Mr. Liao, a 30-year-old who lives in Changsha City, was admitted to the Endocrinology Department of the Second People's Hospital of Hunan Province due to an acute gout attack. Mr. Liao was very depressed, he did not drink beer or eat seafood, what caused him to have a gout attack?
Zhang Haitao, director of the Department of Endocrinology of the Second People's Hospital of Hunan Province, introduced: Mr. Liao has a hobby that modern young people have, do not like to drink water, and drink drinks for a long time. While most drinks have a higher fructose content, the effect of fructose on the level of blood uric acid comes from two aspects: on the one hand, it increases the level of blood uric acid, and on the other hand, it reduces the excretion of uric acid. Therefore, limiting purine intake is not a long-term solution, and it is more important to pay attention to the excretion of uric acid. So, who is the real culprit who prevents uric acid from being excreted? That's right, fructose.
Fructose, as the name suggests, is derived from the "natural health" of the fruit sugar, in fact, fructose does not necessarily mean that it comes from the fruit, and is very sweet, if the sweetness of different types of sugar is compared, sucrose is 100 points, glucose 74 points, lactose is only 16 points, and fructose up to 173 points! Fructose does not produce a feeling of fullness and is more likely to increase appetite than glucose. Fructose is the only carbohydrate that has an effect on uric acid metabolism. Large one-time intake of fructose (more than 50 g) of sweet beverages rich in fructose may lead to gout attacks, such as honey, sugary drinks or fruit juices, which increase the risk of elevated serum uric acid. Similarly, fructose-rich fruits such as oranges may also increase the risk of gout.
In addition, fructose can also reduce uric acid excretion and promote endogenous uric acid synthesis. The study found that fructose reduces uric acid clearance by 9.8%, and the mechanism is that fructose causes insulin resistance.
Molecular structure of fructose
Reports from abroad conducted a 12-year prospective follow-up study of 46,393 men without a history of gout, of which 755 men developed gout. Increased soft drink intake was positively correlated with the incidence of gout: compared with those who consumed less than 1 cup per month, the risk of developing gout was 1.29 for those who consumed 5 to 6 soft drinks per week, compared with 1.45 for those who took 1 cup per day and 1.85 for those who ≥ 2 cups per day. The final conclusion was that long-term intake of soft drinks can be an independent risk factor for gout in men.
80% of the source of uric acid in the serum is decomposed from amino acids, nucleic acids, etc. in the body (endogenous factors), while 20% is metabolized from foods containing purines or nuclear proteins (exogenous factors). Purines in the body are metabolized by the liver to form uric acid, and finally the uric acid is excreted with the urine by the kidneys, but gout occurs when the amount of uric acid produced and excreted in our body is unbalanced, or when the concentration of uric acid in the blood is higher than the saturation point such as soluble. If we focus on the intake of purines to reduce uric acid, the effect of fructose on endogenous uric acid production and uric acid excretion may eventually lead to a decrease in our purines, but uric acid remains high, and gout still recurs. In addition to interfering with purine metabolism, fructose also interferes with insulin metabolism. If too much fructose is consumed, insulin sensitivity decreases, insulin resistance develops, and diabetes can be caused in the long run.
For patients with hyperuricemia or who have had gout, Director Zhang Haitao reminds you:
1, eat less fat, drink less hot pot soup, broth: too much fat intake will inhibit uric acid metabolism, increase the risk of gout attacks. In particular, animal fats and fried foods should be eaten less.
2, pay attention to the intake of fruit: the appropriate amount of fruit can make the urine become alkaline, promote the crystalline uric acid to dissolve and easy to be excreted in the urine. Fruit intake should be controlled at 200 to 400g/day. Avoid a large amount of fruit with high fructose content at one time, and choose fruits with low sugar content, such as strawberries, bayberry, peaches, cherries, etc. Among common fruits, pears, plums, grapes, apples, watermelons and lychees are high in fructose and should be avoided as much as possible. At the same time, fruits rich in sucrose, such as honey oranges, navel oranges, sugar cane, etc. will also have an impact on uric acid metabolism in gout patients, and it is necessary to reduce intake.
3, less alcohol: there are some alcohol purine content is not low, such as aged Shaoxing wine, Shaoxing wine and beer, and alcohol itself will affect uric acid metabolism, the higher the alcohol concentration, the greater the impact on kidney health. People with high uric acid try to stay away from alcohol, especially those who rarely drink alcohol, if they suddenly drink heavily, it is easy to cause acute gout.
4, soy products limited to eat: as long as not to eat during the acute attack period, and limited, such as 1 cup of soy milk or 1 piece of tofu a day, there is no adverse effect.
5, drink more water: enough water to allow uric acid to be metabolized normally. Drink at least 8 cups of water (about 250 ml per cup) a day, divided into several small sips, and do not pour 500 or 800 ml at a time.
Contributed by: Yi Dan, Department of Endocrinology, Second People's Hospital of Hunan Province (Hunan Brain Hospital).
Editor: Liu Yuchen
Image: From the Internet, intrusion and deletion