Feast like a king, and you could get gout like one too.
The condition, a type of inflammatory arthritis, can arise when people load up on purine-rich foods and drinks — things like bacon, steak, scallops, veal, and alcohol. Eating and drinking too much of this stuff can cause harmful stores of uric acid to build up in our joints. That buildup can lead to sudden, painful gout symptoms in the hands and feet.
Gout has been identified clinically since at least the time of ancient Egyptians, around 2640 BC. Traditionally, this form of arthritis affected only the small sliver of society that could afford rich meats and sugary alcohols — hence its reputation as the "disease of kings." But no more.
Gout is making a comeback across the US. The Lewin Group, a healthcare consulting firm, estimated in 2006 that the prevalence of gout across the country would increase by 38% by 2025. The condition already affects more than one in 25 Americans and is the most common form of inflammatory arthritis, according to the Arthritis Foundation.
One recent example: Paul Manafort, President Donald Trump's former campaign chairman, reportedly has gout that sometimes leads him to use a wheelchair.
Gout can come on suddenly and be extremely painful
Hippocrates called gouty arthritis the "unwalkable disease," since the sudden pains of a bout of gout can make it nearly impossible to move.
"An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire," the Mayo Clinic said. "The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable."
Gout is often triggered by hyperuricemia, or too much uric acid in our blood — the body is either producing too much or not getting rid of enough of it, so uric acid crystals begin to build up in tissues and joints. The reason poor diets make it easier to get gout is that the purine compounds in some meat, seafood, and alcohol can easily raise a person's uric acid to unsafe levels.
During a gout episode, a person's toes, ankles, knees, elbows, wrists, and fingers can become swollen, hot, and red. The pain is most severe during the first hours, but the discomfort can last for days or weeks. People with gout can take non-steroidal anti-inflammatory medications like ibuprofen (Advil) to help ease their symptoms, and ice packs can also help hurting joints. Some prescription drugs can block uric acid production in the body (xanthine oxidase inhibitors) and help remove uric acid (uricosurics).
People with advanced gout flare-ups can develop bulbous nodules under their skin called tophi, which are bulging deposits of urate crystals.
Why gout is making a comeback
Back in the day, Benjamin Franklin (a well-known beer lover) had gout, as did Thomas Jefferson.
In 2011, a study of more than 5,700 Americans found that 5.9% of US men and 2% of women had gout, partly because people are getting heavier and high blood pressure is becoming more common.
Being overweight can promote gout attacks because extra weight leads to more uric acid production in the body and makes it more difficult for the kidneys — the body's built-in detoxifiers— to flush that acid. Making matters worse, drugs for high blood pressure, like water pills that make your kidneys release more sodium, often increase levels of uric acid in the body.
Our modern diets and habits of eating to excess are also partly to blame for the condition's prevalence. Doctors have suggested that more sugary drinks in our diets may play a role as well.
The number of people with gout is expected to continue ballooning in the coming years, along with the nation's obesity epidemic.
Connections between the keto diet and gout
Some fad diets increase people's risk of gout too. Followers of the keto diet and other low-carbohydrate regimens sometimes trade in carb-heavy foods for more beef and other gout-inducing foods.
"Quick-fix diets like keto and paleo, where your intake is very high in fat and proteins, those can lead to gout," Dr. Leigh Vinocur recently told The Cut. "It's ironic: modern living — from the food industrial complex to those brand-new diets like keto — have led to an uptick in one of the world's earliest diseases."
But that doesn't have to be the case if low-carb diets like keto are done properly. A 2017 Yale study that used mice suggested that a keto diet may actually protect against gout by reducing inflammation in the body.
"It's actually a better condition, as long as one stays in nutritional ketosis," Dr. Stephen Phinney, the founder of Virta Health, recently said in a video.
Other doctors agree that relying too much on meat is a flawed approach to keto eating.
"Some of the problem might lie in the way that people interpret the keto diet," Dr. Thomas Chi, a urologist at the University of California at San Francisco, recently told Business Insider. He added that a combination of " tons of meat" and not enough water could lead to kidney stones — another complication of gout.
Rapid weight loss and yo-yo-dieting strategies can also contribute to severe ups and downs in the body's uric acid levels, something that can also trigger gout.
"The body loves consistency," Phinney said.