Taming The Toe Monster: How to Survive a Bout with Gout

During the most festive time of the year—the six weeks that begin tomorrow and lasts through New Year’s Day—the visions I have dancing in my head do not involve sugar plums. My delectable daydreams are of parties and family dinners where any kind of meat and fish are in abundance, the alcohol is flowing freely, and rich, delicious desserts are irresistible temptations. 

At least I used to have such visions. They had to be expunged from my brain 16 years ago, after I was attacked by The Toe Monster. 

That summer, the assault came without warning in the middle of the night. It engendered a pain the intensity of which I hadn’t experienced since having some teeth removed with pliers as a child. The area of this excruciating ache centered in my right big toe and made the spot so sensitive even a bed sheet slithering across it induced a blood-curdling scream. 

By morning, I somehow managed to hobble to my podiatrist and my amateur diagnosis was a stress fracture, most likely a delayed reaction to a baseball injury suffered during a game the day before. Foot doctor scanned the surface of my toe and noticed that it was red, shiny, and felt hot to the touch. “No doubt,” he said, setting up his short but disturbing rhyme, “you have GOUT.” 

*”The Gout” by James Gillray. Published May 14, 1799

If this late 18th century depiction of a foot being assaulted by “The Toe Monster” looks scary, you can only imagine what an attack of gout must feel like.

Gout? Wait a minute, I thought. Isn’t gout a member of the ancient malady pantheon, right up there with rickets and scurvy, ailments people haven’t suffered since the days of King Henry VIII and Benjamin Franklin? 

Apparently not. According to 2017 data published by the journal Arthritis and Rheumatology, there were approximately 41.2 million cases of gout worldwide. The National Kidney Foundation reports that gout is the most common type of inflammatory condition in adults and estimates that 39 percent of American adults—6.1 million of them men 40-and-over—have bouts with gout. 

Hundreds of years ago, gout was called “The Disease of Kings,” because it was associated with wealthy men who over-indulged in food and drink. Red meat (especially organ meats and the meat of wild game), fish (especially shellfish, sardines, trout, and tuna), vegetables (asparagus, spinach, and cauliflower), and beer and red wine, all contain purines. When the body breaks down purines it produces a lot of uric acid in the blood, the main culprit in what causes gout. 

Uric acid isn’t necessarily harmful. In fact, it’s a powerful antioxidant that protects cells from damage. It usually dissolves in the blood and then passes through the kidneys and is eliminated through urine. But if there is more uric acid than the kidneys can expel, it causes a condition called hyperuricemia—sharp, needle-like monosodium urate crystals that form in connective tissue, in the joint space between two bones or in both. (Besides, the big toe, ankles, knees, wrists, and fingers can also be affected.) Under a microscope, these crystals can look like images seen through a kaleidoscope, but the way they inflame the joints isn’t very pretty. (A condition called “pseudogout” is sometimes confused with gout because it produces similar symptoms of inflammation, but the crystals are made of calcium phosphate, not uric acid.)

Gout can also be caused by obesity, high blood pressure, and tends to be genetic. I’d never heard any quaint family histories involving gout, mainly because most of the men had died relatively young, so I was more than a tad skeptical about having this particular affliction. But as I sat in foot doctor’s office, I remembered the massive steak and eggs with unlimited Bloody Mary’s Sunday brunch I’d had the day before. Without immediate treatment, I might be looking at days, if not weeks, of debilitating discomfort. According to the Arthritis Foundation, despite the severity of gout in America, just 10 percent of sufferers are getting needed, ongoing treatment. Left untreated, the Foundation says, gout can lead to permanent joint damage and other health issues such as kidney stones. 

At the time The Toe Monster attacked I was editing a health and nutrition magazine published by a nutritional supplement company. When I decided to write about my gout experience, they naturally wanted me to emphasize how a diet including natural herbs and nutritional supplements could minimize the pain, if not prevent it. To be sure, inflammation-reducing supplements such as Omega-3 fatty acids, and anti-oxidants like Quercetin can be beneficial, while Bilberry (stabilizes the protein collagen), Bromelain (speeds decomposition of uric acid crystals), and celery seed extract (reduces uric acid levels) can also be effective. Even tart cherry juice or cherry extract help fight inflammation and arthritis pain. 

When I first got gout, I did consume mass quantities of cherry juice, but usually to swallow what turned out to be my miracle drug—Allopurinol—a prescription medication that can rapidly lower uric acid levels. At least it did in my case. A 100 mg dose over a few days did the trick. Over the past 15 years, whenever I’ve experienced attacks of The Toe Monster (thankfully, less violent than that first one), Allopurinol has come to my rescue (other effective drugs are Febuxostat and Colchicine). I keep a cache in my medicine cabinet just in case I lose my head and binge on skirt steak and cabernet. 

The foods to avoid on the right contain purines which can produce significant uric acid in the body. If the body creates more uric acid than can be expelled through the kidney, the result can be an arthritic-like attack on joints. 

Such episodes happen much less frequently now thanks to my daughter Jean. When The Toe Monster initially visited me in the dead of night, Jean was a pre-teen and terrified by her dad’s screams of pain. Now, she is an experienced dietitian nutritionist (who has written about food and nutrition for this website) and lovingly lectures me about much more than just laying off the salt. 

“Some of the ways people can minimize gout attacks are pretty obvious,” my family nutritionist—literally—observes. “If one is overweight, research suggests that a reduced caloric diet, minimizing carbohydrates, and greater protein intake can reduce serum urate levels—and you’ll lose weight at the same time. An obese person is three times more likely to develop gout than someone of normal weight, so avoiding high purine foods and limiting alcohol, especially beer [which contains the purine guanosine] is a must.” 

Jean Hanks, RDN, also advises eschewing the high-fructose corn syrup consumption found in soda, juices, processed food, cereals, and candy. “Some research also suggests that Vitamin C can help reduce uric acid levels, but there’s not enough compelling evidence to confirm that. It’s best to focus on consuming high-quality fruits and veggies with Vitamin C as opposed to using supplements. And, of course, stay hydrated—at least 64 ounces of water a day and more if you exercise.” 

Lest you think that the “Disease of Kings” spares queens, think again. Gout does attack men more often than women because women tend to possess lower uric acid levels. But according to the Arthritis Foundation, in the last 20 years, gout cases have more than doubled among women. Today, two million women in the U.S. are attacked by The Toe Monster. While the female hormone estrogen naturally causes uric acid to be flushed through urine, when women lose estrogen after menopause, uric acid levels in the blood increase. That’s why it’s rare to find gout in women on estrogen-replacement therapy. 

“When a woman under 60 suffers from gout,” explains Dr. Brian F. Mandell, a rheumatologist and board member of the Gout & Uric Acid Education Society, “she usually has other risk factors, including taking diuretics or a history of kidney problems.” In fact, studies have shown that women with gout are more likely than men to have other conditions, including high-blood pressure, diabetes, and obesity. And as opposed to men with gout, in women gout is more likely to appear over time and in multiple joints—like fingers, knees, and wrists—where they may already have some osteoarthritis-related damage. And in 2010, a study published in the Annals of Rheumatic Diseases showed that women with gout were about 39 percent more likely to have a heart attack than people without gout. That number for men was only 11 percent. 

So, if you want to prevent middle-of-the night terror from The Toe Monster this holiday season and beyond (especially those 40-and-over), the message is this: Moderation rules! Keep the gout trigger foods to a minimum and wave off that third and fourth glass of wine, beer, or hard liquor. But, just in case, load up on the cherry juice and have your doctor’s phone number on the bedroom nightstand.

*Image of “The Gout” by James Gillray is in the public domain.