Should gout patients eat less high-purine foods such as seafood and eat more low-purine foods?

Popular saying: Gout is a very common disease of rheumatism and immunity, and is also often called "rich man's disease" and "emperor's disease". Gout patients should remember one principle in their diet: avoid high-purine foods and eat more low-purine foods.

Truth-checking: It is indeed true

Verification points:

1. Gout patients should avoid foods high in purine, such as: animal offal, seafood (note that some seafood can still be eaten, such as sea cucumbers, which have a very low purine content and can be eaten), and soup. In addition, we should also try to avoid meat such as beef and mutton. Try not to drink beverages, as many beverages contain a lot of fructose, which can cause a significant increase in uric acid.

2. Eat more foods with low purine content, such as skim milk, which not only has low purine content, but also has a certain effect of lowering uric acid, and is a very good food for gout patients. Other foods such as eggs, green vegetables, and some fruits can also be eaten in moderation by gout patients. Studies have shown that eating about three taels of cherries a day can also effectively reduce the probability of gout attacks, and also has a certain effect of lowering uric acid.

How painful is gout? The typical symptom of gout is sudden and severe redness, swelling, heat and pain in a single joint. The onset of gout is mainly related to blood uric acid. When the uric acid in the blood increases and exceeds the saturation concentration (420μmol/L), a lot of uric acid will appear in the form of crystals, causing uric acid crystals to deposit in the joints. Long-term uric acid crystal deposition causes local inflammatory reactions in the joints, and eventually causes sudden redness, swelling, heat and pain in the joints.

How painful is an acute gout attack? I cannot describe it accurately because I have not experienced it myself. But I have seen many patients who are in excruciating pain every time they have a gout attack. For example, the father of one of my classmates came to me and said: Doctor He, every time I have a gout attack, I want to cut off my leg. It is so painful that I dare not move. Even a gust of wind will make me feel excruciating pain.

How should you deal with an acute gout attack?

First, take painkillers. Currently, commonly used painkillers include nonsteroidal anti-inflammatory drugs (etoricoxib, diclofenac, etc.), colchicine, and hormone drugs. How to choose painkillers specifically needs to be done under the guidance of a professional doctor.

Second, auxiliary treatment options include joint immobilization, ice compress, external plaster, etc. Everyone, please note that when gout attacks acutely, the joints are locally red, swollen, hot and painful. At this time, you cannot apply hot compresses, but only ice compresses to relieve swelling. Similarly, you can only apply cold plasters, and never apply hot plasters (for example, some magnetic therapy plasters will generate heat). Generally speaking, after symptomatic treatment, gout can be completely relieved in 3-5 days.

Is alcohol really a catalyst for gout? Many gout patients are warned to stay away from alcohol. There is also a saying that "alcohol is a catalyst for gout". Is this true?

It turns out that alcohol increases blood uric acid and induces gout attacks mainly through two pathways:

1. Reduce the excretion of uric acid. Alcohol can be metabolized into lactic acid in the body, which can competitively inhibit the excretion of uric acid in the kidneys, resulting in a decrease in the excretion of uric acid in the urine and an increase in the level of uric acid in the blood.

2. Alcohol can lead to increased uric acid production, which in turn leads to increased uric acid production by increasing the degradation of adenosine triphosphate.

Some people may ask, are there any differences between different types of wine?

Relatively speaking, beer and rice wine have the greatest impact on uric acid, so you should never drink them. Try not to drink white wine and foreign wine (spirits). As for red wine, the current research conclusions are not completely consistent. Some studies say that it will not increase uric acid, while others say that it may increase uric acid and induce acute gout attacks. But no matter what, try not to drink it. If you really need to drink for social occasions, you can choose red wine.

In addition to alcohol, what else should we pay attention to in terms of diet? Simply put, avoid foods high in purine, such as: animal offal, seafood (note that some seafood can still be eaten, such as sea cucumbers, which have a very low purine content and can be eaten), and stewed soup. In addition, we should also try to avoid meat such as beef and mutton. Try not to drink beverages, as many beverages contain a lot of fructose, which can cause a significant increase in uric acid.

What foods can gout patients eat? The answer is also very simple, that is, foods with low purine content, such as skim milk, which not only has low purine content, but also has a certain effect of lowering uric acid, and is a very good food for gout patients. Other foods such as eggs, green vegetables, and some fruits can also be eaten in moderation by gout patients. Studies have shown that eating about three taels of cherries a day can also effectively reduce the probability of gout attacks, and at the same time has a certain effect of lowering uric acid.

In short, gout patients should remember one standard in their diet: avoid high-purine foods and eat more low-purine foods.

Is it true that gout is more common in boys than girls? Overall, the incidence of gout is very high in men and very low in women. Studies have shown that blood uric acid is low in childhood, increases significantly in men during adolescence, and only slightly increases in women during adolescence. It is not until menopause that women experience another peak in uric acid increase. After menopause, women's uric acid levels approach those of men.

Why is this so? This may be related to the secretion of estrogen in the body. Many studies have shown that estrogen can promote the excretion of uric acid by acting on organic ion transporters. This also explains why the first onset of gout in men is mostly between 40 and 60 years old, while the first onset of gout in women is mostly after 60 years old.

Can gout be cured? Whether gout can be cured is the most common question encountered in clinical practice. Generally, my answer is: for most patients, after regular uric acid lowering (usually takes half a year to a year), gout will no longer have acute attacks, and uric acid deposited in the joint cavity will slowly dissolve (including some uric acid kidney stones). When the gout condition tends to stabilize, the dosage of uric acid lowering drugs can be slowly reduced.

However, only a very small number of patients can completely stop taking the medicine and their uric acid levels return to normal. This is because most of the hyperuricemia is caused by metabolic problems (accounting for 80%), and only a small part is caused by diet (20%). This also explains why no matter how strict the diet is, it can only reduce uric acid by about 15%.

Gout treatment is very simple, just lower uric acid regularly. Currently, commonly used uric acid-lowering drugs include allopurinol and febuxostat to inhibit uric acid production, benzbromarone to promote uric acid excretion, sodium bicarbonate and potassium citrate to alkalinize urine. As for what drug treatment to choose? It needs to be decided by a rheumatologist after an overall assessment of the condition. Do not buy and take medicine at will.

In the outpatient clinic, we often encounter patients who have problems after buying medicine on their own. For example, there was an uncle who had kidney stones (multiple, scattered stones) and chose to take benzbromarone. As a result, his kidney stones grew larger, blocked the ureters, and caused renal colic, which was not worth the cost.

There are also many patients who take large doses of allopurinol on their own without undergoing HLA-B508*1 gene testing (patients who are positive for this gene are prone to be allergic to allopurinol). As a result, some patients develop severe allergic reactions, exfoliative dermatitis and other symptoms.

So, although it seems simple to lower uric acid, how to use the drug reasonably is also an art. Everyone needs to use the drug under the guidance of a rheumatologist.

How should office workers prevent and treat gout? Gout or hyperuricemia is a disease that is very harmful to the body and has a great impact on the kidneys, cardiovascular and cerebrovascular systems, blood sugar, blood lipids, and body weight.

If the blood uric acid level is within 550μmol/L, you can consider lowering uric acid through diet control, work and rest schedule adjustment, lifestyle adjustment, etc., and check regularly. If uric acid still cannot be controlled below 420μmol/L, then additional medication is needed. If uric acid exceeds 550μmol/L, it is recommended to take uric acid-lowering drugs on the basis of diet control, starting with a small dose and gradually adjusting.