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The Gout Dugout.Issue #038. It's not the disease of Kings; gout and British royalty; Lesinurad;
March 21, 2011
Hello and Welcome to the February 2011 edition of the Gout Dugout newsletter the 10 minutes' read of a free gout newsletter that gives you useful gout beating ideas. I'm still behind schedule but I'm catching up.
THE DISEASE OF KINGS AND THE KING OF DISEASES?
How many times have I read this ridiculous description of gout? So many within the first three months of studying the disease that I promised myself I'd never use it. And I haven't... till now.
The other over-used one is that one about the bed sheet. Couldn't writers think of another way of describing gout pain? The bed sheet explanation originated, it's thought, with Thomas Sydenham, the doctor and gout sufferer who wrote about gout in the late 1600's. I have never used this one either.
The disease of Kings? Look at any list of famous people from the past who got gout and you'll see that monarchs make up just a small percentage.
The King of diseases? Was this phrase invented by those in the 18th century who thought (crazily as we now know) that if you got gout you wouldn't get anything else? And wouldn't the King of diseases be the one that killed the most people, such as a global virus? This definitely rules out gout.
So this is a nonsense phrase, one designed I'm sure just to give very minor comfort to those who suffer it.
"Well.... umm.... it's not too bad, I've got the King of diseases in my left foot and the disease of Kings in my right."
This might get a laugh, but I doubt this would impress many members of the opposite sex, nor those people who are attuned to a touch of slight snobbery.
Gout and the British Royal family
If gout is the disease of Kings you might expect it to be 100% hereditary, appearing every time there's a new monarch from the same royal house. But it doesn't.
Since there is to be a British Royal wedding in the near future - actually on Friday 29 April - when Prince William marries Catherine Middleton in London's Westminster Abbey - let's have a look at gout in the British monarchy. The British monarchy's longevity has meant it has had almost the most Kings and Queens that have ever presided over any nation, so it's a good place to look.
How many British Kings and Queens, since the well known case of King Henry VIII (born 1492, died 1548), have suffered gout? The answer is precisely two out of 20 monarchs (including one uncrowned because he abdicated, and I've counted William and Mary as one). To repeat, that is 2 out of 20 since Henry VIII.
The two were George IV and Queen Anne. George IV was a classic case of gout - a hugely rotund gluttonous man whose enormous appetite must have caused his gout, not hereditary factors.
And the "stout-with-gout" Queen Anne, whose gout appears to have been more unlucky. She was suffering a gout attack during her Coronation in 1702. What a shame she didn't know she should munch on the eponymous American Royal Anne cherries. Anne was the first gouty monarch since Henry VIII, and he lived about 140 years before she did. I'm not a geneticist, but I'd say there's nothing hereditary about that.
Did Queen Victoria suffer from gout?
I should add that Queen Victoria has been listed in a list of famous gout sufferers, but trying to find any information about her gout is very hard. Whenever I've seen a Queen Victoria biography I've looked up the index for the word gout and never found anything. The Internet has nothing substantial to say, and the only thing approaching evidence is the fact that Sir Alfred Garrod (the discoverer of the true gout cause) was appointed a "physician extraordinary" to Victoria when she was 70, a classic age to get gout. It seems an odd title in our age, but I guess it meant she could call him whenever necessary.
Maybe because she lived to be 81 years old she did have a touch of gout towards the end, but that isn't hereditary either. Hereditary cases tend to start younger than usual. You might think "why else did Victoria appoint him if she didn't suffer gout", but Garrod was an expert in all the rheumatic diseases. Victoria died in 1901. Since then, there's been no public case of gout in the British royal family, and that's 110 years ago. And if she didn't have gout, you have to go way back to George IV who died in 1830.
So there isn't really anything in the British Royal family's history to suggest it's the disease of Kings, and hereditary in their case. Prince William, who seems to be a very sensible fellow, has nothing to worry about.
WELCOME TO LESINURAD
RDEA594 is one of the anti gout drugs currently in the trials stage. I haven't said much about it because it's still a long way from possible approval. But it has been doing well in its trials so far, and its developers, Ardea Biosciences, have now given it a generic name - Lesinurad. Remember this name. You'll be hearing much more about it in the future. The brand name comes later - when the developers think it's likely to get marketing approval.
How does it work? Lesinurad is another drug that encourages uric acid excretion. These kinds of gout meds tend to remove more uric acid than the xanthine oxidase inhibitors, Allopurinol and Febuxostat (Uloric, Adenuric etc).
Perhaps Benzbromarone, another excretor improver, should have been called Mercedes Benz-bromarone, because it could get uric acid down in some people by a whopping 5.0 mg/dL. But it was removed from the market in the U.S. and some European countries, because of liver toxicity in a few cases. However, I think it's still available in some countries.
One Lesinurad problem will probably be that it can't be used by those who have more than mild kidney disease. A simple explanation of how it works is that it inhibits the URAT1 transporter that carries uric acid back into the blood from a kidney tubule. So less uric acid is returned to the blood, and more gets excreted. There are other transporters proteins in the kidneys which return uric acid to the blood, but URAT1 is reckoned the most important.
You can be sure that a drug that inhibits all the kidney transporters for uric acid will be invented and trialed sooner or later.
The ABCG2 gene coded protein The ABCG2 gene coded protein, whose discovery was announced in mid 2009, transports uric acid out of the kidney and into
urine - as opposed to URAT1 and the others which carry uric acid back into the blood. This one needs a drug that encourages it to do more, and stop it from malfunctioning. It was said when it was discovered that its malfunctioning causes 10% of all gout cases, which is a lot.
My explanation in the last issue that Arctic Medical Ltd., based in the U.K., can ship the UASure uric acid meter and home test kit worldwide (including the U.S.) brought a big response. If you didn't see it, and you're interested in measuring your uric acid level at home, click on the link below, and you'll go to the Arctic Medical website for this meter.
FREE pH FOODS CHART AND RECIPES
If you want a free pH food chart with 45 alkalizing recipes, click on this link to phionbalance.com and when the home page arrives, the download link for the chart is on the right. You can then print out the food chart, and take it with you when you go food shopping. pHionbalance products
The charts have good lists of alkalizing and acidifying foods, but if you want numbers (i./e how acidic or how alkaline) you'll have to go to
John Mepham BA.(Econ).
799, Infantry Street,
P.S. You may distribute this newsletter freely and free-of-charge, providing any links in it remain unchanged and it remains intact. Partial copying is not allowed.
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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