Podcast Summary
A deep dive into the history and causes of gout: Gout is a painful condition caused by uric acid crystals in the joints, with symptoms including intense pain, bone dislocation sensation, chills, fever, and swelling. The cause of the excess uric acid is unknown, but it's linked to a Western diet high in red meat, seafood, and alcohol.
Gout is an ancient disease with a distinct and distinctively painful presentation, as described by Thomas Sydenham in the late 17th century. The patient experiences intense pain, often with a sensation of bone dislocation, followed by chills, fever, and swelling. This condition, which can affect various parts of the foot, is caused by an excess of uric acid in the body, leading to the formation of crystals in the joints. While we know the cause of the symptoms, the underlying reasons for the excess uric acid are unknown. In modern times, gout is often associated with a Western diet high in red meat, seafood, and alcohol, as well as other lifestyle factors. During this episode of "This Podcast Will Kill You," Erin Welsh and Erin Allman Updike delve into the history and biology of gout, discussing its symptoms, causes, and treatments throughout history. They also share a gout-themed quarantini recipe, which, despite its deliciousness, may be best avoided by those with the condition due to its high purine content.
Gout: Sudden onset inflammation in adults: Gout is a common form of arthritis causing sudden onset pain, redness, warmth, and swelling in adults due to urate crystal deposition in joints, often in the big toe.
Gout is the most common form of inflammatory arthritis in adults, characterized by the deposition of urate crystals in joints leading to inflammation, pain, and swelling. It typically affects one joint, most commonly the big toe, but can occur in various other joints. The first symptoms are often sudden onset pain, redness, warmth, and swelling. Gout can cause recurrences in the same joint or new joints, and in severe cases, it may lead to systemic inflammatory symptoms such as fever, chills, and overall malaise. Gout is often monoarticular or affects a few joints, unlike other inflammatory arthritis that may affect multiple joints symmetrically.
The Three Phases of Gout: Hyperuricemia, Crystal Formation, and Inflammation: Gout is caused by an abnormal elevation in urate levels (hyperuricemia), which leads to crystal formation and an inflammatory response. Factors like genetics, diet, and metabolic issues can contribute to hyperuricemia.
Gout is a condition that develops in three main phases: hyperuricemia, the formation of monosodium urate crystals, and an inflammatory response to those crystals. Hyperuricemia occurs when there is an abnormal elevation in urate levels in the blood. This can be caused by various factors, including genetic predisposition, diet, and metabolic issues. Humans have higher levels of urate than most other mammals due to evolutionary quirks, and some individuals produce even more than others. Factors like diet, specifically high intake of purine-rich foods, fructose, and alcohol, can contribute to increased urate production. The second phase involves the combination of urate with sodium to form monosodium urate, which can then crystallize in the joints. However, not everyone with high urate levels will develop gout, as it is the inflammatory response to these crystals that triggers the disease. The why behind these phases is fascinating, with humans having lost the ability to further metabolize urate, leading to its accumulation in the body. While urate may have some biological functions, such as serving as an antioxidant, the reasons why some individuals have higher levels than others are complex and multifactorial.
Factors influencing gout development beyond urate levels: Genetics, kidney function, and individual health conditions can influence urate levels and gout development. The immune response to urate crystals is the primary cause of gout symptoms.
While diet and genetics play a role in urate levels, they may not be the sole determinants of who develops gout. The propensity towards having high urate levels, or hyperuricemia, is influenced by various factors including genetics, kidney function, and individual health conditions. However, even with similar urate levels, one person may develop gout while another does not due to the immune response to urate crystals. The crystal deposition process involves reduced solubility, nucleation, and crystal growth, with specific joints being more susceptible due to factors like temperature and joint degeneration. The inflammatory response to these crystals is the key driver of gout symptoms, but the exact reason for this response remains unclear.
Understanding the Complexities of Gout: Gout is a chronic disease with inflammation and damage caused by uric acid crystals. Age increases risk due to kidney function decline and joint degradation. Acute flares last up to 10 days, while chronic inflammation leads to tophi. Prevention involves long-term Urate Lowering Therapy to reduce uric acid levels.
Gout is a complex and chronic disease involving the buildup of uric acid crystals, primarily in joints and soft tissues, leading to inflammation and potential damage. Neutrophils play a crucial role in the inflammatory response, but the reasons why some people develop gout and others do not are not fully understood. Age is a significant risk factor due to declining kidney function and increased joint degradation. Acute gout flares can last up to 10 days and are treated with anti-inflammatory medications, while chronic inflammation can result in the formation of tophi, painful or painless nodules that can cause damage to bones and tissues. Preventing recurrent flares requires long-term treatment, such as Urate Lowering Therapy, which aims to reduce uric acid levels in the body.
Gout: A Disease of Aristocracy or Health Concern?: Historically viewed as a sign of aristocracy, gout is now known to be caused by high levels of uric acid and can negatively impact quality of life. Its evolutionary benefits and association with other health conditions make it an important area of study.
Throughout history, gout was perceived differently than many other diseases. Instead of being seen as a sign of personal failure or a negative identity, gout was often viewed as a sign of aristocracy and intelligence. This perception shifted as medical knowledge advanced and the cause of gout became better understood. Today, we know that high levels of uric acid, a key factor in gout, can lead to negative health consequences, but they may also have evolutionary benefits. Gout is not a fatal disease, but it can significantly impact a person's quality of life. Despite this, prevalence estimates suggest that a large number of people suffer from gout, making it an important area of study. From an evolutionary perspective, the high levels of uric acid in humans may have been selected for, as they are associated with other health conditions and may provide some benefits. Understanding the historical and current perceptions of gout, as well as its underlying causes and health implications, can help us better appreciate this complex disease.
The inactivation of uricase in early humans: This mutation helped our ancestors maintain blood pressure and act as a replacement antiacid, but left them susceptible to gout for millions of years.
The inactivation of uricase in early humans may have had significant implications for their survival and health. This event, which occurred after the loss of the ability to synthesize vitamin C, could have helped our ancestors maintain blood pressure when they didn't have access to much salt, acted as a replacement antiacid, and possibly even contributed to their longevity. However, this same mutation has left humans susceptible to gout for millions of years. This condition, which involves the buildup of uric acid in the body, has been documented in ancient human remains and even in extinct animals like T. Rex. The disease was once considered a sign of decadence and indulgence in ancient Greece and Rome, and its prevalence may have been exacerbated by factors like lead poisoning. Overall, the inactivation of uricase is an intriguing example of how a genetic mutation can have both positive and negative effects on a species over the course of millions of years.
Ancient beliefs and treatments for gout: Ancient treatments for gout included colchicum derived from autumn crocus, but none provided consistent relief until modern medications like allopurinol were discovered in the 20th century.
Throughout history, gout was believed to be caused by various factors, including the displeasure of a vengeful goddess or an imbalance of bodily humors. The disease was prevalent and widely written about in ancient times, leading to numerous treatments being proposed, some more effective than others. One of the most notable ancient treatments was colchicum, derived from the autumn crocus or meadow saffron, which was used to relieve the pain associated with gout as early as 500 BCE. However, its use fell out of favor and was only rediscovered in the 1700s. The golden age of gout began around the 1600s and lasted until the early 1800s, during which time it was considered a fashionable disease among the aristocracy. Despite the many treatments proposed throughout history, none of them provided consistent relief until the discovery of allopurinol and other modern medications in the 20th century.
Gout as a badge of honor among the aristocracy: During the 1600s and 1700s, gout was viewed as a symbol of wealth, power, and exclusivity among the aristocracy, rather than a source of shame
During the 1600s and 1700s, gout held a reputation as a badge of honor among the aristocracy due to its high prevalence among famous and powerful people. Scholars of the time, many of whom had gout themselves, wrote about the disease with pride rather than shame. Gout was seen as a sign of wealth, power, and exclusivity, and those who suffered from it were considered worthy. This ideology reinforced social hierarchies and even led some to flaunt their gout as a symbol of status. The disease was associated with large heads, a plethora, and a strong constitution, and was believed to destroy more rich and wise men than poor and foolish ones. Gout was even described as a fashionable ailment, as it kept its sufferers at home and on their thrones. This perspective on gout is quite different from how we view it today, and it speaks to the complex relationship between illness, power, and social status in history.
Perception of gout shifts from blessing to curse: Historically, gout was seen as a blessing, but by the 19th century, it became a symbol of excess and lack of self-control, shifting public perception and removing gouty characters from literature.
Throughout history, the perception of gout as a disease has shifted significantly. In the 1600 and 1700, some believed that having gout was a blessing due to the belief that it protected individuals from other deadly diseases and acted as a reminder to slow down and live in moderation. However, as the 19th century approached, the narrative around gout began to change. It became a symbol of overconsumption, excess, and lack of self-control, and those with the disease were no longer viewed as distinguished gentlemen, but rather as punished for their indulgences. William Cadogan's dissertation in 1771, which claimed that gout was entirely self-inflicted and not hereditary, sparked controversy and rebuttals, as many believed that gout was a genetic condition and could not be cured or prevented. This shift in perception marked the beginning of gout being viewed less favorably and the gradual disappearance of gouty characters from literature.
From a sign of wealth to a hidden disease: During the early 1800s, gout shifted from being a sign of wealth and status to a disease to hide due to its association with overindulgence and degeneration, leading to advancements in medical understanding and diagnosis.
The perception and understanding of gout underwent significant changes during the early 1800s. Gout, once considered a sign of wealth and status, became a disease to hide due to its association with overindulgence and degeneration. This shift coincided with the rise of the temperance movement and advancements in medical understanding, transforming gout from a personality trait into a clinical disease. Early medical pioneers like Paracelsus and Antonie von Leeuwenhoek made important discoveries about gout, leading to the identification of uric acid as the primary cause of the disease. Despite these advancements, gout continued to be the subject of various quack remedies and even gout-specific furniture. As medical knowledge grew, so did the development of tests to diagnose and treat gout. However, some beliefs about gout persisted, such as the association of gout with intelligence and certain personality traits. These beliefs were challenged throughout the 20th century as researchers made further strides in understanding the disease and developing effective treatments.
Historical narratives of gout and their societal contexts: Understanding historical perspectives of gout provides insights into societal attitudes towards the disease and highlights the importance of addressing financial barriers to treatment for a prevalent chronic disease
The perception and meaning attached to diseases, such as gout, have evolved significantly over time and are shaped by those constructing the medical narratives. Historically, gout was viewed positively due to its association with the elite, but this changed as negative connotations emerged for other diseases like endometriosis, hookworm, and syphilis. Understanding these historical narratives can provide insights into the perspectives of those who wrote about these diseases and their societal contexts. Today, gout remains a prevalent disease, with an estimated global prevalence of 0.6%, but this number varies greatly depending on the population and location. The disease is strongly linked to aging, and rates are predicted to rise as the global population ages. However, only about one-third to half of diagnosed gout patients are receiving urate-lowering therapy, primarily due to financial barriers. This is concerning for a chronic disease with a known cure. By examining the historical narratives and current realities of gout, we can gain a deeper appreciation for the complexities of disease perception and the importance of addressing access to healthcare.
Understanding the Complexity of Gout: Gout is a complex disease influenced by genetics and environmental factors, including the microbiome. It's important to challenge stigmas and support research to improve diagnosis and treatment.
Gout is a chronic disease that can cause significant joint damage, yet it is often stigmatized and misunderstood. Many people do not receive proper diagnosis or treatment due to outdated perceptions and biases. The disease is not solely caused by lifestyle factors, but rather a complex interplay of genetics and environmental factors. One exciting area of research is exploring the role of the microbiome in gout, as recent studies suggest a potential link between gut dysbiosis and the condition. It's important to recognize that gout is not a disease of personal failure, but rather a medical condition that requires proper diagnosis and treatment. Let's continue to challenge stigmas and biases, and support research to better understand and manage this disease. Sources: [1] [Study on Microbiome and Gout] [2] [Study on Genetics and Environmental Interactions in Gout] [3] [Historical Perception of Gout]
Understanding Gout: Essential Papers and Resources: Two papers by Tan et al and Kratzer et al, a book by Russo and Porter, and recent studies by Dalbeth et al and Dalen et al are crucial for understanding gout's causes, symptoms, diagnosis, and treatments. Listeners can find a comprehensive list of sources on thispodcastwillkillyou.com.
The papers by Tan et al (2016) and Kratzer et al (2014) are essential resources for understanding gout. These papers, along with a book called "Gout, the patrician malady" by George Russo and Roy Porter, provided the bulk of the information for this episode. Two more recent papers, by Dalbeth et al (2019) and Dalen et al (2020), were also crucial in providing up-to-date information on the global prevalence, incidence, treatment patterns, and risk factors of gout. Other notable papers, such as the one on the gut microbiome, added interesting insights to the discussion. For a comprehensive list of sources, listeners can visit this podcast's website, thispodcastwillkillyou.com, under the episodes tab. The music for the podcast is provided by Bloodmobile, and the podcast is a part of the Exactly Right Network. A special thanks to the listeners for their support, and a reminder that there are only two more episodes in this season. Stay tuned! And don't forget to wash your hands.
