From time to time, gout patients ask me: "Dr. Liu, can I lower uric acid without eating sodium bicarbonate and drinking soda water?" ”
Or they will also ask: "Dr. Liu, can long-term drinking soda cure gout?" ”
Both questions have the same meaning.
I would also be curious, breaking the casserole and asking the gout patient to the end: "Why do you think that you can cure gout by drinking soda alone?" "Although I already have the answer in my mind, I still need to ask for verification.
What is the answer? In fact, whether it is for gout patients or patients with other diseases, no one will want to take medicine every day, take medicine every year, and the medicine cannot be stopped; everyone has a good wish in their hearts, that is, they hope to be able to cure the disease without drugs.
For gout patients, they also often see that doctors will prescribe baking soda, that is, sodium bicarbonate, according to the condition, when prescribing drugs, and will ask patients to drink more water. So someone took this to heart: "Baking soda, drink more water, then together is not soda water?" ”
So there is such a rumor: "Soda is alkaline water, after drinking it will neutralize the acidic constitution, so as to achieve acid-base balance, play a role in lowering uric acid." ”
At first glance, such a statement is not unreasonable; if you look closely, it is full of loopholes. Today, Dr. Liu will talk about whether drinking soda is helpful for gout patients? Can you cure gout and lower uric acid?
Can drinking soda really reduce uric acid and cure gout?
<h1 class= "pgc-h-arrow-right" >Why do doctors let some gout patients alkalinize urine? </h1>
At present, for the treatment of gout, there are three types of drugs that can be selected for the treatment of uric acid, such as allopurinol and non-buscid, drugs that inhibit uric acid synthesis, drugs such as probenecid and benzbromomarone that promote uric acid excretion, and uric acid oxidase drugs, in fact, baking soda is not among them.
So when is sodium bicarbonate (baking soda) used for the treatment of gout patients? Why is it used for the treatment of gout patients? Let's take a look at the basis for the doctor's prescription of this medicine.
Sodium bicarbonate is commonly prescribed in patients with gout
We all know that there are two forms of uric acid in the urine, one is free uric acid, which belongs to non-ionized uric acid; the other is uric acid, which belongs to ionized uric acid. Uric acid is a weak organic acid that can be converted into urate with higher solubility in alkaline environments.
Under normal physiological conditions, the pH (pH) in blood and tissue fluid is 7.35 to 7.45, which is weakly alkaline. In normal conditions, urate has a solubility of 380 μmol/L in blood and tissue fluids; if this solubility is exceeded, urate precipitates in needle-like crystals, forming sodium urate crystals that lead to gout attacks.
That is, a decrease in pH in blood and tissue fluid is one of the common triggers of acute gout arthritis. The main reasons for the decrease in pH are:
After strenuous exercise, the concentration of lactate in the part of the joint muscles increases, and the pH in the local tissue fluid decreases;
After drinking liquor and beer, ethanol metabolism leads to an increase in the concentration of blood lactate, resulting in a decrease in the pH in the blood;
Hunger leads to an increase in organic acids such as lactic acids and fatty acids, resulting in reduced uric acid excretion in the renal tubules and a decrease in pH in the urine.
Pathogenesis of acute gouty arthritis
Therefore, maintaining the pH in the blood, tissue fluid and urine within the normal range is one of the main measures for the prevention and treatment of gout. So, what is the reason why doctors let gout patients take sodium bicarbonate (baking soda)?
The main thing is to let uric acid in a weak alkaline environment, can be converted into urate with higher solubility, which is conducive to the excretion of uric acid from the urine by the kidneys and reduces the kidney damage caused by uric acid deposition.
That is to say, the use of sodium bicarbonate (baking soda) is mainly to alkalinize the urine and help urinary acid excretion; that is, sodium bicarbonate itself does not have a direct uric acid-lowering effect. So when is sodium bicarbonate suitable for use? What are the contraindications? Let's move on:
Sodium bicarbonate can be used when using benzbromomarone for the treatment of gout: because drugs that promote uric acid excretion such as benzbromomarone promote uric acid excretion from the kidney by inhibiting the reabsorption of uric acid by the renal tubules, after use, the concentration of uric acid in the renal tubules will increase by more than 60%, in order to prevent the formation of uric acid crystals and stones, alkalizing urine is required to increase the solubility of uric acid in the original urine, while drinking more water to promote urinary excretion.
Sodium bicarbonate can be used to avoid further kidney damage in the presence of gouty kidney damage: Since patients with acute and chronic uric acid kidney disease have different degrees of kidney damage, sodium bicarbonate is used to increase urine output and alkalinize urine to reduce the concentration of uric acid in the kidneys and urinary system and increase its solubility, avoiding further deposition of uric acid in the kidneys and causing greater damage.
The transport mechanism of uric acid in the human kidneys and intestines
That is to say, not every patient with gout can be applied to sodium bicarbonate, in general, sodium bicarbonate is suitable for patients with hyperuricemia and gout with reduced renal uric acid excretion. Only when the pH of the urine is lower than 6.2, the drug treatment of alkalized urine such as sodium bicarbonate and sodium citrate is used to maintain the pH value between 6.2 and 6.9. It is not recommended for patients with increased uric acid production, a high risk of kidney stones, or already having uric acid kidney stones. In addition, whether it is intravenous infusion or oral sodium bicarbonate, it is also necessary to pay attention to acid-base balance and electrolyte levels.
Indications and precautions for alkalizing urine drugs
<h1 class= "pgc-h-arrow-right" > does drinking soda help gout alkalinize urine? </h1>
When we understand why sodium bicarbonate (baking soda) is used in the treatment of gout patients, let's return to the main topic: that is, can soda also play a role in alkalining the urine of gout patients like sodium bicarbonate?
Dr. Liu couldn't help but wonder if gout patients need alkalized urine, but not every one of them. Moreover, alkalizing urine treatment needs to consider the balance of potassium and sodium. If sodium bicarbonate is not used properly, it will increase the patient's calcium excretion and promote the formation of calcium stones. What is improper use of sodium bicarbonate? It is the urine pH > 7.0, resulting in excessive alkalinization of the urine, but it is easy to form calcium oxalate or other types of kidney stones, or form a phosphate shell on the surface of uric acid stones, thereby preventing its further dissolution.
Therefore, in general, sodium bicarbonate is used during the beginning of the use of drugs that promote the excretion of uric acid, alkalizing uric acid should also be moderate. On the other hand, regardless of whether or not drugs that alkalinize urine such as sodium bicarbonate are used, even if it is soda, we must pay attention to the moderation of alkalized urine.
Acid-alkaline dipsticks show acidic or alkaline color distinctions
Daily drinking soda water is also generally said to be not helpful for alkalizing urine. Why do I tell you so categorically? There are two main reasons:
Some sodas contain fructose, which may increase uric acid: common sodas are often fortified with fructose, corn syrup, lemon juice or flavor for taste. Fructose can increase plasma uric acid levels by promoting the degradation of ATP to adenosine phosphate, the predecessor of uric acid; the phosphorylation process of fructose in the liver requires the participation of ATP, while excessive consumption of phosphate limits the conversion of ADP to ATP, and excess ADP is converted to uric acid during enzymatic digestion. That is, if after consuming excessive amounts of fructose-containing soda, uric acid may be significantly elevated for a short period of time, leading to an acute gout attack.
The mechanism by which fructose causes an increase in blood uric acid
Some sodas contain carbon dioxide, which can acidify the blood: not every soda is made with baking soda, and many sodas are added with carbon dioxide to simulate taste. Carbon dioxide dissolved in water will become carbonic acid, carbonic acid is a medium weak acidity of the substance, so it will cause the soda water to be acidic as a whole. We need to know that when the urine pH drops from 6.9 to 5.0, the solubility of uric acid in the urine is reduced by nearly 20 times, and the lower the pH of the urine, the higher the incidence of renal uric acid stones and urate crystal deposition in the joint. That is to say, if it is a soda or effervescent water with a large number of bubbles, the water quality is actually acidic rather than weakly alkaline.
In addition, the daily sight of soda does not change the pH of the human body. Because soda is drunk directly, the gastrointestinal tract will quickly adjust the pH of the weak alkaline soda in the body to the pH of the internal environment through its own regulatory function. That is, if alkalinization of urine is really needed, sodium bicarbonate will be more direct in comparison. Compared with the clinical use of sodium bicarbonate, the dosage is generally 0.5 to 1 gram, oral three times a day, soda is at most only an auxiliary effect, do not delay taking medicine.
Although many sodas are labeled sugar-free, they are slightly acidic sparkling water
<h1 class="pgc-h-arrow-right" what water > drink to help gout patients lower uric acid? </h1>
Real soda, in fact, there are very few bubbles. If you want to make soda, the process is also very simple, that is, take a little baking soda powder, add boiled water on the line, but its taste must be most people can not accept, its taste is a little astringent and salty taste. So instead of soda, it's better to have sodium bicarbonate.
And sodium bicarbonate is not suitable for long-term use, generally after taking there will be belching, acid reflux, bloating, etc., so patients with stomach disease are not recommended to take; long-term large amounts, may cause alkalemia and electrolyte disorders, congestive heart failure, edema, renal insufficiency with caution; gastric paralysis, stomach pain is unknown, upper peptic ulcer, bleeding and recent surgery, the elderly should be cautious; there is hyperglycemia and hypertension when taking increased sodium load leads to further increased blood pressure, avoid taking with a large number of milk and dairy products, Avoid the appearance of lactine syndrome.
As we said earlier, the use of sodium bicarbonate or attempts to use soda is to alkalize the urine and promote the excretion of uric acid, dissolve uric stones and prevent the formation of new stones. If you can not use it, then try not to use it. A simple and practical way to promote uric acid excretion is actually to drink cold and white, which is economical, and can also promote blood circulation and let uric acid be excreted with urine.
A pot of cool white can strengthen uric acid excretion
The amount of boiled water: ensure the amount of water drunk about 2500ml per day, so that the urine output reaches or exceeds 2000ml;
Boiled water drinking method: drink water anytime and anywhere, can not wait until thirsty or lack of water to drink, thirsty drinking water is only to supplement the lack of water in the body, can not promote uric acid excretion; there is sweating to drink water in time, to avoid uric acid concentration.
Time to drink boiled water: It is generally recommended to drink water between two meals, 45 minutes after dinner to bedtime, wake up in the middle of the night, get up in the morning and before breakfast, before and after exercise and before and after bathing.
Maintaining the body is important, but improper maintenance may be counterproductive, and only by using the right method can we do more with less. So, don't ask me if soda can replace sodium bicarbonate (baking soda), it's always right to drink more water every day.
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