Over the past five days or so, I have had many opportunities to look at my right foot, with its shades of pale flesh, slightly pink inflammation, deep redness in some unusual spots that are only slightly sensitive to the touch as well as close to the area of most intense swelling, and even a little bit of purple that indicates a fair amount of bruising, which accounts for at least some of the unfortunate nature of my hobbling, which has made walking, sitting, driving, and laying down quite painful at times. I have noticed that so far in this particular round of gout attacks that the pain has been largely alternating in days. When it started on Sabbath my mobility was only slightly impaired and I had very minimal pain. The next day, of course, my foot was extremely painful and I was deeply limited in my mobility [1]. Then the next day things were a little better and while I was walking around slowly, my coworkers did not notice my discomfort to any great degree. Then, of course, yesterday, my pain was much worse and attracted a great deal of attention, as I was barely able to move around most of the day and under great pain. So far today appears better than yesterday, though by no means good enough.

There are a lot of similarities between the way that gout works and the way that I tend to drink iced tea, and the two may not be unrelated. One of the (hopefully few) vices I acquired as a young person growing up in Central Florida was a love of sweet drinks, particularly my grandmother’s sun tea. As a child I learned how to add sugar spoonful by spoonful into a glass and stir it carefully, seeking to put as much sugar as possible as would dissolve, lest putting in too much would cause it to crystalize out of solution and fall to the bottom of the glass, which would be a bit of a waste as far as sweetening the drink was concerned. Gout, rather unsurprisingly, tends to work the same way, when the body produces too much uric acid (not necessarily because of diet, as this is usually only a minor cause, unless one happens to drink a lot of alcohol and eat a huge amount of meat, especially pork and lamb and fish, and that generally isn’t the case for me) that the kidneys cannot secrete, so that once the uric acid has gone beyond the supersaturation point, it crystalizes out of the bloodstream and deposits itself somewhere, like the joints of my right big toe (which is the most popular place for gout to occur).

It is, notably, not the only place where gout occurs. I recently spoke with a minister who happened to tell me about his own experiences with gout that manifested itself as kidney stones made of uric acid crystals, which sounds immensely painful, and is among the rarest types of gout. There are other joints where gout can occur, like the knees or elbows, or even the ears, but mine is fairly ordinary in that it chooses the right big toe (why the right toe and not the left toe is a bit of a mystery to me, given that I am fairly strongly left-handed and that most of my serious injuries in life have happened on the left side of the body), but that also appears to be the norm as far as gout is concerned. While it may be unusual that as a relatively fit and healthy 32 year old with a fairly moderate (if not somewhat ascetic) lifestyle that I have a disease known for those who live a luxuriant life full of sex and drinking, two things my life is not notably full of at all, I have learned to accept the fact that my life has often been painfully ironic.

In looking at the other sort of beings, besides human beings, that get gout, I was struck by two particular examples in the world of animals. The first was dalmatians, who tend to get gout despite the fact that they are not particularly large animals, but rather have rather severe dietary restrictions (which sounds a bit familiar) and are animals with very high levels of energy and intensity. The image of an intense and somewhat high-strung animal being subject to the same sort of difficulties that I am at least provides some sort of contrast. The same is true at least of some T-rex fossils [2]. The T-rex itself was certainly a large animal (gout is often associated with obesity, after all) and a somewhat ferocious one, making it a rare species that has to deal with that sort of arthritis, one that would make it rather difficult to hunt a stegasaurus, for example.

So much of the difference between the sweet-tasting sugar crystals at the bottom of a glass of iced tea and the pain of uric acid crystals in the joints of one’s toe is a matter of context. The chemistry involved in the two is much the same; tea or blood can only hold so much of a concentration of chemicals, which when they reach some kind of critical level must be deposited somewhere. Unfortunately, the solubility of uric acid in water is not particularly high, as it takes 15,000 units of cold water to dissolve one unit of uric acid [3], and uric acid levels can be increased by high-fructose corn syrup and table sugar (which is not particularly a pleasant thought). Lest we think of the little crystals in my foot as a purely bad thing, they also serve as an antioxidant and can lead to prolonged life.

Strikingly, though, gout tends to make sense of some of my many quirks. For example, gout tends to occur in the early morning, when low temperatures (which reduces solubility) triggers an attack. One of the ways to prevent this is to try to keep one’s feet warm, like always wanting to wear socks to bed or stay snuggled in layers and layers of warm blankets. My native tendency to prefer warm feet is thus a natural defense against such attacks. Likewise, the consumption of milk products is also related to lowering gout. Although it is difficult for me to enjoy milk directly because of lactose intolerance, my love of cheese is fairly legendary, and itself another way that I have a natural inclination for protection from the worst aspects of my goutiness.

There is one more additional connection that is worthy of comment here. Scientific studies have shown a moderate correlation between intellectual achievement, which may be related to the similar chemical structure that uric acid has to caffeine. This would make uric acid a natural stimulant, which accounts for the higher levels of gout among those inclined to be rather like college professors, making gout a sort of side effect of having an internal and natural state of fairly constant stimulation, which would increase energy on a regular basis [4] and apparently also some level of impulsiveness as well [5]. How convenient it is to see a relationship between so many different areas of life related to a fairly simple naturally-occurring chemical that my body simply cannot get rid of quickly enough to prevent it from causing mischief from time to time. Perhaps I have something to be grateful for to the little crystals in my foot that fall out of my blood from time to time like the sugar from a slightly over-sweetened glass of tea after all. I’ll drink to that.

[1] See, for example:

https://edgeinducedcohesion.wordpress.com/2014/05/18/gout-and-decrepitude/

https://edgeinducedcohesion.wordpress.com/2014/05/19/murphy-was-an-optimist/

[2] See, for example: Rothschild, BM; Tanke D; Carpenter K (1997). “Tyrannosaurs suffered from gout”. Nature 387 (6631): 357.

[3] http://en.wikipedia.org/wiki/Uric_acid

[4] Arthur Jensen; SN Sinha (1993). “Physical correlates of human intelligence”. In Philip A. Vernon. Biological approaches to the study of human intelligence. Norwood, NJ: Ablex Publ. Corp. ISBN 9780893917982.

[5] Sutin, AR; Cutler, RG; Camandola, S; Uda, M; Feldman, NH; Cucca, F; Zonderman, AB; Mattson, MP; Ferrucci, L; Schlessinger, David; Terracciano, Antonio (2013). “Impulsivity is Associated with Uric Acid: Evidence from Humans and Mice”. Biological Psychiatry. doi:10.1016/j.biopsych.2013.02.024. PMID 23582268.