Dietary guidance
1. Develop dietary treatment cards.
Restricting the intake of purine-containing foods to reduce exogenous nucleoproteins and lower serum uric acid levels is important to prevent or alleviate acute attacks of gout, reduce the deposition of urate in the body and prevent the formation of uric acid stones. However, during the admission assessment of inpatients, it was found that patients had little knowledge of dietary therapy despite their long medical history, and there was an urgent need to learn about the types of purine-containing foods and dietary therapy. For this reason, we have developed a dietary therapy card, which includes the types of foods that patients frequently consume for their reference.
The specific content of the food is divided into 3 categories according to the amount of purine in the food: Category 1 is the food with high purine content, 100-1000mg of purine per 100g of food, such as liver, kidney, heart, brain, pancreas and other animal offal; meat stuffing, broth; carp, mackerel, fish eggs, small shrimp, oysters, sardines, etc.; goose, partridge, and also yeast. The above foods are prohibited in the acute and remission phases. The second category is the food containing moderate amount of purine, 90-100mg of purine per 100g of food, such as beef, pork and lamb; spinach, peas, mushrooms, dried beans, lentils, asparagus, peanuts, etc. The third category is foods containing trace amounts of purines, such as milk, eggs, refined white flour, rice, sugar, coffee, cocoa and vegetables and fruits other than those listed in the second category.
2. Dietary choices for the acute and remission periods.
Acute period: Foods with high purine content should be strictly limited to avoid excessive intake of exogenous purine. Choose food group 3, with milk and eggs as the main source of high quality protein and refined white flour and rice as the main source of calories. Choose vegetables and fruits with low purine content and limit the amount of fat. In remission: Give a normal balanced diet to maintain ideal body weight and normal blood uric acid level. As protein intake can accelerate the synthesis of uric acid in gout patients, daily intake should not exceed 1g/kg. avoid food group 1, choose food group 3 in a limited amount, choose food group 3 2d per week and choose food group 2 containing medium amount of purine for 5d. We should continue to maintain the ideal weight and avoid weight gain, and the fat limit should be adhered to for a long time.
3. Encourage the selection of alkaline foods.
Increasing alkaline food intake can reduce the concentration of serum uric acid and even make the urine alkaline, thus increasing the solubility of uric acid in the urine and promoting the excretion of uric acid. Patients should be encouraged to choose alkaline foods such as vegetables and fruits, which can both promote the excretion of uric acid and supply rich vitamins and inorganic salts to facilitate the recovery of gout. Such as vegetables, potatoes, sweet potatoes, milk, citrus, etc.
4. Encourage patients to drink more water.
As the urine pH 6, 0 below, need to take alkaline drugs to alkalize the urine, to facilitate the ionization, dissolution and excretion of uric acid. Therefore, it is necessary to drink more water to dilute the urine, and the total daily fluid intake should reach 2500-3,000 ml, so that the daily urine output can reach more than 2,000 ml to prevent the formation of stones. To prevent concentration of urine, let the patient drink water at bedtime or in the middle of the night. Accurately record the patient’s water intake and urine volume.
5.Limit alcohol consumption and drink in moderation.
Drinking alcohol tends to make lactic acid accumulate in the body, and lactic acid has a competitive inhibitory effect on the excretion of uric acid. Therefore, although a large amount of alcohol, can also make a significant increase in serum uric acid content, inducing gout attacks. Chronic alcohol consumption in small amounts can stimulate an increase in purine synthesis and raise serum and urine uric acid levels. Beer also contains components of alcohol, so it should be avoided. Tea base or caffeine is metabolized into methyl urate in the body, not urate, not deposited in gout stones, can not generate gout stones, so coffee, cocoa, tea is not strictly limited, can be used in moderation, yogurt because it contains more lactic acid, is not good for gout patients, so should not drink. You should try to eat less sucrose or beet sugar, because half of them become fructose after decomposition and metabolism, and fructose can increase the generation of uric acid, honey also contains high fructose, should not be consumed. Smoking should be prohibited.
6, pay attention to food cooking methods.
Reasonable cooking methods can reduce the amount of purines contained in food, such as cooking meat first and discarding the soup before cooking. In addition, chili, curry, pepper, mustard, ginger and other food seasonings can excite the vegetative nerves and induce an acute attack of gout, and should be avoided as far as possible.
Exercise therapy
Appropriate exercise can prevent gout attacks, reduce visceral fat, and reduce insulin resistance. The amount of exercise is generally moderate, and patients around 50 years old can reach a heart rate of 110-120/min after exercise, and a small amount of sweating is appropriate. Daily 30 min in the morning and 30 min in the evening, 3-5 times a week. The type of exercise is aerobic exercise with high oxygen consumption such as walking, playing tennis and fitness exercise. Vigorous exercise will change aerobic exercise to anaerobic exercise, which will increase oxygen consumption of tissues, increase anaerobic enzymatic lactic acid production and decrease pH, etc., which may induce acute gout attack, so it should be avoided as much as possible.
Care of painful areas in the acute phase
Patients with severe pain should rest in bed, elevate the affected limbs, brake the joints, and try to protect the affected parts from injury.
Eliminate stressful conditions
Gout is easily triggered by stress, excessive fatigue, anxiety, and strong mental trauma. Advise the patient to combine work and rest, ensure sleep, and lead a regular life to eliminate various psychological stresses.