Gout is a crystal arthritis caused by disorders of purine metabolism and reduced uric acid, excretion, clinical manifestations of hyperuricemia and urate crystals deposition caused by the characteristic acute arthritis, gout stone formation gout stone chronic arthritis complicating uric acid nephropathy, uric acid urinary calculi, etc., severe arthritis disability, renal insufficiency. Gout is often associated with central obesity, hyperlipidemia, diabetes, hypertension, and cardiovascular disease. It has been found that gout is caused by a combination of two factors: congenital genetic predisposition and acquired dietary environment.
Risk factors for gout
Age: The age of first attack is usually 40 years or older. Gender: 95% are male, and most female patients are postmenopausal. Occupation: Brain workers drinking more alcohol is significantly associated with gout, high purine diet, family history of hypertension, family history of coronary heart disease, obese people, family history of gout is positive in about 10-20% of patients, and dyslipidemia. When blood uric acid exceeds 70 mg/L (0.41 mmol/L), its plasma solubility is saturated, and excessive uric acid is prone to form sodium urate crystals, which are deposited in joints and nearby soft tissue areas, causing redness and pain in joints throughout the body, especially in the fingers, toes, wrists, ankles and knees.
Gout can be clinically divided into four stages.
The first stage is the hyperuricemia stage, in which the patient only has elevated blood uric acid and has not yet developed clinical symptoms of gout.
The second stage is the early stage of gout, where blood uric acid is persistently elevated, leading to a sudden attack of acute gouty arthritis. The majority of people are awakened in their sleep by knife-like pain, the first site is often the big toe, manifesting as red, swollen, burning and painful joints, and the symptoms may disappear spontaneously within months or weeks.
The third stage is the middle stage of gout, in which the gouty arthritis has repeated acute attacks, gradually spreading to the joints of the fingers, toes, wrists, ankles, knees and other joints throughout the body, and then the surrounding soft tissues and bones are also damaged to varying degrees, resulting in dysfunction and the deposition of uric acid crystals, which slowly form “gout stones” like stones. The kidney function is normal or mildly declining.
In the fourth stage of gout, the deformity and dysfunction of the joints become more and more serious, and the gout stones increase in size and easily break down and flow out white uric acid crystals. Due to the permanent deformity of the joints, it affects the daily work and life, and brings great pain to the patient’s body and mind.
The root cause of gout is excessive uric acid in the body. Uric acid is metabolized by purines, and only 20% of purines are consumed in the diet of a normal person, while the rest are produced during the metabolism of the body. Although the purine intake from food is small, it is rarely used by the body and most of it is broken down and converted into uric acid, so the influence of purine from diet on uric acid level should not be ignored.
Principles of dietary treatment of gout.
Reduce the source of exogenous uric acid and promote the excretion of uric acid in the body. “Three low and one high”, namely: low purine diet, weight reduction, low salt and low fat diet and plenty of water.
1. Restrict total calories and maintain ideal body weight
Gout patients are mostly accompanied by obesity, hypertension and diabetes, so they should restrict energy intake and maintain ideal body weight as much as possible. Overweight patients can reduce the total calorie intake by 10%~15% daily, so that the weight can be gradually reduced to the standard range. Weight reduction should be gradual to prevent acute attacks of ketosis or gout.
2.Limit fat intake
Fat has the effect of hindering the excretion of uric acid by the kidneys. Fat intake should be controlled within 20%-25% of total calories, and the total daily fat intake should be about 50 grams, paying attention to vegetable oil and less animal fat.
3.Limit purine intake
Purine is a component of the cell nucleus, all food containing cells contain purine, and animal food contains more purine. The main reason for the increase of purine due to protein intake is that the nucleic acid in food is mostly combined with protein to form nucleoprotein present in the cell. The consumption of protein inevitably leads to the intake of nucleic acids. For example, meat products contain a large number of cells and mitochondria, which contain a large amount of genetic material such as DNA and RNA, and cell rupture, leading to an increase in purines. Protein can be consumed at 0.8~1g/kg (standard weight), mainly milk and eggs. In case of lean meat, chicken and duck meat, etc., they should be boiled and de-souped for consumption; avoid stewed or marinated meat; total daily protein should be controlled at about 40 grams, and the intake of fish and bean food should be appropriately limited; foods with high purine content are prohibited.
Offal > meat and fish > dry beans and nuts > leafy vegetables > cereals > starch; eat more food containing less purine or no purine such as refined white rice, refined white noodles, corn, cabbage, carrots, cucumber, celery, eggplant, kale lettuce, pumpkin, tomatoes, zucchini, mountain sprouts, potatoes, all kinds of milk all kinds of fruits, etc. Forbid eating animal offal, kidneys, brain, sardines, shrimp crabmeat, yeast and all kinds of meat soup.
4, eat more vegetables and fruits
In addition to mushrooms, beans (such as lentils) and spinach should not be eaten in large quantities, most of the remaining vegetables can be used, and fruit is not contraindicated. Vegetables and fruits are rich in B vitamins and vitamin C, which are alkaline foods and can promote the dissolution of crystalline uric acid and easily discharged from the urine. Alkaline drinks also have a similar effect.
5, prohibit alcohol, less use of stimulating drinks or condiments
Alcohol tends to make the body lactic acid accumulation, has an inhibitory effect on uric acid discharge, easy to induce gout. Coffee, tea, cocoa and other beverages can also hinder the discharge of uric acid. Traditional Chinese medicine emphasizes the avoidance of stimulating beverages such as strong coffee and tea, and even condiments and spices should not be used. However, modern medicine advocates the selection of food according to the purine content in the food.
6. Drink a lot of water to promote uric acid discharge
You should drink a lot of water, the best is plain water. You should drink 2000~3000ml of water daily to facilitate urine dilution and uric acid excretion to ensure that the daily urine volume is more than 2000ml.
7, prohibit or use less drugs that affect uric acid excretion
Such as penicillin, tetracycline, high-dose thiazide and aminoglutethimide and other diuretics, aspirin, etc.
8.Exercise therapy
Appropriate exercise can reduce weight, reduce visceral fat, reduce pancreatic resistance, the amount of exercise to moderate, such as 30 minutes each morning and evening, such as walking, fitness, etc. It is worth noting that not strenuous exercise, but strenuous exercise to reduce blood volume, kidney blood flow, uric acid, creatine, excretion, resulting in transient hyperuricemia.
In addition, gout patients should pay attention to the combination of work and rest, to avoid overwork and mental tension, generally do not advocate gout patients to participate in running and other strong physical exercise, or long-distance walking tours.
Barley porridge]
Take the right amount of barley and white rice, the ratio of the two is about three to one barley first soaked in water for four or five hours, white rice soaked for thirty minutes, then the two mixed, add water and boil together into porridge. The barley has the effect of diuretic and dampness, strengthening the spleen, protecting the kidneys and replenishing the qi, which is very beneficial to gout patients.
Winter melon soup]
Take 300 grams of peeled winter melon, five or six red dates, and a little ginger. First use the oil to burst the ginger, then put it into the pot with the sliced winter melon and red dates, add water and the right amount of seasoning to make soup. Winter melon has a very good diuretic effect, can make easy uric acid dissolved discharge.
[White foxglove drink]
Fresh bamboo leaves, white foxglove 10 grams each, washed and put in a thermos cup with boiling water for 30 minutes, drink as tea. Fresh bamboo leaves, white foxglove can diuretic, prevent gouty kidney stones.
Maize whiskers drink]
Add 100 grams of fresh corn husk, add water, decoct for 1 hour to filter out the juice, concentrate to 100 ml over low heat, cease fire to be cold, add sugar and stir to absorb all the juice, cool down and press the powder into a bottle. Three times a day, 10 grams per day with boiling water, with diuretic effect, can prevent kidney stones.