My friend Prashant and I had important matters to discuss. We chose to go to the “Cinnamon” up the Margão Monte Hill. Once there, we occupied a corner table and soon the waiter came, “Welcome to Cinnamon. Here are your menus. I’ll be back to take your order in a minute.” Thirsty as we were, we ordered presto a Patiala peg of Black & White Scotch to be shared between us. No sooner we started quenching our parched throats with the nectar, the waiter returned, “Are you ready with your snacks order?” “I’d like masala-fried oysters”, I said (something which I had relished on a previous occasion). “And you?” he asked Prashant. “Raw vegetable salad for me!” muttered my friend. Both preparations reached us almost simultaneously. After prolonged silence, our otherwise gutsy Prashant — like a tamed man — began to pour out his heart. “You know doctor; I’ve problems with “uric acid” and avoid oysters.” I jumped to my feet, “Blimey! Prashant, do you suffer from gout?” He candidly replied, “Nay, but my blood test done with Dr Babita reveals that my uric acid is 1.5 mg. above the upper limit of normal”. A lugubrious Prashant then confided, “I heard so many bad things about “uric acid”… I’m too scared to eat oysters!
Oblivious of our surroundings, our conversation thenceforth veered towards uric acid and we totally forgot the very purpose of our meeting. Sometime later, after a spirited discussion, I decided to try the appetizing oysters. To my dismay, Prashant – without me noticing – had gulped them all. What is more, with all bravado he could muster, inflating his 36-inch chest, yelled, “Doctor-ji, my friend, damn that uric acid!”…Pause… In a joyous mood now, I nodded in agreement and gamely we decided to make a truce with uric acid. Clinking our glasses triumphantly we asked the waiter for a chhota refill.
“Hyperuricemia” is defined as serum uric acid levels above 7 mg/dl. Individuals with higher levels are at increased risk of developing “gout”, one of the most painful forms of arthritis caused by a buildup of uric acid crystals in the joints. Uric acid is a breakdown product of “purines” that are part of many foods we eat. Crystals deposit in joints, often in the big toe. For most people, the first attack of gout is an unforgettable experience. It wakes a person from sleep. The toe is very sore, red, warm, and swollen. Rarely, other joints are affected but it always starts by attacking the big toe.
A “gout attack” can be brought on by stressful events, alcohol, drugs, or another illness. You are more likely to have gout if you have family members with the disease, if you are overweight, if you drink too much alcohol, if you eat too many purines (shellfish, anchovies, oysters, mussels, scallops and some meats, such as bacon, turkey, veal, and organ meats like liver). There are other causes especially the use of some medicines.
The history of gout goes back over 4,000 years. Initially, it was misperceived as a “king’s disease” – affecting only those wealthy enough to indulge in alcohol and “purine” foods. But today we know it can affect anyone and more than 8 million people have it, and the rates have doubled in the last 50 years.
Here are two famous people who have been diagnosed with gout: 1) King Henry VIII of England. This monarch is one reason gout used to be known as the “disease of kings.” When he wasn’t lopping off his wives’ heads, King Henry VIII was coping with attacks of gout. The British king was overweight and is often pictured holding a chunk of meat or glass of wine (all three increase the risk of gout!) 2) Benjamin Franklin, the 18th century Renaissance man, who discovered electricity, invented bifocals and was one of the founding fathers of the United States also had gout. In fact, Franklin missed many meetings that were held to draft the Declaration of Independence due to gout.
Now, coming to our most loving and affectionate Prashant’s case, what was he ailing from? From a condition called “asymptomatic hyperuricemia”. Prashant had a reason to be cautious because a relationship between hyperuricemia and CV (cardiovascular) disease (heart attacks and strokes) has been established since the 1900’s. Increased uric acid serum levels are a common finding in patients with high blood pressure, insulin resistance/diabetes, obesity and CV disease. The role of uric acid as a CV risk factor has been borne out by numerous prospective and cohort studies. Luckily, we have two drugs, “allopurinol” and the novel “febuxostat” as a preventive in patients with asymptomatic hyperuricemia. But further studies are needed to assess the exact role of uric acid reduction in the progression of CV events.
Meanwhile, there’s no doubt that the pathological role of uric acid, nowadays, is being exaggerated. We physicians keep seeing in our clinics patients attributing any pain whatsoever, and even the weirdest complaints, to uric acid. It has almost become a fad. Many turn neurotics. Yet an ounce of prevention is worth a pound of cure! But, permit me to say, just as there is for everyone something called a “drug holiday”, our good-hearted and chivalrous Prashant too is entitled to give the go-by to a rigorous diet (alcohol included) on an “auspicious day.” Cheers!
(Dr. Francisco Colaço is a seniormost consulting
physician, pioneer of Echocardiography in Goa and column writer)
