Living on Planet Gout

My gout-infested left foot, photographed
in the ER on May 6th, 2026

In 19^th-Century literature, gout, the disease, signals seedy characters: cruel landlords, rapacious capitalists, maiden aunts judging your choice in men. Buth Austen and Dickens used “gout” as shorthand to indicate that this character didn’t understand current mores, because this character couldn’t walk out of the house without excruciating pain. In 21^st-Century literature, gout barely exists. Like malaria, it’s become something Anglophone writers no longer mention.

That’s why, when I was diagnosed with gout last week, my first thought was: I’ve become an anachronism. Based on the Availability Heuristic, a logical fallacy, gout seems rare today because it’s mainly mentioned in older literature. But gout remains, indeed, remarkably common. It’s not that the disease doesn’t exist anymore, it’s that we’ve stopped talking about it. As I’ve needed to think about it recently, I’ve reached some conclusions.

Austen and Dickens used gout as a moralistic shorthand which their intended audiences simply understood. That context has drifted away. We can consider why this happened by what causes gout. Though the underlying cause is usually medical, like kidney disease or cancer, the proximate cause to symptom flares is usually lifestyle-related, and reflects the foods we eat. It’s common after consuming salt and sugar, but especially animal proteins and alcohol.

When Austen and Dickens wrote, meat agriculture and brewing were still labor-intensive processes that racked up costs which knocked onto consumers. Not that people didn’t eat meat or drink alcohol in older times; venerable traditions like Christmas hams and Saturday booze-ups preceded these authors. But they were less common indulgences. Only when automation streamlined production did most people consume red meat and liquor regularly.

Victorian authors wrote when most ordinary citizens subsisted on diets composed mainly of cheap carbohydrates. As Paul Graham writes, before the 20^th Century, most people’s diets consisted more than half of bread, not because it was highly nutritious, but because it left people feeling full. More nutritionally dense foods, like vegetables, protein, and seeds, kept humans alive, but weren’t very filling. Also, without salt and spices, they often tasted bland.

Humans evolved in conditions where vital nutrients like magnesium, calcium, and zinc were abundant, but sodium, protein, and sugar were rare. These latter three are necessary in appropriate quantities. However, because they’re rare in nature, our bodies retain them greedily, while our kidneys process away the more abundant nutrients in our urine. As Dr. Janet Bond Brill writes, modern diets after automated agriculture are backward to our bodies’ processing abilities.

A Victorian cartoon of the capitalist
hierarchy (click to enlarge)

The landlords, capitalists, and sexually repressed older relatives who populated Victorian moral fables, were therefore coded as having the resources to consume steak, wine, and dessert. In a time when these foods were uncommon and expensive, simply having gout meant these characters had enough money to spend it on themselves, not their families or communities. Marx would later shorthand such characters as “the bourgeoisie.”

But economic conditions have changed. Not only do more of us have more money, but a combination of extractive farming, automated production, and government subsidies have made once-expensive foods downright cheap, in constant dollar terms. Red meat and wine, once occasional indulgences, have become snacks we gobble without thinking. Convenience foods, the staple of poverty diets, are flush with sodium and protein that only the rich could once afford.

Gout is, therefore, no longer a moral judgement on individuals; it represents a consumer society. While not everyone has gout, we who do are more likely to have painful flares earlier and more often than our ancestors did. In Victorian times, switching to a gout-resistant diet meant eschewing self-indulgent goodies which most people couldn’t afford. Today it means pricier, unsubsidized fresh ingredients. Gout has become the default, not the exception.

Maybe that’s partly why the anti-bourgeoisie revolution Marx predicted never occurred. Not because we aren’t disfranchised like our ancestors during the Industrial Revolution, but because our society buys our loyalty with cheap treats. Marxist revolutionary art often specifically depicts the bourgeoisie class overeating and drinking. Nowadays, excessive rich food is a sign of poverty, not wealth. Time and capitalism have overturned Marx’s economic equilibrium.

If you’ve never had gout, I don’t wish it upon you. The excruciating pain is often poorly placed; I could barely walk for a week, as putting any weight on my left foot caused nearly the worst pain I’ve ever experienced. However, statistically, you’re more likely to have flaming gout flares than virtually any generation ever. And preventing that won’t be possible through good individual moral choices; it requires amending an indulgent economic system.