"My Unexpected Bout With Gout"

This disease didn't leave the earth with Henry VIII. Risk factors include being overweight and postmenopausal—but as our writer found out for herself, being a skinny health nut is no protection either.

by Norine Dworkin-McDaniel

At first I thought I'd broken my big toe. Not that I could recall any tripping or bumping or twisting. But instead of wearing sneakers for an afternoon of mini golf, I'd roamed the hilly course in sandals to show off my new pedicure. Later that night, a stabbing pain woke me up. By morning, my right foot had tripled in size, and I figured my impractical shoewear had somehow led to my toes' getting banged up.

My father, a doctor, told me over the phone that there isn't much to do for injured toes beyond toughing out the pain with ice and ibuprofen. Free advice is always good—but after a few days of hobbling around, unable to put any weight on my foot, I was more than ready to pay for a second opinion. Or at least for some decent meds. Hey, the last time I was in this much pain, I was given an epidural.

Instead, I received the surprise of my life.

“That,” said my doctor, checking out my foot, “is textbook gout.”

Gout? Seriously? Doesn't gout happen to fat, boozy old codgers who never leave their Barcaloungers? Yeah, OK, I know women can get it—but not until after menopause (the last time I checked my driver's license, I was still in my early forties) and not unless they're overweight (I'm a reasonably active, near-vegetarian size 0).

Honestly, I could not be more embarrassed. I have a healthy lifestyle. How do I have a lifestyle disease?

Gout develops when you have an overabundance of uric acid—because your body produces too much or doesn't do a good enough job of flushing it out (via urine). Either way, having an overabundance of the stuff causes crystals to form in a joint. Those babies are sharp, which is why gout feels as if someone is using your toe as a voodoo doll. Left untreated, gout can lead to worse pain and permanent joint and tissue damage.

And while many people think gout is a disease of the past, like bubonic plague, the fact is that doctors are seeing a lot of it these days. Though it's still very much a man's disease—afflicting more than three times as many guys—the rate among women has doubled over the past two decades, according to the Mayo Clinic's Rochester Epidemiology Project, and 2 percent of American women (about 2.2 million) will be affected during their lifetime. A big reason for the increase is that gout is one of the many conditions, like diabetes, hypertension and high cholesterol, that go along with being overweight.

Gout usually doesn't develop in women until they hit their sixties, perhaps because estrogen (which helps the kidneys eliminate uric acid) protects them before menopause, notes Sherine Gabriel, MD, a Mayo Clinic professor of medicine and epidemiology.

That makes sense. But it still doesn't explain why I was struck with gout. I don't get to say the following very often, but I really am too young for this, by at least 15 years, maybe 25.

To get some answers, I consulted Nathan Wei, MD, a rheumatologist and director of the Arthritis Treatment Center in Frederick, Maryland. He quizzed me about my diet—a huge factor in gout. Once upon a time, gout was called “the rich man's disease”—payback, essentially, for overindulgence in rich food and drink. There are compounds called purines in foods like beef, pork and organ meats that boost uric acid levels and can lead to gout. But I couldn't be full of purines—not because of my tax bracket but because I'm a low-fat-dairy, whole-grains, lean-proteins, fruits-and-vegetables kinda gal.

“Purines can be found in some vegetables … ” Wei started telling me.

Wait … What?

“ … beans, peas, spinach, cauliflower, asparagus … ”

Uh-oh. I eat those vegetables every day. I can go through a bag of spinach, sautéed in olive oil, in a single dinner.

“What about shellfish?” was his next question.

I nodded unhappily. Crab cakes. Shrimp. Scallops. These are my go-to foods when I'm tired of salmon. Turns out that tuna, another of my diet mainstays, is also brimming with purines. Come to think of it, in the weeks before my gout flare-up, I'd gone on a bit of a tuna-palooza binge: tuna steak, tuna salad, tuna sushi rolls, seared ahi. Talk about dietary excess—I'd been practically mainlining purines.

“How about alcohol? Beer, wine and hard liquor can elevate uric acid levels,” Wei continued.

Strike three. I admit, for a forty-something mom, I can drink like a party girl.

And there it was: By chance, I'd cherry-picked enough “healthy” foods that, mixed with a few cocktails a week, added up to a big fat gout diagnosis.

“You know, if you just ate the shellfish and vegetables, you'd probably be OK,” Wei said delicately. “Maybe what tipped you over the edge was the alcohol.” He paused. “It doesn't take that much, really.” He was trying to be diplomatic. But the numbers are on his side. In 2010, researchers at the Boston University School of Medicine found that more than five drinks a week—not quite the equivalent of the “one cocktail a night” that most health experts say is OK for women—will triple a woman's risk for gout. Apparently, even before menopause, vodka can trump estrogen.

One diagnosis and three powerful anti-inflammatory injections later, I was back on my feet. I've since had to make some lifestyle changes to avoid additional flare-ups. And it isn't only my big toes that are at risk. Though that's where men typically suffer from gout, “in women, it just as often affects spots such as the instep, ankle, heel, knee, Achilles tendon, wrist, finger or elbow,” says N. Lawrence Edwards, MD, chairman of the nonprofit Gout & Uric Acid Education Society.

So I'm trying to follow the rules. While I'm delighted to finally have a medically sanctioned excuse for the three mugs of Italian roast I drink in the morning (coffee is associated with lower uric acid levels), I've also had to give up a few things: asparagus, seared ahi and tuna sushi (I ask the sushi chef to substitute yellowtail or salmon in my favorite rolls). And, oh yes, I finally accepted that I had to give my well-worn cocktail shaker a rest and climbed (albeit reluctantly) on the wagon. As a result, in the 18 months since my diagnosis, I haven't had a single flare-up, not even a twinge of toe pain.

I believe that calls for a drink. Shirley Temples, anyone?

Originally published in the December 2011/January 2012 issue ofMore.

Next: How to Prevent Gout

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First Published Tue, 2011-11-08 11:06

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