Gout symptoms and dietary taboos

The most typical manifestation of gout is severe swelling and pain in joints without any trigger. The first metatarsophalangeal joint (that is, the base of the big toe) is the first symptom. During the attack period, high-purine foods, alcohol, and high-fructose drinks must be strictly avoided. During the remission period, there is no need to completely abstain from medium-purine foods. All it takes is to control the total purine intake and maintain the stability of blood uric acid.

I met a 32-year-old Internet programmer a while ago. The night before, he had sex with his colleagues and drank cold beer until midnight. He slept until three in the morning and was suddenly woken up by pain. His big toe was so swollen that he couldn't even bear the weight of the quilt. He took a taxi to the emergency room and had his blood uric acid spiked to 720 μmol/L, which is a typical acute gout attack. Don’t think that this is only for middle-aged and elderly people. Nowadays, a lot of children in their early 20s are getting sick. Of course, not everyone suffers from pain in their big toe. Some people first experience pain in their ankles, knees, or even wrists and fingers. Others only have a dull soreness in their joints in the early stages, thinking it is a sports strain, and they wait until the pain is so severe that they can't walk before going to see a doctor. Oh, by the way, there are still a small number of people who have a low-grade fever when they have an attack. Don’t treat it as a cold and take medicine. First, feel if any joints are red, swollen and hot, and then check the blood uric acid to basically confirm the diagnosis.

There is also a type of people with high uric acid who are asymptomatic and need to be more careful. They usually feel nothing, but a physical examination reveals that the uric acid exceeds 420 μmol/L (the upper limit of normal value for men) and 360 μmol/L (the upper limit of normal value for women before menopause). This is already a gout reserve. There are also different views on whether this group of people should take medication for intervention: one group believes that as long as uric acid exceeds the threshold, it should be controlled as soon as possible to avoid subsequent damage to joints and kidneys. ； The other group believes that if there is no history of joint attacks, kidney stones or abnormal kidney function, it is enough to adjust your lifestyle first. There is no need to rush to medication. Regular review is enough. You can ask two more doctors based on your own test results, and there is no need to stick to a certain theory.

Now that we understand the signs of an attack, let’s talk about the dietary issue that everyone is most concerned about - various taboo lists are spread all over the Internet. In fact, many of them are outdated or even ridiculously wrong.

The few days during the attack period are really special. I have seen people eat butter hot pot as soon as the swelling subsided. It should have been relieved in 3 days, but the pain was excruciating for two weeks, and the knees were swollen like steamed buns. In those days, animal offal such as pork liver and intestines, bone soup and hot pot soup base that had been simmered for several hours, as well as shelled fresh seafood such as oysters and shrimps, were not to be touched. Alcohol must be completely banned, whether it is cold beer or liquor that has been stored for ten years. There is even a rumor on the Internet that "a small amount of red wine will not affect the disease." The latest "China's Guidelines for the Diagnosis and Treatment of Hyperuricemia and Gout" also clearly recommends that all alcoholic beverages be avoided, and don't take chances during the attack.

Many people don’t know that the biggest problem is high-fructose foods. Do you think it’s safe if you don’t drink alcohol or eat seafood? Drinking tons of milk tea, cola, and even freshly squeezed juice as water every day can still cause uric acid to explode. I once treated a 19-year-old young man who never ate seafood or drank alcohol, but loved two cups of iced milk tea every day. The pain caused him to shed tears in the emergency room for the first time. He asked how he got gout. When he asked about his diet, he understood everything - fructose promotes the production of uric acid and inhibits the excretion of uric acid, raising uric acid faster than eating meat.

As for the remission period, you really don’t have to live like an ascetic. If you don’t dare to touch anything, it will make you panic. If you can’t help but eat a big meal one day, it will make you more likely to have an attack. I know an old patient who has suffered from gout for 12 years. Now he can occasionally eat two or three prawns and bite a small piece of salmon sashimi. As long as he doesn't eat it all the time, drinks two liters of warm water afterward and urinates frequently, and eats lightly the next day, there will be no problems. It was previously said that people with gout should not eat tofu or spinach. In fact, the conclusion has been updated a long time ago. During the processing of soy products, most of the purine has been lost, which is conducive to the excretion of uric acid. Blanching spinach removes most of the oxalic acid, and eating it normally has no effect at all. Oh, by the way, there are also different clinical opinions on this part. Some old-school doctors still recommend eating less soy products. If you are really worried, just control the amount and don't worry too much.

In fact, gout is simply a metabolic disease. The pain is really painful. If you don’t care about it for a long time, you will develop tophi and damage your kidneys, but it’s not that terrible. I chatted with many rheumatologists and found that some of them had high uric acid. Occasionally they would be craving for a barbecue and run to the toilet twice more after eating. They also ate more vegetables and whole grains in the next two days and rarely had attacks. Don't believe in the folk remedies of "drinking vinegar to lower uric acid" or "eating alkaline foods to cure gout". If it is true that uric acid remains high or attacks occur more than twice a year, don't just rely on adjusting your diet. When you should, see a doctor to prescribe uric acid-lowering drugs. Diet is only a supplement. Don't regret it until irreversible damage occurs.

To put it bluntly, just one sentence: Don’t force yourself to eat anything, and don’t take advantage of your youth to eat and drink. Find out your body’s tolerance, and most people can coexist peacefully with it.