Diet plans that aim at shedding weight quickly can precipitate gout

IN the nineteenth century it allowed cartoonists to poke fun at portly old gents with throbbing big toes. Now, however, gout is no laughing matter for a growing band of much younger men and women and the Atkins’ diet may be behind some of the new cases.

Rates of the incurable condition, once synonymous with outrageous, upper-class over-indulgence have more than doubled since the 1950s, in UK at least, and experts are predicting a further surge as more people enjoy excessive lifestyles at an early age.

While carrying too much weight greatly increases the risk of gout, shedding weight quickly can also spark the condition. Rapid action weight loss plans such as the Atkins’ diet, which cut out entire food groups, are already precipitating attacks.

Gout strikes when uric acid builds up in the body to such an extent that the kidneys are unable to flush it out. The acid crystallises, then collects around joints. In 70 per cent of cases the first area hit is the big toe, to which crystals are drawn by gravity.

Gout can cause excruciating pain and lack of mobility. Eventually, crystal build-up can wear down joints to such an extent that they are rendered useless.

Famous victims of the arthritic condition include numerous Dickens characters along with real-life sufferers King Henry VIII, Alfred Lord Tennyson, Immanuel Kant, Samuel Johnson and Thomas Jefferson. Another, Benjamin Franklin, described it as an enemy which "would not only torment my body to death, but ruin my good name"— such was gout’s association with alcohol.

Ian Phillips doesn’t drink any more. He’s only 30, but the security guard at London-Heathrow airport has been plagued by gout for seven years. "I was 23 when it began," he said. "I thought I had a broken ankle, or perhaps a sprain. But the pain was too extreme for that. It went undiagnosed for four years. When the tests came in I couldn’t believe it. I thought, ‘How have I got gout? That’s a disease rich old folk get.’" Phillips had a fairly stable diet and hadn’t touched alcohol since the age of 20, but for four years beforehand he’d been in the Royal Navy and admits to having drunk heavily. Often, though, there is a hereditary factor and Phillips’s grandfather was also a sufferer. When he was diagnosed, Phillips was teased by friends, but since then his condition has worsened and they have seen just how debilitating a condition it can be. "The pain is hard to describe. I’m a 1.88-metre doorman and security guard, but it has had me in tears."

Ankles, knees, elbows, and shins are all affected. He has spent lengthy periods in hospital and, on occasions, has been confined to a wheelchair. "I started a new job last year and I had a bad attack soon afterwards, resulting in two weeks off work. Itembarrassing, but what can I do? I’m afraid that I will soon become unemployable." Many more women are now having to deal with the disease. Once, there were virtually no female gout sufferers, but now one in five people with the disease is a woman.

Shelly Rees-Langley had her first attack in the middle of the night. She was 38 years old. It came shuddering up from her big toe. "It was excruciating," she said. Her husband rushed her to hospital and the hospital diagnosed it as gout. It was Boxing Day (26 December) and hospital staff asked Rees-Langley if she’d been indulging over the festive season. She had not. But she had been dieting.

Dr Michael Snaith of the UK Gout Society, a charity which was formed a year ago to raise awareness of the growing affliction, believes the type of gout sufferer is changing and that many more women will develop symptoms in coming years.

"It is almost inevitable that younger women will start to develop gout because they are getting fatter and binge-drinking," he said. "I expect to see a lot more women with gout, as they are behaving more like men in their eating and drinking habits."

Dr Snaith added that the Atkins’ diet could precipitate gout, because, as a high-protein diet, it burns off fat and produces lactic acid. It then joins a queue of acids waiting to be expelled by the kidneys and uric acid levels remain high. Crystallisation follows.That is what happened to 40-year-old Richard Jaques.

"I’m an ex-rugby player and carry a bit of weight," he said. "I went on the Atkins last year." The side-effects of the diet triggered an attack. Jaques is hit by three or four bouts of gout a year, but the Atkins-led episode was different. "Normally it comes on quickly, but when I was following the Atkins, it built up slowly over three weeks. By the end I was in a lot of pain."

— The Guardian