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Presidential maladies: gout and Grover Cleveland

Posted on Feb. 18, 2013 ( comments)
In honor of Presidents Day this month, we've asked MultiCare's health experts to look back at the ailments of past U.S. presidents, then offer their perspective on how these conditions might be treated differently today. This look at President Grover Cleveland's poor lifestyle choices and ensuing complications is the second in our series, "Presidential Maladies."

The president: Grover Cleveland

The year: 1885

The malady: obesity and gout

Description: What does it take to be named Fitness Magazine’s unhealthiest president? For 22nd president Grover Cleveland, it was obesity, an insatiable appetite for food, alcohol, and cigars, and a long battle with gout that earned him the top spot.

“Uncle Jumbo,” as his nieces and nephews called him, is believed to have suffered from gout as early as 1885, when he was seen limping at the funeral of Ulysses Grant. By Cleveland’s last day in office in 1897, his gout was so painful he could barely stand. He walked with a limp and his foot heavily bandaged.

Gout is caused by too much uric acid in the blood, which can build up in joints and form hard crystals. The chances of developing gout are much higher for people who are overweight and tend to overindulge on alcohol (beer, in particular), meat and fish. Cleveland loved to eat and drink, especially beer. Historians relay a story in which Cleveland and a friend decided to limit themselves to four glasses of beer each day, before deciding that ration was much too skimpy and upping their supplies.

“In Grover’s day it was known as the rich man’s disease, because it could be brought on by excessive consumption of meat, fish, and alcohol (especially beer) and aggravated by obesity. In cartoons, sufferers were caricatured as rich, fat and lazy, sitting with bandaged feet resting on stools. Grover was certainly not lazy, but his gluttonous proclivities and aversion to exercise were practically a recipe for gout, and the ailment would plague him for the rest of his life.” (Source: The President is a Sick Man: Wherein the Supposedly Virtuous Grover Cleveland Survives a Secret Surgery at Sea and Vilifies the Courageous Newspaperman Who Dared Expose the Truth.)

The most common sign of gout is a nighttime attack of swelling, tenderness, redness, and sharp pain in the big toe. Gout attacks can also occur in the foot, ankle, or knees, or other joints. The attacks can last a few days or many weeks before the pain goes away. Another attack may not happen for months or years.

How treatment is different today:

A carefully managed diet can help manage gout - eating moderate amounts of a healthy mix of foods to control weight and get necessary nutrients, and limiting daily intake of meat, seafood, and alcohol (especially beer). Drinking lots of water and other fluids is a must. In short, making healthy lifestyle choices and avoiding the risk factors that can lead to an attack of gout.

Obesity is complex issue with a multitude of factors playing into its causes. Eating less and being more active are not enough on their own. They are surface treatments that can be fuel for a century of diet and exercise regime – many of which can become downright dangerous,says Peggy Norman, a coordinator with MultiCare’s Family Wellness Program.

Top of the line treatments today would include:

  • An in-depth medical assessment to rule out any underlying factors that may be fueling his appetite or affecting in energy level.
  • Motivational interviewing to determine readiness to change.
  • A personalized eating and activity plan, short term goals, perhaps a health coach, perhaps he would agree to counseling if emotional eating is the issue.
  • Referrals to AA and Smoking cessation might be encouraged.
“I would like to think we are more sensitive to the complexity of weight today and would not judge a President by his height, race, gender, or size,” says Norman.

MultiCare's Pediatric Weight and Wellness Program provides access to specialists and health care professionals with expertise in helping families make healthy changes. MultiCare also offers Family Wellness Groups, featuring multidisciplinary programs designed especially for children, teens, and their parents. Participants learn to take charge of their eating habits and to become proficient in expressing and dealing with their feelings. Family Wellness does not promote restrictive dieting, and instead guides parents in supporting their children through effective limits, nurturing, and communication.

Historical significance:

Cleveland’s poor bill of health caused him much discomfort throughout his life and presidency. During his third campaign for presidency in 1892, his poor health allowed him to make just a handful of public appearances. Despite this, he spent his second (non-consecutive) term in office dealing directly with a Treasury crisis and depression, and was able to save the Treasury’s gold reserves. Cleveland suffered a heart attack in 1908 and died at the age of 71. His New York Times obituary cited gout and gastric attacks as the cause of his heart failure.

Read more: A Modern Look at Woodrow Wilson's Stroke.

Read more: JFK's Adrenal Disease

Posted in: Healthy Living | History

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