Red meat and seafood are a great way to keep uric acid levels high. Nowadays, with the improvement of living standards, more and more people see the word “hyperuricemia” on their medical checkups. Soon, some of them are suffering from gout due to red, swollen and painful toes, deformed joints, impaired kidney function and stones. Some young and middle-aged gout sufferers are so strong that they can’t even go to work.
High uric acid is one of the “diseases of affluence” and “diseases of modern life”. In addition to manifesting as “gouty stones” and joint deformities, gout can also damage kidney function and cause “gouty kidneys”, which can also cause and exacerbate hypertension and cardiovascular disease in older patients. For young and middle-aged “gout” patients, early dietary and lifestyle interventions and standardized medication in accordance with medical advice can slow down the progress of the disease and reduce the harm.
Gout precursors: uric acid saturation over 7 mg, feeling red and hot pain in the toes
While the obese population is expanding, the number of people with high uric acid is increasing, and the number of young and middle-aged patients is growing year by year. “Hyperuricemia can also be called pre-gout, and about one-third of patients will eventually progress to gout.”
The high uric acid referred to is the solubility of uric acid in the body, and a person’s blood pH (pH) is about 7.4, when the maximum saturation of uric acid is 7 mg. When the serum uric acid level exceeds this concentration, it is considered to be hyperuricemia.
The over-saturated uric acid will precipitate out as urate crystals and be deposited in various joints, thus triggering gout. Xiao Haipeng noted that 90 percent of patients first feel red, hot, swollen and painful toes, especially the first toe, while others show gout stones in their ears. “Why does gout specifically run to the toes and ears to attack? Because the blood circulation at the end of these limbs is the worst.”
Because of the acidic blood pH, uric acid crystals are difficult to dissolve and are easily deposited at the end of the limbs. If the concentration of uric acid in the body remains high, gout will recur, and it is like being sentenced to “life imprisonment”.
Age of prevalence: 30% of 30-year-old men are affected, and women have a high incidence after menopause
The survey found that the incidence of hyperuricemia has been increasing year by year in recent years. There is a tendency for men to increase in all age groups from 20 to 60 years old, and in Japan, for example, the incidence of hyperuricemia among 30-year-old men reached 30%.
The incidence also varies in women before and after amenorrhea, from 1.3 percent under age 50 to 3.7 percent over age 50. “We find that female patients tend to develop high uric acid at age 50 after menopause. Because women have estrogen, and estrogen promotes uric acid excretion, women in their reproductive years tend to have few gout problems unless there is a specific etiology.”
Male patients are different, with some being struck before they are 30 years old, mainly blamed on obesity due to overeating. At the famous doctor’s lecture, several male readers who looked to be in their early thirties actively asked questions. They were already on the precipice of gout due to hyperuricemia.
Hyperuricemia: It makes five major diseases more likely to flare up
The reason hyperuricemia is so scary is related to the fact that it can cause five major diseases.
The first is gouty arthritis. Gouty arthritis is an inflammation of the joints caused by deposits of uric acid precipitated from the joints. Patients with gout often have yellowish bumps, or gout nodules, all over their finger joints. When the serum uric acid value exceeds 7.0 mg/dl, the risk of gouty arthritis increases as the uric acid value rises, and the longer the hyperuricemia lasts and the higher the uric acid value, the more likely gouty nodules will develop. Acute gout attacks tend to occur in the first middle toe joint and foot joints, etc.
This is followed by impairment of renal function. Serum uric acid values are associated with the development and progression of chronic kidney disease (CKD). The prevalence of chronic kidney disease (CKD) in the adult population over 18 years of age in China is 10.8%, with early-stage patients predominating and first- and second-stage patients accounting for 84% of the total. Xiao Haipeng pointed out that for the general population, hyperuricemia is a risk factor for renal insufficiency. Especially for IgA nephropathy, hyperuricemia may affect the prognosis of patients. And in patients with combined CKD and gout, it may be related to lead accumulation in the body.
Again, it is urinary stones. Xiao Haipeng pointed out that there are three risk factors for urinary stones, which are too little urine, hyperuricemia and aciduria. Some patients with hyperuricemia will have urinary stones. In addition to the possibility that hyperuricemia itself may increase the frequency of urinary stones, excess purine intake and acidic urine, when uric acid excretion-promoting drugs are used to lower uric acid, can also promote the formation of urinary stones. However, this is not inevitable, and some patients with hyperuricemia do not necessarily develop urinary stones.
The fourth is hypertension and cardiovascular disease. Studies have shown that in people with poor lifestyle habits, developing cardiovascular disease and high serum uric acid values often occur together. Experts believe that serum uric acid values may serve as an independent risk factor for the development of hypertension and are expected to be used as an indicator to help predict the occurrence and recurrence of stroke and to determine the effectiveness of treatment for patients with cardiac insufficiency.
The fifth is metabolic syndrome, including diabetes mellitus. The incidence of metabolic syndrome increases with elevated serum uric acid values, and its peripheral symptoms include hyperuricemia. It is common to see patients with gout in the clinic who also have metabolic syndrome. Hyperinsulinemia also contributes to increased reabsorption of uric acid in the renal tubules and accumulation of visceral fat, which can increase uric acid values.
Timing of surgery: surgery only when gout stones cause infected deformities
The significance of treating hyperuricemia and gout is to improve the symptoms of uric acid deposition by eliminating the urate crystals deposited in the body’s tissues. For patients with combined diseases such as obesity, hypertension, and abnormal glucose metabolism, lifestyle changes are required. In addition, lowering uric acid can also improve the prognosis of patients at high risk of cardiovascular disease and ensure life safety.
Gout treatment medications include non-steroidal anti-inflammatory drugs, pain medications, drugs that promote uric acid excretion and drugs that inhibit uric acid synthesis. “Intervention is required if the serum uric acid value exceeds 7 mg. When it drops to 6 milligrams, or 360 units, it is less likely to develop a gout attack.” He noted that there are also some patients who need to get their serum uric acid values down to 5 milligrams. In particular, patients who have gout stones inside their kidneys and need to eliminate the stones and reduce the damage to the kidneys need to get their serum uric acid values down to 5 milligrams.
Some patients have gout stones in the joints of the limbs, which cause infection or joint deformity due to compression of the nerves by the gout stones. This is when surgery is needed to relieve the pain. If the gout stone is “honest” and the patient only wants to have surgery to remove the stone for aesthetic reasons, surgery is usually not needed and the uric acid stone will slowly become smaller with the use of uric acid lowering medication to 5 mg.
If you want to lower uric acid, you need to take medicine alone, but you also need to change your bad habits. This includes adhering to the right diet therapy and limiting foods that contain a lot of purines, because 20% of uric acid is synthesized due to the purines consumed. Also, patients with hyperuricemia should limit alcohol consumption, lose weight and recommend proper exercise. It should also be emphasized that patients with hyperuricemia and gout should strictly follow medical advice and take their medication on time.
Reminder: hyperuricemia is not the same as gout
It is important to note that a gout attack does not necessarily show high serum uric acid values. Xiao Haipeng pointed out that the diagnosis of gout includes characteristic symptoms, hyperuricemia, deposition of uric acid salts in the joint fluid, gout nodules may be present, and poor lifestyle habits. While hyperuricemia and gout are two different stages, people with hyperuricemia do not necessarily develop gout, and only one-third of patients will develop gout.
Many people wonder why an increase in uric acid can trigger hyperuricemia. There are two main reasons for this. First, the kidneys excrete less uric acid, and the uric acid excreted outside the body by the kidneys accounts for 80% to 90% of the total uric acid excretion. The second is an increase in dietary sources, with 20 percent of uric acid being synthesized from dietary intake of purines.
”If serum uric acid values are higher than 13 milligrams in men and 10 milligrams in women, the risk to kidney function is greatly increased when uric acid stones, especially kidney stones, are easily formed at this time.” Xiao Haipeng pointed out that when kidney function is impaired, uric acid excretion is reduced, and the increase in uric acid produced by dietary intake can cause hyperuricemia.
Gout Prevention and Control
Drinking green papaya water to cure gout? not reliable
Q: Honey is a low purine food, but it is said that the fructose in honey is not good for gout patients, can I still eat honey for gout?
A: The intake of large amounts of fructose will indeed promote uric acid synthesis, but a small amount of intake will not affect, and fruits can be eaten in moderation.
Q: Can I drink soda for a long time to cure gout?
A: Drinking soda has some effect, but to really achieve the purpose of alkalizing urine, drinking 2,000 ml of soda a day is not enough, far from the amount ingested by 1 gram of baking soda tablets three times a day. To know if your urine has reached alkalinization, you can use pH test paper to measure it, and if it is between 6 and 6.5, it has reached alkalinization.
Q: I used to take ibuprofen tablets for pain relief in gout attacks, but since I got a stomach ulcer I’m not too afraid to take them. What medication should I take like in gout attacks? Also, I usually take allopurinol and baking soda to control uric acid, but I heard that allopurinol can be allergic and lead to exfoliative dermatitis or even fatal?
A: During a gout attack, etoricoxib tablets have fewer side effects on the stomach compared to ibuprofen tablets, and you can take omeprazole at the same time to protect the stomach. Allopurinol allergy is only to a certain genetic type of people. If you have taken it before without allergy, you will not be allergic in the future, so there is no need to worry.
Q: In addition to high uric acid, I also have high blood pressure and have to take antihypertensive medication, will it cause uric acid to rise?
A: Among hypertension drugs, only diuretics can cause uric acid to rise. And cloxacin A tablet has the function of assisting in lowering uric acid while lowering blood pressure, so you can pay attention to it when choosing antihypertensive drugs. The triglyceride-lowering fenofibrate also has the function of assisting in lowering uric acid. But none of the above can replace its own uric acid-lowering drugs.
Q: I have high uric acid, my doctor told me to stop taking aspirin, why is that?
A: Aspirin can cause uric acid to rise. If you have heart disease, it is recommended that you do not stop taking 100 mg of aspirin per day, because the heart is more important than the heart, or switch to clopidogrel hydrogen sulfate tablets instead of aspirin. If it is to prevent heart disease, it is not necessary to take it.
Q: Can drinking water made from green papaya lower uric acid?
A: There is no scientific basis for these folk claims. In fact, as long as you drink more water and urinate more, it is good for lowering uric acid. Drinking water, soup and fruit every day is recommended to reach 2000ml.
Q: My son has gout at a young age. He still has pain after taking allopurinol and painkillers, what should I do?
A: If the gout attack cannot be stopped with etoricoxib tablets, you can use colchicine, which is 100% effective, but has side effects and should not be consumed for a long time. Allopurinol and baking soda are not for pain relief but for lowering uric acid, and should also be taken consistently during a gout attack.
(Special thanks to Dr. Cao Xiaopei, Chief Physician, Department of Endocrinology, Zhongshan First Hospital)
Dietary guidance
Gout patients should drink at least 2000 ml of water every day
With the increase of uric acid, drinking and eating also become a worrying thing. “If uric acid is high, it is better to eat chicken than duck, and better to eat beef than pork.” Zhongshan First Hospital, deputy director of the Department of Nutrition Dr. Yanbin Ye said that gout patients should keep their mouths shut, eggs and milk are safe food for gout attacks because of their low purine content.
She said that the “old fire soup” that Cantonese people love to drink and the seafood that young people love can trigger gout because of its high purine content, so they should avoid eating it.
She pointed out that patients with high uric acid and gout should follow seven dietary control principles.
1. Limit the intake of foods containing more purines, with a daily purine intake of <150mg;
2. Drink plenty of water, more than 2000ml per day;
3.Incorporate more alkaline plant foods, such as vegetables and fruits, etc;
4.Protein sources are preferred to foods with low purine content, such as milk, eggs, etc;
5, adjust the diet and exercise intensity to maintain body weight in the normal range;
6, obese people should be appropriate weight loss, but do not seek rapid weight loss, because rapid weight loss can cause a large number of ketone body production, but inhibit uric acid excretion.
7, hyperlipidemia to limit the intake of fat.
Eat meat without soup to reduce purine intake
Dr. Yanbin Ye, deputy director of the nutrition department of Zhongshan First Hospital, pointed out that common foods can be roughly divided into three categories according to their purine content.
According to the severity of gout, patients can develop recipes according to the following principles: choose the first category of food in the acute period, and patients should drink a total of not less than 3,000 ml of liquid per day. In the remission period, the third category of food should be prohibited, the second category of food should be chosen in a limited amount, and the first category of food should be freely chosen. Cooking method has influence on purine in food, such as boiling meat and eating only meat without soup, which can reduce the intake of purine.
Pay attention to the amount of purines in three types of food
1. The first type of food: purine content less than 50mg/100g
Cereals and potatoes: rice, millet, rice flour, glutinous rice, barley, wheat, buckwheat, rich flour, flour, macaroni, hanging noodles, noodles, bread, steamed bread, cereals, white potatoes, potatoes, taro.
Vegetables: cabbage, cabbage, mustard, celery, bok choy leaves, hollow cabbage, kale, chrysanthemum, leek, cucumber, bitter melon, winter squash, pumpkin, loofah, zucchini, cauliflower, eggplant, bean sprouts, green pepper, radish, carrot, onion, tomato, lettuce, kimchi, pickles, onion, ginger, garlic, water chestnut.
Fruits: orange, tangerine, apple, pear, peach, watermelon, cantaloupe, banana, apple juice, jelly, dried fruit, sugar, syrup, jam.
Eggs and milk: eggs, duck eggs, skinned eggs, milk, milk powder, cheese, yogurt, condensed milk.
Nuts and others: pig blood, pig skin, sea cucumber, jellyfish skin, seaweed, red dates, raisins, fungus, honey, melon seeds, almonds, chestnuts, lotus seeds, peanuts, walnuts, peanut butter, wolfberries, tea, coffee, sodium bicarbonate (baking soda), chocolate, cocoa, fats and oils (limited use).
2, the second type of food (purine content 50 ~ 150mg/100g)
Mixed grains: rice bran, wheat bran, wheat germ, coarse grains, green beans, red beans, peas, flower beans, vegetable beans, dried bean curd, tofu, green beans, black beans.
Meat: pork, beef, veal, lamb, chicken, rabbit, duck, goose, pigeon, turkey, ham, beef tongue.
Fish, shrimp and crab: eel, eel, carp, grass carp, cod, salmon (salmon), black pomfret, halibut, pike, fish ball, shrimp, lobster, squid, crab.
Others: fresh mushrooms, asparagus, fresh peas, kombu, string beans, spinach.
3.The third food group (purine content is 150~1000mg/100g)
Animal offal: liver, belly, kidney, small intestine, brain, pancreas.
Fish and shellfish: white scallop, white pomfret, sardine, anchovy, silver carp, herring, mackerel, dried small fish, oyster, clam.
Soups: thick gravy, thick chicken and broth, fondue soup, yeast powder.
Gout remission period: how to set the recipe?
Breakfast: 250 ml of skim milk, 100 g of bread.
Lunch: rice (100g of rice), scrambled eggs with tomatoes (60g of eggs, 100g of tomatoes), 150g of fried cabbage.
Additional meal in the afternoon: one fruit (150g).
Dinner: rice (rice 100g), shredded chicken and fried celery (chicken 80g, celery 100g) or fried cabbage 150g, oil 20g for the whole day.
(Total energy supply throughout the day 1800 kcal, total purine content 225 mg, suitable for medium-sized gout remission patients)