Why Is This Old-Time Rich Man’s Disease Making a Modern Comeback?

Brought on by overindulging in food and drink, gout was once considered a disease of the monied classes, but nowadays those of a lower socioeconomic status may be more likely to have the disease, due to overindulgence in fast food and sugary drinks. Research suggests that the number of cases here in the US doubled from 1977 to 1997, with an estimated six million Americans suffering this painful, debilitating form of arthritis.

Gout is characterized by sudden, severe attacks of pain, redness and tenderness typically affecting the big toe, but potentially other joints, such as the ankles, knees, fingers, wrists and elbows as well. Gout incidence is more common in men, although women are increasingly susceptible after menopause. I was told by Hyon Choi, MD, DrPh, professor of medicine at Boston University and an expert on the topic, however, that the reason behind the resurgence of gout is obesity and certain western lifestyle factors. Eating the kinds of foods that lead to being overweight, including red meat, particularly in combination with sugary soda, is the key factor behind this trend, Dr. Choi told me, noting that gout is also a red flag for metabolic syndrome. Sixty percent of those with gout also have metabolic syndrome, he said, adding that “it’s not just about having gout, it is also about associated serious medical conditions in the future.”


Gout develops from a buildup of uric acid, a chemical in the blood formed by the breakdown of purines, which are found in meat, seafood and in some beers. Consuming lots of these means that your body has more purines to break down — and more purines lead to higher levels of uric acid. This can cause the formation of uric acid crystals (a solid form of uric acid), which accumulate in the joints, causing inflammation, swelling and pain.

The good news is that changing your ways usually reduces symptoms and also can prevent recurrence of gout altogether. Step one, of course, is to lose weight. “Being overweight is the most important of all the risk factors,” emphasizes Dr. Choi. “Increased fat cell mass increases uric acid production, decreases uric acid excretion and increases risk for metabolic syndrome.” In addition to maintaining a healthy weight, gout sufferers should limit alcohol and sugary drinks and reduce consumption of purine-rich foods, such as animal proteins.

In addition to altering your diet, natural remedies include…

  • If you’re a coffee drinker, keep at it. Both regular and decaffeinated coffees have been found helpful in lowering uric acid levels and reducing risk for gout. Experts believe an antioxidant in coffee decreases insulin sensitivity, and insulin resistance is strongly linked to elevated uric acid levels. Drinking coffee black is best.
  • Take vitamin C. Supplements of 500 mg to 1,500 mg increase the excretion of uric acid. Research reported in the March 9, 2009, issue of Archives of Internal Medicine found that people who took vitamin C supplements reduced their risk of developing gout by up to 45%.
  • Choose low-fat dairy products. Research has suggested that choosing low-fat dairy products, such as skim milk and low-fat yogurt, over the higher-fat products increases uric acid secretion.
  • Eat cherries or drink cherry juice concentrate, both of which seem to help reduce symptoms for some people.
  • Soothe sore joints with a comfrey poultice application, which has been used since 400 BC. (Grind comfrey leaves and mix with distilled water to apply as a paste, then wrap the afflicted area in gauze or an ace bandage.)


Though lifestyle changes are always helpful, they may not be able to control severe cases of gout, Dr. Choi told me. So, predictably enough, drug manufacturers have seen opportunity in the rising numbers, leading to the first new drug for the condition in 40 years. Until now, the medication most commonly used to ease discomfort and prevent future gout attacks has been zyloprim (Allopurinol), taken orally, which works by reducing the uric acid level in the blood. Dr. Choi told me that it is prescribed by many doctors but only about half of patients get “satisfactory relief” from the drug.

Earlier this year, the Food and Drug Administration approved another oral drug treatment, called febuxostat (Uloric), which works similarly to Allopurinol but seems to be more effective in lowering uric acid levels. Uloric is also a viable alternative for the 2% of patients who are allergic to Allopurinol.

Another new drug, Krystexxa, awaiting FDA approval, also lowers the level of uric acid but is administered by intravenous infusion every few weeks. It seems to work faster than Allopurinol and Uloric, but it is much more expensive.

Finally, there is some promising new research coming out of Johns Hopkins Medical Institutions that indicates a gene variant may be a factor for about 10% of gout patients. Researchers believe the mutated gene can cause insufficient excretion of uric acid. They hope to target the gene with a drug that makes excretion faster and more efficient, though that will be years away.