Beer makes a good servant but

Beer makes a good servant but a very bad master; a short story.

“Mr L, I’m sorry, but this pain in your sacro-iliac joint just does not present in the normal way. There is something very odd about it; tell me again.”

“Well it all started very suddenly and for no reason. I had not been gardening, or on a long journey. I have not turned the mattress this week, and the wife and I haven’t indulged.”

I nodded trying not to grin; it is amazing how often men have lower back trouble after sex. Then I know they’re not doing their exercises before going to sleep. “Describe the pain for me.”

“It’s severe; the worst pain I have ever had.”

This page was updated on 9th May, 2023.

“Now wait a minute, when you pulled a muscle in your right shoulder, um, let me look; oh yes, a year ago, just before Easter you said that pain was the worst you’d ever had.”

“That's true. And that pain in my middle finger was bad too.”

“Odd that was exactly two years ago. Well, anyway,” I said to Mr L, “this just doesn’t present like a spinal problem. So, I am not going to adjust the joint.”

“Oh, please, anything for some relief. Last night the only escape I could get was to lie on my hand on the other side, and lift that hip up off the bed.”

“Gosh and how long did you lie like that?”

“As long as I could, then I’d collapse on the bed again, the wife would bring me another ice-pack, or I would get up and roam the house; lying down was the worst.”

“Look, I hate to say this, but take a couple anti-inflammatories for three days, and let me see you on Thursday. We may need some X-rays.”

“X-rays! Why?” Mr L demanded.

I answered evasively. You don’t want to tell the patient he might have cancer, or something else bizarre, without good reason. “I just do not have a diagnosis, and this worries me. Is your prostate okay? How many times a night do you get up?”

“At least twice; occasionally three times.”

“Well, you may have to see a urologist too. That’s getting to be quite frequent.”

Three days later the mysterious pain had gone, just like the pain in his thumb and shoulder.

It was whole year later that I noticed Mr L’s name in the appointment book again. Oh damn, I wonder what he has got this time, I wondered, watching him hobbling down the corridor to my office, slipper on his left foot, obviously in severe pain again.

“Kicked the dog, this time, Mr L?”

“No! But my big toe, it’s so sore; swollen too.”

“Let’s have a look at it.”

Gingerly Mr L eased his slipper off, grimacing. If I’d switched the light off, I am sure I would have been able to see it glowing in the dark; red-hot, swollen and inflamed. In fact the swelling affected the whole foot and the inflammation was beginning to stretch up his leg.

 “What’s it this time, doc?”

“No doubt about it, Mr L, you have gout.”

“Gout! But I don’t drink wine. I am not much into red meat; and we do not eat that rich French cuisine.”

“What about mushrooms and beer?”

Mr L hung his head. “I’ve been drinking too much. You are right, and we had mushrooms this week.”

“How many pints is too much, Mr L? Is it only beer?”

He nodded. “Two quarts a night.”

“Mm, that is a lot. Every night?”

“Most nights.”

“During the day? Ever get drunk?”

“No, I never drink in the day. And I don’t get drunk but the good wife says I do get silly. I am usually in bed and asleep by eight-thirty.”

“Why so much, Mr L? You do realise this means you’re an alcoholic?”

“I s’pose but I do not get drunk. And I never drink in the day!” he added hotly.

I nodded. “But nevertheless, it’s obviously the cause of all these bizarre pains you have been experiencing.”

“I don’t think so.”

“Why not? Beer’s the major cause of gout.”

“Because I stopped three days before this began.”

“You quit?”

“Look, I know I’ve been drinking too much and just to prove to myself, and she who must be obeyed that my beer still only has servant status in my life, I quit every year for Lent.”

I knew Mr L was quite religious. “Mm,” I said, musingly. “So you quit for about six-weeks every year. That’s good.” Turning to my computer, I googled “lent” in search of the dates.

“By George, every year we have a pancake evening on Shrove Tuesday; and I always choose the mushroom filling.”

“Shrove Tuesday?"

“That’s the beginning of Lent.”

Checking his file against the dates on Google over the last few years, sure enough, three to four days after Shrove Tuesday, Mr L was man-down. 

“But why after I quit the booze? Next year, instead of taking the damned pills, I’ll just start the beer again!”

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Beer makes a good servant but a very bad master.

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We laughed together, easily. “I think I have it. It is probably partly the mushrooms but the major factor is that every year, at the beginning of Lent you drink two quarts less liquid every night. That’s what washes away those uric-acid crystals that are being embedded in your joints.

"I’m just not going to give up beer for Lent any more. It hurts too much; perhaps chocolates next year. And that mushrooms filling seems to trouble me," he added, jokingly.

I smiled. “Seriously, it’s good that you can give up your booze cold-turkey like that. But still it is far too much alcohol. So, between every glass of beer, have a shot of water; and try and stick to one quart.

“Right, I’ll start tonight,” he said with a wink.

“But it’s Lent!" It is indeed good to prove to yourself that beer is your servant, not your master. But do go on having a quart of water every night through Lent if you quit.

“And this toe?”

“Ice it, sleep with an icepack on it, in a sock; and take one anti-inflammatory every night before bed. Will you phone me in a week please.”

Mr L nodded, giving me a sheepish smile, and left. He phoned a week later, the pain in his toe nearly over. And added, “I don’t know if I told you doc but I get severe heartburn at least two or three nights a week, and have to sit up for two hours. In fact it was so bad, I had to have a gastroscopy^[1]. My doc was worried about a tumour. It also gave me a sore throat for two months.

Well, since I stopped the beer, guess what? I have just realised, in Lent I don’t get heartburn either! And I do not have to get up at night to pee."

“You writing another one of your damned blogs?”

I nodded, glancing up at she who is always right.

“Who are you writing about this time?” she demanded imperiously.

“Me!” I dared not mention that my heartburn was a matter of the past. "I told you so." She wouldn't let up for months.

What is the main trigger for gout?

I am a gout sufferer. I have had five attacks in the last ten years; only one was bad and it started indeed when I gave up beer and started drinking large amounts of freshly-squeezed orange juice instead.

For me acidic fruit is the main trigger for gout. The current bout has been set off by a bumper harvest of cherry guavas.

In men gout is the most prevalent inflammatory arthritis; I can confirm that attacks, infrequent in my case are exceptionally painful. Twice I have not been able to wear a shoe.

So the saying goes, beer makes a good servent but a very bad master; all alcohol, of course. But it's not the cause of my gout; I have to beware of acidic fruits.

What foods causes gout?

Traditionally it's reckoned that red meat and shellfish are the chief causes of gout. I eat very little of either, so they are not the villains of the peace for me.

It does remain a mystery disease for me. Meat does not cause it, neither does beer. Why is it in the right foot sometimes; and then the next the left is afflicted?

Alcohol is also traditionally one of the causes of gout but I drink quite large amounts of natural mead and am unaffected; two or three glasses most evenings.

Even this cherry guava mead does not afflict me; but the fresh fruit does. It is my favourite. Beer makes a good servant but it's not the cause of my gout.

Mayo Clinic fingers fructose. That in my experience is the chief cause of my gout; in fresh acidic fruits. In mead the sugars are fermented into alcohol.

• Cherry guava honey mead

There have been huge increases in the prevalence of gout in recent times; high fructose corn syrup is a likely cause.

Ketogenic diets

It's generally accepted that the ketogenic diets increase the likelihood of a gout attack. It is probably caused by the large amounts of purines in the red meat that is advocated to replace protein from legumes; because of their starch.

The Modified Banting Diet^[5] gets around this by advocating low refined carbs; legumes are actually encouraged.

Orange juice

I have one more little fact to add. These are only anecdotes but would provide interesting material for research.

When I gave up beer for Lent, I took to squeezing three oranges and drinking that instead of the alcohol. Particularly if the fruit is not quite ripe then it gives me a severe attack of gout. It's the acidity; one fruit is enough, and I now use the pulp too.

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