Diet for gout
Gastroenterology / / May 07, 2016
Gout - one of the oldest diseases of mankind.Hippocrates described the first time, it is quite often referred to as medical, as well as in literature for centuries.
Gout - chronic disease, which is characterized by an increased concentration of uric acid in the blood, the deposition of urate in the tissues and clinically most recurrent acute arthritis.The first attack of gout can develop at any age, but most cases occur between the ages of 40 to 50 years .
Increased levels of uric acid in the blood (hyperuricemia) is the main biochemical signs of gout, but nevertheless a strict correspondence between this index and the clinical manifestations of the disease is absent.The appearance of clinical symptoms of gout is increasingly determined by the deposition of uric acid crystals in tissues, which depends not only on its concentration, but also on several other factors, many of which are poorly understood.Articular symptoms and changes in other organ systems, especially the kidney, due to direct exposure
incorrectly identified hyperuricemia with gout.However, in severe hyperuricemia gout risk is very high, and the deleterious effect is increased uric acid in the kidney and cardiovascular system.Therefore hyperuricemia itself (without gout) sometimes is an indication for treatment.Currently, the upper limit content of uric acid in the blood standards consider men 0.41 mol / l, and for women 0.35 mol / l.
Normally sources formation of uric acid in the body are purine substances introduced with food (food nucleic acids), and cellular nucleoproteins new synthesis of purines in the body of the simple substances (glutamine, glycine, etc.) Are always present in the body.Uric acid excretion from the body is broken down in the intestine by the action of intestinal bacteria.
most commonly gout - the primary disease is not associated with other diseases, has a hereditary character.As a rule, 1/3 patients with gout have relatives (mostly in the male line), who suffers from gout.In 25% of the family members of patients with gout, hyperuricemia is found.The increase is caused by uric acid levels in primary gout?The first is an increase in the endogenous synthesis of purines (metabolic type gout).Causes of hyperuricemia and violation of uric acid excretion by the kidneys (renal type of primary gout).
Knowing the type of disease enables you to select the most appropriate method for a particular patient diet and drug therapy.In 2-5% of the increase of uric acid level can result from certain diseases or the use of drugs.For example, renal failure, myeloid leukemia, anemia, multiple myeloma may be accompanied by hyperuricemia as a result of the collapse of the cell nuclei and enhanced catabolism (digestion) of cellular nucleoprotein.Diuretics increase serum uric acid by inhibiting its secretion tubules is mainly due to a decrease in extracellular fluid volume.
very briefly on the clinical picture of gout
Home gout usually associated with primary joint attack.Articular attack occurs suddenly, often at night.The most common is the appearance of pain in the joints of the toes first, which was the basis for the name of the disease, "gout" in Greek means "foot in a trap."The pain is accompanied by swelling, erythema, it is so strong that the patient is unable to tolerate even the touch of the sheets.Acute pain lasts from several hours to 2 days and 3 gradually subsides.After 2 weeks, spontaneous pain disappeared, pain persists during the movement caused by residual edema.joint swelling gradually disappears, and movement in it restored in full.After various crises in duration period is repeated.Over the years, attacks are becoming more frequent and severe, it affected a growing number of joints.In most cases, to identify factors that trigger joint attack fails.In some cases a crisis can be triggered by heavy meal or drinking alcoholic beverages, as well as heavy physical or mental stress, infection, surgery.
5-10 years after the first joint attacks in some patients appear gouty nodules (tophi), which indicates the transition of the disease into a chronic form.The nodules usually appear quickly, but can become inflamed and cause severe pain.Their sizes vary from pinhead to apple.When inflammation can occur softening of tophi and formed a fistula, which is released through this mass - urate crystals.Tophi are formed mainly in poorly vascularized tissues: on the ears, in the elbow joint, around the joints of the foot and hand.May themselves be affected joints and bones.Of particular importance is the deposition of uric acid in the kidneys (kidney gout or gouty nephropathy).Uremia, heart failure and stroke, associated with nephrogenic hypertension are the most common cause of death in patients with gout.Gouty nephropathy - a collective term that includes all of the renal pathology, observed in gout.It tophi in the renal parenchyma (50% of patients), urate stones in the renal pelvis (10-20%).Both processes create the conditions for a urinary tract infection and the development of interstitial nephritis.Later develop glomerular sclerosis and renal scarring with the development of hypertension and renal failure.
Turning to the question of dietary treatment of gout, it should be noted that currently do not include gout disease, the occurrence of which is associated mainly with eating disorders.At the same time a role in the development of gout nutritional factors undoubtedly play.This is confirmed by a higher percentage of cases among persons consuming large amounts of high-calorie foods with a predominance of animal products;the effect of provoking an abundant, rich in purines meat fatty foods and alcoholic beverages on the occurrence of gout;the therapeutic effect of a diet with a low content of purines.
treatment for gout is aimed at reducing the level of uric acid compounds is achieved, on the one hand, the appointment of drugs which depress the formation of uric acid and its salts in the body and increases their excretion by the kidneys, and the other restriction of purines administered with food.
sharply restricted or eliminated from the diet foods rich in purine bases.These include offal (liver, kidneys, brain, tongue), the meat of young animals and birds (beef, chicken), fatty meats and fish, smoked herring, sprats, sardines, meat and fish broth.Of the plant foods rich in purines enough fresh pods of legumes, mushrooms, spinach, cauliflower.They contain purines as coffee, tea, cocoa, chocolate, yeast.
purines are poor milk and dairy products, eggs, potatoes, most vegetables, breads, cereals, fruits and berries.
Gout diet without exacerbation shows number 6 with a small restriction of protein, animal fat, a sharp restriction of purine-rich foods.
chemical composition of diet number 6 (put on):
proteins 70-80 g (50-60% of these animals, mainly dairy), 80-90 g fat (of which 30% of the plant), 400 g carbohydrates. Calorie diet of 2700 kcal.Salt 6-7 g should be a sufficient amount of free liquid: 2 l or more (in the absence of contraindications of the cardiovascular system).The liquid is introduced in the form of weak tea, fruit drinks, juice, alkaline mineral water.Diet: 4-5 times a day, in drinking intervals.
Recommended dishes and products
Poultry meat - low-fat, no more than 1-2 times a week, boiled.Recall that when cooked to 50% of purines contained in food passes into the broth.Fishermen lean, 1-2 times a week, boiled.Dairy products - milk, milk beverages, cheese, meals out of it, sour cream, cheese.Eggs - 1 egg per day in any cooking.
fats - butter, ghee, vegetable oil.Cereals - all in moderation.
bread - wheat and rye, various flour products.Limit products and puff pastry.
Vegetables - among authorized in all forms.Limit salty and pickled.
Soups - dairy, fruit, vegetables (excluding peas, beans, sorrel).Cold appetizers - salads, vinaigrettes, vegetable caviar, squash, eggplant.Fruit, desserts, sweets - all fruits and berries, fresh and in any cooking.Creams, milk jelly, marmalade, candy, honey.Very good citrus, especially lemons and grapefruit.Sauces and spices - on a vegetable broth, tomato, sour cream, milk;citric acid, vanillin, cinnamon.Drinks - weak tea and coffee, juices, fruit drinks, brew, broth hips, alkaline mineral water.Prohibited: liver, kidneys, brains, tongue, meat of young animals;sausages, smoked meats, canned food;fatty, salty, smoked fish, canned fish;sharp, salty cheese, beef, mutton, cooking oil;beans, mushrooms, spinach, radishes, Brussels sprouts and cauliflower;meat, fish, chicken, mushroom broth;raspberries, figs;chocolate, cocoa, strong tea and coffee.Completely eliminated all alcoholic beverages.
All patients were advised to spend 1 day a week fasting days, especially vegetable, dairy, fruit, cheese, kefir.This creates unloading various exchange parties interested in this disease.
However, although sick and showing contrasting fasting days, in any case should not be prescribed hungry days or recommend a course of fasting.Fasting in the first days leads to an increase in uric acid blood levels with the subsequent development of gout.When
gout combined with obesity, and this combination is observed quite often prescribed diet № 8 with restriction meat and fish to 200-300 g per week, and more frequent use of unloading days (3-4 times per week).
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Sample menu diet №6
1st breakfast.Boiled egg, salad with vegetable oil, tea with milk.
2nd breakfast.Salad of carrots and apples and vegetable oil, a drink made from the bran.
Lunch.Barley soup with vegetables veggie, potato casserole with onions, stewed fruit.
Snack.A decoction of rose hips.Dinner.Cabbage rolls stuffed with vegetables and rice, lapshevnik with cottage cheese, tea with lemon.
the night.1 cup Kefir.
on all day.Wheat Bread 150 g, 150 g of rye bread, butter 15 grams, 15 grams of vegetable oil, 30 g sugar, lemon '50
In acute gout appointed strict bed rest, diet and drug therapy.For the entire period of exacerbation of the diet completely exclude meat and fish products.Diet.It consists mainly of liquid food (milk, milk products, jellies, compotes, fruit and vegetable juices, especially indicated lemon juice with water, vegetable soups, liquid porridge).It is necessary that the patient drink at least 2 liters per day.Gentle diet appointed in connection with dyspeptic symptoms are aggravated by drug therapy.