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What Is Gout and Why Is It Undertreated?

This 'disease of kings' afflicts those in midlife most

“Imagine if you were swinging back your leg to kick a soccer ball as hard as you could, but at the last second somebody switched the soccer ball for a solid iron cannon ball, and that’s what you kicked with full force.”
That’s how Nick Gregory (not his real name), 56, of Atlanta, Ga., describes what a flare-up of gout feels like.
Another gout sufferer, Timothy Blair (also not his real name), 50, of San Francisco, Calif., says: “When it’s bad, you can’t even put a sheet over your foot.”

(MORE: 5 Causes of Foot Pain and How to Fix Them)
A Condition With a Stigma

There is a reason these men asked me not to use their real names in this article. Gout — a form of acute arthritis, usually in men, that frequently affects the big toe — often comes with a stigma. It is, after all, sometimes called "the disease of kings." And that stigma, according to a 2011 National Institutes of Health (NIH) study to understand the experience of men living with it, leads to shame, embarrassment and “the trivialization” of the impact of the disease “despite its severity.”
But gout is hardly rare. According to a 2008 report by Dr. John Croft, Jr., a professor of Rheumatology at Georgetown University Medical School, gout affects more people than rheumatoid arthritis. In about 10 years, it is expected to affect as many people as are currently affected by osteoporosis.

So it’s amazing that even in the 21st century, gout is so misunderstood and commonly undertreated. The NIH study points out that “few data are available about the lived experience of gout or the barriers to effective urate-lowering therapy in men with gout.”
It took Timothy Blair three years after his first flare-up to realize he had gout, but he wasn’t officially diagnosed with a blood test until almost 10 years after that first attack. “I had no idea what gout was,” he said. “There was something about it being the ‘disease of kings,' and since I wasn’t a king I figured it wasn’t relevant to me. I thought I was sleepwalking and stubbing my toe.”
“The onset of gout came as a total surprise to me,” said Nick Gregory. “I thought gout was something like polio or smallpox that had largely disappeared from the modern civilized world. I was completely floored when I learned I have gout. I vaguely thought of it as something people in olden times got after excessive consumption of rich foods, as with the English King Henry the Eighth.”
Causes and Cures
What actually causes gout? There was a clue in one of the previous paragraphs: urates. Sodium urate crystals are formed by uric acid, which itself is a product of the metabolic breakdown of purines. Purines are found in high concentrations in a number of meats, including liver; seafood such as anchovies, sardines, mackerel, herring and scallops and beer (because of the yeast). It's the intake of those foods that led to the "disease of kings" name.

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Normally, excess uric acid leaves the body in the urine. However, according to a 2010 Harvard Medical report, this system can “fall out of kilter,” possibly as a result of excessive weight gain combined with (or caused by) the consumption of high quantities of the aforementioned foods. High-fructose corn syrup has also been identified as a potential contributor to the problem.
Treatment options range from a change of habits and diet (exercise, lose weight, avoid foods high in purine) to prescription medications. Timothy Blair’s doctor prescribed diet and exercise.
“We decided to fix the problem instead of treating the symptoms,” he said. “I now avoid beer completely, as well as foods like sausages and mussels. I limit red meat and other trigger foods. Drinking lots of water and taking Ibuprofen for a flare-up helps. Skim milks helps, as well. I am slowly losing weight, as a quick loss of weight can bring on an attack.”
His last flare-up was about 15 months ago and was triggered by one beer. Blair's alcohol intake now consists exclusively of red wine. If he feels that a flare-up might be imminent, he avoids all alcohol (even though red wine isn’t a trigger) because dehydration makes it worse.
Nick Gregory’s doctor also counseled him to lose weight and change his diet. His first attack came after eating “a lot of sauerkraut and fresh asparagus.” He found, however, that fresh cherries “are almost a miracle drug when there’s a flare-up.” A lover of German and American craft beer, Gregory switched his alcohol intake, for a while anyway, exclusively to a sangria he made with red wine, cherries, cherry juice and 7-Up.

(MORE: How Denial Kept Him From Confronting His Weight)
As for drugs, Gregory said: “Colcrys (the brand name for colchicine) worked great for relieving my symptoms, but eventually we found that taking one allopurinol tablet nightly completely prevents any flare-ups. I have taken it nightly ever since and have had only one full-blown attack, which was after a overdoing it on trigger foods and beer, and I fell asleep without taking the allopurinol. I don’t even fill my Colcrys prescriptions anymore.”
Who Gets Gout

According to the Oxford Journal of Rheumatology, “All studies consistently have shown that gout predominantly affects older men. Presentation is unusual before the age of 45 years, but in men older than this, both the incidence and prevalence of gout increase with age.” Disease of kings? More like the disease of boomers and Gen X'ers.
Gout affects primarily overweight men (three to four times more than women), but the rate it affects women goes up significantly after menopause, according to the Centers for Disease Control. The incidence of gout among black men is almost twice as high as among white men.
If you suspect you might have gout, consult your doctor right away, without shame or embarrassment.

Stephen L. Antczak is an Atlanta-based freelance writer and is the author of four books and more than 50 short stories.

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