The first step is to keep your mouth shut. Is keeping your mouth shut enough? Uric acid comes mainly from the breakdown of nucleotides in the diet. It accounts for about 20% of the total uric acid in the body, which means that if you keep your mouth shut, you can reduce uric acid by 20% at most. Endogenous metabolic disorders are more important than exogenous factors in the human body for hyperuricemia. Metabolic disorders of purine substances in the body and reduced uric acid excretion are the main causes of hyperuricemia. Hyperuricemia is closely related to hyperlipidemia, abnormal glucose tolerance and hypertension. Hyperuricemia with hyperlipidemia, abnormal glucose tolerance and hypertension plus obesity make up the metabolic syndrome. What is the most important thing about metabolic syndrome? The core of the metabolic syndrome is insulin resistance. Insulin resistance is one of the main causes of primary hyperuricemia. As a result of insulin resistance, insulin levels in the body increase, and high levels of insulin and insulin precursors lead to increased absorption of uric acid by the renal tubules, which leads to impaired uric acid excretion and increased blood uric acid. Hyperinsulinemia also causes the transfer of intermediates in glycolysis to ribose 5-phosphate and ribose phosphate pyrophosphate, which can lead to increased blood uric acid production. High insulin levels in the blood also increase fatty acid synthesis in the liver, leading to increased purine metabolism and increased uric acid production. As a result of these three major causes, the production of blood uric acid increases and excretion decreases in the patient, leading to hyperuricemia. In the early stage of metabolic syndrome, it is reversible through dietary control and better exercise. And improving insulin resistance will reduce hyperuricemia, and at the same time it will be possible to treat gout. How to improve insulin resistance There are many causes of insulin resistance, including increased caloric intake, reduced physical activity, obesity, hyperglycemia and some drugs that affect the action of insulin. Among them, reduced activity and excessive calorie intake are the main causes. Therefore, the treatment of insulin resistance should take a combination of measures, including diet control, exercise and medication. Dietary control to improve insulin resistance First of all, dietary control is the basic method to improve insulin sensitivity. The type and amount of food intake affect the effect of insulin. A low-calorie diet can improve insulin sensitivity, especially in obese patients. It is important to pay attention to how much energy is consumed each day to ensure that the body needs nutrition without making weight gain due to excessive intake. Controlling caloric intake in obese people can reduce body weight and thus improve insulin sensitivity. The diet should pay attention to the appropriate ratio of sugar, fat and protein, avoid excessive intake of sugar and sugary foods, reduce the intake of high-fat and high-cholesterol foods, eat high dietary fiber foods in moderation, and eat less and more meals instead of overeating. Reducing the intake of fat in food, especially saturated fat (animal-derived fat) and trans fatty acids (fast food, popcorn, etc. often contain such fatty acids), is beneficial to reducing insulin resistance. Exercise improves insulin resistance In general, fasting insulin levels are positively correlated with insulin resistance. It was found that exercise can reduce insulin levels. It is suggested that exercise can improve the effect of insulin. Exercise not only increases energy consumption, but also makes the body cells use glucose more efficiently, reduces the body fat content, increases the body muscle tissue content and promotes aerobic metabolism, but these effects disappear after a few days of stopping exercise, so exercise should be persisted. The choice of exercise for diabetic patients should be made under the guidance of a doctor and follow the principles of individualization, safety and effectiveness. Appropriate physical exercise for gout patients can reduce visceral fat production and reduce insulin resistance, thus contributing to the prevention of gout attacks. But gout patients exercise with care, to exercise, to gradually increase the amount of exercise, exercise rather than strenuous exercise. This is because excessive exercise can also easily cause gout. A group of college students, before exercise and after ten minutes of intense exercise, blood was drawn every hour to check the average value of uric acid in the blood, and the data before exercise was used as a benchmark, the value of uric acid rose slowly after exercise, rising 2mg/dl for two hours as the highest, then it began to fall slowly, and after twenty-four hours, the value of uric acid could return to the normal value before exercise. The reason for high uric acid due to exercise is that exercise accelerates metabolism and therefore increases uric acid production. Another reason is the increase in sweating during intense exercise, so the amount of urine will decrease, and since uric acid is excreted in urine, the excretion of uric acid will decrease and the relative accumulation of uric acid in the body will increase. Gout patients already have higher than normal blood uric acid, so if they exercise vigorously at the beginning, it will definitely lead to an acute attack of gout or make the blood uric acid even higher. Choose a suitable physical exercise program according to your physical condition, and determine the intensity and time of the exercise. Personally, I recommend swimming, mainly because gout patients have joint destruction, swimming does not require joint stress, swimming is a coordinated movement of the whole body muscles, which helps to improve insulin resistance. Bicycling is also recommended, as this exercise is less stressful on the joints and is also based on muscle stress. Other sports such as: slow and short distance trotting, taijiquan, qigong, radio exercises, fast walking, table tennis, etc. are more suitable for gout patients; while competitive, strenuous and physically demanding projects, such as fast running, soccer, basketball, skating, mountain climbing, long-distance running, etc., are not suitable. Exercise starts with light activity, and gradually increases as physical strength increases. Gout patients must not exercise too much, so that the body lactic acid production increased, which will inhibit the kidneys to excrete uric acid, inducing gout attacks, should promptly stop exercise, wait for the symptoms to completely subside and then resume. Early in the morning when you get up, the human muscle, joint and visceral function is low, can not quickly adapt to the activities, at this time exercise is easy to cause acute and chronic injury. At the same time, the night sleep without food and water, blood concentration, such as sweating and loss of water, blood is more viscous, the risk of heart disease and stroke. In addition, the exercise in the dark is not advisable, the best choice after the nap to dinner before this time. How to grasp the exercise time? Physical activity and exercise are the main measures to improve insulin resistance. Maintaining a stable weight over time requires an active lifestyle, and people who are more active have less weight gain or are less likely to become obese. Strong research evidence suggests that participation in 150 to 250 min of moderate to vigorous physical activity per week is effective in preventing weight gain by 3%. In studies of overweight or obese individuals who do not exercise regularly, increased physical activity alone can achieve clinically meaningful weight loss, i.e., 5% of initial body weight. The greater the negative energy balance, the greater the weight loss. 225-420 min of physical activity per week over a long period of time can reduce body weight by 5.0-7.5 kg. To achieve greater weight loss, most people need to increase dietary control measures. Physical activity can prevent weight regain after weight loss. Physical activity is essential for weight maintenance and is the best tool to maintain weight after weight loss, and physical activity levels are associated with maintaining rebound after weight loss. Subjects with more than 200 min of moderate intensity physical activity per week had virtually no weight regain. Higher levels of physical activity significantly reduced weight regain. For early gout patients, weight control and improvement of insulin resistance can be effective in controlling uric acid, and in long-term clinical observations, we have found that many gout patients are in the early stages of diabetes. Through exercise, the insulin resistance of patients can be effectively improved, and many early gout patients can have normal uric acid even without medication. For patients with severe gout, they can also benefit by reducing the dose of uric acid-lowering drugs through exercise. Of course, for gout patients who cannot control their uric acid through the first step of controlling their mouth and the second step of opening their legs, medication is necessary, in which case we recommend a combination of Chinese and Western medicine to treat gout.