About a year ago, I had my first attack of gout.
It came on during the weekend we were moving into our house, and I
was convinced I’d somehow broken my big toe in the move. I’d dropped a
box on it or rolled a dolly over it or something — I must have, because
that’s the only way I could possibly be in so much pain. By Monday, when
I went to the local clinic to get it looked at, I could barely walk.
The doctor took little time arriving at the diagnosis, which left me
in disbelief. I only had a vague idea of what gout was, and it sounded
positively medieval. Clearly this was something that should have been
cured long ago — in fact, wasn’t iodized salt supposed to have taken
care of it?
I was, of course, confusing my condition with goiter, a swelling of
the thyroid caused primarily by iodine deficiency. Gout was something
different entirely — an acute arthritis brought on when excess uric acid
crystallizes and settles in a joint, typically the big toe. The immune
system kicks in and inflames the area, causing debilitating pain for
about a week unless treated.
I was treated, fortunately, with a strong anti-inflammatory, and
about 4 hours later my pain started to subside, though it would be 36
hours before it was gone entirely and nearly a week before the swelling
went down and I could fit back into my shoes.
I resolved never to have another gout attack, whatever it took.
Seeking the cure
As I experienced, the first line of defence for gout is symptomatic
treatment — reducing the inflammation with anti-inflammatories. Since
the condition is typically self-correcting, this is often enough for
sufferers of occasional acute attacks. For chronic gout sufferers, there
are several prescription products that work by reducing uric acid
Fortunately, I was not a chronic sufferer yet, and I was determined
not to become one. Surely, I thought, there must be lifestyle changes
that could keep my uric acid levels in check without medication. After
all, gout is known as the “rich man’s disease” because of its
association with obesity and a meat-rich diet. I unfortunately could
check both boxes, so clearly all I had to do was uncheck them.
Being a skeptic, I knew I needed some hard data to support my efforts, and I found it in the 2004 study “Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men”,
a 12-year prospective study of 47,000 men, over 700 of whom developed
gout during the study period. Large scale and apparently well designed,
it continues to be a well cited and influential study, so I cracked into
it with gusto.
The take-aways were fairly straightforward: red meat (pork, beef,
lamb), seafood (white fish, red fish, and shellfish), and alcohol (beer,
spirits) are all positively correlated with gout. Poultry, beans,
fruits and vegetables are uncorrelated. Wine and low-fat dairy are
negatively correlated — though several secondary sources suggested that
this might be due to confounding variables (wine drinkers & low-fat
dairy eaters tend to be fitter generally), so it’s best to treat them as
neutral and not expect them to counteract the effects of red meat &
It didn’t take too much to rework my diet around these
recommendation. Substitute ground turkey for ground beef & pork,
find a decent turkey sausage, add in the odd vegetarian night, and keep
portions of red meat modest and infrequent. As a first step, I decided
to see if I could get away with not cutting back on seafood because of
its other health benefits. This seemed not to limit the effect of the
treatment, and a year later — with not a single repeat attack — I can
confidently declare this science-based intervention a success!
Or can I?
Though if I’m being completely honest, there might be a few problems with this conclusion.
Like how my dietary changes resulted in some modest weight loss,
which I decided was a good excuse to kickstart a more formalized weight
loss effort. In all, I’ve lost about 60 lbs in the last year, as I’ve
described in other posts.
I mention this only because the above study showed that gout is
positively correlated with obesity and that weight loss lowers that
risk. So perhaps it was the weight loss and not the specifics of the
diet that cured my gout. Yeah, I guess that might be a confounder here.
And now that I think about it, some of the sources I read did say
that gout doesn’t typically respond well to dietary interventions at
all, and that without medication, even the most extreme gout diets only
lower uric acid levels 15-20%. So all this time I’ve been eating turkey burgers for no reason? Well, maybe.
There was one other thing as well. What was it? Oh yeah, now I
remember: the intercritical period. That’s the time in between gout
attacks, and after the first attack it’s typically up to two years. As I’m only a year in, it’s perfectly possible that I’ve cured nothing and another attack is just around the corner.
Which would suck.
I know I’ve taken a long time getting to the point, so let me bring
this back to skepticism by leaving you with three thoughts I’ve kept
coming back to throughout this experience:
1) Food is not medicine. The idea that diet can cure
disease is extremely attractive, and of course promoted aggressively by
alternative medicine practitioners and other charlatans. But even in
cases like gout where legitimate science says that the cause is diet,
that still doesn’t mean that diet is the cure.
2) Confounders abound. Human interaction with food
is monstrously complex, and I expect we’ll still be teasing out those
complexities long after I shuffle off this mortal coil. The idea that I
can run an n=1 reflexive study and glean anything meaningful from it may
be comforting, but it’s also bollocks.
3) Occam’s Razor. Even in diet, the simplest answer
is usually the best. My radical home intervention amounted to losing
weight and adopting a more Mediterranean-style diet.
It’s a simple, science-based “best practices” approach that addresses
multiple health concerns at once without significant risk. Maybe it
cured my gout and maybe it didn’t — given the confounders it’s hard to
tell — but any further dietary fiddling was simply not supported by the