More than 20 years ago, gout was an extremely rare disease in China. Gout was a common disease in the West and a rare disease in China. But today in China, the incidence of gout is much higher than in the West. Why is this?
1, gout and meat food related
The concentration of uric acid in the blood increases and urate crystals are precipitated, which is the main culprit of gout. If urate crystals are deposited in the joints, it leads to an acute attack of gouty arthritis; if urate crystals are deposited in the kidneys, it leads to gouty nephropathy or uric acid kidney stones.
Uric acid is the end product of purine metabolism and is excreted by the kidneys. If the amount of purine in food is high, the amount of uric acid produced into the body will increase beyond the capacity of physiological excretion. This leads to an increase in the concentration of uric acid in the blood, which is medically known as “hyperuricemia”.
In general, meat contains high purine and cereal is low purine; animal protein contains high purine and vegetable protein contains low purine. Therefore, some of the people who have been vegetarian for a long time for religious reasons, etc., almost all of them do not suffer from gout. In the past, the Chinese people who mainly eat cereals, also rarely appear gout.
2.A sudden change in diet structure is the culprit
The sudden change in dietary structure is the culprit that makes gout from a “rare disease” to a “common disease” in Eastern peoples, and is also the main reason why the incidence of gout is higher in Eastern peoples than in Western peoples today.
For generations, Chinese people have been eating mainly cereals, while Westerners have traditionally been eating mainly meat. From a physiological evolutionary point of view, the Chinese physiological metabolism is adapted to a low purine food structure.
In the last decade or so, there has been a sudden and dramatic change in the Chinese food structure. Twenty years ago, urban dwellers were complaining that twenty-seven pounds of rice per month was not enough to eat, while today many people do not eat five pounds of rice per month.
The change in the structure of food, so that cereal is being replaced by meat food. Foods with higher purine content are replacing the traditional low purine foods, exceeding our physiological metabolic capacity. As a result, the incidence of gout has increased rapidly and has become a “common disease” in a decade or so from a “rare disease”.
The effect of a sudden change in diet on gout was first discovered by American doctors. Filipinos living in the United States had a higher incidence of gout than not only native Filipinos, but also Americans. Then came the period of economic recovery in Japan after the Second World War, and the incidence of gout in Japan increased rapidly almost simultaneously with economic development, and after the 1980s, the incidence of gout in Japan was already higher than that in the United States. Taiwan and mainland China have also experienced a rapid increase in the incidence of gout in tandem with economic development.
3.What foods contain high purine
Among meat foods, those with particularly high purine content include: various animal offal, sardines (while most fish are of medium purine content), shellfish (especially oysters have high purine content), crab (especially paste crab), etc.; foods with medium purine content include: fish and shrimp, meat, spinach, peas, etc.; as for milk, eggs, fruits and vegetables, they are all low purine foods.
Gout patients need to control their diet, but never to strictly abstain from eating. Eat more low purine foods, moderate amount of medium purine foods, and less high purine foods. Here the emphasis on high purine food is on eating less, not taboo.
4. Gout is a sacrifice in the temple of the god of wine
In the last decade or so, the rapid development of the wine industry, the consumption of alcoholic food, is also one of the reasons for the increase of gout.
In a museum in France, the collection of a famous painting of the Middle Ages: a desolate gentleman lying on a sofa, a small monster with a fire to burn his bunions. A line in the painting reads, “Gout is a sacrifice in the temple of the gods of wine and lust.” Modern science does not consider gout to be associated with proximity to women, but it does make sense to say that he is a sacrifice in the temple of the god of wine.
Many gout patients will have experienced a scene of open and painful drinking the day before an acute attack of gout. Why does alcohol consumption trigger acute attacks in gout patients?
Ethanol metabolism in the body, can make the blood lactic acid concentration significantly higher, on the one hand, lactic acid can inhibit the excretion of uric acid by the kidneys, on the other hand, lactic acid can make the pH of the blood drop, prompting urate precipitation crystals, deposited in the joints and kidneys, inducing acute arthritis and damage to the kidneys.
It is a simple chemical principle that urates are more soluble in alkaline environment and crystals are easily precipitated in acidic environment. In addition, ethanol promotes the accelerated breakdown of adenine nucleotides, resulting in increased formation of uric acid. Beer contains a large amount of guanosine, which is converted to purine in the body and is equivalent to a high purine food.
Therefore, from a medical point of view, patients with gout and elevated blood uric acid need to be warned: for the sake of health, do not crave beer.