Gout Diet Adjustment I. Dietary control Dietary control is simple and easy to implement, is one of the basic measures to prevent and control gout. Its indications include: 1, high-risk groups with a family history of gout. 2, with gout-related diseases. Such as obesity, hypertension, diabetes mellitus, hyperlipidemia and cardiovascular diseases.3, hyperuricemia.4, gouty arthritis (including acute attack and intermittent period), gouty nephropathy and uric acid kidney stones. The basic principle of dietary control is not to drink alcohol, do not eat animal offal (such as liver, kidney, brain, heart, intestines, etc.) and meat soups, eat less seafood, and drink plenty of water, other foods can be consumed appropriately, but if the excessive intake of a certain food has caused your gouty attack, then it should also be limited. There is no good test for the purine content of foods, and reports vary widely. Inaccurate quantification may be misleading for patients. For this reason, this section only presents some dietary principles that gout patients must adhere to for reference. 1、Total calories: The supply of total calories varies from person to person, such as the resting state is different from that of manual labor. For resting patients, calories should be given at 25kcal-30kcal per kilogram of body weight per day, while for manual laborers, it should be 30kcal-40kcal. For obese or overweight patients, the total calories should be limited, and a low-calorie diet should be adopted, i.e., it should be given at 10kcal-20kcal per kilogram of body weight per day. Generally speaking, it is appropriate to reduce 50g of staple food per day for obese people. 1g of protein or 1g of carbohydrate can produce 4kcal (16.8kJ) of heat energy by oxidation in the body, while 1g of fat can produce 9kcal (37.8kJ) of heat energy. Conversion of heat energy unit: 1kcal = 4.18kJ (or simplified to 4.2kJ), 1kJ = 0.239kcal, 1MJ = 1000kJ. 2, purine intake: the normal intake of purine can be as much as 600 ~ 1000mg / day. Gout patients in the arthritis attack daily should not be more than 100 ~ 150mg. After the treatment of blood uric acid can be maintained at a normal level for a long time, the intake can be increased appropriately. However, it is difficult to do quantitative intake in specific operation. I believe that no one can know the exact amount of purine in three meals a day is how much, but a rough estimate is still easy to judge, this aspect will be detailed in the following. 3, carbohydrates: gout patients staple food should be carbohydrate-based, carbohydrates should account for 50% to 60% of the total calories, and even up to 70%. Rice, corn, flour and its products (such as steamed bread, noodles, bread, etc.) can be used. But combined with diabetes, carbohydrate intake should be added to control, daily per kilogram of body weight 4 ~ 5g to give appropriate, accounting for about 50% of the total calories ~ 55%. 4, protein: protein daily intake of 0.8 ~ 1.0g per kilogram of body weight should be given, accounting for about 12% to 14% of the total calories, the daily supply of protein up to 60 grams or so. For wasting, manual laborers, the elderly appropriate relaxation. Protein to milk and eggs as the main, can be moderate consumption of river fish, can also be moderate consumption of lean meat, poultry, but it is recommended to cut pieces, boiling to let purine dissolved in water, and then go to the soup before eating. High purine-containing foods such as animal offal and seafood, need to reduce intake or prohibit consumption. 5, fat: fat daily intake of 0.6 ~ 1g per kilogram of body weight to give appropriate, accounting for about 20% to 25% of the total calories. Complicated hyperlipidemia should be appropriately limited, especially in acute gout attacks need to avoid high-fat diet, this is because high-fat diet will inhibit uric acid excretion. The daily intake of cholesterol should preferably not exceed 300 mg. eat less fried food. The variety of fat consumed should be mainly vegetable fats and oils, for example: soybean oil, peanut oil, corn oil, etc. 6, salt: the combination of hypertension, heart disease, kidney damage should limit the intake of salt, no more than 6g per day is appropriate, generally controlled at about 2 ~ 5g. 7, vegetables, fruits: vegetables can be eaten except mushrooms, beans (such as lentils), nori and spinach should not be eaten in large quantities, and fruits are not contraindicated. Patients can drink a moderate amount of fruit juice, vegetable juice, can make the urine become alkaline, prompting the crystallization of uric acid dissolution and easy to be discharged from the urine. At the same time, fruit juice and vegetable juice are rich in vitamins, which can help improve the symptoms of gout. 8, drinks and condiments: traditional Chinese medicine emphasizes the avoidance of stimulating beverages, such as strong coffee and strong tea, even including condiments, spices, etc. should not be used. However, modern medicine is mainly based on the purine content of food to determine whether it is appropriate, so there is no restriction on coffee, tea and condiments. Alkaline beverages are also recommended, such as Coke, Sprite, soft drinks and soda can alkalize the urine and help uric acid excretion. However, the general beverage contains more sugar, for combined diabetes should not be, for obese people can not drink too much. 9, water: you should drink more water, daily water consumption recommended 2000 ~ 3000ml or so, can play a role in increasing urine output (the best to maintain about 1500 ml of urination per day), to promote uric acid excretion and to avoid the formation of urinary tract stones. Although water is not toxic, but in some cases should not drink more. For example: combined with severe cardiac insufficiency, severe renal insufficiency with significant edema, should not drink. 10, alcohol: gout patients must ban alcohol, especially beer is most likely to cause gout attacks, should be absolutely prohibited. Although theoretically you can drink a small glass of beer, but who will do it? So it is better not to drink. The mechanism is: (1) although the purine content of beer itself is not high, about 2 to 5mg/100ml, it contains more guanosine, which is metabolized to produce purine. (2) Alcohol in the body will be metabolized to lactic acid, easy to make the body lactic acid accumulation, lactic acid can inhibit uric acid excretion by the kidneys. (3) Alcohol will promote the conversion of adenine nucleotides, accelerate the decomposition of ATP in the body, producing uric acid. 11, bean products: you can eat a little bit in moderation. Some scholars have found that, among all the causes of gout attacks, beer is the most common (60%), followed by seafood (18%), offal food (14%), and bean products rarely cause gout attacks (2%). Measured purine content of legumes are very low except for dried soybeans. Vegetarians, such as monks and nuns, who consume mainly legumes, rarely get gout. These are suggestive of bean products can be consumed in moderation, the folk misinformation gout contraindication of bean products said the lack of scientific basis. But beans and their products should not be consumed too much, especially unprocessed beans, I have encountered a case in the green beans on the market when eating a big bowl of gout-induced patients. Second, gout reference recipes According to the purine content, the food is divided into low purine food (per 100g of food containing purine <25mg), medium purine food (per 100g of food containing purine 25 ~ 150mg) and high purine food (per 100g of food containing purine 150 ~ 1000mg) three categories. However, this is only a principle estimate, in clinical practice need to make necessary adjustments according to the actual situation. 1, can eat low purine food (1) staple food: rice (rice, corn, millet, glutinous rice, etc.), wheat (barley, wheat, oats, caper wheat, cereals, etc.), pasta products (refined white flour, rich flour, noodles, cornmeal, steamed bread, bread, cookies, cakes), soda cookies, butter snacks, starch, sorghum, macaroni, potatoes (potatoes), sweet potatoes, yams, winter flour, water chestnuts, etc.. (2) Milk: fresh milk, condensed milk, cheese, yogurt, cream of wheat, milk powder, ice cream, etc. (3) Meat and Eggs: Eggs, Duck Eggs, Skinned Eggs, Pig's Blood, Duck's Blood, Chicken's Blood, Goose's Blood, etc. (4) Vegetables: cabbage, cabbage, lettuce greens (lettuce), amaranth, sorrel, coriander, celery, mustard leaves, water urn, leeks, chives, tomatoes, eggplants, melons (cucumber, winter melon, squash, pumpkin, cucumber, bitter melon, etc.), radishes (including carrots, dried radishes, etc.), collards, kale, cucurbits, gourds, peppers, onions, shallots, garlic, garlickers, ginger, fungus, squash, chili peppers, pickles Pickles, pickles, etc. (5) Fruits: apples, bananas, jujubes, black dates, pears, mangoes, tangerines, oranges, lemons, limes, grapes, pomegranates, peaches, loquats, pineapples, peaches, plums, kumquats, watermelons, bok choy, papayas, tulsi melons, raisins, and dried longans. (6) Beverages: soda, cola, soft drink, mineral water, tea, fruit juice, coffee, cream of wheat, chocolate, cocoa, jelly, etc. (7) Others: buttered snacks, tomato paste, peanut butter, jam, soy sauce, winter melon candy, honey. Oils and fats (melon seeds, vegetable oil, butter, cream, almonds, walnuts, hazelnuts), Coix lacryma, dried fruits, sugar, honey, jellyfish, seaweed, animal glue or agar made of snacks and condiments. 2, it is appropriate to limit the medium purine food (1) beans and their products: soy products (tofu, dried tofu, milk tofu, soy milk, soymilk), dry legumes (mung beans, red beans, black beans, fava beans), bean sprouts, soybean sprouts. (2) Meat: Chicken, pheasant, turkey, spotted chicken, stone chicken, duck, goose, pigeon, quail, pork, pork rinds, beef, lamb, dog, venison, rabbit. (3) Aquatic products: grass carp, carp, cod, flounder, perch, pike, swordfish, crab, eel, eel, snail, chopped red meat, red trevally, abalone, fish ball, shark's fin. (4) Vegetables: spinach, bamboo shoots (asparagus, asparagus, dried bamboo shoots), beans (green beans, green peas, kidney beans, cowpeas, peas), kelp, golden needles, fungus, mushrooms, nine-layer pagoda, cauliflower, and longbeans. (5) fats and oils and others: peanuts, cashews, sesame seeds, chestnuts, lotus seeds, almonds. (1) Legumes and vegetables: soybeans, lentils. Purple cabbage, mushrooms. (2) meat: liver (pig liver, cow liver, chicken liver, duck liver, goose liver), intestines (pig intestines, cow intestines, chicken intestines, duck intestines, goose intestines), heart (pig heart, cow heart, chicken heart, duck heart, goose heart), belly and stomach (pig liver, cow liver, chicken stomach, duck stomach, goose stomach), kidneys (pig kidneys, cow kidneys), lungs, brain, pancreas, preserved meat, thick gravy, mincemeat. (3) aquatic products: fish (fish skin, fish eggs, dried fish, sardines, wind-tailed fish, mackerel, chub, mullet, shark, scallop, kissing fish, moray eel, dried flatfish, pomfret), shellfish (clams, oysters, clams, oysters, tamarinds, dried mussels), shrimp (grass shrimp, golden hook shrimp, shrimp, shrimp), sea cucumbers. (4) Others: yeast powder, various kinds of alcohol (especially beer). Third, the review of dietary control food only accounts for 1/3 to 1/6 of the daily source of uric acid, the rest of the body's metabolism, most of the dietary control can only make the uric acid down 60umol / L. If the dietary control is too strict, the vitamins and essential nutrients are insufficient, will result in an imbalance in protein intake, leading to the body's decomposition of tissues, the production of large quantities of endogenous uric acid, which in turn makes the blood uric acid rise and aggravate the gout. Gout. In short, some people hear that uric acid is too high on the over-emphasis on dietary restrictions, thus losing the joy of life, while some people ignore, resulting in more serious complications, too little is not the correct attitude of health, the only patience to adjust and adhere to the long-term follow-up is the key to the success of the treatment. Fourth, the recommended dietary control methods Diet in the acute phase: acute phase should strictly limit the intake of purine, daily below 150mg, you can use edible low purine food. Protein 50g ~ 70g per day, with milk (250g per day), eggs (especially egg white), cereals as the main source of protein, fat not more than 50g, with carbohydrates to make up the caloric needs. High purine food is prohibited, and medium purine food should also be controlled. Fluid intake should not be less than 3000ml per day, in addition, drugs such as sodium bicarbonate can be used to alkalize the urine. Diet in remission (intermittent period): Give a normal balanced diet to maintain ideal body weight. Protein should not exceed 80g per day. Complicated renal function significantly impaired people should reduce the intake of protein. High purine food is prohibited, and medium purine food is chosen in a limited way, of which meat, fish and poultry can be used 60g~100g per day, and meat can also be cooked and discarded after consumption of soup. Low purine food can be free to choose, including fresh vegetables daily 250g ~ 500g, fruits daily 100g ~ 200g. If the patient insists on taking uric acid-lowering drugs, blood uric acid long-term to maintain in a more ideal level, dietary control can be relatively relaxed. On the contrary, if the blood uric acid is high, the dietary control will be relatively strict. Examples of one-day recipes are as follows: staple food (rice, steamed buns, noodles, bread, etc. can be), 1 bag of milk, 1 egg or egg whites 2 copies, lean meat or river fish 2 two, 1 two soybean products, 1 catty of green leafy vegetables, 200 grams of fresh fruit, 20 grams of vegetable oil (about 2 tablespoons), 4 grams of salt.