Can controlling your diet cure gout? 6 common rumors, all explained

Recently, the news that "a man with gout blindly took painkillers for a long time and suffered kidney failure before he was 40" has become a hot search. The man had a history of gout for ten years and took painkillers on his own when gout attacked. Before he was 40, he had severe deformities in multiple joints and suffered kidney failure.

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Gout is a disease that is widely known, but there are many misunderstandings about it, some of which may delay the treatment and lead to serious consequences. For example, the widely circulated "Can gout be cured by taking painkillers? Will gout cause high uric acid levels? The lower the uric acid level, the better?" Let's analyze them one by one.

Gout treatment only

Just take painkillers?

**Analysis: **Gout is not a single disease, but a syndrome. **The clinical characteristics of gout are recurrent acute arthritis and chronic manifestations: **tophea, ankylosis, joint deformity, renal parenchymal damage, urinary tract stones, hyperuricemia. Gout patients are often accompanied by metabolic abnormalities in the body, and are prone to complications such as obesity, hypertension, hyperlipidemia, and type 2 diabetes.

Some people with gout do not restrict their diet and take painkillers to relieve pain when an attack occurs. Although the principle of acute gout treatment is indeed to quickly control joint inflammation and pain, gout is a chronic disease and oral uric acid-lowering drugs are still needed for long-term uric acid-lowering treatment after the acute phase of gout.

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Long-term control of blood uric acid levels can reduce the frequency of gout attacks. Abuse of painkillers will not only delay the treatment of gout, damage liver function, and damage the gastric mucosa to cause gastric bleeding, but more seriously, if gout crystals block the renal tubules, they will cause renal failure.

**The truth: **Painkillers only relieve the symptoms of gout attacks, but do not really lower uric acid and treat gout. Uric acid-lowering treatment should be started after the acute gout symptoms disappear completely (≥2 weeks). Otherwise, gout will recur and even lead to serious complications such as renal insufficiency and uremia.

Joint pain but no high uric acid

Surely it's not gout?

**Analysis: **The body's blood uric acid level will fluctuate. The test results are closely related to the meal conditions on the day before the test, such as whether it is a low-purine diet, and the stage of the disease.

Not all gout patients have high uric acid levels. 30% of patients have normal uric acid levels during acute attacks. **Some gout patients have even lower blood uric acid levels than usual during acute attacks. **Because during acute attacks of gout, the human body is in a state of stress, the body often fully exerts its self-regulatory function, secretes anti-inflammatory factors, and a large amount of uric acid is precipitated from the blood and deposited in the joints. At this time, the uric acid content in the blood is relatively reduced, and the test results of some patients can even be normal. If you don't understand this, it is easy to miss or misdiagnose.

**The truth: **If you have joint pain but low uric acid, do not easily deny the diagnosis of gout. People with particularly typical gout symptoms but low blood uric acid should have their blood uric acid rechecked after the acute phase to avoid missed diagnosis.

When gout attacks

Should antibiotics be used for treatment?

**Analysis: ** Gout is an aseptic inflammation caused by supersaturated urate crystals deposited in joints and surrounding soft tissues. In acute attacks, the affected joints become red, swollen, hot, painful, and dysfunctional, but because they are sterile, antibiotics are ineffective. Even if early gout is not treated, it will gradually improve within 3 to 10 days, and patients may mistakenly believe that antibiotics have a certain therapeutic effect on gout. Most antibiotics need to be excreted through the kidneys, which may interfere with the normal excretion of uric acid, causing an increase in blood uric acid and exacerbating the condition.

**Truth: ** Unless there is conclusive evidence that the gout patient has an infection, antibiotics are prohibited for treating gout attacks.

Through simple dietary control

Can gout be controlled?

**Analysis: **The occurrence of hyperuricemia and gout is closely related to diet and lifestyle. A healthy eating pattern, such as food diversity, purine restriction, sufficient vegetable and dairy products, fructose restriction, sufficient water intake, and alcohol restriction, combined with weight control, can have a positive impact on the incidence of gout and blood uric acid levels.

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However, hyperuricemia and gout are caused by the combined effects of genetic factors, lifestyle and environment. **Only 20% of uric acid in the human body is produced by the metabolism of purine in the food we eat, and the other 80% comes from our own cell metabolism. **Strict dietary control can only reduce blood uric acid by 60~90umol/L at most.

**The truth:** The onset of gout is related to many factors. Gout cannot be completely controlled by simple diet control, and it is difficult to maintain diet control for a long time. Gout patients often need drug intervention.

Can I stop taking the medicine once my blood uric acid level reaches the standard?

**Analysis:** Many people believe that drugs for the treatment of gout are toxic to the liver and kidneys, and should be avoided as much as possible. Whether the drug can be discontinued is mainly determined by the patient's blood uric acid level, the dose of the uric acid-lowering drug, and whether tophi are present. If the patient has no evidence of tophi, and can maintain long-term uric acid standards through low-dose uric acid-lowering drugs on the basis of lifestyle intervention, or even through simple lifestyle intervention, blood uric acid standards can be achieved, then discontinuation of uric acid-lowering drugs may be considered. ** In the process of discontinuing the drug, the principle of gradual reduction and regular review must be followed. ** If the above conditions cannot be met, uric acid-lowering drugs cannot be discontinued.

**The truth: ****After the blood uric acid level reaches the target, the medication cannot be stopped at will. **For patients with asymptomatic hyperuricemia and gout, whether they are in the treatment stage or the medication withdrawal stage, regular follow-up is required to pay close attention to the blood uric acid level and evaluate target organs such as the kidneys.

The lower the blood uric acid level, the better?

For patients with gout, the blood uric acid level is strictly controlled. Long-term control of blood uric acid < 360 µmol/L can not only dissolve urate crystals, reduce the number of crystals and shrink their size, but also prevent the formation of new crystals. For patients with tophi, the guidelines recommend a level below 300 μmo/L.

Blood uric acid is a natural antioxidant in the body that can protect the nervous system and improve human immunity. Low blood uric acid levels may increase the risk of neurological diseases such as Alzheimer's disease and Parkinson's syndrome. Therefore, the lower the blood uric acid level, the better!

The truth: For patients with asymptomatic hyperuricemia, the lower the blood uric acid level, the lower the incidence of gout, but the lower the blood uric acid level is not necessarily better . It is generally recommended that the target level for lowering uric acid should not be lower than 180 μmol/L.

**Warm reminder: **According to the monitoring data of chronic diseases and risk factors in my country in 2018, the prevalence of hyperuricemia among adult residents in my country reached 14.0%, and the prevalence among young men (18-29 years old) reached 32.3%, showing a significant trend of younger age. There is still a distance from high uric acid to gout attacks. Reasonable diet control, proper exercise, and standardized drug treatment can keep uric acid at the standard level for a long time and reduce the number of gout attacks.

Planning and production

Author: Hu Zhongdong, deputy chief physician, registered dietitian, health manager, and speaker of the Healthy China Action

Reviewer: Zhang Yu, Researcher at Chinese Center for Disease Control and Prevention

Editor: Ding Zong

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