Much of my memory of those interminable high school lessons of 15th through 18th century English history; you know… who succeeded who, who killed who, who married who, what and when wars were waged, lost or won… has been tempered by my subsequent medical training. In truth, I am more interested in the prevailing diseases of that time.  Aside from the plague, death in childbirth and horrendous rates of child survival, I remember that many of the historic and (generally) obese kings and noblemen of that period spent an inordinate time feasting on meat and imbibing alcohol. They (the men) also seemed to have had one condition in common; they suffered from gout which most frequently occurred in their big toe. (Gout of the big toe is called podagra. I guess this esoteric knowledge would not suffice to give me more than an “F” in any legitimate history test but it might help my score in game of trivial pursuit.)

Just to refresh your memory: Gout is an excruciatingly painful inflammatory disease of the joints caused by high levels of uric acid in the blood stream. The excess uric acid crystallizes, causing swelling, redness and severe pain in the joint. As gout progresses, attacks of inflammation (usually lasting 5 to 7 days) become more frequent and ultimately deform the affected joint. Moreover, high levels of uric acid can lead to life-shortening medical conditions such as diabetes, coronary vascular disease and fatal heart attack.

In the past, gout was considered a disease of male nobility…But not so in the last few decades; it has unfortunately reached a more democratic and gender-blind distribution, doubling in frequency and occurring in “common” (not related to nobility) men AND women. It has become especially frequent in older women and is diagnosed in up to 5% of women over 70.

We thought that the cause of increased levels of uric acid was a diet rich in organ meats (there goes chopped liver) and alcohol. Recent data, however, has shown that the use of diuretics (which concentrates the uric acid) abets crystal formation and also bears “gout-responsibility”.

According to a study published in a recent issue of JAMA, there are other risk factors for the development of gout in women.  The authors used the Nurses Health Study that was established in 1976. At that time, 121,700 female registered nurses living in 11 states completed a mailed questionnaire providing detailed information about their medical history, lifestyle and presumed risk factors. In 1980, a food questionnaire was added and in 1984 they were asked specifically about their soda intake. By then, the number of women who successfully completed the questionnaire was down to 78,906. (Still an amazingly high number.) The participants were asked whether they drank sugar sweetened colas, diet sodas or various fruit juices as well as how much, on average, they consumed a month, a week and a day. They were also asked if they had a diagnosis of gout or if they had experienced 6 of the 11 criteria for the diagnosis of gout. (Just so you know what they are: More than 1 attack of acute arthritis, redness over joints, painful or swollen joints in the toes, foot, one sided toe joint attack, swelling within a joint, elevated uric acid levels and an attack that starts and stops within a period of time.) The participants were asked to update the questionnaire every two years.  The response rate for the gout questionnaire was 81%.

This was what the study found: Increasing the intake of sugar-sweetened soda was associated with an increasing risk of gout. The relative risk (RR) of gout was 1.74 (74% greater) for 1 daily serving of these sodas when compared to women who had less than 1 such soda a month and 2.39 (more than doubled) for those who had 2 sugar-sweetened sodas a day. Diet sodas did not have a “gouty” impact. Moreover, it was just as bad for orange juice! (Of note to those of us who like fruit juices, orange juice has the highest amount of free fructose when compared to apple juice, grapefruit juice, tomato juice and other fruit juices.) Compared to women who consumed less than one glass (6 oz) of orange juice a month, the RR for gout was 1.41 for one serving per day and 2.42 for 2 or more servings per day. No other fruit juices were significantly associated with risk of gout. (Thank goodness, I drink apple juice every morning.)

Studies have shown that within minutes of a fructose intravenous infusion, blood (and later urinary) uric acid concentrations are increased. Apparently, there is a smaller but significant long-term effect on uric acid levels from fructose when taken orally. The Nurse’s Study has now shown that the sugar sodas and orange juice we drink on a regular basis has a clinical impact on big toe disease and gout. It’s not such a noble (and male) disease anymore!

Bottom line: The fructose in sodas and orange juice may do more than increase your caloric intake; this sugar can increase uric acid levels and ultimately lead to an excruciatingly painful arthritis. You may want to quench your thirst with water… I know we can’t always have our juice and drink it with impunity, but I do bemoan any elimination of orange juice, it is a wonderful source of Vitamin C.