social activity. I simply didn't want to give this up.

Many years ago, I quit drinking entirely, and remained dry for a decade, so I knew I could do it. But I didn't want to.

As I contemplated my options, I recalled how when I was dry I would drink de-alcoholized beer. I couldn't face going back to that crap, after having enjoyed my premium homebrew. And then it came to me: I could develop my own de-alcoholized beer! I looked around on the internet and saw how easy it was: you just have to heat the beer to the boiling point of ethanol. I tried it, and the results were great. After three months, my enzyme levels are almost normal. I plan to try reverse osmosis for alcohol removal. So, I have better health, a whole new horizon of activity in my hobby, and I've got a story to tell that could help others. And now I can have a beer on Saturday morning guilt free!
posted by No Robots at 9:03 AM on March 23, 2012 [1 favorite]


Gout is caused by a genetic problem with uric acid metabolism. It is not your fault if you get it. If you get it, making changes in your diet can help for some patients, .. and these are not changes that those without the genetic predisposition have to face. So, yeah, sympathy is in order, not blaming the victim.
posted by antinomia at 10:05 AM on March 23, 2012 [6 favorites]


The one food that my doctor has indicated may be a contributing factor is high fructose corn syrup.

* lightbulb *

You know, it's only recently that I've been hearing about other people getting gout; when my Dad got it, it was rare enough that most of his friends were all, "weird, I thought that was something from like the Middle Ages or something". Maybe a handful of people got it, but that was it.

But now I'm hearing about a lot more people getting it; and if HFCS is a contributing factor, I wonder if there's any tie-in between the rise of gout and the rise of HFCS use.
posted by EmpressCallipygos at 10:14 AM on March 23, 2012


yeah I think my doctor said I was part of a group that is predisposed to get it (kind of like Type I Diabetes) but that HFCS may be causing people to develop gout who normally might not (like Type II Diabetes).

I could be wrong on those details, but there you go.
posted by Edison Carter at 10:25 AM on March 23, 2012


Gout is caused by a genetic problem with uric acid metabolism. It is not your fault if you get it. If you get it, making changes in your diet can help for some patients, .. and these are not changes that those without the genetic predisposition have to face. So, yeah, sympathy is in order, not blaming the victim.
posted by antinomia at 1:05 PM on March 23


I need to log into another account so I can favorite this again.
posted by Edison Carter at 10:33 AM on March 23, 2012


EmpressCallipygos, the fructose component of HFCS is likely the culprit as fructose is converted to uric acid for circulation. Do you know anyone with gout who's tried to reduce fructose in their diet? I'm curious to hear some anecdata. HFCS is only 55/45% fructose/glucose, while table sugar is 50/50. I think HFCS may be a concern simply because it's possible to consume prodigious amounts of it in sweetened beverages before you feel full, compared to, say, sugar in cake, which also has fat that slow digestion and makes you feel a little fuller. Reducing fructose would entail avoiding all added sugars, including but not limited to HFCS. However, since starches, like bread and pasta, are chains of only glucose, they shouldn't be a factor for gout.
posted by antinomia at 10:45 AM on March 23, 2012


Antimonia: I was more looking at the increase in HFCS's use having an unexpected impact, than I was at the mechanism for "how HFCS affects gout in an individual".

I think HFCS may be a concern simply because it's possible to consume prodigious amounts of it in sweetened beverages before you feel full, compared to, say, sugar in cake, which also has fat that slow digestion and makes you feel a little fuller.

But the concern that people have with HFCS isn't that it gets used in "sweetened beverages", it's that HFCS is in a lot of things other than sweetened beverages - even things that aren't typically thought of as "sweet", and things that don't actually use any other kind of sugar.

In other words: Edison Carter mentioned that some people may have their gout triggered by HFCS. I thought "hey, there's been a huge increase in the use of HFCS since 1980; and now that I think of it, there's also been an increase in the number of people contracting gout then as well. I wonder if that could be related."
posted by EmpressCallipygos at 10:51 AM on March 23, 2012


it's that HFCS is in a lot of things other than sweetened beverages - even things that aren't typically thought of as "sweet", and things that don't actually use any other kind of sugar.

Like breads, soups, and gravies. One has to be very alert to the sneaky ways they get you to eat HFCS.
posted by Edison Carter at 11:05 AM on March 23, 2012


If it's HFCS that would totally explain why treating my pre-diabetes mostly cured my gout.
posted by localroger at 11:37 AM on March 23, 2012


Well, sometimes bread does use a bit of sugar to get the yeast going. But typically not very much.
posted by EmpressCallipygos at 12:03 PM on March 23, 2012


If it's HFCS that would totally explain why treating my pre-diabetes mostly cured my gout.

Hm. Good thinking. Maybe I'll investigate a diabetic diet (even though my blood sugar is perfect), just for general health reasons.
posted by Edison Carter at 12:52 PM on March 23, 2012


I was a racing cyclist, vegetarian, BMI 19, 26 years old, and I got gout. (The pain beggared the imagination.) So much for overindulgence being the cause.

On medical advice I went on a low-protein, low-purine, high carb diet (and gained weight, and got high blood pressure and cholesterol numbers). Twenty years later I'm bordering on metabolic syndrome... and now it appears gout is strongly linked to it! A high carb diet was exactly the wrong thing to do.

I've now cut back drastically on carbohydrates, sat. fat and salt, and increased vegetables, and everything seems to be improving. I've lost 25 lbs, blood glucose is going back down, *and* the blood ureate levels are also dropping. If it weren't actually happening to me I wouldn't believe it.

At least for me it is NOT the case that fructose is the only problematic sugar. Also, beans don't really affect my blood ureate levels as long as my total carb intake is low.

God! How I miss bread and salt!
posted by phliar at 2:07 PM on March 23, 2012


I think there are some strange things going on with gout.

First of all, according to my 15 year-old Merck Index, primates are the only mammals which are not uricolytic-- not able to break down uric acid into simpler components-- because we alone do not produce functional uricase (UO), which accomplishes such degradation in the other mammals.

Second, when a friend of mine got gout a few years ago, I read, as I recall, that 80% of uric acid is dumped into the large intestine, which excretes uric acid with the feces (the other 20% goes out in the urine).

So why would we put it into the joints, where it causes a world of hurt, when we could just dump it into our bowels?

I suspect the answer is that a number of micro-organisms can metabolize uric acid (such as Clostridium uricolyticum, cousin to the Clostridium difficile which causes a colitis that kills quite a few elderly hospital patients every year) and that when our immune system has identified one of these organisms as a bowel pathogen, we try to inhibit its growth by depriving it of a nutrient, uric acid, which we then have to get rid of some other way than by dumping it into the bowel.

We can get rid of it via the kidneys, but too much of it there produces stones (uric acid stones are a common type), and so it ends up in the joints.
posted by jamjam at 8:17 PM on March 23, 2012 [1 favorite]


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