What to do if uric acid is high? Remember to do "4 avoidances, 1 restriction, 5 encouragements"

Since the article "Diabetes Care: Eating right can not only help you lose weight, but also lower uric acid?" was published, many readers have left comments, some saying "Ah? Is the editor crazy?" "If you want to lower uric acid, doctors always restrict your diet. If you encourage eating, won't your uric acid level soar?"

......

After further deep reflection and painful reflection, the editor is sure that he is not crazy, because this article also makes this point clear: if you eat right, you can indeed lower uric acid!

The authoritative magazine’s opinion in the previous article is a bit dry, so let’s seriously talk about it in the following article. What should we eat if we have high uric acid?

It is important to control your diet. With the improvement of living standards, more and more people are not only growing in waist circumference and gaining weight, but also have high uric acid levels. What should I do if I find that my blood uric acid level is elevated during a physical examination?

Serum uric acid levels are affected by many factors, including internal factors (age, gender, genetics, purine metabolism, body weight, etc.) and external factors (diet, drinking, environment, temperature, etc.). Long-term hyperuricemia significantly increases the risk of gout attacks and is an important cause of renal damage. It is also an important comorbidity of obesity, metabolic syndrome, and glucose and lipid metabolism disorders.

Actively coping with hyperuricemia has important health significance. Since diet is the main factor affecting uric acid levels, long-term and standardized lifestyle management, including diet, is a very important basic treatment for patients with hyperuricemia and gout.

The American College of Rheumatology, the UK Health Quality Standards Agency, and the Chinese Medical Association's Endocrinology Division all recommend that patients with gout, hyperuricemia, those with metabolic diseases and cardiovascular risk factors, as well as middle-aged and elderly people, adopt a low-purine diet.

What is a low-purine diet? Purine mainly comes from seafood, red meat and other animal foods. After oxidative metabolism in the liver, it eventually forms the final product of uric acid, which is excreted by the kidneys through urine. A low-purine diet can be understood as a diet that controls the intake of seafood, red meat and other animal foods.

How effective is a low-purine diet in controlling uric acid levels? A low-purine diet can reduce blood uric acid by 10% to 18%, and reduce the number of acute attacks of gout. People with renal insufficiency and those who consume a high-purine diet benefit more significantly.

However, it should be noted that dietary adjustment is only a foundation and cannot replace medication. Those with recurrent gout must take oral uric acid-lowering drugs regularly and for a long time. For those with simple hyperuricemia, if the uric acid level is greater than 540 micromol/L, on the basis of a low-purine diet, medication is also required if necessary.

How to implement a low-purine diet?

The 2012 "American College of Rheumatology Gout Treatment Guidelines" and the 2013 "Chinese Expert Consensus on the Treatment of Hyperuricemia and Gout" both recommend that based on the different dietary sources of purine, various diets should be classified into three categories, namely "avoid", "restrict" and "encourage", so as to carry out targeted interventions.

What are the dietary restrictions? ▶ Seafood, red meat, and animal offal

The seafood that patients should avoid mainly refers to seafood with shells, such as lobsters, scallops, oysters, etc. In 2015, the Austrian Society of Rheumatology and Rehabilitation specifically pointed out that since the monounsaturated fatty acids in fish oil are beneficial for improving blood lipids and reducing the risk of cardiovascular disease, fatty marine fish (such as mackerel and sardines) are not contraindicated for patients with high uric acid who may also have high risk factors for cardiovascular disease, and can still be consumed in moderation.

Red meat and animal offal rich in purine must be strictly limited. They should be avoided during acute gout attacks. For patients with stable gout or hyperuricemia, the intake of animal food should not exceed 50 grams per day, which is about the size of an egg.

▶ Alcohol

Alcohol can significantly increase gout attacks and raise uric acid levels, which has been known since the 1970s. Of course, different types of alcohol have different relationships with the onset of the disease. Beer and high-alcohol distilled spirits (high-alcohol liquor, whiskey, etc.) have more significant harm, and patients should try to avoid them; low-alcohol wine has less impact on uric acid levels, but it still needs to be strictly limited.

The American College of Rheumatology recommends that patients with acute gout attacks, poor drug control, and chronic tophaceous arthritis should completely abstain from alcohol. For patients with stable conditions, drinking should not exceed 4 days per week, and men should not drink more than 2 units of alcohol per day, and women should not drink more than 1 unit of alcohol per day. 1 unit of alcohol is about 14 grams of pure alcohol, equivalent to 100 ml of low-alcohol wine.

▶ Sweets/overly sweet fruits

Restrictions on sweets are often overlooked. Studies have shown that foods, drinks, candies, and even sweet natural fruit juices containing added sugars can increase blood uric acid levels. Therefore, if you want to control uric acid levels, don't forget to put all kinds of sweets and overly sweet fruits on the restriction list.

What to eat more ▶ Dairy products

Dairy products such as milk, yogurt, and cheese are important sources of high-quality protein, and very little uric acid is produced by metabolism. At the same time, whey protein and casein contained in dairy products can promote the reduction of uric acid levels and are important nutritional substitutes for patients who restrict animal foods. Since patients with high uric acid/gout often have chronic metabolic diseases such as overweight, obesity, and metabolic syndrome, it is recommended to choose skim or low-fat dairy products.

▶ Eggs

Eggs also produce very little purine, and are also an important supplement of high-quality protein when limiting animal food. However, since egg yolks contain a considerable amount of fat, they should not be consumed excessively. You can supplement egg white with one egg per day.

▶ Fresh vegetables

Eating a lot of vegetables (250-500 grams per day) is helpful to control uric acid levels. Studies have found that even so-called high-purine vegetables (such as spinach, mushrooms, broccoli, etc.) will not increase the body's uric acid level. This may be related to the fact that the degree of hydrolysis and absorption of purines from plant sources in the gastrointestinal tract is much lower than that of purines from animal sources. Therefore, there is no need to worry about the purine content in different vegetables. The most important thing is to ensure the total amount of vegetables consumed!

▶ Coffee

The caffeine and chlorogenic acid in coffee are strong antioxidants that can lower uric acid levels. Therefore, drinking more coffee can help lower uric acid levels.

▶ Water

Drinking plenty of water and urinating frequently are very important for lowering uric acid levels. Patients with urinary uric acid stones should drink more than 2 liters of water per day.

It is equally important to move your legs. Patients with hyperuricemia/gout often suffer from overweight, obesity, and metabolic syndrome. In addition to a reasonable diet, reducing the intake of refined processed foods and high-fat and high-sugar foods, it is particularly important to control your weight while controlling your diet and moving your legs.

It is recommended that patients with hyperuricemia actively engage in aerobic exercise and cooperate with muscle resistance training. For patients who have already developed gouty arthritis, appropriate immobilization can be performed during the acute phase. As symptoms ease, reasonable exercise can be performed under the guidance of rehabilitation experts. This is more conducive to the long-term management of uric acid.

About the Author

Li Rongrong

Attending physician of the Department of Clinical Nutrition, Peking Union Medical College Hospital. Member of the Clinical Nutrition Branch of the Beijing Medical Association, and member of the Nutrition and Food Safety Branch of the Chinese Geriatrics Society. He is responsible for the main clinical, teaching, and scientific research work of the department. He is good at nutritional intervention and support in clinical situations such as common chronic diseases (obesity, diabetes, kidney disease, gout and hyperuricemia), tumors, and surgical operations, nutritional treatment of difficult genetic metabolic diseases, and nutritional evaluation and intervention in special periods such as pregnancy and infants. He mainly participated in the formulation of two national health standards (Dietary Guidelines for Patients with Gout and Hyperuricemia, Dietary Nutrition Guidelines for Gestational Diabetes) and a clinical guideline (Expert Consensus on Nutritional Management of Patients in the Recovery Period of Malignant Tumors), published more than 20 articles in domestic core journals and 5 SCI articles, and edited a popular science book "Be a Mother Like Me, Look Here for Confinement Diet".

Chen Wei

Deputy Director of the Clinical Nutrition Department of Peking Union Medical College Hospital, Chief Physician, Doctoral Supervisor. Expert of the National Health Science Popularization Expert Database, participated in many national research projects, and won 3 provincial science and technology awards. Published 74 academic papers, 25 of which were included in SCI as the first author and corresponding author, and wrote 35 popular science books.

丨The article was first published on the "Healthy China" platform, planned by Tan Jia, edited by Wang Jianying

Editor: Liu Yang and Zhao Na; Proofreader: Li Na, Li Yule and Dong Zhe; Producer: Wu Wenming

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