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Gout Dugout.Issue #063. alas Mr.Smith | purines tables | sugary drinks and the risk of gout
September 29, 2013

Hello and Welcome to the Autumn/Fall, (September) 2013, edition of the Gout Dugout newsletter. The Gout Dugout is the 10 minutes' read that gives you ideas that may help with your gout. Copy and print if you prefer to read a version on paper.

The first article in this issue is about someone who didn't treat his gout well and seems to have paid the price.


In July there was the sad news that British comedian Mel Smith had died at only 60. Most people in Britain remember Smith for a satirical sketch comedy shows such as Not the 9 o'clock news, the one that kicked off his career and Alas Smith and Jones which had a 16 years' run, made with his comedy partner Griff Rhys Jones.

World-wide not so many people will have heard of Mel Smith and you may not. But one of his early comedy partners was Rowan Atkinson (Mr.Bean), who has a bigger name around the world. And Smith directed the first Mr.Bean film, Bean. Why am I writing about him here? You've probably guessed. Mel Smith had a classic case of gout.

Smith probably had his first attack at about 40 because he had been addicted to Ibuprofen since 1993 which I assume was somewhat after his first gout attack. That means Smith had gout for about 20 years. Gout can do a lot of damage in 20 years if you don't deal with it well. In Mel Smith's case it had spread from his feet to his knees, elbows and elsewhere. And did it lead to the heart attack which killed him? Maybe and possibly.

Now... Mel Smith was a much loved comedian who delivered fun and laughter for 25 years to millions. And from others' accounts, a nice fellow who remained married for 25 years. At the risk of sounding censorious and a gout "too-wise guy", I shall categorise what I see were his mistakes in dealing with gout, from the stories I read. Gout is not a joke and should never be treated casually.

Mel Smith, like fellow British comedian/presenter Jimmy Savile, was a classic case of what-not-to-do-when-you-have-gout. So what did Mel Smith do wrong?

Smith became addicted to his gout medicine. In his case to Nurofen Plus (Ibuprofen plus codeine). He was described as taking Nurofen as if it were Smarties. For those who don’t know Smarties are small pill sized sweets (candies) basically sugar coated chocolate in various colours (colors).

He was a late night party lover. A friend described him as "a drinker." That's like playing Russian roulette with Mr.Gout. His Nurofen Plus addiction probably meant he was not seeing a doctor regularly about his gout and its pain. The "I'll just take more and more of these" approach. He had taken 50 on one occasion which meant he was not getting the right medicine for gout pain but it led to hospitalisation a couple of times for 2 perforated stomach ulcers. No surprise there, ulcers are a side effect of too much Ibuprofen. If they were not working you need something else, not more.

Eventually he did beat this addiction but wasted years of opportunity to treat gout correctly.

All the above suggest Smith knew little about how to eat when you have gout. He did quote "eat heavily."

He weighed, as reported 16 stone (224 lbs). You know what that means to a gout sufferer.

Smith felt the need to hide his gout from his friends and collegues. He hid his Nurofen Plus, around the place where he lived. It suggests his attitude to gout was very defensive. It's a very human weakness,but isn't it better to brave it out than hide it away? He said: "It was my dark secret, and I got deeply depressed."

Was living in the hyped-up world of show business the cause of his defensive attitude to gout? Was he afraid of not getting work if his gout was widely known? I am afraid that's very likely.

You can read more about Mel Smith here.


A very surprising extended report was published online by The Annals of the Rheumatic Diseases Journal earlier in September and it's a first. (1) When a variant of the gene SLC2A9 behaves normally it helps to take out of blood, out of the kidneys, and into urine.

But New Zealand scientists at the Universities of Otago and Auckland found that sugar (sucrose) sweetened soft drinks actually change the function of the gene that transports uric acid in the kidney into urine and out of the body.

And it changes it so that the uric acid returns to the blood. And it is thought that the processing of sugar in the liver also raises uric acid. So a double whammy to raise the uric acid level, and the risk of gout.

They also found that if someone drinks 300ml (millilitres) (that's 10.1 U.S/10.5 U.K. fluid ounces, or a large glass/half a pint) of a sugar sweetened soft drink a day their risk of gout rises by 13%. What about two or three? Each extra daily serving meant at 15% greater risk in those who had this gene variant and 12% extra risk in whose who didn't.

I am not sure 13% extra risk is enough to put off many people from drinking soft drinks, but if you suffer gout and you take it seriously you want to do everything you regard as possible to remove uric acid. In which case sugar sweetened soft drinks should be on your banned list.

And last year a British study (2) found that sugar sweetened beverages raised uric acid amongst a population of 2,076 healthy people, (although fructose in this study did not).

The whole New Zealand study can be read free of charge courtesy of The Annals of the Rheumatic Diseases and you can download it at this URL ,

I have to say genetic studies are very difficult for the non-specialist to understand.

The British study can also be read free of charge courtesy of BMJ Publishing Group and you can download it at this URL

Click on the Flamasil ad to go to the Flamasil website

Alternative Health Research/Flamasil™

The UASure is a DIY home uric acid test kit. It measures the level of uric acid in the blood. Click on the link below to visit a company who can ship it world-wide, including to the United States and Canada, from Britain.


Not only are we short of good scientific studies about various diets for gout, we are also short of good information about the cause of gout's precursor, that is purines, which are turned into uric acid. There really aren't many purines in foods lists. Nor comprehensive details about which of the four purines are in foods and beverages, and in what proportion, and which of the four are most likely to create more uric acid.

Much of the available data is approximations (high, medium, low) which are frequently contradictory. Sometimes a food gets described as high purine in one list, and medium in another. So the information is barely adequate. It's not as good as it should be.

You can't buy little pocket books of purines in foods tables; purines are not well known – you probably had never heard of them until you became interested in gout. They don't trip off everyone's lips like calories, carbohydrates and fats. But should gout continue to grow that will probably change and one day people will look back with incredulity to this era, the same sort of incredulity with which we shrug off the four humours (humors) of Roman and later times that "caused gout."

So it was with surprised pleasure that the other day I found a purines' table website I had not seen before and I want to share it with you.

Just one snag. It's a German site in German. But translating the single words describing foods/beverages shouldn't be hard, but I haven't yet done that. So for the time being I'll leave that to you, except to say that härnsaure is uric acid and purin is you know what. There are plenty of online English-German, German - English dictionaries to help you.

I know from the response for the alkaline foods data that I have a lot of diligent gout sufferers reading this who wish to leave no stone unturned in their search for information So if that's you, click the link to visit:

If you are not a subscriber to the Gout Dugout, this free gout newsletter, you can sign up at this page - click on the link below.

Go to the home page by clicking on the link below.


Use the website's search box, located towards the bottom of the Home Page, to find site references to any word you enter into it. It is a good way to find out where and what the site has to say about any gout topic. There are currently around 210 pages, including all the back issues of this newsletter. It works. Use it!


When you get the next issue it will be Christmas time, and another year will have flown by. Among other items, we'll look at a new study which examined the effect of Mediterranean diets on uric acid levels.

Thanks for reading, and all the best of health.

John Mepham BA.(Econ).

Makati City,

(1) Batt C, Phipps-Green A.J, Black M.A, et al. Sugar-sweetened beverage consumption: a risk factor for prevalent gout with SLC2A9 genotypespecific effects on serum urate and risk of gout Annals of the Rheumatic Diseases Published Online First: 11 September 2013 doi:10.1136/annrheumdis-2013-203600

(2) Zgaga L, Theodoratou E, Kyle J, Farrington SM, Agakov F, et al. (2012) The Association of Dietary Intake of Purine-Rich Vegetables, Sugar-Sweetened Beverages and Dairy with Plasma Urate, in a Cross-Sectional Study. PLoS ONE 7(6): e38123. doi:10.1371/journal.pone.0038123

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NB. The contents of this newsletter contain medical information, not medical advice. Please always discuss gout remedies with a doctor, or other health care professional, before implementing any treatment.

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