Gout has been called the disease of kings because European royalty appears to have been disproportionately afflicted by the disease. Monarchs and other luminaries were described as having arthritic attacks that are strongly suggestive of gout attacks. And paintings done at the time show deformities that look to be tophi, the nodules of uric acid crystals characteristic of untreated gout.

Several years ago, Spanish researchers confirmed that Holy Roman Emperor Charles V (also known as King Charles I of Spain) was a gout sufferer. They used a scanning electron microscope to examine a finger that had been preserved separately from the rest of his body. They saw needle-shaped crystals containing large amounts of sodium, which is a solid clue that the Charles V had gout. This wouldn’t have been news to the emperor: he wrote about having gout in correspondence to his sister.

Gout may have run in some royal families. Another factor might have been exposure to the lead acetate (so-called lead sugar) that was added to wine to make it sweeter. Gluttonous appetites for food and drink that only royalty had the means to satisfy might also be to blame. Charles V gorged on meat and drank large amounts of beer and wine.

Now people from all walks of life can afford to eat and drink like kings, and some get the disease of kings as a result.