When it comes to gout this disease, 90% of the people think it is eat out, the evening after work a few brothers about to jerk a skewer drink some cold beer and then nagging 200 dollars high, the wind is simply relaxed! It wasn't long before I heard that Liu had gout next door.

It is true that gout is closely related to eating a diet high in purines in large quantities over a long period of time. But did you know? Gout is not all about eating. Dr. Zhang Xuewu of the People's Hospital of Peking University, in his outpatient clinic, can come across patients who usually keep a tight rein on their mouths and never eat too much, but they still can't escape from the clutches of gout. What causes their gout? This article reveals the five main reasons besides "eating".

Starting today, Zi Lin Medical Science launched a gout series, inviting a number of authoritative experts from Peking University People's Hospital and Peking University Third Hospital to talk to us about gout.

Cause 1: Inactivity

Why does not exercise cause gout? Dr. Zhang Xuewu said, moderate exercise can accelerate metabolism, conducive to uric acid excretion. Less exercise is easy to cause blood uric acid metabolism is not smooth, triggering hyperuricemia.

Some chronic diseases, such as hypertension, diabetes, hyperlipidemia, obesity, etc., also like to "target" people who do not like to exercise. Hypertension, hyperlipidemia, diabetes, obesity, hyperuricemia are high risk factors for gout.

Expert Tip:

Moderate exercise will not only reduce blood uric acid appropriately, but also improve high blood pressure, high blood cholesterol and other risk factors for gout.

Cause 2: Excessive Exercise

Zhang Xuewu's clinic because of excessive exercise to the gout patients are not a few, some of them are athletes, we may be through the example of athletes to illustrate why excessive exercise can cause gout.

There was a study on the relationship between exercise and uric acid: a group of college students between the ages of 20 and 24 had their blood drawn to check the average value of uric acid in their blood before and after 10 minutes of intense exercise.

Taking the serum uric acid value before exercise as the benchmark, +93.6μmol/l after one hour of exercise, +113.4μmol/l at two hours as the highest, +82.8μmol/l at three hours gradually declined again, +76.8μmol/l at five hours, +53.4μmol/l at seven hours gradually recovered, and -10.8μmol/l at twenty-four hours, which has returned to the normal value before exercise. It was -10.8 μmol/l after twenty-four hours, and had returned to the normal value before exercise.

It can be seen that after exercise, there is a transient increase in uric acid, which returns to normal after 24 hours. However, athletes have to do a lot of training every day, the uric acid value has not waited to return to normal, and then start the next day's intense training, blood uric acid has been in a state of increase.

And intense exercise will also cause lactic acid buildup, lactic acid buildup will make the blood and urine in the state of acidic. Uric acid is most easily excreted at a pH value of 6.5, and the pH value of uric acid in the body after strenuous exercise is usually less than 6.5.

Coupled with the fact that athletes have more protein and sugar in their diets to maintain high intensity exercise, they are prone to abnormal lipid and glucose metabolism, which increases the risk factors for gout.

Most athletes don't exercise as much as they used to after they retire, which causes them to gain weight too quickly, plus they eat too much, and their joints have been damaged during their previous sports, so athletes are also at high risk for gout.

Reason 3: Joints have been injured before

The first location of gouty arthritis is usually in the first metatarsophalangeal joint (pictured above). In some people, the first sign of gouty arthritis is not in this location, but in the knee, ankle, and even the wrist and elbow.

Because there is a characteristic of gout, joints that have had injuries are more likely to develop or develop gout earlier. For example, there is a history of elbow inflammation, fracture, broken ankle and so on. Soccer players always use their toes to kick the ball, so gout is good in the toe joints. Such a joint, its structure has changed, uric acid is more likely to be deposited on such a joint, just like blood clots are prone to occur after there are some plaques in the blood vessels.

The normal blood uric acid value for men is 428 μmol/l, and many people with high uric acid may not start to have an attack of gouty arthritis until 600 μmol/l. And once there is joint damage, perhaps 500 μmol/l gouty arthritis flares up.

Expert Tip:

In addition to the broken foot, rubbing and massaging the joints vigorously, sauna, the joints localized urate will be easy to precipitate quickly, gout will be easy to attack.

If you have high uric acid and a joint injury, it is even more important to keep an eye on your blood uric acid levels, have your blood uric acid checked every six months, and be careful not to have a joint injury.

Cause 4: Long-term use of certain drugs

Long-term use of certain drugs can also cause an increase in blood uric acid and thus gout. For example: aspirin, diuretics for lowering blood pressure, some anti-tuberculosis drugs.

Aspirin is a commonly used drug for the prevention of cardiovascular and cerebrovascular diseases, and its main ingredient is salicylic acid, and it has been found through years of clinical investigations that this ingredient can have some effect on the excretion of uric acid. Therefore, aspirin should be taken only when necessary, not without authorization, and a doctor's assessment is required.

Diuretics from the name sounds "diuretic", but on the excretion of uric acid will produce some obstruction. We would like to remind gout patients with high blood pressure to take diuretics as prescribed by their doctors.

Long-term use of aspirin, blood pressure-lowering diuretics, and anti-tuberculosis drugs should be checked every six months for blood uric acid levels, so that any problems can be detected and measures taken early.

Cause 5: Renal Insufficiency

Kidneys are in charge of metabolism and help us metabolize the waste in our body every moment. A variety of acute and chronic kidney diseases such as glomerulonephritis can cause renal insufficiency, leading to elevated blood uric acid and causing gout. Just like a blocked sewer, not to mention uric acid, no waste in the body can be discharged.

Zi Lin Fan Question

1、What kind of exercise is best for gout patients?

Zhang Xuewu: Exercise methods with no weight bearing on the joints are most suitable for gout patients, and the principle of exercise for gout patients is to protect the joints. You should choose exercises that are not weight-bearing on the joints, such as swimming, walking, dancing and cycling.

2. Gout attacks hurt too much, what should I do?

The most important principle during a gout attack is to stop the pain first, then lower the uric acid. Don't take uric acid-lowering drugs during an acute attack of gout. If you take uric acid medicine, you will have more pain.

Because blood uric acid levels fluctuate during a sudden attack of gout, taking uric acid-lowering medications can exacerbate the fluctuations and lead to prolonged swelling and pain.

Another condition worth noting is that in some patients the blood uric acid may drop more than usual during an acute attack, because the pain of gout is so intense that it excites the sympathetic nerves, and the endocrine glands of the pituitary gland force the kidneys to accelerate the excretion of uric acid.

The principle of pain relief is to take anti-inflammatory painkillers or apply topical painkillers. Get plenty of rest, lie flat and keep your feet elevated. Also drink plenty of water.

3、Does having gout mean that you have to take medication for a long time?

It is recommended that gout patients after diagnosis, regular compliance with the doctor's instructions to take a period of time to adjust the drug. After adjusting for a period of time, the dosage can be gradually reduced, and long-term patients with normal blood uric acid can be appropriately discontinued, according to the regular examination of the blood uric acid value to decide whether to continue to take the drug.

Instead, you should not wait until you have an attack of gouty joint pain to take your medication. Without regular medication, gouty arthritis will recur at shorter and shorter intervals, even if you eat right and exercise properly.

Thank you for your question.

(1) Gout is a disease caused by purine metabolism disorders, which will lead to excessive production of uric acid in the body or reduced excretion of uric acid by the kidneys, resulting in elevated uric acid in the blood and the formation of hyperuricemia, which can lead to recurrent gouty acute arthritis, gouty stone deposition, gouty chronic arthritis, and joint deformities and other clinical symptoms. (Uric acid is the end product of purine metabolism in the body)

(2) According to modern medical theory, hyperuricemia is a prerequisite for gout attacks, and studies have shown that 20% of the body's uric acid is derived from food, which shows that unhealthy dietary habits play an important role in the development of gout.

For this reason, we advocate "three lows and one high" in terms of diet: i.e., a low purine diet, low calorie intake, low protein and fat intake, and plenty of water.

Other aspects: quit smoking and drinking; weight control; appropriate exercise, pay attention to timely replenishment of water; pay attention to joint warmth and avoid joint damage; work and rest, avoid overwork and so on;

You can try a few dietary therapy: lily soup, lily 20-30g decoction or boiled to take; red bean barley porridge, adzuki beans 50 grams, 50 grams of barley, porridge to take; Poria japonica rice porridge, Poria 30 grams of Poria japonica 50 grams, the first Poria decocted into a medicinal liquid, and then put into the Japonica rice boiled into a thin rice.

I hope it helps you!

The authoritative interpretation of Pharmaceutical Affairs, unauthorized reproduction, plagiarism will be punished.

Thanks to Wukong for the invitation and welcome to follow my headline for more specialized medical science.

What causes gout.I have answered this question many times. Very simple, gout is caused by hyperuricemia, blood uric acid concentration is too high, more than the saturation concentration of 420 μmol / L, blood uric acid will form crystals, crystals in the position of the joints through the local blood circulation is very slow, uric acid crystals will easily be deposited in the joints localized, slowly accumulating day after day, the joints localized uric acid crystals more and more, finally one day activated local immune cells (such as neutrophils macrophages, etc., causing the immune inflammatory response, resulting in redness, swelling and heat pain. Finally one day activate the local immune cells (such as neutrophils, macrophages, etc.), causing an immune-inflammatory reaction, resulting in local joints red, swollen, hot and painful. This is the cause of gout attacks.

Is there a relationship between gout and diet?Gout is definitely related to diet, but not only to diet. Many high-purine diets can lead to elevated blood uric acid, which can cause gout. However, many studies have shown that diet is only part of the diet in hyperuricemia, and diet only plays a role in about 20% of the increase in blood uric acid; therefore, diet is only one aspect of hyperuricemia, which is related to genetics, metabolism, endocrine factors, etc. Estrogen, for example, can inhibit the increase in uric acid; in the case of estrogen, it can inhibit the increase in uric acid. For example, estrogen can inhibit the rise of uric acid; in women before menopause, the incidence of gout is very low, after menopause, the incidence of gout gradually increased, and finally no difference with men, which is likely to be caused by the protective effect of estrogen.

Once the gout attack, you need regular uric acid lowering treatment, how to choose drugs, need to be completed under the guidance of a professional rheumatologist, do not use their own drugs indiscriminately.

What causes gout and is it an eating problem? The cause of gout is mostly unknown, but gout is mainly divided into two categories, one is primary gout, which often occurs with obesity/disorders of glucose and lipid metabolism/hypertension/atherosclerosis and coronary heart disease. The other is secondary gout, which is mainly caused by reduced uric acid excretion due to renal disease, as well as inhibition of uric acid excretion by certain medications, but for primary gout, there is a very close relationship with diet.

Whether it is obesity/glycolipid metabolism disorder/hypertension/arteriosclerosis or coronary heart disease, all these factors affecting gout are inseparably related to diet, and irrational dietary structure and excessive total energy intake are the main reasons leading to these problems, especially obesity. As the saying goes, all diseases begin with fatness. If the problem of obesity is not solved, then other diseases will follow, especially chronic cardiovascular diseases, which in turn will bring about various new complications.

Although diet is not the only factor that causes gout, if you already have gout, diet is the most important factor that affects gout attacks. People who have gout usually have problems with uric acid metabolism, and if the diet increases too much uric acid, then it can trigger a gouty attack. The following is a list of foods that contain more or less purines, and foods that are high in purines and medium in purines are not suitable for people with gout, especially during an acute attack, and must be avoided:

As the standard of living continues to improve, more and more people are beginning to suffer from gout and suffering.

Gout is a kind of urate deposition inflammatory disease, which is caused by long-term heterogeneous purine metabolism active triggering hyperuricemia, and then acute inflammation of tissues or joints, destroying the joints, causing recurrent acute arthritis, gout stone deposition, gouty stone chronic arthritis, etc., and in severe cases, renal pathology can even occur. There are many reasons for the increase of uric acid in the blood, which can be summarized as the excessive production of urate, reduced excretion and other factors.

Excessive urate production is first affected by genetic factors, according to statistics, about 10-25% of primary gout patients have a family history of gout, HGPRT defects, PRPP synthetase activity and other hereditary diseases may induce hyperuricemia. Other diseases such as psoriasis, erythrocytosis, hemolytic disease, myeloproliferative disease, the development of obesity, alcohol consumption, excessive consumption of purine-rich foods, etc. is also an important factor that leads to excessive production of uric acid in the body. ATP is involved in the body's metabolism of purine, therefore, when the body due to strenuous exercise, surgery, alcoholism, radiation therapy, chemotherapy, etc., a large amount of consumption of ATP can also produce hyperuricemia. Renal insufficiency, hypertension, hypothyroidism, hyperparathyroidism, polycystic kidneys, acidosis, lead poisoning and other disease development and taking certain drugs such as aspirin, levodopa, diuretics, etc. may cause urate discharge is too small, resulting in the body of uric acid is too high.

The source of uric acid in the human body is mainly divided into two categories, of which exogenous accounted for about 20%, mainly from the decomposition of nucleotides in food, and endogenous accounted for 80%, by the body of amino acids, ribose phosphate and other small molecules synthesized by the synthesis of compounds or the breakdown of nucleic acids, which can be seen that endogenous metabolic disorders for the occurrence of hyperuricemia is much higher than the exogenous factors, so the dietary disorders is one of the factors in the occurrence of gout, but not the only and the most important factor. Dietary control is an important part of the prevention and treatment of gout, but it must be accompanied by medication to block its pathogenesis.

So, how do you control your diet?

First of all, the staple food can choose rice, corn, wheat, sorghum, oats and other alkaline food; vegetables choose winter melon, cucumber, pumpkin, squash and cabbage and other non-purine or less purine-containing vegetables; fruits choose alkaline, such as pears, watermelon and grapes, or low purine content of fruits, such as apples, lemons and bananas, etc.; meat and eggs to select the eggs, duck eggs and river fish, and others, such as animal offal and so on, try to Limit consumption.

Text: Yue Zengbao/Wang Chuanhang

谢邀.

Gout is not all about food

Many people think that gout is eaten out, in fact, not entirely right. Gout is a disorder of purine metabolism in the body or uric acid excretion caused by a disease, its "father" is high uric acid. The blood of uric acid, 80% by the body metabolism, only 20% from food. Therefore, to control gout, diet alone is not enough, the key is to solve their own metabolic disorder.

Primary gout is caused by a genetic defect, where the patient's body lacks a certain enzyme, and is often accompanied by hyperlipidemia, high blood pressure, diabetes, and so on. Secondary gout can be caused by a variety of reasons such as kidney disease, blood disease and drugs.

How to prevent gout

For primary, only the frequency of attacks can be minimized. For secondary, data show that more than 50% of gout patients are overweight, 75% are associated with hyperlipidemia, and the relationship between acute gout attacks and alcoholism is well recognized - alcohol, i.e. ethanol, is metabolized to increase blood lactate, which inhibits renal excretion of uric acid.

So, to prevent gout.The first is to stop drinking alcohol, the second is to lose weight (increase exercise), the third is to find out other causes of gout and treat them actively, the fourth is to control diet, the fifth is to drink more water, and the sixth is to avoid triggering factors such as over-exertion, nervousness, exposure to cold and mental stress.

The so-called gout, a crystal-associated arthropathy caused by monosodium urate (MSU) deposition, is categorized into primary and secondary gout. Primary gout is mainly directly related to purine metabolism disorders and/or hyperuricemia due to decreased uric acid excretion, while secondary gout may be associated with certain medications, diet, and diseases.

Currently, the prevalence of gout in China is between 1% and 3%, and is on the rise year after year. The main cause of gout is the excessive production of uric acid from various causes, and/or reduced excretion, which ultimately leads to the deposition of urate crystals and crystal deposits. So the occurrence of gout in the uric acid level is closely related, we also know that seafood, beer and some other high-purine diet will induce gout, so is it gout whether it is eaten out?

A recent study published in BMJ, a top international journal, found that no single food can explain more than 1% of the variation in serum uric acid levels in an organism, but when all foods are combined together explains less than 0.5% of the variation in uric acid levels, and that genetic variations can explain to a large extent the variation in serum uric acid in their organisms.

The researchers concluded that a healthy diet is associated with lower levels of serum urate, which plays a role in protecting the body against gout, but that overall the effect of diet on uric acid levels is very low.

Of course, the study does not say for sure that diet does not have a greater impact on uric acid levels in these gout patients, and more research is needed to determine that seafood and other high-purine diets should still be avoided, but uric acid metabolism factors such as heredity may be more relevant to gout.

With the continuous development of society, people's living standards significantly improve, diet is more and more rich, the diet structure in daily life has also undergone significant changes, the incidence of many diseases is also a clear upward trend, such as gout. So, what exactly is the cause of gout, gout is "eat out" disease?

First of all, take you a brief understanding of what gout is a disease. Gout is essentially a metabolic disease, from the theory that the occurrence of gout and purine metabolism disorders, as well as reduced uric acid discharge caused by the overall rise in hyperuricemia, there is a direct relationship between the occurrence of gout and purine metabolism disorders, as well as reduced uric acid discharge caused by the overall rise in hyperuricemia. Many foods in daily life contain more purine, dietary intake of purine produced by the general public can be excreted through the body's metabolism, but many people because of a variety of reasons resulting in excessive purine output or excretion disorders, excessive purine in the body will be formed in various parts of the crystals, thus accumulating the joints, resulting in severe pain in the surrounding tissues, the majority of patients with gout first appeared for the thumb of the foot symptoms The first symptom that most gout patients experience is obvious redness, swelling and heat pain in the joints of the feet.

Simply put, in the clinical uric acid higher disease, we can according to the patient with or without acute arthritis symptoms, to assist in the judgment, uric acid significantly elevated, some patients have acute arthritis symptoms, we can diagnose gout, if there is no acute arthritis symptoms, we can consider for hyperuricemia.

The occurrence of gout does have a lot to do with diet, but some people are theoretically more susceptible to gout disease. For example, hypertensive patients, coronary heart disease patients, diabetic patients to a certain extent more prone to gout, people with various causes of renal insufficiency, people with high metabolic syndrome, people with secondary hyperuricemia, these are high-risk groups of gout attacks.

Therefore, people who are prone to gout need to pay attention to their diet, and should minimize the consumption of higher purine foods, such as animal offal, clams, fish and shrimp, thick broth, peas, alcohol, and so on.

Answerer: Zhao Chongcheng, M.S., M.A.

Welcome to Life Calling for more useful health knowledge.

The essential cause of gout is the elevated level of uric acid in the body, which causes the deposition of urates in the joints and kidney areas.

The causes of elevated levels of uric acid in the body can be attributed to the body's metabolism of uric acid, which is characterized by two pathways: too much production and too little elimination. In addition, from the point of view of whether there is currently a clear secondary disease or drug and other conditions, can be categorized into primary and secondary.

1. Primary hyperuricemia

(1) Reduced uric acid excretion: 90% of primary gout patients with hyperuricemia is associated with reduced uric acid excretion, and its possible mechanisms are: ① reduced glomerular filtration; ② increased tubular reabsorption; ③ reduced tubular secretion.

(2) Excessive uric acid production: The cause of hyperuricemia in 10% of patients with primary gout is related to excessive uric acid production. The mechanism may be endogenous overproduction of uric acid. It is related to an increase in the number and activity of some enzymes that promote the process of uric acid production and/or a decrease in the number and activity of some enzymes that inhibit uric acid production. The enzyme defects are associated with genetic variants, which may be polygenic or monogenic. The mode of inheritance can be classified as autosomal recessive, autosomal dominant and sex-linked.

2. Secondary hyperuricemia

(1) reduced renal excretion of uric acid: ① renal lesions such as glomerulopathy leading to a reduction in uric acid filtration and tubular lesions leading to a reduction in uric acid secretion; ② diuretics, especially thiazide diuretics, and other drugs such as aspirin, pyrazinamide, levodopa, ethambutol, ethanol and so on can interfere with tubular reabsorption of uric acid; ③ increase in the body's organic acids such as ketoacetic acid, lactic acid can be competitive inhibition of renal tubular uric acid secretion.

(2) Excessive uric acid production is seen in myeloproliferative and lymphoproliferative disorders. During chemotherapy and radiotherapy for leukemia and lymphoma, the large amount of cell destruction can lead to accelerated nucleic acid metabolism, which in turn leads to secondary hyperuricemia.

The vast majority of gout or hyperuricemia encountered in clinical practice is primary in nature and is associated with metabolic problems in the body. Uric acid is a powerful reducing substance in the body, once the body has excessive oxidative stress, the body will inevitably use some metabolic pathway changes to increase the concentration of reducing substances in the body to deal with excessive oxidative stress. Therefore, in the face of gout or hyperuricemia, we should not only focus on lowering the uric acid level, but also think about changing the body's oxidative stress to fundamentally change the abnormalities of the entire metabolic process.

Diet plays an important role in the development of gout and hyperuricemia. Because on the one hand, purines in the diet are the source of uric acid in the blood, and purines are metabolized in the body to produce uric acid; on the other hand, an uncontrolled diet or a diet with irrational nutritional combinations will lead to excessive oxidative stress in the body. Therefore, both foreign and domestic guidelines on gout or hyperuricemia emphasize dietary management and lifestyle changes as the basis of treatment.

When the concentration of uric acid in our blood exceeds 420 millimoles per liter, it can cause damage to our joints, kidneys and cardiovascular system, and this is when we are diagnosed by our doctor as hyperuricemia. Hyperuricemia causes the deposition of uric acid in the joint tissues and the formation of urate crystals. The constant irritation of these crystals in the joint tissues will cause inflammation of the joints, which will result in redness, swelling, heat, and pain, which is often referred to as a gouty attack.

Fundamentally gout is a metabolic disease, a specific arthropathy caused by hyperuricemia due to disturbances in the metabolism of purine substances in the body and abnormal uric acid excretion. When it comes to the underlying causes of gout attacks, they are not yet fully understood. However, gout has a strong geographical distribution and family aggregation, which indicates that the occurrence of hyperuricemia and gout has a certain genetic predisposition.

In addition to the fact that some people are naturally more susceptible to purine metabolism disorders than others, a number of poor dietary and lifestyle habits can lead to purine metabolism disorders and uric acid buildup:

1, the body is obese, the body is obese people itself there are lipids, blood sugar and other metabolic disorders, of course, including purine substance metabolism disorders;

2, a lot of alcohol, alcohol itself will lead to a large number of purine substances, but also will prevent the excretion of uric acid;

3, improper diet, accustomed to excessive consumption of animal food, high-fat food and high sugar food people, prone to obesity problems, resulting in purine substance metabolism disorders; these diets themselves on the excretion of uric acid is also unfavorable;

4, drink less water, uric acid excretion of the most important form is through the urine out of the body, insufficient hydration will cause too little urine, will also cause excessive accumulation of uric acid in the body.

In addition to the above causes of excessive uric acid accumulation, there are a number of factors that can trigger a gout attack, such as:

1. Cold in the body, especially in the affected limbs;

2. Overwork, especially after engaging in heavy physical labor;

3, limb injuries, some surgical procedures can also trigger gout attacks;

4. Heavy drinking, overeating, etc.

It is evident that gout attacks are associated with disturbances in purine metabolism, poor lifestyle habits and certain stressful life events. Poor diet, although not the only causative factor, is one of the very key predisposing factors.