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 levels directly.
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 & seafood.
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 evidence.