My Bout with Gout; Why Dieting is Bad for Your Health

Over the past nine months I have suffered from a mysterious recurring pain in one of my big toes. This is not an ache: it is an intense, debilitating pain that makes all other thoughts and feelings disappear. It has usually lasted for a few days, during which time I have treated it with mega-doses of ibuprofen and rest. Then it recedes, only to reappear suddenly and without obvious cause a few months later.

This last bout was the most difficult to overcome, waking me up at night, making it impossible to wear regular shoes or to walk with any degree of normalcy. In fact, it was so bad that I actually made an appointment with my doc to see what on earth was going on. After a few minutes of squeezing, prodding and asking me a few questions he concluded that I have gout. Gout?! What am I, some kind of red-meat-eating, hard-drinking idiot who doesn't pay any attention to my health? Not at all. As a friend of mine likes to quip, I'm not a vegetarian, I just mostly eat like one. As far as alcohol goes, I may have a drink or two per month, which I don't think makes me AA material.

So I began researching the causes of this annoying illness.

From the Mayo Clinic website:
Gout occurs when urate crystals accumulate around your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines, substances that are found naturally in your body, as well as in certain foods, such as organ meats, anchovies, herring, asparagus and mushrooms.

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.

And those sharp crystals commonly invade toes, which is precisely what happened to me. Among the factors that can lead to an excess of uric acid are: genetics (a family history of gout or other forms of arthritis), obesity, untreated hypertension, high consumption of red meat and certain seafoods, heavy alcohol use, and certain medications (chemotherapy drugs, aspirin and diuretics). The only indicator there for me is obesity - it runs in my family and has been the bane of my existence for my whole life. But as I've looked further into the chemistry of gout some other potential causes have become apparent.

Going back as far as my teen years I have been on every imaginable weight loss plan. Carlton Fredericks, Weight Watchers, Atkins, Optifast... you name it, I've tried it. What the strictest of these diets have in common is exactly what I now believe is partially to blame for the onset of gout in my body.

Very low calorie diets cause the body to go into "starvation mode", in which one's body breaks down more muscle than fat and greater quantities of ketones are created. Ketones are a by-product or waste product that appears when your body burns stored fat for energy. The ketones also inhibit uric acid excretion. Persons who go on very low calorie (less than 900 calories per day), actually can cause their uric acid levels to go even higher, which increases the risk of gout.

From About.com's article on diabetes:

Ketosis is a natural process that occurs when fats are converted into energy by the body -- usually when there is not enough glucose (carbohydrates) to provide for the body's energy needs. Instead, the fat is broken down into energy, and "ketone bodies" are the molecular by-products of this metabolic process.

Ketosis may occur during fasting, after an extended period of exercise, or when a high-fat/low carb diet is followed.

So, very low calorie diets cause ketosis, one clear risk factor for developing gout. One of the diets I used about twenty years ago was the Optifast diet (remember when Oprah was pushing this one?). This was a long term fasting plan which consisted of nothing but a liquid protein that, if I remember correctly, was around 800 calories per day. I lost a lot of weight on this plan, of course.

About a decade later, after having re-gained all of that weight, I decided to try the Dr. Atkins diet for the second time in my life (I had been on it for awhile as a teenager). This diet specifically induces ketosis by only allowing the consumption of protein with little or no carbohydrate.

I believe that this history of low calorie, low-carb, ketosis-inducing dieting, along with my hereditary obesity is the main precipitating factor in the onset of my gout. If the world needed more proof that dieting is not only ineffective but also downright dangerous, I think that the link to gout would certainly qualify.

The Kitchen Project - Part 1 (Before)

I love my Chicago style brick bungalow. It is the kind of house I'd always wanted to own: solidly built in 1927, it's old but in excellent condition. It has strength and character, along with a two-car garage (the best thing about having a home of one's own), a separate entrance I use for my teaching studio, and some wonderful stylistic touches that distinguish it from the many similar homes in Chicago's "bungalow belt."

But I hate my kitchen. It has been the bane of my so-called lifestyle since I moved in several years ago. I like to cook and I have children to cook for. But I've been very frustrated by this kitchen, with its one pathetic wall cabinet, total absence of counter space, a falling apart oven, a leaky refrigerator and a horrid white tile floor that seems to magnify every micron of dust. And that's just for starters.

My kitchen also has an architectural quirk that seems to be common in homes built in this era: The stairs leading up to the attic can only be accessed from one corner of my kitchen, thus rendering that area useless in terms of counter space and wall storage.

Here's a couple of shots of that wretched corner:






This is the evil appliance area, which occupies the only corner:



The doorway/hallway that leads to the dining room:



The pantry and door leading to the mudroom and the great outdoors:



Finally, a view from the dining room entrance:


As you can see, this very small room has 4 (count 'em, four) doorways and only 1 (that's one) usable corner. There has been many a time in the midst of trying to prepare a meal that I've gotten stuck holding the cutting board or a full pot with no place to set it down. I bought that butcher block on wheels so I'd have SOME place to chop vegetables and store some pans but that thing is hardly adequate.

This kitchen has had me muttering obscenities on a regular basis. I blame this room for my borderline high blood pressure and my need for several years of primal scream therapy.

So when my mother, bless her soul, offered to help me pay for a kitchen rehab I could hardly contain my passionate desire to buy a sledgehammer and start the demolition immediately.

Next time: The Plan

Tragedy at N.I.U. - Why 'Why" is the Wrong Question

Earlier this morning I read a letter from a close friend whose son is s student at Northern Illinois University in DeKalb. His son is understandably freaked out and my pal is furious. He wrote to his congressman about the insanely easy availability of guns. His response is the most cogent answer I've yet heard in all the prattling that's been going on in the media since this most recent shooting.



As a society there is NOTHING we can do about the states of mind that might cause an individual to commit seemingly random violence. We cannot monitor everyone's psychological health nor make it illegal to stop taking one's meds. It is not the responsibility of classmates, peers, family or school administrators to keep tabs on people's emotional well being. So 'why' Steven Kazmierczak opened fire on 200 students in a lecture hall at N.I.U. is impossible to answer. It is also a dangerously misguided question.

The question is this: How can this society continue to allow the gun lobby and the 2nd amendment fundamentalists to distort the painfully plain reality that these kinds of weapons are far too easy to acquire? As my friend points out, we now have all kinds of laws that purport to make public safety a high priority. In Illinois, a potential driver has to take classes, pass both a written and a practical driving test to get a certificate, then do 50 hours of practice driving before getting a license to drive. You can get busted for not wearing a seat belt. People are no longer allowed to smoke in public places.

Yet anyone with a few dollars in their pocket can legally purchase a deadly weapon with no training, virtually no delay and without any compelling and certifiable evidence that they should be allowed to possess a device that can do unspeakable harm in a matter of seconds. All of the NRA's arguments notwithstanding, the simple truth is that the easy access to guns is responsible for the current state of terror many Americans are experiencing. This internal threat is just as alarming as the danger posed by state sponsored terrorism and we ought to take it just as seriously.

'Why' is irrelevant. 'How' is the only question that can be answered and it is the crucial one for the safety of all citizens. In societies where there are more guns there are more murders. In countries where there are strict gun control laws fewer people get killed by their fellow citizens. Remember that we are not discussing criminal activity here - just the access to guns that each and every one of us has, whether or not we are sane, competent, intelligent or have a demonstrable need to own a gun.

Here's a question worth considering on a philosophical level: Can a compelling argument be made that, while driving is a "privilege, not a a right", gun ownership is just the opposite: a right allegedly guaranteed to all Americans? Perhaps we need to take another look at that Constitution of ours.

I have a son who is a student at a college in central Illinois. This tragedy could just as easily have occurred at his school; he might have been a victim. I have two other children who will attend college soon. My definition of "homeland security" includes reasonable protection for my children (and yours as well) from people who can purchase and use deadly weapons regardless of their intellectual or emotional stability. The only protection we have is on the "supply side" of the equation. Let's not let the wackos in the NRA dictate gun policy. We need the kind of protection that only strict gun control can provide.

My House Is A Mess

Things are topsy-turvy over here. I'm in the middle of week three of a kitchen remodeling project. No, I am NOT doing the work myself; I'm not that stupid. I have been taking pictures of the process, which I will post as soon as I can get some time to poke through the dozens of images to find the best of the lot.

I am fortunate to have a second tiny kitchen in the "in-law" apartment in my basement, so I don't have to live on cold soup and take out. But the main floor of my house is like a war zone. There's plastic coverings (some with zippers) over four doorways and heavy paper taped to the floor of my dining room. The furniture that was too difficult to move is wrapped in plastic, giving the room the charming look of a mausoleum.

The last couple of weeks have been intense on the work front as well. I had been spending most of my waking hours on the arranging project I wrote about in my last post. Now I am done with that...not sure if I quit or was fired, perhaps a little of each. The problem was that the music director I was indirectly working for turned out to be, um, let's just say...a problem. Since this is a family column I can't really go into detail, but I feel lucky to be exiting before fisticuffs broke out. I did a good chunk of the work, learned a few things about my limitations and about some of the questions I didn't know to ask before embarking on a job of this type. Well, we won't get fooled again.