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A (very) short history of diets for gout

A (very) short history of diets for gout Rheumatology 2004;43:1054 doi:10.1093/rheumatology/keh019 Heberden Historical Series/Series Editor: M. I. V. Jayson M. Snaith Gout has been a relatively well-defined condition for centuries, is the distemper of a hackney coachman’) to Ambrose Bearse in throughout which diet has featured in its treatment. In this context, his Devil’s Dictionary (‘Gout n—A physician’s name for the it is rather difficult to distinguish diet from medication. Medical rheumatism of a rich patient’), gout was synonymous with wealth opinion, admixed with clinical observation and anecdotes, has and greed. The 20th century saw an end to that. The increase in reflected contemporary health beliefs up to and including modern gout among South Pacific islanders when they became exposed to times (Fig. 1). For example, the Hippocratic school recommended Westernization is one of the best examples of the interaction of diet barley water, for which I can think of no particular virtue. How- and metabolic genetics. ever, white hellebore was also suggested. This may be because it The mid-20th century saw a rapid expansion in the understand- bears some of the characteristics of colchicum, to which it is related. ing of nucleic acid chemistry, including purine metabolism. A strict However, it may also have been because, by producing diarrhoea, it low-purine diet can lower plasma urate by around 20%. However, equated with therapeutic gastrointestinal purging. Dehydration the development of uricosuric drugs, then of xanthine oxidase and ketosis would have worsened hyperuricaemia, but dysentery inhibition, encouraged enthusiasm for a pharmacological magic was said to be beneficial for gout. To Hippocratic purging, Galen bullet, and dietary advice was dropped from most standard medical added venesection and spring sea voyages, perhaps for some texts and practice. Now that the relatively health-conscious western therapeutic vomiting. Colchicine, discovered by the ancient Greek middle classes may be belatedly endeavouring to reverse the trends and Islamic physicians, fell out of favour in the 18th century, with towards ever more atherosclerosis, the less well-educated, wealthy the Sydenham-inspired abandonment of purging. When colchicine or motivated are certainly not. Contributors to internet chat rooms was reintroduced, it was as much a treatment for dropsy as for gout. on dietary treatments for their gout favour Montmorency cherries Anecdotal observation, deductive reasoning and the power of and celery seeds over colchicine and allopurinol. placebo all conspired in the development of medical treatments for The sociological, dietary, metabolic and genetic aspects of gout as much as other conditions. gout are now coming together with the recognition of the critical Hippocrates, Sydenham and Galen advocated barley water and role of insulin resistance in linking vascular disease, diabetes barley bread for gout. Is there something undiscovered here? Their and urate retention. A drug such as fenofibrate is found to health beliefs may have been misplaced by modern standards, but have unexpected benefits for urate levels; a diet high in protein, Sydenham also urged that exercise should be taken and food and restricted in calories but not specifically in purine, is shown to drink moderated. He considered gout to be the product of humours reduce urate. Rheumatologists should have regard for their gouty that had accumulated because of gluttony. The difference between patients’ cardiovascular status, not just because they are good then and now is the social profile of gout. From Lord Stanhope physicians but also because it may be good for the management of (‘gout is the distemper of a gentleman—whereas the rheumatism gout. Diet is back. Further Reading Porter R, Rousseau GS. Gout: the patrician malady. New Haven: Yale University Press, 1998. Wyngaarden JB, Kelley WN. Gout and hyperuricaemia. New York: Grune & Stratton, 1976. Facchini F, Chen Y-D, Hollenbeck CB, Reaven GM. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance and plasma uric acid concentration. JAMA 1991;266: 3008–11. Dessein PH, Shipton EA, Stanwix AE et al. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000;59:539–43. Fam AG. Gout, diet and the insulin resistance syndrome [editorial]. J Rheumatol 2002;29:1350–5. Yamashita S, Matsuzawa Y, Tokunaga K, Fujioka S, Tarui S. Studies on the impaired metabolism of uric acid in obese subjects: marked reduc- FIG. 1. Gout as a sociological stereotype in former times (with tion of renal urate excretion and its improvement by a low-calorie acknowledgement to the Arthritis Research Campaign). diet. Int J Obesity 1986;10:255–64. Sheffield Medical School, Division of Genomic Medicine, Sheffield, UK. E-mail: michael@mikesnaith.demon.co.uk Rheumatology Vol. 43 No. 8  British Society for Rheumatology 2004; all rights reserved http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Rheumatology Oxford University Press

A (very) short history of diets for gout

Snaith, M.
Rheumatology , Volume 43 (8) – Aug 1, 2004
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Publisher
Oxford University Press
Copyright
Rheumatology Vol. 43 No. 8 © British Society for Rheumatology 2004; all rights reserved
ISSN
1462-0324
eISSN
1462-0332
DOI
10.1093/rheumatology/keh019
pmid
15258292
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Abstract

Rheumatology 2004;43:1054 doi:10.1093/rheumatology/keh019 Heberden Historical Series/Series Editor: M. I. V. Jayson M. Snaith Gout has been a relatively well-defined condition for centuries, is the distemper of a hackney coachman’) to Ambrose Bearse in throughout which diet has featured in its treatment. In this context, his Devil’s Dictionary (‘Gout n—A physician’s name for the it is rather difficult to distinguish diet from medication. Medical rheumatism of a rich patient’), gout was synonymous with wealth opinion, admixed with clinical observation and anecdotes, has and greed. The 20th century saw an end to that. The increase in reflected contemporary health beliefs up to and including modern gout among South Pacific islanders when they became exposed to times (Fig. 1). For example, the Hippocratic school recommended Westernization is one of the best examples of the interaction of diet barley water, for which I can think of no particular virtue. How- and metabolic genetics. ever, white hellebore was also suggested. This may be because it The mid-20th century saw a rapid expansion in the understand- bears some of the characteristics of colchicum, to which it is related. ing of nucleic acid chemistry, including purine metabolism. A strict However, it may also have been because, by producing diarrhoea, it low-purine diet can lower plasma urate by around 20%. However, equated with therapeutic gastrointestinal purging. Dehydration the development of uricosuric drugs, then of xanthine oxidase and ketosis would have worsened hyperuricaemia, but dysentery inhibition, encouraged enthusiasm for a pharmacological magic was said to be beneficial for gout. To Hippocratic purging, Galen bullet, and dietary advice was dropped from most standard medical added venesection and spring sea voyages, perhaps for some texts and practice. Now that the relatively health-conscious western therapeutic vomiting. Colchicine, discovered by the ancient Greek middle classes may be belatedly endeavouring to reverse the trends and Islamic physicians, fell out of favour in the 18th century, with towards ever more atherosclerosis, the less well-educated, wealthy the Sydenham-inspired abandonment of purging. When colchicine or motivated are certainly not. Contributors to internet chat rooms was reintroduced, it was as much a treatment for dropsy as for gout. on dietary treatments for their gout favour Montmorency cherries Anecdotal observation, deductive reasoning and the power of and celery seeds over colchicine and allopurinol. placebo all conspired in the development of medical treatments for The sociological, dietary, metabolic and genetic aspects of gout as much as other conditions. gout are now coming together with the recognition of the critical Hippocrates, Sydenham and Galen advocated barley water and role of insulin resistance in linking vascular disease, diabetes barley bread for gout. Is there something undiscovered here? Their and urate retention. A drug such as fenofibrate is found to health beliefs may have been misplaced by modern standards, but have unexpected benefits for urate levels; a diet high in protein, Sydenham also urged that exercise should be taken and food and restricted in calories but not specifically in purine, is shown to drink moderated. He considered gout to be the product of humours reduce urate. Rheumatologists should have regard for their gouty that had accumulated because of gluttony. The difference between patients’ cardiovascular status, not just because they are good then and now is the social profile of gout. From Lord Stanhope physicians but also because it may be good for the management of (‘gout is the distemper of a gentleman—whereas the rheumatism gout. Diet is back. Further Reading Porter R, Rousseau GS. Gout: the patrician malady. New Haven: Yale University Press, 1998. Wyngaarden JB, Kelley WN. Gout and hyperuricaemia. New York: Grune & Stratton, 1976. Facchini F, Chen Y-D, Hollenbeck CB, Reaven GM. Relationship between resistance to insulin-mediated glucose uptake, urinary uric acid clearance and plasma uric acid concentration. JAMA 1991;266: 3008–11. Dessein PH, Shipton EA, Stanwix AE et al. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis 2000;59:539–43. Fam AG. Gout, diet and the insulin resistance syndrome [editorial]. J Rheumatol 2002;29:1350–5. Yamashita S, Matsuzawa Y, Tokunaga K, Fujioka S, Tarui S. Studies on the impaired metabolism of uric acid in obese subjects: marked reduc- FIG. 1. Gout as a sociological stereotype in former times (with tion of renal urate excretion and its improvement by a low-calorie acknowledgement to the Arthritis Research Campaign). diet. Int J Obesity 1986;10:255–64. Sheffield Medical School, Division of Genomic Medicine, Sheffield, UK. E-mail: michael@mikesnaith.demon.co.uk Rheumatology Vol. 43 No. 8  British Society for Rheumatology 2004; all rights reserved

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Rheumatology – Oxford University Press

Published: Aug 1, 2004

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