My Swollen Ankle Turned Out to Be Gout, the 'Disease of Kings'
This is what this ancient form of arthritis feels like—and how to stop the pain.
Years ago, when I was editor of a men's magazine, waking up with a pounding head after a night out wasn’t exactly unusual. (Hey, those booze reviews weren’t going to research themselves.) But this summer after having just two civilized beers the night before at a work event, I woke up with a totally different kind of bodily pounding—it was in my foot.
At first I thought I must have slept on it funny. But as I tried to walk it off and felt the pain in my ankle and foot explode with each step, I began to wonder if maybe I had dropped a piano on it and somehow forgot. It was red, hot, swollen, tender—not at all a happy foot. Had I twisted my ankle at the gym? I tackled this medical issue the way men tend to (i.e., ignored it, hoping that if I said, “I’m fine, I’m fine,” enough, I would trick my body into actually being fine).
When I woke up in the middle of the night with pain so bad I wanted to chop my foot off, I knew Advil wasn't going to save me. I finally I gave in to my wife’s gentle suggestions that I "stop being so stubborn and go to the doctor."
The doctor checked me out, ran some blood tests, and called me with the official diagnosis: “You have gout.”
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Gout? Wait, wasn't that “the king’s disease” I vaguely remembered from 6th grade history? Isn’t that something only Benjamin Franklin and dead French people named Louis got?
No, I learned that gout—a form of inflammatory arthritis brought on by a build-up of uric acid crystals in the joints—is an increasingly common diagnosis: 8-12 million Americans have it, according to rheumatologist Michael Pillinger, MD, Professor of Medicine, Biochemistry and Molecular Pharmacology at NYU Langone Medical Center.
Men typically first develop the condition in their 20s and 30s (I’m in my 40s). Women rarely get it that young because female hormones are protective. Go hormones! But don't get too excited, ladies, Dr. Pillinger cautions: “After menopause women become much more vulnerable to gout and begin to catch up.”
My big question was what could I do to avoid future flare-ups? It was not fun for the two weeks that I had to get around with a cane. When someone says, "Oh my God, what happened?" you want to be able to tell the story of how you fought off a bear or even got hit by a bus. When I explained to an intern that I had gout, her look said, "Oh my God, I hope I never get that old."
Scouring the Internet for prevention information led me to a lot of contradictory advice (I know, shocker) but Dr. Pillinger and Health's contributing nutrition editor, Cynthia Sass, RD, were able to debunk some of the junk science out there and put me on the right path to preventing another attack. Here’s what I learned that may help you, and Jared Leto, too.
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Watch the surf and turf
Compounds called purines—found in our bodies and also in some foods—break down into uric acid. Eating a lot of high-purine foods like red meat and seafood, such as scallops, mussels, and tuna, can trigger a gout flare-up, says Sass, so think moderation. You don't have to limit high-purine veggies like spinach and asparagus though, according to the Mayo Clinic. A recent study showed that the produce-rich, low-fat DASH diet helps reduce uric acid levels and prevent gout flares.
Beware of beer
Beer is the worst drink for your uric acid levels because it's not only dehydrating but contains purines; wine seems to have the least impact. Hard liquors sit somewhere in-between on the swelling scale. In general, staying well-hydrated is helpful.
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Listen to your body
While some people—I'm looking at you, Tom Brady—believe that nightshade vegetables trigger inflammation, there are no well-designed scientific studies that show a link, says Dr. Pillinger. Still, if you notice that tomatoes make your joints puffy, leave them behind at the salad bar, he adds: “Never ignore personal experience."
Take my wife’s advice and go to the doctor
“Even a very strict diet may not be enough to resolve gout,” says Dr. Pillinger. Drag. The reality is that many people require pharmaceutical help to manage the pain and swelling and prevent painful flare-ups. Common treatments include OTC and prescription anti-inflammatory meds, steroids, and preventive drugs such as Allopurinol.
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The good news and the bad news
Gout is a chronic condition, and can run in families. But the good news, Dr. Pillinger said, is that a low-purine diet isn't too restrictive and doesn't require a total reboot of what you eat and drink. And for the most part, it tracks with what you already know about healthy eating: Have less red meat, down water instead of sweetened drinks, don't put away too much booze, and eat more plants.
My gout seems to be manageable through diet and anti-inflammatories, which honestly is nice and a bit of a bummer. I have a friend who has gout and he takes Rx medicine for it, so he can, as he puts it, "eat and drink whatever the hell I want." Since I don't have a bottle of magic pills waiting for me, I am constantly pestered by whispers from my foot. "You sure you want a third beer?"
No, foot, I guess I don't.