Beer is banned for a reason:
1. Although the purine content in beer is not high, it is the highest in all kinds of wines. Rich in guanine nucleotides (most easily absorbed), easy to increase blood uric acid;
2. Compared with meat, the daily intake of meat will not be too much; But when it comes to drinking beer, I'm afraid three or five bottles are indispensable. And when drinking, you will unconsciously eat more foods with high purine, high protein, high calorie and high fat. Not only the intake of purine has soared, but also the substances (sugar and oil) that affect purine excretion have been ingested too much;
3. The total alcohol consumption is positively correlated with the increase of serum uric acid. Excessive alcohol will cause the accumulation of lactic acid and ketone bodies in the body, and lactic acid is a strong inhibitor of uric acid excretion, which inhibits uric acid excretion.
The increase of serum uric acid in beer is mainly affected by these three aspects, and the third point is mainly in liquor.
In fact, the latest authoritative guideline for diagnosis and treatment issued by Endocrinology Branch of Chinese Medical Association-Guidelines for Diagnosis and Treatment of Hyperuricemia and Gout in China (20 19) suggests that all patients with hyperuricemia and gout should maintain a healthy lifestyle, including: controlling weight and exercising regularly; Limit the intake of alcohol, high purine and high fructose diet; Encourage the intake of dairy products and fresh vegetables and appropriate drinking water; The intake of bean products (such as tofu) is not recommended or restricted. ...
Combined with clinical experience, most patients with hyperuricemia and gout have poor self-control and compliance, so it is not easy to check uric acid on time. If the strictest standards are put forward at the beginning of the initial diagnosis, their rebellious psychology will be very strong, but the degree of treatment cooperation will be very poor.
Therefore, at the first visit, I will tell patients that alcohol can not be completely banned, but they must cooperate with me to complete the standardized treatment first. Want to drink, naturally there are some conditions:
Can't drink when gout is acute; Uric acid should not be drunk unless it falls below the target value (gout 360umol/L, tophus 300 umol/L); Try not to touch beer! If you want to drink, recommend red wine. Proper amount of red wine can slightly reduce blood uric acid. Red wine is rich in antioxidants, vasodilators and anticoagulant stimulants, which can reduce the influence of alcohol on uric acid.
Regarding the amount of drinking, Teacher Joe suggested:
Liquor: no more than 2 A Liang weeks, no more than 1 2 cups each time (about 1/2 cups);
Beer: No more than two cups per day. The purine content in beer must be calculated to ensure that the total purine intake per day does not exceed the standard.
Red wine: no more than 1 twice a day and no more than 4 times a week.
Restricting alcohol consumption is only one kind of non-drug treatment for gout, and it is particularly important to do a good job in these aspects.
Non-drug treatment is the basis of gout treatment. Most treatments, especially healthy diet and treatment of complications, need patients' lifelong companionship. Simple diet and lifestyle intervention can reduce uric acid and/or prevent acute gouty arthritis to some extent, which is the basis of other gout treatment strategies.
1. low purine diet
The diet of gout patients should encourage foods with low purine content, limit foods with medium purine content and avoid foods with high purine content (the purine content of common ingredients is attached, so it is recommended to collect them). Low purine diet can bring five benefits: it can reduce serum uric acid1~ 2 mg/dl; Reduce acute attack of gout; Shorten the attack time; Reduce urate deposition to form stones; Reduce the use of uric acid-lowering drugs.
2. Eat more vegetables and fruits
Vegetables and fruits are rich in potassium, calcium, magnesium ions and vitamins. Potassium, calcium and magnesium ions produced after metabolism can fine-tune the pH value of human internal environment to "alkaline", which is beneficial to the dissolution and elimination of urate crystals. The latest research also shows that adequate vitamin C supplementation can reduce the number of gout attacks.
3. Keep 2500ml of drinking water.
Drink more water, so that the daily urine volume is more than 2000ml, which is helpful for the excretion of uric acid. It is recommended to drink more alkaline mineral water instead of mineral water and pure water. Coffee, cocoa and tea are not strictly restricted, and fructose drinks must be strictly controlled.
4. Insist on moderate exercise and control weight.
Insisting on physical exercise is not only beneficial to weight control, but also beneficial to uric acid excretion. Encourage proper aerobic exercise, make the heart rate reach 1 10 ~ 120 times/min and sweat a little, 30 minutes in the morning and evening every day, 3 ~ 5 times a week, especially playing ball, dancing, swimming and fitness exercise. Avoid strenuous exercise and anaerobic exercise, which can decompose adenosine triphosphate in muscle, release inosine and hypoxanthine into blood, and increase blood uric acid. In order to control weight, you should not lose weight on an empty stomach, because when you are hungry, fat will be decomposed into energy, which will increase blood ketone bodies and organic acids and inhibit uric acid excretion.
5. Avoid other inducing factors
In addition to dietary factors, the most common inducing factors include fatigue, cold, joint trauma, strenuous exercise, diuretics and other drugs, which should be avoided.
6. Related complications need to be paid attention to and treated together.
Gout is more common in middle-aged and obese men, and these patients are often complicated with hypertension, hyperlipidemia, abnormal glucose tolerance and obesity (collectively referred to as metabolic syndrome), cardiovascular diseases, renal insufficiency and other diseases. It is found that obesity, hyperlipidemia, hyperglycemia, hypertension, ischemic heart disease and renal insufficiency are all independent risk factors of gout attack, so only by controlling these risk factors ideally can gout itself be well treated.
Some patients with chronic renal insufficiency and urinary tract obstruction have gout attacks due to uric acid excretion disorder, so the treatment of the primary disease is also very important.
abstract
The immediate premise of gout attack is that uric acid exceeds the standard, and gout will not occur if uric acid is reduced. There are many reasons for the increase of uric acid, and there are many other controllable factors besides the level of self-metabolism. If you want to help reduce uric acid quickly and effectively, you often need to attack from all sides to achieve the desired effect. You need to do more than just reduce and limit alcohol intake.
In the game with gout, it is often the patient's own willpower that is more "strategic" than the doctor's medical skill. This willpower not only refers to being able to adhere to all aspects I have mentioned above, but also includes not listening to all kinds of folk remedies, magic drugs and slanders. I hope all friends with gout can keep their faith and win in this long struggle.