Are you afraid of the "devil's gnawing" that is more deadly than toothache and the "hurricane" on your toes?

——Gout Science Popularization: Diet

Author: Pan Jiawei, deputy chief nurse, Shanghai First People's Hospital

Fan Renjing Shanghai First People's Hospital

Liu Mingmin Shanghai First People's Hospital

Lu Lei Shanghai First People's Hospital

Zhong Zhijie Shanghai First People's Hospital

Reviewer: Zhao Li, deputy chief physician, Shanghai First People's Hospital

As the saying goes, "toothache is not a disease, but it is really painful when it happens." However, there is a kind of pain that is even worse than toothache, like a sudden storm that violently attacks the human body, and it is the pain of acute gout. With the continuous improvement of living standards, hyperuricemia has become the "fourth high" after hypertension, hyperglycemia, and hyperlipidemia. Among patients with hyperuricemia, about 1/3 will develop gout. Gout is also the second largest metabolic disease after diabetes. In addition to being related to genetic factors, the occurrence of gout is also closely related to diet. Therefore, in addition to receiving specialized treatment for the disease, gout patients must also pay attention to diet. Diet management is essential for the prevention and treatment of gout.

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So what exactly is gout?

Gout, to put it simply, is a disease caused by impaired purine metabolism in the human body. If the metabolite of purine, "uric acid", is produced excessively or cannot be excreted, it will cause an increase in the level of uric acid in the blood. Uric acid that is not dissolved in the blood will be deposited in the joints, cartilage and other tissues in the form of urate crystals. Urate crystals are like small needles piercing the joints, constantly irritating the cartilage tissue, causing joint inflammation (typical manifestations: redness, swelling, heat, and pain), which is more common in the big toe. Imagine a needle constantly piercing the joint, how can it not hurt? Therefore, some people vividly describe the pain during a gout attack as "the devil's gnawing."

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So why does the uric acid level in the blood increase?

The sources of uric acid in our body are divided into two categories: endogenous uric acid and exogenous uric acid, of which endogenous accounts for 80% and exogenous accounts for 20%. Endogenous uric acid is a natural product of human metabolism, while exogenous uric acid is mainly decomposed from purine in food. The cleansing of uric acid in the body is mainly responsible for the kidneys and intestines, of which 2/3 of uric acid is excreted through the kidneys with urine, and 1/3 of uric acid is excreted through the intestines with feces. If the liver produces more uric acid, or the kidneys and intestines excrete less uric acid, the uric acid level in the blood will increase. The main causes of increased uric acid levels can be divided into the following three categories: ① Kidney disease or abnormal renal function causes reduced uric acid excretion; ② Excessive intake of high-purine foods causes excessive uric acid production; ③ Genetic factors cause abnormal purine metabolism. Knowing the reasons for the increase in uric acid levels in the blood, we know that dietary control plays a vital role in lowering uric acid levels.

So how should gout patients eat?

Please remember the mantra: "Don't eat too much": don't eat high-purine foods, alcoholic beverages, high-sugar beverages, and foods containing yeast; you can eat low-fat dairy products, poultry eggs, and soy products; eat more fresh fruits and vegetables, especially those rich in vitamin C. Let me tell you in detail below.

1. How do gout patients choose meat?

Gout patients should pay attention to the type, amount and processing method of meat when eating.

(1) Types: Eat more white meat (chicken, duck, goose, and freshwater fish, etc.), and less red meat (beef, lamb, pork, etc.); eat lean meat and less fatty meat; avoid eating animal offal as it has a high purine content; foods such as egg white, milk, and sea cucumber have a low purine content and can be appropriately chosen.

(2) Consumption: When there is no acute attack of gout, the patient's meat consumption generally does not exceed 100g per day. During an acute attack of gout, the patient's meat consumption should be reduced or even eliminated.

(3) Processing methods: Gout patients should try to eat fresh meat. Cured, pickled or smoked meats have high purine and salt content, which will interfere with uric acid metabolism and should not be eaten. When eating meat, you can boil it in water and discard the soup. Deep-frying, frying, braising or hot pot cooking methods are not recommended. Use less salt, sugar and spices when cooking.

2. How should gout patients eat vegetables and fruits?

Gout patients should eat more fresh vegetables and fruits in their daily lives, but the choice of vegetables and fruits also requires careful consideration.

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(1) Avoid eating too much fruit that is high in sugar (especially fructose), such as apples, oranges, longans, lychees, persimmons, and pomegranates.

(2) Lemons, cherries, olives and other fruits are recommended for consumption as they are beneficial for gout patients.

(3) Watermelon, coconut, grapes, strawberries, plums and peaches can be eaten in moderation.

(4) Most melons, tubers, roots and leafy vegetables are low-purine foods and are recommended for consumption.

(5) It is not advisable to eat too much plant-based foods with high purine content, such as dried shiitake mushrooms, straw mushrooms, asparagus, seaweed, and kelp.

3. How do gout patients drink water?

Drinking more water can reduce the frequency of gout attacks, lower the level of uric acid in the blood, and promote the excretion of uric acid by the kidneys through frequent urination. In the absence of contraindications such as kidney disease and heart failure, gout patients can do the following when drinking water: ① Drink 2 to 3 liters of water a day, and try to ensure that the daily urine volume reaches 2 liters; ② Drink water in divided doses, about 500 ml of water each in the morning, noon, and evening, but pay attention to drinking water in small amounts and multiple times, rather than drinking a large amount of water at one time. It is generally recommended not to exceed 200 ml at a time, and do not drink a large amount of water before and after meals; ③ Try to choose weakly alkaline, small molecule water for drinking water; ④ Add 1 to 2 fresh lemon slices to 2 to 3 liters of water for drinking, which helps to lower uric acid; ⑤ Drink coffee appropriately, but do not drink beer, etc.

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Regarding the prevention of gout attacks, in addition to the key control of diet, it is also necessary to maintain healthy living habits, keep weight within a normal range, exercise appropriately, and treat chronic diseases in a timely manner. As long as you follow the above suggestions, acute gout attacks will slowly stay away from you!