To prevent gout in summer, pay attention to 8 misunderstandings

In the hot summer, air conditioning, cola, beer, edamame, peanuts, crayfish, etc. have become the "standard configuration" for many people's happy life. Here we remind everyone that these so-called comfortable "standard configuration" may be a "mine" that may explode at any time and cause acute gout attacks. Why does gout attack more frequently in summer? The following 8 misunderstandings need special attention.

Myth 1: Just stay away from seafood and beer

Summer is the season for eating seafood and drinking beer. Eating hot pot in an air-conditioned room is also a habit for many people. As we all know, seafood and animal offal are high-purine foods, and beer itself contains a lot of purine. In addition, alcohol will metabolize into lactic acid after entering the human body. Lactic acid will inhibit the secretion of uric acid by the renal tubules, reducing the kidney's ability to excrete uric acid. Therefore, when people drink beer and eat barbecue, the uric acid concentration will rise rapidly, which can easily induce gout.

So if you refuse seafood and beer, you can always have a plate of edamame and peanuts, right? Both edamame and peanuts are medium-purine foods, with 100 grams of peanuts containing 50 to 100 mg of purine. Even though the purine content of edamame is as low as 27 mg/100 grams, it is not a low-purine food. Recently, it was reported that an elderly man in Nanjing drank edamame with alcohol for a long time, which led to gout and joint deformity. Gout patients are advised to avoid consuming large amounts of such medium-purine foods.

Myth 2: Using iced drinks instead of alcohol to cool down

Some gout patients know that drinking is not good, so they drink iced drinks to cool off. Although general beverages are not high-purine foods, most beverages contain a lot of fructose. Intake of a large amount of fructose-rich beverages at one time can also induce gout. Why does excessive fructose intake cause gout attacks? Because fructose is an accomplice of gout, consuming a large amount of fructose will significantly increase the level of uric acid in the body in a short period of time. At the same time, fructose will also reduce renal uric acid excretion, further causing an increase in uric acid in the body. For gout patients, sugar is the second largest unhealthy food after a high-purine diet, and the harm of fructose drinks to the body cannot be ignored. Therefore, in addition to resisting the temptation of drinking beer and eating seafood, gout patients must also refuse the temptation of beverages and desserts.

Misconception 3: Simply avoid eating and drinking water

The weather is hot in summer, and people sweat a lot. If water is not replenished in time or not in time, it will cause blood concentration and lead to increased blood uric acid levels. Drinking less water will also lead to reduced urine volume and reduced excretion of uric acid, which can easily cause gout attacks. Gout patients should drink more water to promote the excretion of uric acid and avoid the formation of tophi, thereby delaying progressive kidney damage. It is recommended to drink more water, mainly boiled water, generally at least 2000 ml a day, and those with kidney stones should drink 3000 ml. However, those with renal insufficiency or abnormal cardiopulmonary function should limit water intake according to their condition.

Myth 4: I don’t have to worry about attacks if I don’t eat meat

Many people believe that gout is caused by eating too much meat, so "as long as you don't eat meat, it won't happen", but this is not true. If you eat certain vegetables or fruits without restriction, even if you don't eat meat, it will induce gout, such as edamame, peanuts, mushrooms, seaweed, etc. Gout patients should try to avoid excessive consumption. In addition, if you don't consume meat in your daily diet for a long time, the functions of various tissues and organs in the body will decline, and the ability to metabolize purine will also decline. Therefore, gout patients can also eat meat moderately and reasonably during the interval period.

Myth 5: The less you eat, the better

In order to avoid recurrent attacks of gout, some people are too strict in their diet control and stay away from animal foods such as fish, meat, eggs, and milk. This is not only difficult to stick to, but also reduces the quality of life and even leads to malnutrition, which is not good for health. In fact, if you have gout, it is not the case that the less you eat, the better. Instead, you should selectively eat low-purine foods while controlling the total calories and try to maintain a balanced nutrition. Milk and eggs are low-purine foods and high-quality proteins rich in essential amino acids. Gout patients can eat them. Patients with hypercholesterolemia should be careful not to consume too much egg yolk.

Myth 6: The lower the air conditioning temperature, the better

In summer, when the temperature is high, people prefer to stay indoors with air conditioning. Now almost every household turns on the air conditioner, but do you know? If the indoor air conditioning temperature is too low, or the body is too close to the air outlet, gout can be easily induced. Because urate is more likely to precipitate crystals in a low temperature environment, deposit around the joints, and cause arthritis attacks. Therefore, gout patients should also pay attention to avoid staying in air-conditioned rooms for a long time in summer, and avoid blowing cold air directly at the air outlet of the air conditioner; the temperature in the air-conditioned room should not be adjusted too low, and try to keep it at 26℃~27℃; the temperature difference between indoor and outdoor should not be too large, and it is best to turn off the air conditioner half an hour in advance when leaving the air-conditioned room.

Myth 7: Rapidly lowering uric acid levels is necessary when an attack occurs

Gout causes severe pain during an attack, and some patients buy uric acid-lowering drugs on their own, hoping to quickly lower uric acid to relieve pain. Some patients also increase the dosage of uric acid-lowering drugs without authorization, or even use several drugs together, trying their best to deal with high uric acid. Unexpectedly, the joint swelling and pain not only did not improve, but became more and more severe. In fact, it is not recommended to temporarily add uric acid-lowering drugs during an acute attack of gout, and the faster the uric acid level drops, the better. Because if uric acid drops suddenly, on the one hand, it will cause the insoluble urate crystals that have been deposited in the joints and surrounding tissues to fall off, and on the other hand, it will cause blood uric acid to deposit in the joint cavity, thereby aggravating pain. In the acute phase, the main focus should be on controlling joint inflammation and pain. After the symptoms are completely relieved for 7 to 10 days, uric acid-lowering drug treatment should be gradually started. It is advisable to gradually and steadily lower uric acid levels with small doses.

Myth 8: You can stop taking the medicine if the gout pain stops

Does gout not need treatment as long as it is not painful? This is also a misunderstanding. Gout patients need to persist in uric acid-lowering treatment for a long time. Stopping the medication without authorization will cause a rapid increase in uric acid levels and induce gout attacks. Moreover, in addition to being deposited in the joints and causing joint deformities, urate crystals that are not ideally controlled for a long time may also be deposited in the kidneys, causing urinary stones, chronic renal insufficiency, and even renal failure. At the same time, long-term hyperuricemia can also induce and aggravate diseases such as diabetes, coronary heart disease, stroke, and hypertension. Gout patients should improve their lifestyle on the basis of drug control, regularly check their blood uric acid levels, and gradually adjust the dosage of uric acid-lowering drugs under the guidance of a doctor according to the uric acid level.

Author: Zhao Like, deputy chief physician of the Department of Rheumatology and Immunology, Beijing Hospital

Review | Expert of National Health Science Expert Database

Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

Lv Liangjing, Chief Physician of Rheumatology Department

Planning | Tan Jia and Wu Weihong

Editor | Yu Yunxi