First published 5/22/11 on The Doctor Weighs In
Watching the scandal de jour unfold on TV, as Dominique Strauss-Kahn was being hauled from his Olympian heights at the IMF and $3000 a night hotel suite to a cell in the Riker Island jail, made me think about the misfortunes befalling our rich and famous. Think Lindsay Lohan, or Brittney Spears, or Arnold the Schartzenator, or paper tiger Woods, or… (fill in the blanks). It seems they all succumbed to the vice of hubris; they thought they were above the laws of mere mortals –and were brought down with a vengeance. Of course, this is nothing new; a whole theatrical industry flourished in ancient Greece revolving around the tragedy wrought by hubris. But at least today’s demigod celebrities look to me hale and fit; none of those plebeian maladies of obesity, diabetes and heart disease.It hasn’t been always thus. There used to be a time when the powerful and the rich paid for their transgressions not with jail time, but with disease.
Gout used to be called “the disease of kings” or “blue-blooded disease”. Some very famous people suffered from this affliction, such as Alexander the Great, Christopher Columbus, Isaac Newton, and Henry VIII. Even Shakespeare’s Falstaff, the hard living, hard-drinking buffoon, exclaimed “a pox on my gout, a gout on my pox” (Henry IV, Part 2). Going even further back, an Egyptian medical hieroglyph from 2500 years ago describes the symptoms of gout. Now, Egyptian doctors of the time did not bother themselves with diseases of the masses; they ministered to the Royal court and the priesthood. So gout must have been quite common among these privileged classes.
Clinically, gout is caused by precipitation of uric acid crystals in joints, especially the one at the base of the big toe ( a condition known as podagra). Uric acid is a metabolic product of purines, a class of nucleic acid bases, which are present in large quantities in yeast, red meats, sea food, alcohol such as beer, stout and port wine. Many people have a genetic disposition to hyperuricemia (high uric acid concentration in the blood). But that’s not enough to precipitate a gout attack. Acute gout is brought on when uric acid precipitates in the joints in the form of sharp needle-like crystals, which cause inflammation and severe pain. Major causes of gout are a high-purine diet, as well as obesity and metabolic syndrome. And this is why the ruling classes were prone to gout: they were the only ones who could afford the fois gras of their days. As a fringe benefit of the democratization of modern society we all share now in the delights of fois gras and le gout.
* Historical footnote: it was Anthonie van Leewenhoek, inventor the microscope in 1716 who first saw those nasty crystals in a joint aspirate, and thus dispelled the notion that gout was the work of the devil, or caused by “bad humors”. Strike one for science.
I can already hear the cries of anguish: why us? Why don’t other animals that eat red meat (albeit don’t drink alcohol) suffer from gout? The answer is that upon becoming “thinking people” ( which is what Homo sapiens means, more or less) we lost the enzyme that converted uric acid to a water- soluble product that is readily excreted in the urine. We, and Dalmatian dogs, believe it or not. I don’t know if the poor dogs suffer from the Royal Disease, but I wouldn’t be surprised if it affected their famous temperament, which is charitably described as a royal pain.( Dalmatian lovers, keep the emails civil, please).
This one is based on Irvin Modlin, a professor of surgery at Yale University, and a historian of medicine par excellence. In his book “Medical Tales of the Tagus” he relates a delightful vignette. The duoro valley of Portugal has been a wine-growing region of the Iberian peninsula since antiquity. One specialty of the region was (and still is) port wine. We already know that port wine is rich in purines (see gout, above). But to add insult to injury, ancient port was rich in lead. How come? Because the wine-growers of the duoro knew how to make wine, but didn’t know how to fire their storage amphoras to high enough temperatures as to avoid leaching of lead from the ceramic. The Roman legions who conquered Iberia brought back with them some port, which immediately became popular among the Romans and kindled huge demand. That caused prices to skyrocket, with the obvious result: only the rich could afford it. Bone biopsies of Roman aristocratic skeletons revealed levels of lead that are in the toxic range. Since lead causes neurological and cognitive impairment, could it contribute to the slow decline and final fall of the Roman Empire?
In an April 13, 2011 post we discussed an MRI study of Egyptian mummies, showing widespread atherosclerosis and coronary arteries narrowing. Here is a quote:
“They performed CT scans on 52 of their mummies and found that 44 of the mummies still possessed identifiable cardiovascular tissue, and of these 45% exhibited definite or probable hardening of the arteries. Average age of death was 40.
Ancient Egyptian Lifestyle
Obviously, the mummified bodies did not belong to the proletariat; only royalty, their household (nursemaids, children of royalty), high officials and priests, merited embalming. Their diet consisted of salted fish (cause for hypertension?), bread, and cheese like the rest of the hoi polloi, but they also dined on rich foods such as cow, sheep, and goat meat, as well as something similar to today’s Bakhlava.”
The poor slaves who built those fabulous pyramids died even younger; average lifespan in Egypt was 30-35 years. But they didn’t have the privilege of dying of heart disease, or suffering from gout. They typically succumbed to infections and parasitic diseases.
Today’s ills of the rich and famous are shared by us plebeians. But the fall from grace due to social indiscretions and sheer hubris is still by and large their province, if for no other reason than when we do it nobody gives a hoot, but when they do it we experience a bit of Schadenfreude (look it up).
Chinese proverb:” be careful of what you can afford. You may be sorry you could.”
Translated and improved by D.M
Dov Michaeli, MD, PhD is a basic medical researcher writing at The Doctor Weighs In.