The first batch of post-95s have already started to suffer from gout...

The pain of gout is enough to make an eagle-like adult shed tears of regret. I used to think that gout is more common in old age, but I didn’t expect that a young person who has always controlled his diet and loved fitness would also get gout just because he climbed a mountain...

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That’s right! Like high blood pressure, cerebral infarction and other diseases, gout, which we once thought was an “old age disease”, has also begun to affect young people.

A study conducted by Wuhan Tongji Hospital from 2010 to 2019 surveyed 732,527 local adults. The results showed that the prevalence of hyperuricemia in people aged 20 to 39 increased from 22.5% to 40.1% in ten years , nearly doubling, which is the fastest increase in incidence among all age groups.

Another study conducted in Qingdao also found that in the past decade, the incidence of gout has shown a clear trend of younger people. In the survey, from 2013 to 2018, the average age of gout patients decreased by 4.14 years, and the proportion of early-onset patients under the age of 30 increased by 12%.

Therefore, the pain and fatal risks caused by high uric acid and gout are indeed gradually approaching young people.

01

How big is the impact of gout on health?

Hyperuricemia and gout are a continuous, chronic pathological process. Hyperuricemia is a metabolic syndrome caused by purine metabolism disorder. Regardless of gender, as long as the blood uric acid level exceeds 420μmol/L twice on different days, it is called hyperuricemia. When blood uric acid exceeds its saturation in the blood or tissues, sodium urate crystals will form and deposit in the joints, inducing local inflammatory reactions and tissue destruction, which is what we call gout.

Simply put, as long as the uric acid level in the blood exceeds the standard, it is hyperuricemia. When patients with hyperuricemia experience joint swelling and pain, it is gout. High uric acid levels may not necessarily cause gout, but gout is definitely caused by high uric acid. How high the uric acid level is to cause gout varies from person to person. Some people will develop the disease when the blood uric acid level is 400-500, while others have no symptoms at 700-800. Therefore, gout attacks are very hidden at the beginning.

Initially, it may be just redness, swelling, and inflammation of the fingers and toes. If you don’t pay attention, you may think it is just an ordinary muscle strain and fatigue, which basically will not affect normal life. But if you don’t pay attention, more crystals will be deposited, and the pain will gradually spread to large joints such as the knees and elbows. The pain will become difficult to ignore. The whole joint will show serious redness, swelling, deformation, and even burning sensation. When the attack occurs, it is often too painful to walk. Once the joints are stressed, they will produce bursts of continuous pain like needles. Some people can only lie in bed to rest when they have an attack. But even so, it is very uncomfortable. Gout often occurs at night, and there is often a sudden needle-like pain in the dream, followed by a sleepless night.

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After the pain, if uric acid crystals are deposited in the kidneys, they may also cause kidney disease, chronic interstitial nephritis or kidney stones, and in severe cases, they may induce fatal renal failure. In addition, because uric acid crystals can damage multiple organs and tissues throughout the body, gout is also associated with hypertension, diabetes, arteriosclerosis, coronary heart disease and other diseases. Therefore, gout is not only extremely painful, it can actually kill you!

So where does this terrible gout come from?

02

How does gout come about?

The root cause of hyperuricemia and gout is the problem of uric acid metabolism in the body. When uric acid is high, the risk comes.

Uric acid is the final product of purine metabolism in the human body. Under normal circumstances, 90% of uric acid will be absorbed by the human body, and the remaining 10% will be excreted from the body in the form of urine, sweat, and feces, so that the uric acid level in the body maintains a dynamic balance. However, if it is produced too much or is not excreted in time, it will lead to accumulation of uric acid in the body.

The human body produces uric acid continuously every day. These uric acids are divided into endogenous uric acid and exogenous uric acid. Endogenous uric acid accounts for about 80% of it, which is produced during the aging and decomposition of cells in the human body; exogenous uric acid accounts for about 20%, which is produced by the body in order to digest and decompose the purine substances ingested in food.

Although endogenous uric acid contributes about 80% of the total uric acid level, it is a normal metabolic product and does not affect our health. We cannot control this level - as long as the body is functioning normally, this part of the production is inevitable.

Excessive accumulation of uric acid in the body is mainly because we eat too well, resulting in excessive exogenous uric acid production. When the purine we ingest through food exceeds the limit of normal production and decomposition, it will lead to an imbalance in blood uric acid levels.

Some seafood, beef and mutton are common high-purine foods. No wonder gout was called a rich man's disease in the past - who can afford to eat meat and fish every day if they are not rich? However, with the development of the economy, ordinary people can now enjoy seafood, beef and mutton at will, so it is no wonder that gout has become common. Now that we know how gout comes, how can we avoid being targeted by "gout"?

03

How to stay away from gout? You can try these 9 points!

1

Eat seafood, beef and mutton in moderation!

If you want to reduce the risk of gout, you should first control the amount of seafood you eat. People who eat seafood frequently have a gout risk that is about 1.5 times higher than those who rarely eat seafood.

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China's coastal provinces, such as Guangdong, Jiangsu, Zhejiang, and Shandong, which are accustomed to eating seafood, are all high-incidence provinces of hyperuricemia and gout, with the incidence rate significantly higher than other provinces.

Excessive intake of beef and mutton will also increase uric acid levels. Inner Mongolia and Xinjiang, provinces with large beef and mutton consumption, also have a high incidence of hyperuricemia. Offal is also a major source of purine. Sichuan and Chongqing, which love to eat beef and mutton and are good at eating offal in various ways, also have a high incidence of gout.

In addition to the type of meat, the quality of the meat is also very important. Since a high-fat diet can promote uric acid metabolism disorders, you should try to choose meat with low fat content when eating it. It is best to blanch it before cooking to remove some purines. For example, when eating Chaoshan beef pot, just eat the meat and don't drink the broth. After all, Guangdong Province, which loves to drink traditional soup, is also a province with a high incidence of gout.

2

Vegetables and mushrooms should be eaten in moderation

There are also some high-purine players in fruits and vegetables and mushrooms, such as beans, spinach, cauliflower, seaweed, fungus, asparagus, celery, coriander, as well as shiitake mushrooms, tea tree mushrooms, nameko mushrooms, hericium erinaceus, hazel mushrooms, etc.

However, compared with animal-based high-purine foods, plant-based high-purine foods are not so "lethal". Some other nutrients contained in beans can help lower uric acid levels. Therefore, the guidelines for the diagnosis and treatment of hyperuricemia in the United States and Europe only recommend limiting the intake of animal-based foods, but do not limit the intake of purine-rich vegetables and purine-rich fruits.

3

Don’t drink or eat sugary drinks or desserts!

In addition to high-purine foods in the daily diet that directly affect uric acid levels, some other eating habits will aggravate the accumulation of uric acid.

High-sugar foods, especially high-fructose foods, accelerate the formation of uric acid. A survey conducted in the United States found that excessive intake of added sugar through sugary soda will significantly increase the prevalence of hyperuricemia. Compared with those who do not drink sugary soda, young men aged 20 to 34 who have the habit of drinking sugary soda have a 1.5-fold increased risk of the disease, and those aged 35 to 49 have a 1.5-fold increased risk.

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Since estrogen can inhibit the decomposition of purines and increase uric acid excretion, the incidence of hyperuricemia in women is lower than that in men, and it often occurs when estrogen levels decrease before and after menopause. However, the intake of added sugars can also affect the incidence in women. The incidence of women over 35 years old also increases by 1.6 to 2.3 times due to excessive intake of added sugars.

Although sugary drinks do not directly cause gout, they may be the last straw that breaks the camel's back. If you are already on the verge of developing hyperuricemia or gout, then quitting sugary drinks may really save you from the torture .

4

Losing weight properly is really healthier

Obesity also amplifies the impact of added sugar on the prevalence of hyperuricemia. Obesity alone will increase the risk of hyperuricemia. The mechanism may be that excessive fat accumulation will produce and accumulate uric acid, especially the accumulation of visceral fat will lead to a surge in uric acid production. Obese people are usually accompanied by a series of metabolic disorders such as hyperuricemia and diabetes.

If you are obese and have the habit of drinking sugary drinks, then the risk is doubled. The above survey conducted in the United States found that regardless of age and gender, people who are obese and consume too many sugary drinks are more likely to suffer from hyperuricemia than others. Among them, young men who are obese and drink sugary drinks have a 3.4 to 7 times higher risk of disease than those with normal body shape and do not drink beverages. If it is a middle-aged man who is obese and drinks sugary drinks, his risk of disease is directly increased by 6.3 to 29.9 times.

5

Fruits can be eaten in moderation, just choose the right ones and you will be fine

In addition, it should be noted that the connection between a high-sugar diet and gout is mainly due to added sugar, that is, sugary drinks, desserts, syrups, etc. should be eaten less or not. However, there is no need to worry too much about the "natural sugar" in fruits and vegetables. Although consuming a large amount of rich fruits in a short period of time will lead to increased uric acid levels, eating a moderate amount of fruits regularly can promote the excretion of uric acid. Therefore, even if you are already a gout patient, you can still choose fruits with low fructose content, such as watermelon, strawberry, pineapple, cherry, blueberry, etc.

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Eating a moderate amount of fruit every day, which is rich in dietary fiber and vitamins, is very important to the human body. Vitamin C has also been shown by studies to play a role in regulating blood uric acid levels.

6

This time, drinking more water really helps

Since we need to use water as a carrier to excrete excess urea in the form of urine and sweat, if we do not drink enough water for a long time, the excretion of uric acid will be affected. Drinking too little water is a risk factor for hyperuricemia and gout. If gout has already occurred, drinking more than 2000ml of water a day to increase uric acid excretion can also help relieve gout.

7

Coffee, drink in moderation!

If you feel that pure water is not effective enough, you can try coffee.

Two studies in the United States found that people who drank more than four cups of coffee a day had a 40% lower risk of gout than those who did not drink coffee. Another study conducted in the UK found that people who drank three cups of coffee a day also had a significantly lower risk of the disease.

However, since excessive coffee intake can also cause other problems, you must drink coffee in moderation. Drinking just one cup of coffee a day can actually reduce the risk of gout . The more likely reason why Americans and British drink so much is... they really love to drink coffee like water.

8

Don't drink any alcohol!

Many people should know about the relationship between alcohol and gout, but a common misconception is that only beer is harmful, and both white wine and red wine are fine. In fact, any alcohol will increase the risk of disease, and beer is just the most harmful one. If you are already a gout patient or have a high risk, don't think that drinking alcohol can relieve your worries, because the more you drink, the more worries you will have.

In general, preventing gout actually has a lot in common with losing weight - controlling your diet and moving your legs, it really works.

9

Moderate exercise is healthier

However, not all leg-stretching exercises are suitable for patients with hyperuricemia and gout. Just like the 29-year-old girl at the beginning, excessively high-intensity exercise can sometimes induce gout.

During high-intensity anaerobic exercise, a large amount of uric acid raw materials, adenosine and hypoxanthine, are produced in the muscles for energy supply. After metabolism, they increase the blood uric acid concentration in the body. The increased sweating and reduced urine volume caused by intense exercise will also affect the excretion of uric acid. After high-intensity exercise, a large amount of lactic acid will also be produced in the muscle tissue, which will lower the local pH value, promote uric acid crystallization, and further hinder uric acid excretion.

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Therefore, low-intensity aerobic exercises such as brisk walking, jogging, and swimming are good choices, while high-intensity exercises such as sprinting, football, and mountain climbing are not suitable.

In short, since gout cannot be cured, once it strikes, it will accompany you for the rest of your life like a ghost. It is best to plan ahead and monitor your uric acid level early. Don't wait until you start to feel pain before you regret it, because it will be too late.

References

[1] Chinese Society of Endocrinology. (2020). Chinese Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout (2019). Chinese Journal of Endocrinology and Metabolism, 036(001), 1-13.

[2] CBNData. (2022). 2021 China Hyperuricemia and Gout Trend White Paper

[3] Wan, Z., Song, L., Hu, L., Lei, X., Huang, Y., & Lv, Y. (2021). Temporal trends in hyperuricaemia among adults in Wuhan city, China, from 2010 to 2019: a cross-sectional study. BMJ open, 11(3), e043917.

[4]Gao, Q., Cheng,

[5] Álvarez-Lario, B., & Macarrón-Vicente, J. (2010). Uric acid and evolution. Rheumatology, 49(11), 2010-2015

[6] Danve, A., Sehra, ST, & Neogi, T. (2021). Role of diet in hyperuricemia and gout. Best practice & research Clinical rheumatology, 35(4), 101723..

[7]Aihemaitijiang, S., Zhang, Y., Zhang, L., Yang, J., Ye, C., Halimulati, M., ... & Zhang, Z. (2020). The association between purine-rich food intake and hyperuricemia: A cross-sectional study in Chinese adult residents. Nutrients, 12(12), 3835.

[8]Zhang, Y., Chen, S., Yuan, M., Xu, Y., & Xu, H. (2022). Gout and diet: a comprehensive review of mechanisms and management. Nutrients, 14(17), 3525.

[9]Lin, WT, Kao, YH, Lin, HY, Li, MS, Luo, T., Fritz, JM, ... & Tseng, TS (2021). Age difference in the combined effect of soda drinks consumption and body adiposity on hyperuricaemia in US adults. Public Health Nutrition, 24(17), 5756-5768.

[10]Chen, Y., Zhang, N., Sun, G., Guo, X., Yu, S., Yang, H., ... & Sun, Y. (2016). Metabolically healthy obesity also has risk for hyperuricemia among Chinese general population: a cross-sectional study. Obesity research & clinical practice, 10, S84-S95.

[11]Tsushima, Y., Nishizawa, H., Tochino, Y., Nakatsuji, H., Sekimoto, R., Nagao, H., ... & Shimomura, I. (2013). Uric acid secretion from adipose tissue and its increase in obesity. Journal of Biological Chemistry, 288(38), 27138-27149.

[12]Gong, M., Wen, S., Nguyen, T., Wang, C., Jin, J., & Zhou, L. (2020). Converging relationships of obesity and hyperuricemia with special reference to metabolic disorders and plausible therapeutic implications. Diabetes, Metabolic Syndrome and Obesity, 943-962.

Planning and production

Author: Shi Nanping, a popular science writer

Reviewer: Tang Qin, Director and Researcher of the Science Popularization Department of the Chinese Medical Association

Planning丨Yinuo

Editor: Yinuo