Xiao Chen, a young man from Hangzhou, is only 26 years old, but he is already an "old disease" of gout. I finally made up my mind to lose weight, took fat loss meals seriously, and went to the gym every day to make iron, but I didn't expect his uric acid to rise instead of falling, and it reached a record high, and taking painkillers could not relieve the pain of gout......
Swollen and sore toes after eating and drinking together
Xiao Chen likes to drink drinks since he was a child, and he doesn't like to drink water. After only a few years of work, he quickly mastered the social rules of the workplace, and had dinner and drinks with his classmates when he had nothing to do.
In the past two years, his weight has reached 180 kilograms, and the blood uric acid in the physical examination has continued to be high, 490umol/L last year, and 510umol/L this year. But he was willful, and he never listened to the advice of the medical examiner to go to the specialist.
Until the beginning of this year, after a dinner party and drinking, Xiao Chen suddenly felt a terrible pain in his toes. Thinking that it was twisted after drinking, he quickly took the leftover "safflower oil" at home and rubbed it vigorously, but the pain was not relieved at all, and the toes became more and more swollen, and the place where the oil was rubbed was red, as if it had been roasted, and even the wind blew it hurt.
He came to Zhejiang Provincial Tongde Hospital early the next morning for treatment, and wanted to go to the orthopedic department, but the guide doctor saw his situation and immediately suggested going to the nephrology and rheumatology department for treatment.
I don't know if I don't know, Xiao Chen's blood uric acid has reached 590umol/L this time, the inflammatory indicator hypersensitive C-reactive protein is 96mg/L, and the musculoskeletal ultrasound shows that there are already gout crystals deposited on the toes.
The doctor advised him to eat a low-purine diet, lose weight, drink plenty of fluids, and add anti-inflammatory and painkiller drugs, and then come to the hospital for follow-up in 2 weeks, and then consider adding uric acid-lowering drugs.
Don't listen to the doctor, uric acid hits a new high
After Xiao Chen went home and took anti-inflammatory painkillers orally, his toe pain quickly improved. But he felt that he was still young and didn't want to take uric acid-lowering drugs all the time, so he didn't have a follow-up appointment after two weeks.
After checking the information on the Internet, he found that obesity and gout are closely related, and many people lose weight and uric acid drops. So he bought a fat-loss recipe, began to eat fat-loss meals, and also got a fitness card, and went to the gym every day after work.
The process of fitness is very hard, and Xiao Chen gritted his teeth in order to lose weight. However, during the three months of losing weight, he found that he often had gout despite eating a fat-reducing meal and doing intense fitness exercises.
Until recently, taking painkillers could not relieve the pain again, so he had to come to the outpatient clinic of the Department of Nephrology and Rheumatology of Zhejiang Provincial Tongde Hospital again. This time, blood uric acid reached a record high: 720umol/L!
Fitness and eating fat loss meals aggravate gout?
Xiao Chen couldn't figure it out, why did he have a gout attack after eating fat loss meals and strengthening fitness exercises?
To this end, Chen Qin, director of the Department of Nephrology and Rheumatology of Zhejiang Provincial Tongde Hospital, explained the traditional Chinese medicine doctor.
First of all, lactic acid is produced after exercise, and lactic acid competes with uric acid excretion, resulting in a decrease in uric acid excretion, which leads to an increase in blood uric acid, which will be deposited in the joints, causing gout attacks.
Secondly, increased perspiration after exercise and lack of timely hydration can also lead to a decrease in uric acid excretion and an increase in the level of blood uric acid.
In addition, strenuous or excessive exercise can easily cause joint damage, resulting in urate shedding, which can easily induce gouty arthritis.
Director Chen Qin pointed out in particular: "Fat reduction meals are not the same as low-purine meals! Many fat reduction meals will increase a lot of meat food in order to reduce carbohydrate intake, and even some gym people who advocate the 'ketogenic diet' will completely replace carbohydrates with meat and vegetables." The ketones produced by the human body when ingesting a large amount of meat and mobilizing fat digestion can lead to an increase in the body's acidic metabolites, affect the excretion of uric acid, and often cause hyperuricemia. ”
So, can gout patients still exercise? Director Chen Qin suggested that if it is in the acute attack of gout, it is indeed necessary to rest and not suitable for exercise. If it is not acute, patients with gout should choose appropriate exercise programs, such as jogging, swimming, aerobics and other aerobic exercises. Exercise in moderation and gradually increase the amount of exercise.
How does uric acid in men get out of control?
Do you have this feeling, when it comes to gout, it seems that there are more men. In fact, gout is really related to gender.
The predecessor of uric acid is called purine, which can provide energy and help metabolism, and is an indispensable substance for the human body. 80% of the purines in the human body are synthesized by the body itself, and 20% of the purines come from the food eaten every day. But no matter which purine it is, it is mainly synthesized, decomposed and metabolized in the liver. The "waste product" produced by purine metabolism is uric acid. Uric acid is transported through the bloodstream and ends up mostly in the kidneys, where it is filtered and decomposed and excreted.
If all the above processes are normal, the liver produces purines and the kidneys excrete purines, and the uric acid in the human body will be maintained in a state of dynamic equilibrium.
But!
The first step of uric acid loss of control: the androgens in the male body will prevent the kidneys from excreting uric acid, reducing the metabolic efficiency of the kidneys, and the uric acid in the male body will accumulate in the blood. Therefore, men are naturally prone to high uric acid, which is why the normal blood uric acid value in adult men is higher than the normal value in women of childbearing age.
The second step of uric acid out-of-control: congenitally prone to high uric acid, if men consume too much high-purine food, such as beer, seafood, fungi, animal offal, purine metabolism produces more and more uric acid, plus drink cola, milk tea and other beverages with high fructose content, fructose metabolites will also cause uric acid production more, then uric acid levels will be "worse" and gradually out of control.
Uric acid loss out of control Step 3: Hyperuricemia is the pathological basis for the occurrence of gout. When the production of uric acid in the liver exceeds the standard, but the kidneys have limited excretion, and more and more uric acid is in the blood, urate crystals will be precipitated, and these crystals will flow to the joints and bones in the human body with the blood, and set up camp in the hands, arms, knees, feet and other parts.
Slowly, if there is no timely intervention, hyperuricemia will develop into gout, and the man's uric acid will be completely out of control. In the early stage, the patient's joints may be severely painful, some joints appear red and swollen, gradually the scope of pain expands, and affects movement, some people have to sit in a wheelchair, and then later, the hand joints and foot joints may be seriously deformed, and huge tophi grow.
How is gout treated?
In the treatment of gout, Director Chen Qin said that lifestyle changes are crucial, following the following five points: healthy diet, regular exercise, weight control, increased water intake, and staying away from smoking, alcohol, and sweet drinks.
Secondly, in terms of drugs, the treatment of gout is divided into acute phase and urate-lowering therapy.
Acute phase: bed rest should be made, the affected limb should be elevated, and drugs to control the acute inflammation should be started, preferably within 24 hours of the onset.
Urate-lowering therapy: Most guidelines do not recommend starting urate-lowering drugs during an acute gout attack, and require anti-inflammatory and analgesic drugs for 2 weeks before using them as appropriate, and some guidelines also propose that urate-lowering therapy is allowed in the acute phase of gout with adequate anti-inflammatory and analgesic drugs. The specific medication varies from person to person, and it is recommended to go to the nephrology and rheumatology department for outpatient examination and make a special plan.
In addition, Director Chen Qin introduced that gout belongs to the category of "paralysis" in traditional Chinese medicine, and there are often manifestations of dampness and heat in the acute stage, so it can be relieved by taking a decoction of traditional Chinese medicine, and combined with external application of a topical ointment of traditional Chinese medicine to clear heat and dampness to relieve pain;
Source: Metro Express