Author: Deng Bo (Sichuan Provincial People’s Hospital)
Gout is closely related to uric acid, which is a product of purine metabolism. For patients with gout and hyperuricemia, it is necessary to control the intake of exogenous purines to reduce blood uric acid levels.
Doctors will emphasize limiting the intake of purines in the diet, so how to control purines?
1. What range of purine intake should be controlled?
We can usually take in 600~1000mg of purines through food every day. After metabolism, they can be excreted from the body in a short time. However, patients with gout have metabolic disorders, and excessive intake of purines will aggravate the disease. [1][2] Therefore, purine intake needs to be restricted at different stages of the disease.
During the acute attack of gout, the daily purine intake needs to be controlled within 150 mg [1], and during the gout remission period, the daily purine intake should not exceed 600 mg.
Second, to control purine, learn to distinguish food
In order to facilitate the choice of food for gout patients, according to the purine content of food, food is divided into high-purine food, medium-purine food and low-purine food.
It is recommended that patients in the acute phase choose low-purine foods, moderate purine foods in the remission phase, and high-purine foods should be avoided in both the acute phase and the remission phase.
Different foods, different parts of foods and foods from different origins have very different purine content[1][2][3][4][5][6]. See table below.
In terms of specific values, animal offal, unshelled seafood, meat and broth are high in purines, while milk, eggs, vegetables, and fruits are low in purines.
Three, how to achieve purine intake within 150mg during acute gout attack?
1. Avoid high-purine foods (see Table 1)
Animal offal, seafood, livestock and poultry meat, broth, etc. are not allowed to be eaten.
2. Don’t drink
Yellow wine, beer, etc. themselves contain purines, and alcohol can also affect the excretion of uric acid, so alcohol must not be consumed in the acute stage of gout.
3. You can eat milk and eggs
You can drink 300g of milk and eat 1 egg every day, which can provide high-quality protein.
It should be noted that gout patients are not recommended to eat yogurt, because yogurt will affect the excretion of uric acid.
4. Drink plenty of water
Drink no less than 2000ml[7] of water every day to maintain a certain amount of urine to promote the excretion of uric acid.
The water is suitable for warm boiled water. If you are used to drinking tea or coffee, you can also drink it in moderation. It is a low-purine food.
5. Enough staple food
If the energy intake is insufficient, in a state of starvation, the body uses fat to decompose for energy, which can produce ketone bodies, which can interfere with uric acid metabolism and are not conducive to disease control.
You can eat 250~400 grams of staple food every day. You can choose rice, wheat flour, corn flour, black rice, buckwheat, sweet potato, etc. It is recommended to match the thickness. Here is an example of a recipe.
Example: The patient, Mr. Zhang, is 55 years old, 165cm tall and 60kg in weight. During the acute attack of gout, he needs to strictly control the diet of purine (no more than 150mg per day).
An example of their one-day recipe is as follows:
Note: The above food quantities are all raw weight (the weight of the food before cooking).
Recipe Analysis:
Purine Content: The above recipe contains about 120mg of purines (less than 150mg).
Food replacement: You can refer to low-purine foods (Table 3) for food replacement. For example, the staple food can be replaced with brown rice, corn, millet, sweet potatoes, potatoes, etc., so as to diversify the food.
Protein: This recipe provides more than 20 grams of high-quality protein, which can prevent excessive production of endogenous purines due to insufficient dietary protein intake and muscle breakdown.
During the acute stage of gout, it is possible to eat meat in moderation, preferably no more than 50g (raw weight) per day. The key lies in the selection of meat varieties and the use of correct cooking methods .
According to research[5], if the meat is boiled in water for 30 minutes or more, more than half of the purines in the meat will be dissolved in the soup. If you discard the soup and eat the meat, you can effectively reduce the intake of purines.
In the acute stage of gout, chicken essence, seafood sauce, bean paste, soy sauce and other seasonings cannot be used in cooking [8], because the total purine content in these seasonings can reach up to 500mg /100g or more, although the amount is not large, if it is used in noodles and cooking, it is easy to cause the total purine in the whole day’s diet to exceed the standard.
Choose salt and vinegar for seasoning, or use garlic and ginger as seasoning.
Image source: Zhanku Hailuo
4. How to control purine intake during remission period
During the gout remission period, it is still necessary to limit the purine content in food, but the variety of food can be appropriately relaxed.
Animal food: You can eat 60~120g of meat, fish, etc. per day, but pay attention to the cooking method, mostly steaming, boiling, stewing, and discarding soup After eating.
If you eat out, especially when you eat hot pot or shabu-shabu, remember not to drink hot pot soup, because the purines in the food are dissolved in the soup.
Fruits: Fruits are low-purine foods.
But fruits and fruit juices with high fructose should be appropriately limited, such as: persimmon, apple, banana, lychee, longan, bayberry, pomegranate, etc., because fructose will be metabolized into uric acid in the human body, It can also reduce uric acid excretion, which is not conducive to blood uric acid control.
You can choose more fruits with less fructose[9][10], such as: watermelon, crystal pear, plum, etc.
In addition, the cherries in the fruit have been confirmed by many domestic and foreign studies that they can reduce the level of blood uric acid and reduce the risk of gout attacks. You may wish to eat more when conditions permit.
Honey: Honey is high in fructose and should not be eaten by people with gout.
Eat balance and maintain ideal body weight: Overweight and obesity increase the risk of hyperuricemia and gout.
For this part of the population, on the basis of a balanced diet, reducing the daily intake of food by 30% to 50%, combined with 30 minutes of exercise 5 days a week, can reduce body weight. Generally, it is enough to maintain the rate of reducing 0.5~1kg per week, which helps to control blood uric acid and reduce the acute attack of gout.
Image source: Zhanku Hailuo
References:
[1] Endocrinology Branch of Chinese Medical Association. Guidelines for the diagnosis and treatment of hyperuricemia and gout in China (2019). Chinese Journal of Endocrinology and Metabolism, 2020, 36(1): 1~13.< /p>
[2] Huang Chengyu, editor-in-chief. Nutritional therapy for metabolic and immune diseases [M]. Nutritional therapy for diseases. Sichuan: Sichuan University Press. 2006.
[3] Sun Changhao, editor-in-chief. Nutrition and Gout [M]. Nutrition and Food Hygiene. 7th Edition, Beijing: People’s Health Publishing House. 2012.
[4] Pan Hongzhi, Rong Shengzhong, Zou Lina, etc. Purine content in common animal foods in China [J]. Journal of Nutrition, 2012, 34(1): 74~78.< /p>
[5] Yang Haibin, Zhang Jialing, Liu Guiying, etc. Study on the content and distribution of purine and uric acid in different tissues of chickens and ducks [J]. Journal of Nutrition, 2013, 35(5): 505~507.
[6] Liu Guiying, Yang Haibin, Zhang Jialing. Determination of Purine Content in Fungal Foods by High Performance Liquid Chromatography [J]. Chinese Public Health, 2012, 28(4): 554~555.< /p>
[7] Health Industry Standards of the People’s Republic of China. Dietary guidance for patients with hyperuricemia and gout (WS/T 560-2017) [S]2017.
[8] Ding Yuting, Zhang Jing, Zhou Xuxia, etc. Analysis and distribution of purine components in common foods and condiments. Food and Fermentation Industry [J], CNKI exclusive Online premiere, 2020.04.22.
[9] Zhang Wenting, Lu Qiuyan. Determination and analysis of sugar components in subtropical fruits [J]. Chinese Journal of Nutrition, 2019, 41(3): 308~312.
[10] Zhang Yushu, Yang Tiantian, Ma Mengshuo, etc. Analysis and evaluation of fructose content in watermelon fruits [J]. Southwest Agricultural University, April 2018 (24): 786~ 795.
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