Etching after G.M. Woodward, 1801 (Wikimedia Commons).

So what’s this doing on a spirituality blog? Only this: Yesterday a doctor told me he thinks I have may have gout. At this point it’s more of a hunch than a diagnosis, and there are other suspects in the lineup. But I got on the internet and started looking up gout as soon as I got home. Up till now, I’d thought it was an 18th-century affliction of the crowned heads of Europe, the landed gentry and the gluttonous. Not quite true, I found out, at least not in the 21st century. Dr. Google defines it as a “disease in which defective metabolism of uric acid causes arthritis, especially in the smaller bones of the feet.” When I do a consult with Dr. Google, I like to check out the Mayo Clinic, the CDC website and WebMD — all have the basic information on gout. It’s not uncommon.

Turns out that gout is more a matter of genetics now than the consumption of port wine, fatted goose, mutton and plum pudding. But dietary changes can help alleviate it — is there anything they don’t help? — and I amassed a welter of information that might come in useful later. Most of it’s good stuff, anyway, no matter what diagnosis I eventually get. Eat right. Exercise. Plus some truly awesome information about cherry juice I don’t want to forget.

Especially the bit about cherries. I got it from a reader’s comment on an otherwise unremarkable story on gout in The Guardian:

User402920      chymist I used to suffer from gout but since starting to take celery extract and cherry extract pills daily n Dec 2016 no more attacks…cherry and celery are old English folkremedies …a Lot cheaper than eating fresh cherries which are very seasonal

The story itself was a humor piece headlined “Gout is on the rise — and it’s not just gluttonous sovereigns who get it.” It was about as funny as, well, a pain in the big toe. But the comments were informative, as readers shared their experience with gout, along with tips recommending not only cherries and celery but also cranberries, oranges and vitamin C (but not all vitamin C tablets, some of which have a filler that can be problematic). Also porridge, which I had hitherto associated only with Goldilocks and the Three Bears. Obviously I have a lot to learn. Several commenters recommended cherries or cherry juice.

So, reminding myself to look up porridge later, I did a few quick Google searches on cherry juice. I don’t remember seeing it in Schnucks or Hy-Vee (back before the pandemic when I used to go to the store), and I don’t think Maraschino cherries or cherry pie filling are exactly what I’m looking for, but the juice is worth a try

Therefore I’m tucking a study in a medical journal called Therapeutic Advances in Musculoskeletal Disease away in my electronic filing cabinet. It’s by Marcum W. Collins and Kenneth G. Saag of the University of Alabama Birmingham and Jasvinder A. Singh of the VA Medical Center in Birmingham, and it asks “Is there a role for cherries in the management of gout?” Collins, Saag and Singh answer their question with a qualified yes:

Given the potential beneficial effects of cherries, this powerful fruit is becoming a more attractive option, and clearly has a role in the management of gout. Unfortunately, there are no large RCTs [randomized controled trials] on the use of cherries in the treatment of gout. It would seem that this is long overdue and may provide additional evidence as to the role cherries could play in the future management of a burdensome disease. Additionally, a number of questions still remain when it comes to using cherries in the management of gout, and the answers to these questions may provide substantial insight into the future role cherries may best fit into. Based on the data presented here and new data generated with rigorous RCTs and other translational studies, one potential future option might be to manage gout using ULT [urate-lowering therapy] with ‘a cherry on the top.’

Not exactly a ringing endorsement, but, hey, science doesn’t traffic in ringing endorsements. (Best to leave that to the politicians. Horse dewormer, anyone?) Anyway, until a randomized clinical trial comes along, I’ve been checking out cherry juice, concentrates and extracts online. It gives me something more constructive to do than keeping up with the junior senator from Kentucky’s evolving views on the COVID-19 pandemic.

While I was Googling around, I came across an article in The Atlantic by John-Manuel Andriote, a freelance writer who has written extensively on scientific and medical issues. It’s readable and informative. So into the filing cabinet it goes.

For one thing, he puts gout in historical perspective. If it turns out that’s what I have, I’ll be in pretty good company, past and present:

Recognized throughout human history, gout’s famous sufferers have included Alexander the Great, Charlemagne, King Henry VIII and “Piero The Gouty” of the famed Florentine Medici family. Benjamin Franklin at age 74 penned a dialogue in 1780 between himself and “Madam Gout,” pleading to know, “What have I done to merit these cruel sufferings?” Gout replied, “Many things; you have ate and drank too freely, and too much indulged those legs of yours in their indolence.”

Gout may seem so … 18th century. But the number of people suffering from the disease here and now has been growing both domestically and abroad. “In the past few decades,” according to a recent review published in Nature, “gout has approximately doubled in prevalence in the USA, and is also markedly increasing in prevalence in other countries with established and emerging economies.”

That’s right: The number of people afflicted with gout, the disease of Charlemagne and Henry VIII, has doubled in our lifetime.

Andriote says gout isn’t necessarily caused by an overly rich diet; instead it’s caused by something called hyperuricemia , which means an elevated level of uric acid in the blood. Diet is certainly one of the factors leading to hyperuricemia, but it’s not the only one. Andriotte explains:

Diet alone doesn’t generally cause hyperuricemia and gout. Being overweight and sedentary, lead exposure, diuretic medications to eliminate excess fluid from the body, other medications (such as protease inhibitors used to treat HIV infection), even aspirin, can increase risk. Other health problems–such as high blood pressure or an underactive thyroid gland (hypothyroidism)–can also prevent the kidneys from properly ridding the body of excess uric acid. […]

Another factor: Too much sugar in the diet.

Richard J. Johnson, a professor of medicine and head of the division of Renal Diseases and Hypertension at the University of Colorado-Denver, said there is “overwhelming” evidence that the fructose in high-fructose corn syrup–it’s been called “metabolic poison”–increases the risk for gout. The use of HFCS in virtually all processed foods makes it hard to avoid, but has a great deal to do with the apparent uptick in gout cases in recent years.

“The classic thinking,” said Johnson, “is that the rise in obesity itself may be responsible for the rise in uric acid.” But epidemiological studies show that the rise in uric acid precedes the development of obesity and diabetes. “Therefore,” he said, “it is likely that there are other reasons uric acid is increasing in our population. Our studies suggest that this is driven in part by the intake of sugar and high fructose corn syrup.” He said his research also suggests that uric acid may have a role in causing hypertension and insulin resistance (diabetes).

Which means this:

The American College of Rheumatology in its forthcoming updated treatment guidelines “provides general guidance on what foods to avoid, limit or encourage,” said UCLA associate clinical professor of medicine John Fitzgerald, one of the guideline authors, adding, “Foods containing high fructose are something specifically mentioned to avoid.” Although not everything in the guidelines is “new and different,” Fitzgerald said it’s “important to remember these guidelines are not just for rheumatologists, but for primary physicians and family physicians,” who actually see and treat more gout cases than rheumatologists, who tend to see the harder cases.

So it’s a good idea to lay off the high-fructose carbonated soft dranks. News flash! Didn’t we already know that? Of course we did. It’s always good advice. Andriote concludes with more overall good advice, along with yet another plug for cherries and an allusion to Ben Franklin’s painful retribution from Madam Gout:

There are also natural ways to prevent gout attacks. Avoiding dehydration by simply drinking water is a simple, safe and effective one. Drinking six or more cups of coffee per day appears to lower the risk of gout attacks in men over 40, those most at risk. Vitamin C supplements, milk and other dairy products also seem to offer protection.

Scott Zashin, clinical professor of medicine at the University of Texas and author of the newly published book Natural Arthritis Treatment, is enthusiastic about the effectiveness of tart cherries. Although it’s uncertain whether cherries or products made from them can reduce uric acid, Zashin said “they may be useful for preventing acute gout attacks.”

Of course when “Madam Gout” cracks her whip, your only thought is to end the pain, fast. Preventing further attacks, however, takes time. “Men tend to want things to happen fast and not be compliant,” said Zashin. Subsequent gout attacks have a way of changing that. “The main thing,” he said, “is patients have to recognize they have to be patient. It may take a year to get things under control.”

You can’t change the uricase-free way evolution made you. But you can choose to eat foods and drink beverages–in moderation, as Quan emphasized–and take the medication your doctor prescribes if you’ve already made Ms. Gout’s unwelcome acquaintance. Unless, of course, excruciating pain is your thing.

Works Cited

John-Manuel Andriote, “Every Man a King: Henry VIII’s Worst Affliction Is on the Rise in America,” The Atlantic, June 5, 2012

Marcum W. Collins, Kenneth G. Saag and Jasvinder A. Singh, “Is there a role for cherries in the management of gout?” Ther Adv Musculoskelet Dis [Therapeutic Advances in Musculoskeletal Disease], 2019, in PubMed Central, National Institutes of Health, National Library of Medicine, May 17, 2019

“Gout is on the rise – and it’s not just gluttonous sovereigns who get it,” The Guardian, Jan. 6, 2019

Martin Pengelly, “Rand Paul: ‘Hatred for Trump’ blocks Covid study of horse drug ivermectin,” The Guardian, Aug. 30, 2021

[Published Sept. 18, 2021]

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