Gout in Natural Health

In conventional medicine, gout is a disease caused by prolonged purine metabolic disturbance, clinically characterized by hyperuricemia, repeated attack of acute arthritis, gouty tophus sedimentation, chronic arthritis with deformity of joints, pathogenic change of renal parenchyma and formation of the tophus.

Essentials for Diagnosis

• At the initial stage, it is symptomless, with only increased uric acid in the blood. In the acute phase, its typical manifestation is a sudden onset of arthralgia, and in most cases would suddenly be woken up by sharp arthralgia when sleeping. The affected parts are mostly the first metatarsophalangeal joint or other metatarsophalangeal joints with localized redness, swelling, a burning sensation, pain, and limited flexibility. When the greater joint is involved. There may be some exudate. In addition, such symptoms as chills, fatigue, poor appetite, and headache may appear. However, the symptoms mentioned above would be relieved in 1-2 weeks.
• At the chronic stage, there may be gouty tophus, deformity and rigidity of joints, and renal lesions.
• Laboratory examination shows uric acid in the blood increases to over 420 pmol/L. In a roentgenogram, a round or irregular transparent defective area be found in the bone substance of the joint adjacent to the osteochondral edge, which is characteristic of gout in X-ray examination.

Dietary guidance for patients with gout and hyperuricemia

General principle
Based on the principle of individualization, reasonable eating habits and a good lifestyle should be established, high-purine animal foods should be limited to control the energy supply ratio of energy and nutrients, maintain a healthy weight, cooperate with regular uric acid-lowering drug treatment, and conduct regular monitoring and follow-up.

Table A.1 Purine content of common animal foods

 Table A.2 Purine content of common plant foods

Foods that patients with hyperuricemia should not eat

Alcoholic beverages should also be contraindicated in patients with acute gout attacks, poor drug control, or chronic tophi arthritis. 

• Animal foods with high purine content, such as beef, lamb, pork, etc.
• Fish food.
• Foods containing more fructose and sucrose.
• Alcoholic beverages of all kinds, especially beer and distilled spirits (liquor). The overall alcohol consumption should not exceed 2 alcohol units/day for men and 1 alcohol unit/day for women (1 alcohol unit is about 14g of pure alcohol). One alcohol unit is equivalent to 145mL of ABV12% red wine, 497mL of ABV3.5% beer or 43mL of ABV40% distilled spirits.

• Skimmed or low-fat milk and its products, 300 ml per day.
• Eggs, one egg per day.
• A sufficient amount of fresh vegetables should reach 500g or more per day.
• Encourage the intake of low GI cereals.
• Drink plenty of water (including tea and coffee, etc.), at least 2000 ml per day.

Weight management
Patients who are overweight or obese should lose weight slowly to achieve and maintain a normal weight.

Eating habits
Establish good eating habits. Eat regularly and quantitatively or eat small and frequent meals, and do not overeat or eat a lot of meat in one meal. Use less harsh seasonings. Seafood, meat, and high-purine plant foods can reduce the amount of purines after cooking and discarding the soup.

Recommended intake of energy and nutrients for patients with hyperuricemia

• Energy
  Energy intake to achieve and maintain a normal body weight as the standard. Energy requirements should be estimated based on patient sex, age, height, weight, and physical activity. In the case of light physical activity (such as working in a sitting position), people with normal weight are given 25kcal/kg-30kcal/kg of energy per day, those who are underweight are given 35kcal/kg of energy per day, and those who are overweight/obese are given 20kcal/kg per day ～25kcal/kg energy; in the case of moderate physical activity level (such as electrician installation), normal weight people are given 30kcal/kg～35kcal/kg daily energy, underweight people are given 40kcal/kg daily energy, overweight/obese people Give 30kcal/kg energy per day; in the case of heavy physical activity (such as porters), normal weight people give 40kcal/kg daily energy, underweight people give 45kcal/kg～50kcal/kg daily energy, overweight/ Obese people are given 35kcal/kg of energy per day.
  The body mass index (BMI) was used to determine the weight status. The standard was: BMl<18.5kg/m2 was underweight, 18.52 was normal weight, 24.02 was overweight, and BMI>28.0kg/m2 was obesity.
• Carbohydrate
  The energy provided by carbohydrates accounts for 50% to 60% of the total energy. Added sugar intake should be limited. Choose low GI foods. Encourage whole grain foods to account for more than 30% of the daily staple food. The daily dietary fiber intake should reach 25g-30g.
• Protein
  The dietary intake of protein is 1g/kg/d, and the energy provided accounts for 10% to 20% of the total energy. Food sources recommend dairy products and eggs.
• Fat
  The energy provided by fat accounts for 20% to 30% of the total energy throughout the day. People with obesity or metabolic syndrome should strictly limit their daily fat intake to no more than 25% of their total daily energy, and saturated fatty acids to no more than 10% of their total daily energy. For those with elevated plasma low-density lipoprotein cholesterol (>2.59mmol/L), the intake of saturated fatty acids should be less than 7% of the total energy. Trans fatty acids should be less than 1% of total energy throughout the day. The daily intake of linoleic acid and α-linolenic acid should account for 5% to 8% and 1% to 2% of the total daily energy respectively. The daily intake of monounsaturated fatty acids should account for 10% to 15% of the total energy.