This question is very representative. Many gout patients know that the onset of gout is related to high uric acid, which is converted from purine. Therefore, "eating less or not eating food with high purine content" has become the main means for many people to control gout. However, a large number of people will find that gout will recur even if the taboo is strict. This is because only 20% uric acid is ingested through food, and the other 80% uric acid is synthesized by our body (liver synthesis). Therefore, only relying on diet to control gout, even if the taboo is strict, can not completely eliminate the recurrence of gout. If gout recurs, ask yourself the following questions.
First question: Is your uric acid level stable?
Uric acid is closely related to gout. Only when uric acid is maintained at a stable level will it have a long-term stable effect. If you want uric acid to be stable, you can't do without drug therapy, such as drugs that inhibit the formation of uric acid and drugs that promote uric acid excretion. Some people take medicine when gout attacks, and then stop taking medicine after remission. Uric acid value fluctuates from time to time, which easily leads to recurrent gout. Patients with gout can check uric acid regularly every month and adjust the treatment plan.
Serum uric acid level should be controlled below the target value. Generally speaking, the blood uric acid level exceeds 420 micromoles/liter, which is hyperuricemia. It is suggested that patients with gout with tophus should reduce their serum uric acid to below 300 μ mol/L, and patients without tophus should reduce their serum uric acid to below 360 μ mol/L, which can not only prevent gout attacks, but also promote the dissolution of existing urate crystals. If the uric acid level reaches the standard for a long time, it can be reduced or even stopped under the guidance of a doctor, and the recurrence can be prevented by controlling the diet. It should be noted that uric acid should not be lowered too fast, and uric acid will drop too fast, which will also induce acute gout attack.
The second question: Is your taboo correct?
Many gout patients know that "seafood, meat and bean products" can't be eaten, which is very general. Because in aquatic products, such as mandarin fish, perch, salmon, sea cucumber, jellyfish, etc., the purine content is not high. After some meat is cooked, the purine content will also drop significantly. Among vegetables, mung bean sprouts, mushrooms, laver, soybean sprouts, asparagus and so on. They are all high purine foods. Taboo should still refer to the purine content in food. If 150 mg/100 g belongs to high purine food, gout and hyperuricemia should be avoided as far as possible. Purine content is between 25 150 mg/100 g, which belongs to medium purine food and can be eaten in limited amount in non-acute phase. 25 mg/100 g is a food with low purine content and should be the main food in daily diet.
We should regard gout as a chronic disease like hypertension and diabetes. It is very important to avoid eating, especially for patients with acute attacks, but it should be "restricted" rather than "forbidden", and it should not be at the expense of nutritional needs and quality of life.
The third question: Is your weight under control?
Obese people are more likely to suffer from gout, especially middle-aged men who don't like exercise and are overnourished. According to the data, a study on the serum uric acid of a group of 494 subjects over 50 years old found that the prevalence of hyperuricemia in obese people was three times higher than that in non-obese people. This is mainly because obesity can increase the uric acid synthesized by the liver, while the function of excreting uric acid by the kidney is weakened, thus increasing the blood uric acid level. Therefore, gout patients must take "weight" as the key control index.
Generally speaking, people will use body mass index (BMI) to judge whether they are obese or not, but in fact, waist circumference is more closely related to hyperuricemia, or waist-hip ratio (waist circumference/hip circumference), which is 0.8 1 for normal men and 0.73 for women. The main way to control weight is to "keep your mouth shut and open your legs", especially to limit high-calorie and high-fat foods, eat three meals regularly and eat less snacks. Gout and obesity can lead to joint damage, so try to choose walking, jogging, swimming, cycling and other sports to reduce the joint burden.
The fourth question: Are your living habits good?
Besides diet, there are many living habits related to gout. For example, drinking alcohol is often the root cause of gout attacks. If you eat foods with high purine, high protein and high fat at the same time, it is more likely to cause acute gout attacks. Because alcohol can lead to an increase in purine content in the body, especially beer. Although the purine content in beer is not high, if you drink a lot of beer every time, it will induce gout. The harm of smoking is well known. For gout patients, nicotine in tobacco can cause vasoconstriction, uric acid excretion disorder and aggravate joint symptoms.
Drinking too little water every day can also induce gout. It is recommended that gout patients drink plenty of water, especially when sweating a lot in summer. It is recommended to drink about 2000 ml of water every day, which is beneficial to the excretion of uric acid. You can choose weakly alkaline mineral water or boiled water for drinking water, and avoid strong tea and sugary drinks (including juice drinks).
Fifth question: Are you accompanied by illness or taking some drugs?
Many people will focus on diet to prevent gout. One factor is easily overlooked, and that is the drug factor. For example, aspirin is a commonly used drug for patients with cardiovascular diseases. Studies have confirmed that aspirin has a dual effect on renal uric acid metabolism. High-dose aspirin (3g/ day) can promote uric acid excretion, while low-dose aspirin (75300mg/ day) can obviously inhibit renal tubular excretion of uric acid, thus increasing blood uric acid. There are also some drugs that can also increase the level of blood uric acid, such as thiazide diuretics, cyclosporine, pyrazinamide, ethambutol, nicotinic acid, warfarin and so on.
In addition, some diseases, such as kidney disease, cardiovascular disease, metabolic syndrome, psoriasis, diabetes, hypothyroidism and so on. Are related to uric acid levels. Gout will recur if other risk factors are superimposed.
Author: Feng Jiang
Director of editorial department of medical and health news
Editor-in-chief of brand column "Dr. Jiang answers questions"
Producer: Hu Lili