Gout has been dubbed 'the disease of kings, and the King of diseases'. Alexander the Great, Henry VIII, Voltaire, Benjamin Franklin and many other great men have woken up in the middle of the night with the agonizing joint pain associated with the chronic ailment. A recent study backs up the long held assertion that gout was once the affliction of the wealthy and powerful, but this is of little succour to modern day sufferers. Incidences of the disease are on the rise, and we don't have to be next in line to the throne to be at significant risk.

The disease is typified by excessively swollen and extremely painful joints, usually in the big toe. It can move on to the ankles, knees, wrists and elbows, affecting one joint at a time. The pain associated with gout is legendary, and most often strikes at night, when even bed sheets can be too much pressure on the afflicted area.

Thanks to new studies by Dr. Hyon K. Choi, a rheumatologist at the Massachusetts General Hospital, we now know that there are elements of truth to the age-old assumptions about this painful disease, but also that they don't tell the whole story. Gout is caused by the excessive build-up of uric acid in the blood, which leads to a condition called hyperuricemia. Uric acid is a waste product caused when the body breaks down chemicals called purines -- which are tiny particles of DNA left over after the natural process of human cell growth. Uric acid is excreted with urine, but if there is an excessive build up, tiny crystals can form on the joints. White blood cells attack these crystals, causing the inflammation, pain and swelling common to the disease. Purines are also present in a variety of foods -- none of which would be out of place on the groaning banquet table of a highborn regent. But unlike days of yore, most North Americans have access to the same princely menu items.

It has long been known that alcohol consumption inhibits the excretion of uric acid. Now, Dr. Choi has confirmed the links between gout and obesity, and also the association between the disease and rich foods such as meat, cream sauces, and more surprisingly, seafood. Dr. Choi discovered, in a study published recently in the Archives of Internal Medicine, that obesity contributes to the incidence rate of gout in two distinct but related areas. Firstly, those who are overweight are more likely to consume richer foodstuffs on a regular basis. Secondly, a larger body mass means a greater surface area for the development of purines, and a higher likelihood of hyperuricemia.

Dr. Choi's study involved 47,000 men and showed that those who ate the most meat were 41 per cent more likely to develop gout, while seafood eaters increased their chances by 51 per cent. Those who substituted several glasses of skim milk for alcohol decreased their chances by almost 30 per cent. Gout sufferers are also at higher risk for developing cardiovascular diseases.

At-risk patients should consider substituting fish-oil capsules for seafood, and significantly cutting down on meat, rich sauces and alcohol. There are drugs on the market that can help control hyperuricemia, as well as the pain associated with gout. But in this case, prevention is the best cure. Perhaps the diet of a pauper may befit us better than the repast of a king.