Regarding the effect of diet on uric acid levels, there are several facts that deserve attention: 20% of normal blood uric acid comes from purine-rich foods, while 80% comes from purine biosynthesis in the body; the total daily purine intake of a normal person on a normal diet is about 150-200 mg, while the total daily purine metabolism in the body is about 600-700 mg; even if the intake of purine can be strictly limited, the blood uric acid level decreases by 15%-20% at most. Even if purine intake can be strictly limited, the blood uric acid level can be reduced by 15%-20% at most. From this set of data, it is easy to see that the amount of purine people take in from food is far less than the amount of purine biosynthesis in the body. Does this mean that diet control is not necessary? The answer is no.
There is a big difference between the end result of purines produced metabolically and those consumed from food. Most of the purines produced by the body’s metabolism are synthesized into nucleic acids and reused by tissue cells, and a small percentage is broken down into uric acid. In contrast, the vast majority of purines from food sources are produced as uric acid, which is rarely used by the body. The amount of purine consumed in food directly affects the level of uric acid in the blood and even triggers an acute attack of gout. Therefore, the importance of diet control cannot be ignored.
According to the amount of purine content in food, food is divided into four categories: purine-free food; low purine food (purine content <75mg per 100g); medium purine food (purine content 75~150mg per 100g); high purine food (purine content 150~1000mg per 100g). The law of purine content in food is: offal > meat, fish > dry beans, nuts > leafy vegetables > cereals > starchy, fruits.
The following is a specific list of these four types of food.
1.Foods with little or no purine content – refined white rice, refined white bread, steamed bread, noodles, macaroni, soda crackers, corn, cabbage, carrots, celery, cucumber, eggplant, kale, lettuce, pumpkin, zucchini, tomatoes, radish, yams, potatoes, various kinds of milk, cheese, yogurt, various kinds of eggs, various kinds of Fruits and dried fruits, various beverages including soft drinks, tea, chocolate, coffee, etc., various fats, jams, kimchi, pickles, etc.
2.Foods with low purine content – mushrooms and other mushrooms, cauliflower, asparagus, spinach, peas, string beans, green beans, beans, cereals, chicken, lamb, white fish, peanuts, peanut butter, beans and products.
3.Foods with medium purine content – carp, striped bass, cod, eel, halibut, sea bass, barracuda, mackerel, eel, shellfish, smoked ham, pork, beef, duck, goose, pigeon, etc., lentils, dry beans (soybeans, fava beans, etc.).
4. Foods with high purine content – animal liver, kidney, pancreas, brain, sardines, anchovies, fish roe, shrimps, crabmeat, yeast, hot pot soup, chicken soup, broth, meat pies.
It is important for those suffering from gout to be familiar with the purine content of foods and to use this as a basis for proper diet control. In addition to this, smoking and alcohol consumption also have an effect on the purine levels in the body.
Serum uric acid levels are highly positively correlated with alcohol consumption, and alcohol consumption is one of the major causes of elevated serum uric acid levels. The lactic acid produced by the metabolism of ethanol can inhibit the excretion of uric acid by the kidneys; alcoholic beverages contain purines, which are metabolized in the body to produce uric acid, etc. The purine content varies depending on the type of alcoholic beverage, with the general rule being: aged yellow wine > beer > common yellow wine > white wine.
There is no direct evidence that smoking can increase uric acid in the blood or cause acute attacks of gouty arthritis. However, there is no doubt that smoking is established as a risk factor for cardiovascular disease. Gout is also a risk factor for cardiovascular disease, and the threat is greatly increased when both risk factors coexist. Therefore, even if smoking does not increase blood uric acid, gout patients should resolutely quit smoking.
Especially easy to be ignored by the patients is the intake of the act. Sodium has a role in precipitating uric acid. Gout is mostly associated with hypertension, coronary heart disease and kidney disease, so gout patients should limit their daily sodium intake. Gout patients may want to eat more vegetables and fruits. Vegetables and fruits are mostly alkaline foods, which can increase the body’s alkaline reserves and raise the pH value of body fluids. Prevent the formation of uric acid crystals and promote their dissolution, increase the amount of uric acid excretion, prevent the formation of stones and make the formed stones dissolve. Vegetables and fruits are mostly rich in potassium, and potassium can promote the kidneys to excrete uric acid and reduce urate deposits.
In general, the principles of dietary control are three low and three high.
Low purine or purine-free diet; low calorie intake; low salt diet; high water intake; high fruit intake; high fiber
Dietary therapy at different stages
The dietary treatment is not exactly the same in different stages of the disease. According to the dietary principles of the acute stage of gout, patients should strictly limit the intake of purines. Choose low purine foods and abstain from high purine foods. Maintain basic calories and a balanced intake of carbohydrates, proteins and fats. Take in sufficient water. Do not drink alcohol or consume stimulating foods. Limit salt. Take 5~6g per day as good.
For patients with non-acute attacks of gout (intermittent and chronic phases), the goal of dietary treatment is instead to keep blood uric acid values within the normal range in the long term. The purine restriction can be relaxed, because excessive restriction can lead to inadequate protein intake and malnutrition. Make a habit of drinking plenty of water and abstaining from alcohol whenever possible.
In contrast, the dietary principles for the asymptomatic hyperuricemia phase are: calorie restriction. Avoid over-nutrition and excessive caloric intake. Maintain ideal body weight and prevent overweight and obesity. Limit the intake of purines, balance the intake of nutrients, and develop the habit of drinking more water. Drink as little alcohol as possible and make efforts to stop drinking.
Management and rehabilitation of gout
For friends with asymptomatic hyperuricemia period, the focus at this time is to spread knowledge and master the diet. Introduce the development process of the disease, and when hyperuricemia is found, further check for other diseases, such as renal insufficiency and blood diseases. Timely prevention and treatment of hypertension, coronary heart disease, diabetes mellitus and obesity; . Avoid triggering factors such as cold, exertional infection, trauma and entering high purine diet; low purine diet, which aims to reduce exogenous uric acid production; family members should be screened early, as gout often has a family history.
In the acute gouty arthritis phase, the focus is on observing the site, nature and extent of pain. Patients with gouty arthritis should prevent excessive joint activity, elevate the affected limbs, avoid weight bearing, keep the inflamed joints at local rest, and place as many daily necessities as possible at the bedside for the patient to access. In acute attacks, patients should rest in bed until 72 hours after the pain is relieved and the triggering factors are removed promptly. Patients are prone to stress, tension and anxiety, and gout is easily triggered by mental trauma. Patients should be told to combine work and rest, ensure sleep, and lead a regular life to eliminate all kinds of psychological stress. Pay attention to whether the patient has any complications after using drugs, such as gastrointestinal bleeding, diarrhea, etc. An empty needle can be used to draw joint fluid for examination during acute attacks, which is especially important for identifying indistinct arthritis.
During the intermittent gout phase, patients should avoid mental stress, overexertion, urinary tract infection, wind chill, cold, joint trauma and other triggers leading to acute gout attacks; treat concomitant conditions such as hypertension, hyperlipidemia, obesity, diabetes, arteriosclerosis and coronary heart disease; and use uric acid-lowering drugs. Take drugs that inhibit uric acid synthesis (such as allopurinol, febuxostat – Uridone 40mg, once daily) and drugs that promote uric acid excretion (benzbromarone – Ligurixian), and review blood uric acid regularly; avoid using drugs that reduce uric acid excretion such as dihydrocoumarol, tachyphylaxis, aspirin, niacin, etc.
Gout stone
Gout stone arthritis without wound: soft clothing is preferred; keep skin clean and intact, avoid injury; wear soft and appropriate shoes; do not cut open the gout stone arbitrarily, as it is difficult to heal; take uric acid-lowering drugs patiently; pay attention to the amount of urine on a regular basis and monitor blood BUN and Cr; if the gout stone is deposited in the wrist, it will easily cause carpal tunnel syndrome, which requires surgical removal of the gout stone or local injection of painkillers.
Gouty stone arthritis with wounds: gouty stone fluid or Y-crystals often flow out of the wound, drug change r should be disinfected clean; aseptic operation; if the wound is combined with infection, bacterial culture is required; if necessary, amputation surgery diet guidance.
Rehabilitation management and psychological care
For the rehabilitation management of gout patients, it is mainly divided into two parts: health education and rehabilitation treatment. Rehabilitation treatment mainly adopts physiotherapy and functional exercise. Physiotherapy includes heat therapy or hot compress, electrotherapy, paraffin therapy, which should generally be used in the chronic period, and should be temporarily discontinued for patients with fever or acute attacks of joint inflammation, so as not to increase the swelling and pain of the affected joints and exacerbate the inflammation. Functional exercise is appropriate exercise, which can prevent gout attacks, reduce visceral fat, and reduce insulin resistance. Strenuous exercise can induce an acute gout attack.
In the psychological care of gout patients, we should strengthen the knowledge of gout publicity, understand the psychological activities of patients, reduce the psychological burden of gout patients, mobilize the subjective initiative of patients, and carry out supplementary treatment. Reduce the psychological stress of patients: gout may be related to mental factors. Mental stress can lead to lifestyle changes that result in increased occurrence of gout.
We hope that the above sharing can benefit gout patients, and use it as a basis for good gout diet treatment and management, and eventually harvest health.