Why can't gout drink beer and white wine?
My name is Liu, and I'm a gout doctor at the western hospital of gout and rheumatism in Chengdu. When facing gout patients, I often tell them: "Don't drink, especially beer!" " Patients will also ask me, "Dr. Liu, you can't drink beer." Can you drink white wine? " Today I'm going to talk about why doctors don't advise gout patients to drink.
Why can't gout patients drink beer? Beer contains more than purine. In people's minds, beer is not good for gout patients because it contains purine. First of all, the influence of purine in beer on uric acid in gout patients is not as great as expected. Why do you say that?
We should be clear that there are two sources of uric acid in the human body. The food rich in purine or nucleoprotein is exogenous, accounting for 20% of uric acid in the body. It is an endogenous substance produced by the synthesis of small molecular compounds such as amino acids and nucleotides and the decomposition and metabolism of nucleic acids, accounting for 80% of the total uric acid in the body.
That is to say, the main reason for the increase of uric acid is endogenous uric acid, which may be due to the lack of enzymes in purine synthesis, or the imbalance of water and sodium, excessive excretion of organic acids, decreased glomerular uric acid filtration rate, increased renal tubular reabsorption and decreased renal tubular uric acid secretion.
However, if too much exogenous purine food is ingested, the purine ingested in vitro can not be utilized by the body, and a large amount of uric acid is produced after oxidation and metabolism, which exceeds the excretion capacity of the kidney, which will also lead to an increase in blood uric acid level. Among them, beer is indeed one of the factors, but it is only one of them. The other two include high purine food and high fructose food.
The purine content of beer itself is not much, which is less than that of yellow rice wine, generally 5.7mg/ 100ml, but doctors still don't want gout patients to drink beer, which is based on the following considerations:
The purine content of a single bottle of beer is not high, but it will be high if you drink too much: the purine content of a bottle of beer is about 30mg, and the purine content of three or four bottles of beer exceeds 100mg, not to mention that people who can drink beer often drink more than two or three bottles. If you accidentally drink too much, it will also lead to excessive intake of purine; When drinking beer, it is easy to go with a high-purity and high-protein diet: a high-purity and high-protein diet is also an inducing factor for gout, and people will get carried away after drinking it. When beer is mixed with these foods, the blood uric acid level will also fluctuate rapidly, often causing acute gout attacks. Some people regard beer as food and drink too much when they are hungry. Hunger itself can lead to the increase of free fatty acids, lactic acid and other organic acids in the human body, which has a competitive inhibitory effect on uric acid secretion by renal tubules and reduces uric acid excretion, leading to a significant increase in blood uric acid and an acute attack of gout. Regarding the relationship between beer and gout, we can look at Qingdao, Shandong Province. The incidence of gout in Qingdao is much higher than the national level, mainly because it is rich in beer and seafood. Of course, beer itself also contains alcohol (ethanol), which we will elaborate on when we talk about liquor next.
Why can't gout patients drink white wine? Liquor will raise uric acid. If you have seen the relationship between gout and beer, you may think it is more appropriate to drink white wine. Because liquor contains no purine, you can drink it with peanuts instead of big fish and big meat.
Of course, people who drink or are addicted to alcohol will always give themselves some suitable reasons to convince themselves. In fact, the influence of alcoholism on gout is much more serious than that of diet, and the influence of liquor on acute gout attack is no less than that of beer. This is mainly because the wine contains ethanol. Does ethanol have an effect on human uric acid?
Ethanol metabolism can reduce uric acid excretion: ethanol itself can increase blood lactic acid concentration. Lactic acid, like other organic acids, can inhibit renal tubular secretion of uric acid and reduce uric acid excretion. If the serum lactic acid level is higher than 20~25mg/dl for a long time, the excretion of uric acid by the kidney will be significantly reduced. Ethanol can increase the synthesis of uric acid: ethanol can promote the conversion of adenine nucleoside and increase the synthesis of uric acid, thus increasing the total amount of uric acid in a short time. Ethanol can reduce the pH of blood: ethanol can reduce the pH of blood, reduce the solubility of uric acid, promote the precipitation of urate crystals, and induce acute gout attacks. The relationship between liquor and gout can be seen in Chengdu, Sichuan. Chengdu people like to drink white wine and eat hot pot, and the incidence of gout is also higher than the national average.
All of the above tells us that both beer and liquor have an impact on gout patients; Beer has the strongest correlation with gout, and the risk of gout of people who drink 340ml beer every day is 1.49 times that of non-drinkers. Liquor can increase the risk of gout.
In addition, after drinking, people's bodies are out of control, and they are more vulnerable to trauma, and the body temperature of limbs may be lower, which is one of the reasons for the increase of gout patients when the temperature drops suddenly in recent days.
Why do gout patients feel pain when they don't drink? High uric acid is not just drinking too much. For people who like to drink, Dr. Liu's advice is: it is best to give up drinking, it is best not to drink in the acute stage, and it is best not to drink in the stable stage; Alcohol intake should be avoided when using uric acid-lowering drugs; When you really need to drink, don't eat viscera, hot pot, seafood, dried fish, etc. Even after drinking, protect yourself from harm, pay attention to rest, and don't let yourself catch cold.
Some gout patients will ask, "Dr. Liu, why can I get gout without alcohol?" The cause of gout is not only drinking, but also many reasons, including the intake of high purine food as I mentioned earlier. I can tell you one by one.
The accumulation of high uric acid is related to genes: 60% of gout is caused by nucleic acid production or purine metabolism in the body, and eating habits only account for 12% of the cause of gout. In other words, we should not only pay attention to the intake and production of uric acid, but also pay attention to its normal excretion. If the kidney is damaged and you drink less water at ordinary times, you should pay more attention. The accumulation of high uric acid is related to calories: in fact, not only high-purity foods, but also high-calorie foods will affect the production and excretion of uric acid, because high-calorie foods will lead to metabolic abnormalities, especially the competitive excretion of lactic acid and uric acid, which will lead to a decrease in uric acid excretion. Therefore, while paying attention to high-purine foods, we should also pay attention to high-calorie foods. Cold joints can also lead to gout: for example, in the current low-temperature weather, the local temperature of joints is reduced, and the solubility of local urate is reduced due to poor perfusion of limb tissues and skin temperature, which promotes the formation and deposition of urate crystals, thus causing an acute attack of gout. Joint injuries can also lead to gout: strenuous exercise, long-distance walking, shoes that don't fit, sprains, etc. It will lead to the sudden increase of urate level in joint synovial fluid, causing urate crystal deposition and leukocytosis. Uric acid will stimulate leukocytes to produce inflammatory cytokines to induce acute gouty arthritis. Mental injury can also lead to gout: fatigue, interpersonal problems, excessive pressure, disorder of work and rest, etc. , can lead to mental injury, lack of energy, but also make the body consume a lot of energy, accumulate metabolic waste, thus infecting the normal excretion of uric acid and inducing the acute attack of gout. In addition, some drugs can infect uric acid and excrete it from the kidney, and some drugs can destroy cells and lead to a large number of endogenous purine metabolism. In a word, the cause of gout is not isolated, and even alcohol is not the only cause of acute gout attack. The etiology of gout should be comprehensively analyzed, but attention should be paid to the etiology that can avoid the acute attack of gout in daily life.