Gout is an unpleasant chronic disease associated with impaired purine metabolism. Purine bases, due to improper metabolism, are converted into uric acid, which is deposited in the joints in the form of sodium urate. The disease is accompanied by attacks of pain, which can be triggered by prolonged walking, cooling, drinking alcohol and foods rich in purines. People suffering from gout are bothered by sharp pain in the joints at rest. The metatarsophalangeal joint of the big toe, ankle and knee joints are most often affected. Without treatment and diet, attacks of pain become more frequent, and new joints become involved in the disease. Over the course of 3-5 years, a chronic form of the disease develops - gouty arthropathy.
For patients with gout, so-called fractional meals are recommended. Food should be taken 5-6 times a day, in small portions. During the day you need to drink 1.5-2 liters of liquid, and not black tea or coffee, but pure water, herbal infusions, juices and compotes.
• meat soups, meat, chicken, mushroom and fish broths;
• canned food (any), smoked meats, marinades, pickles;
• offal: liver, kidneys, brains, tongue, lungs, heart, chicken gizzards, etc.;
• mushrooms, legumes, lettuce, spinach, sorrel;
• some berries, such as raspberries and cranberries;
• dried fruits, baked goods, confectionery products;
For gout, the menu should consist primarily of vegetables and fruits (see the list of permitted vegetables and fruits below), as well as dairy products, cereals and lean meats, poultry and fish.
• any soups made with water and vegetable broth;
• chicken breast, turkey fillet, rabbit, lean fish - all this is only boiled and no more than 3 times a week;
• dairy products and dishes based on them, for example, milk porridges and jelly;
• seafood (shrimp, squid).
Refractory fats (lard, lard, lamb fat) and confectionery fats are strictly prohibited. It is recommended to include vegetable oil, especially flaxseed, and melted butter in small quantities in the menu of gout patients.
An infusion of lingonberry leaves can be an excellent drink and at the same time a remedy for gout. You can buy dried lingonberry leaves at a pharmacy, and if you’re lucky, you can find crushed leaves in filter bags. An ordinary leaf is brewed in the proportion of 1 tablespoon of dry leaves per glass of boiling water, left for an hour and taken 1-2 tablespoons throughout the day.
IT IS IMPORTANT TO KNOW! The only remedy for JOINT PAIN, arthritis, arthrosis, osteochondrosis and other diseases of the musculoskeletal system, recommended by doctors! Read more.
Meals for gout patients should include fresh fruits and vegetables in the form of salads. You can eat boiled vegetables (preferably steamed, unsalted). The principles of therapeutic diet No. 6 are used in the nutrition of patients with gout. Its basic principles are: limiting animal proteins and salt, avoiding foods containing purines and oxalic acid, as well as herbs, spices, and strong alcoholic beverages. It is necessary to follow such a diet during an exacerbation of the disease for 2-3 months.
• fried fatty meat, especially beef;
• fried fish, lard, sardines, sprats, caviar;
• hard and processed cheeses;
• cauliflower, rhubarb, radish, eggplant, rutabaga.
It is undesirable to consume chocolate of any kind, coffee, cocoa. It is recommended to completely abstain from alcohol.
• beets, carrots, potatoes, white cabbage, cucumbers, tomatoes, sweet peppers;
• apples, pears, plums, apricots, peaches, all citrus fruits and bananas;
• eggs - no more than 1 piece per day, can be in any form;
• fruit compotes and jelly;
• marshmallows, marmalade, marshmallows (all this is better homemade, made from natural ingredients);
• porridge: rice, buckwheat, wheat, oatmeal, millet.
It is not difficult to completely restore JOINTS! The most important thing is to rub this into the sore spot 2-3 times a day.
Author: Angelina Beauty
MINISTRY OF EDUCATION AND SCIENCE OF UKRAINE
TAVRICHESKY NATIONAL UNIVERSITY NAMED AFTER V.I.VERNADSKY
SEVASTOPOL ECONOMIC AND HUMANITIES INSTITUTE
DEPARTMENT OF PHYSICAL REHABILITATION
"Therapeutic nutrition for gout"
This abstract discusses gout and nutritional therapy for this disease. Gout, which was once considered the disease of kings, is caused by the very plebeian uric acid. Everyone has it in their blood. But with gout, either too much of it is formed, or a normal amount is formed, but not enough is excreted. [7]
Gout is caused by a disorder of uric acid metabolism. This appears to be the oldest medically described disease. Hippocrates in the 5th century BC. e. called gout (from podos - foot + agra - trap, trap) attacks of acute pain in the foot. In the 5th century AD e. Galen described tophi (nodular formations with the deposition of uric acid crystals) and their connection with arthritis, but only in the 80s of the 18th century Leeuwenhoek saw these needle-shaped crystals in the contents of the tophi using a microscope. In the mid-20th century, a connection between gout and monosodium urate crystals was established.
A healthy person is most often inattentive to what he eats. Having fallen ill, people rush to search for the latest drugs and forget about such a reliable and constantly acting remedy as food. Addiction to drugs often leads to allergies and other complications, so it is important to know and use medicinal, sedative and anti-inflammatory substances contained in food and drinks, including decoctions and infusions. Therapeutic nutrition for gout is aimed at reducing the intake of purines from food, which alleviates the patient’s condition and helps maintain a longer state of remission. Since food purines, as a source of uric acid formation, do not play a major role in the development of gout, the maximum result can be obtained only when combined with medications that inhibit the formation of uric acid and its salts in the body and enhance its excretion from the body.
1. Gout disease
1.1 What is gout?
Gout (Greek podagra, lit. - foot trap), a chronic disease of humans and animals caused by metabolic disorders, with an increase in the level of uric acid in the blood and the deposition of uric acid salts (urates) in various tissues and organs, mainly in the joints. In humans, it manifests itself as acute attacks of arthritis, deformation of joints with disruption of their function. It is believed that in the origin of gout, dysfunctions of various enzymes that regulate the formation and excretion of urates from the body are of primary importance. In some cases, the hereditary nature of the disease is clearly revealed. Additional factors such as overeating, excess consumption of meat and meat products, alcohol abuse, as well as a sedentary lifestyle and nervous fatigue play a certain role in the development of gout. The disease occurs more often in men after 40 years of age; in women it is observed relatively rarely. Factors that provoke an attack of gouty arthritis include surgery, trauma, and taking diuretics.
Where does uric acid come from? Disorders of the metabolism of purine bases (mainly found in nucleic acids) arise mainly due to congenital or acquired weakening of the activity of enzymes that regulate this process. An increase in the level of uric acid in the blood (hyperuricemia) required for gout—above 0.254–0.325 mmol/l—occurs either due to increased breakdown of purine bases or due to decreased excretion of uric acid by the kidneys. Both of these reasons may occur. There are known diseases or situations where gout is only a symptom: for example, with myeloid leukemia, congenital and acquired heart defects that occur with cyanosis, with lead intoxication, with the use of riboxin, etc.
Let's give the modern definition of gout as:
– systemic tophi disease, – developing in places where monosodium urate crystals are deposited, – with inflammation in organs and systems, – in people with persistent hyperuricemia caused by environmental and/or genetic factors.
The role of environmental factors in gout is evidenced by obvious fluctuations in its prevalence associated with the standard of living of people, which leads to the practical disappearance of the disease during wars, famines, etc. and, conversely, an increase in prevalence with rising living standards. At least in all countries with a high standard of living, there is an increase in patients with gouty arthritis.
1.2 Changes in organs and functions
The development of gout is usually accompanied by acute paroxysmal inflammation of one or more joints (arthritis). Usually the joints of the lower extremities are first affected, often the metatarsophalangeal joint of the big toe (in about 75% of patients), metatarsal joints, ankle and knee joints. Less common is arthritis of the small joints of the hands, wrists and elbows. A painful attack usually begins suddenly, often at night. After overeating, alcoholic excess, and often for no apparent reason, acute pain occurs in the affected joint, swelling forms, accompanied by redness and sharp pain at the slightest movement. Chills appear with an increase in temperature. After a few days, the symptoms of arthritis may completely disappear. The intervals between attacks last from several days to 1–2 years. As the disease progresses, attacks become more frequent and last longer, new joints periodically become inflamed, and inflammation can persist for many weeks. This chronic course of gout is characterized by deposits of urates under the skin in the form of nodules, most often near the elbow and knee joints, at small joints of the hands, in the cartilage of the auricles, on the eyelids, wings of the nose, in the epiglottis, bronchi, in the myocardium, heart valves, aorta, on the foreskin of the penis, where nodules of different sizes are formed - tophi. There is a retention of sodium uric acid in the body, its deposition in the ligaments, intestinal wall, and meninges. The fact of the formation of monosodium urate crystals and the formation of microtophus in the gastric mucosa was revealed in more than half of patients with gout. Along with this, the tendons (often the Achilles tendon) and periarticular mucous bursae are affected, and thrombophlebitis develops. The introduction of a secondary infection sometimes leads to suppuration. [10] This confirms the definition of gout as a systemic tophi disease, in which the development of acute or chronic arthritis is only the most striking manifestation of the disease. Often there are deposits of urate in the tissues of the kidneys and urinary tract with the formation of stones, i.e. Uric acid (urate) stones are formed. In 15–20% of patients with gout, urolithiasis occurs (an attack of renal colic can sometimes be the first sign of gout), and interstitial nephritis also develops.
Among the epidemiological patterns, the predominant incidence of men aged 40–50 years, alcoholism and overeating, and the connection with the widespread use of diuretics for the treatment of hypertension, which, like alcohol, reduce the excretion of uric acid, are indisputable. In recent years, there has been an increase in gout in women, associated not only with the postmenopausal period and the cessation of the uricosuric effect of estrogens, but also with concomitant diseases (type 2 diabetes mellitus, arterial hypertension).
Persistent hyperuricemia (increased levels of uric acid in the blood) is an important, but not obligatory, risk factor for the development of gout, which should be taken into account when making a differential diagnosis, modifying lifestyle and choosing a treatment strategy. Therefore, it is important to know the classification criteria for gout recommended by WHO.
1.3 Classification criteria for gout
A. Presence of characteristic crystals of monosodium urate in the synovial fluid.
B. Confirmed tophi (chemical analysis or polarization microscopy).
C. Presence of 6 out of 12 clinical, laboratory and radiological signs:
1. Maximum inflammation of the joint on the first day.
2. Having more than one attack of arthritis.
4. Redness of the joints.
5. Pain and inflammation of the metatarsophalangeal joint of the first finger.
6. Asymmetric inflammation of the metatarsophalangeal joint.
7. Unilateral damage to the tarsal joints.
8. Suspicion of tophi.
10. Asymmetric inflammation of the joints.
11. Subcortical cysts without erosions on X-ray examination.
12. Absence of microorganisms in the culture of synovial fluid.
In accordance with these criteria, a reliable diagnosis of gout can be made only when crystals of monosodium urate are detected in the synovial fluid, which is possible already in the early stages of the disease or when they are detected in tophi, which is usually characteristic of chronic gout. With gout, an increase in the level of uric acid in the blood is constantly observed, which has diagnostic significance.
1.4 Clinical manifestations and features of the course of gout
For the first time, the diagnosis of gout is usually made, as in the time of Hippocrates, on the basis of severe acute arthritis, usually of the first metatarsophalangeal joint, i.e. in the presence of 1, 3, 4, 5 and 6 signs listed in the criteria. Knowledge of provoking factors preceding acute gouty arthritis can also help in diagnosis. As for chronic gouty arthritis, at first it is also more often of an oligoarticular nature. Polyarticularity develops in a combination of tophi in the area of the affected joints and others, among which the most common are tophi in the area of the auricle.
Tophi, including microtophi, are a sign of systemicity in gout. This makes it possible to distinguish the development of tophi disease in connection with the deposition of monosodium urate crystals in tissues and the development of inflammation or in connection with massive excretion (release) of crystals, which is associated with the development of gouty nephropathy (kidney disease).
The pathogenetic basis of local and systemic pathology in gout is microcrystalline inflammation, which is based on the interaction of monosodium urate crystals with endothelial and synovial cells, monocytes / macrophages, neutrophils, accompanied by the production of various cytokines by these cells, in particular TNF-α, IL-lβ, IL 6.
Gout and its exacerbations are a dynamic process, in which several periods are distinguished. It should be noted that as the disease progresses, attacks of acute gouty arthritis become more frequent, which become protracted, leading to a reduction in the inter-attack period, and finally, tophi gout develops, i.e. already chronic gout with systemic manifestations.
There are periods during the course of gout: attack of acute arthritis, interictal period, chronic tophi gout. With systematic treatment, it is possible to transition into the interictal period not only of acute arthritis, but also of chronic one. During the interictal period, it is best to begin systematic therapy with allopurinol, which stops severe attacks of acute gouty arthritis. You should not think that recovery occurs during this period. In contrast, monosodium urate crystals are consistently found in the asymptomatic knee or metatarsophalangeal joint. This contributes to the development of mild (minimal) inflammation, which affects the development and progression of complications of gout , such as atherosclerosis. One of the most common signs of gout is the development of metabolic syndrome. According to modern concepts, metabolic syndrome is a complex of disorders that are risk factors for the development of cardiovascular diseases. These disorders include arterial hypertension and visceral obesity, dyslipidemia and impaired glucose tolerance, etc.
It is now generally accepted that the basis of most of these manifestations is insulin resistance (IR) with a violation of the biological action of insulin, accompanied by a decrease in glucose consumption by skeletal muscles and leading to chronic compensatory hyperinsulinemia. The combination of these disorders significantly accelerates the development and progression of atherosclerosis. It is known that more than 60% of patients with gout die from cardiovascular accidents and no more than a quarter die from chronic renal failure. Visceral obesity is a powerful stimulus for the appearance of hyperinsulinemia. It is in patients with gout with concomitant insulin resistance that both arterial hypertension and dyslipidemia are more pronounced, and high levels of uric acid are noted. There is a pathogenetic basis for this phenomenon: hyperinsulinemia reduces excretion and increases reabsorption of uric acid by the kidneys. Moreover, the hormone has this effect even in healthy people in the case of acute euglycemic hyperinsulinemia, which is induced by intravenous administration of exogenous insulin. Patients with high levels of uric acid have more severe gout. This is manifested by a large number of affected joints, creating the clinical picture of polyarthritis, as well as a pronounced tendency to prolonged inflammation of the joints.
1.5 Treatment of gout
Although treatment for gout is well developed, there are significant shortcomings in its implementation. It should be taken as an axiom that a diagnosis of gout means the need for lifelong treatment, as is already generally accepted in solving the problems of diabetes, hypertension and other chronic diseases. Despite the effectiveness of modern therapy for gout, it cannot be carried out in all patients who are diagnosed with this disease. The organization of an effective treatment process is hindered by 2 reasons. Firstly, there is insufficient familiarity of a wide range of doctors with new, most effective treatment methods and medications. Secondly, methods for achieving unconditional adherence of patients to systematic treatment have not been developed. Anti-gout therapy should consist of two directions: relief of acute gouty arthritis and systematic treatment of disorders of purine metabolism, and in fact, secondary prevention of exacerbations, taking into account the nature of the disease, in which each exacerbation of gout significantly aggravates its course as a whole and contributes to the development of life-threatening complications.
During an acute attack, you should try to keep the affected joint elevated and at rest. According to doctors, during this period, most patients cannot even bear the weight of a sheet on the sensitive joint. The pain causes very severe inflammation around the affected joint, so painkillers and anti-inflammatory drugs are needed. Doctors recommend ibuprofen. But aspirin can actually make gout worse by slowing down the secretion of uric acid. Acetaminophen does not have the ability to fight inflammation and therefore does not provide much benefit. [7] Colchicine is used to treat an acute attack of gout, which suppresses the phagocytic activity of neutrophils and the release of proinflammatory reagents. Preference is given to non-steroidal anti-inflammatory drugs (NSAIDs), which suppress the metabolism of arachidonic acid, and therefore the activity of cyclooxygenase-2, which induces the synthesis of pro-inflammatory prostaglandins, and glucocorticoids (GCs), which most actively suppress acute inflammation. The bias of doctors in choosing a drug is crucial and is determined by the level of familiarity with treatment methods, knowledge of their effectiveness and tolerability, and the frequency of adverse reactions.
NSAIDs are traditionally popular in our country: in previous years, non-selective - indomethacin, then diclofenac sodium (orally or intramuscularly); In recent years, attention has been paid to selective NSAIDs.
As for GC in acute or exacerbation of chronic gouty arthritis, we can recommend a single or double intravenous injection (depending on the number of joints involved) of methylprednisolone in doses of 250–500 mg, which provides a rapid and persistent anti-inflammatory response, combined with a uricosuric effect useful for gout. In the treatment of acute gouty arthritis, nonsteroidal anti-inflammatory drugs are used in maximum or even increased daily doses: voltaren (150–200 mg/day), indomethacin (150–200 mg/day), butadione (0.6 g/day). For frequently recurrent arthritis, kidney damage, urolithiasis, tophi, constant (lifelong) use of allopurinol (milurite) in a daily dose of 0.3–0.4 g is indicated to normalize the level of uric acid in the blood. In the absence of gouty kidney damage, uricosuric drugs are also used: anturan (daily dose 0.2–0.6 g) or etamide (courses of 1–week at a daily dose of 2.8 g with breaks of 1–2 weeks).
Anti-gout therapy itself is also well justified, since its main goal is a persistent reduction in hyperuricemia and not only the prevention of gout progression, but also the possible reverse development of tophi-damaging processes, subject to consistent maintenance therapy in an individually selected dose.
Physical treatment methods are used to improve blood circulation in tissues, provide analgesic, anti-inflammatory and absorbable effects, normalize metabolism, slow down and stop the formation of deformities in joints. [10] During an acute attack, treatment is carried out with UHF EP on the area of the affected joints and novocaine electrophoresis. In the chronic stage, lithium electrophoresis is used. Lithium ions displace uric acid from its salts and form the lithium salt of uric acid, which is easily soluble in water. Dissolved uric acid is eliminated from the body faster. Electrosleep has a positive effect on the main symptoms of gout, purine and lipid metabolism, the functional state of the sympathetic-adrenal and central nervous systems, and the favorable treatment result lasts from 3 to 12 months. Balneotherapy is used in the form of sulfide, radon, iodide-bromine, sage baths (in the absence of kidney damage). Balneotherapy is not indicated for patients with acute or chronic gout. [9] Mud therapy (not used in case of exacerbation) is recommended to be carried out using the application method (mud temperature 40–42 degrees). Physical therapy, massage, sanatorium-resort treatment in the chronic stage at balneo-mud climatic resorts (Odessa, Saki, Evpatoria, etc.) are recommended. ) At resorts, climatotherapy is used in the form of aeroheliotherapy and thalassotherapy, aromatherapy: in case of an acute attack of gout, you can apply cool compresses using essential oils. Cypress, fennel, juniper, lemon and pine oils are used. They can also be added to the bath. When swelling and inflammation in the joints decrease, you can switch to lavender or rosemary oil. They cause local heat and help flush toxins from the joints. It is recommended to drink low-mineralized alkaline sodium bicarbonate waters, which contribute to the alkalinization of urine. Waters such as Borjomi, Essentuki No. 17 and No. 4, Truskavets waters, etc. are used.
It is extremely important to follow a basic diet. It is generally accepted that a low-purine diet is the main one. Due to the frequent combination of gout with metabolic syndrome, it is more rational to use diets recommended by various anti-atherosclerotic societies, and at the same time control body weight.
Thus, summing up the treatment of acute and chronic gout, we can propose the following measures of the doctor’s activity when in contact with the patient
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first line in the treatment of acute or exacerbation of chronic gouty arthritis.
• It is advisable to select anti-gout therapy itself in the manner of “titrating” the dose, starting with small doses, both to avoid side effects and to develop the optimal minimum dose leading to normouricemia, taking into account the pronounced polymorbidity of these patients and the need to take other medications.
• Education of the patient regarding the need to stop systematically drinking alcohol and follow a diet that allows you to maintain body weight or reduce excess weight. Teaching the patient to systematically measure body mass index, keep a diary of well-being, blood pressure levels, and the dose of medication used.
2. Nutrition for gout
2.1 General recommendations from a nutritionist
The main place in the treatment of gout is occupied by therapeutic nutrition. The maximum result can be obtained only when combined with medications that inhibit the formation of uric acid and its salts in the body and enhance its excretion from the body.
Liquid. The diet involves consuming an increased amount of fluid (1.5–2.5 liters per day). Be sure to drink a glass of liquid at night. Vegetable and fruit juices are beneficial. Juices help remove uric acid from the body and prevent its deposition in organs. Use rosehip decoction, milk, alkaline mineral waters, i.e. drinks that have predominantly alkaline valencies. They promote the dissolution of uric acid and thereby prevent the deposition of salts in joints, cartilage, membranes, etc. Milk and dairy products are allowed in any quantity: they not only do not contain purines, but also help remove them from the body. Sour milk and whey are especially useful.
Here are a few recipes for traditional medicine related to the preparation of drinks. 1) The infusion of strawberries is tasty and healthy. 4 tablespoons of dry strawberries per 4 cups of boiling water, steam for 1.5 hours. Drink a glass an hour before meals and at night before bed. Drink 4 glasses during the day.
2) The healing properties of chicory were known back in the time of Avicenna: he recommended applying a thick decoction of chicory roots to gout-affected joints. Today it is recommended to drink an infusion of chicory herb (1-2 teaspoons per glass of boiling water) ½ cup 2-3 times a day 30 minutes before meals.
3) Regular oats can relieve gout pain if you drink the infusion (3 g of dried herb per 25 ml of water) 3-4 cups per day.
4) Nettle or coriander tea helps the kidneys get rid of uric acid. 5) To relieve pain, it is recommended to drink 1 glass 3 times a day of birch sap, collected in early spring. In paragraph No. 4, “Folk Remedies,” various infusions and decoctions are discussed in more detail.
Squirrels. In case of gout, first of all, protein is limited to 0.8–1 g per 1 kg of body weight in order to reduce the formation of uric acid. Exclude those protein products that contain a lot of purines: meat, fish, caviar. The meat of young animals (chickens, veal), all parts of the carcass that give a strong fat (head, legs, etc.), internal organs (heart, liver, kidneys, tongue, brains) are strictly prohibited. Fatty meats and fish, anchovies, herring, sardines, mussels, meat and fish broths, and soups are prohibited. In the non-acute period, meat and fish are allowed, but no more than 2 times a week, and only in boiled form: when boiled, up to 50% of purine substances are released into the broth. Eggs are allowed.
Fats. The amount of fat decreases slightly - to 0.8–1 g per 1 kg of body weight. This amount includes fats from protein products, unsalted butter, cream, sour cream and, of course, vegetable oil. Lamb, beef and pork fats, and various combined fats are not allowed.
Carbohydrates. The amount of carbohydrates is also somewhat reduced, but mainly due to easily digestible ones: sugar, jam, syrups, sweets, honey. You need to give up cocoa and chocolate. Flour and cereal products, some white bread are allowed.
Salt. Limit the use of table salt by adding salt to ready-made dishes.
Vegetables fruits. It is recommended to eat more vegetables, fruits, berries. Vegetables include potatoes, cabbage, cucumbers, carrots, tomatoes, zucchini, pumpkin, melons, and watermelons. In particular, traditional medicine recommends eating 100g of grated carrots with one tablespoon of vegetable oil every day. [6] Exclude legumes rich in purines (peas, beans, beans, lentils), as well as mushrooms, sorrel and spinach. Walnuts are allowed. Among fruits, apples, apricots, plums, pears, peaches, oranges, lemons are especially useful; from berries - grapes, cherries, sweet cherries, strawberries, blueberries, gooseberries. Cherries are an excellent source of proanthocyanidins, which help relieve joint inflammation due to gout [5]. According to Anglo-Saxon tradition, you should eat up to 240 g of fresh cherries per day to avoid gout. Out of season, it is recommended to drink a handful of fresh cherry stalks per 1 liter of boiling water. [4] For mild forms of gout, it is recommended to eat fresh strawberries every day for 1.5 months on an empty stomach, 3-5 glasses a day. In the morning on an empty stomach, 2 glasses half an hour before meals, after lunch - a glass and at night, after meals, 2 glasses. A vegetable or fruit fasting day once a week is useful. American doctors advise[7] to eat cherries. Although there is no reliable scientific evidence that cherries help with gout, many people find their effects beneficial. It doesn't matter whether they eat sweet or sour varieties, whether the cherries are fresh or canned. They talk about different amounts: from a handful (about 10 cherries) per day to 200 g. Successful results have also been reported from taking 1 tablespoon of concentrated cherry juice per day.
The energy value of the diet is slightly reduced. Hence the conclusion - you can’t overeat! In case of exacerbation of gout, only liquid is allowed for 1-2 days - in the form of rosehip decoction, various vegetable, fruit and berry juices, alkaline mineral waters, tea with lemon. On the third day, you can use a dairy-vegetable diet.
2.2 Basic diet for gout
The main diet for gout is Diet No. 6. It is indicated for gout, urolithiasis with the formation of stones from urate and oxalate salts. The diet contains:
1) normal amount of fat (80–90 g), carbohydrates (400–450 g),
2) reduced amount of proteins (70–80 g) and table salt (8–10 g), 3) increased amount of liquid (2–2.5 l).
The weight of the daily ration is 3 kg. Energy value 2500–2700 kcal per day. Meat and fish are prepared only boiled. Patients should eat 4–5 times a day. The food temperature is normal.
Recommended: gray wheat and rye bread, white bread and pastry products in limited quantities. Dishes of cereals and pasta in moderation.
Shchi, borscht, rassolnik, beetroot soup, dairy, vegetarian and fruit soups.
Lean meats and fish 1-2 times a week. Eggs – 1 pc. in a day.
Vegetable and butter.
Various vegetables, fruits, berries in their natural form and in various forms of preparation, fasting days using raw vegetables and fruits. Milk, lactic acid products, cottage cheese and dishes made from them.
Tomato, milk, sour cream sauces. Citric acid, parsley and dill.
Alkaline mineral waters, rosehip decoction, weak tea with milk.
Excluded: sharp cheese, brains, liver, kidneys, lungs, veal, game, meat, fish and mushroom broths, sausages, herring, canned fish and meat, smoked meats, legumes, figs, raspberries, lingonberries, spinach, sorrel, lettuce, rhubarb, horseradish, mustard, black pepper, natural coffee, cocoa, strong tea.
2.3 Approximate seven-day diet menu No. 6
Monday 1st breakfast. Fresh cucumber salad, oatmeal with milk, rosehip infusion 2nd breakfast. Cottage cheese with sour cream, fruit jelly Lunch. Potato soup, zucchini stuffed with rice and vegetables, with sour cream sauce, strawberries with milk Dinner. Lazy dumplings with sour cream, cabbage cutlets with butter, tomato juice Overnight. Fresh apples
1st breakfast. Raw carrot salad with sour cream, rice porridge, tea with lemon, soft-boiled egg
2nd breakfast. Young potatoes in milk sauce with cucumber, apple juice
Dinner. Soup from prefabricated vegetables with sour cream, cottage cheese casserole, milk jelly.
Dinner. Apples baked in an egg white omelet, fruit juice.
1st breakfast. Fresh cabbage salad; pasta with cottage cheese, tea with lemon
2nd breakfast. Potato cutlets baked with sour cream, fruit juice
Dinner. Vegetarian borscht with sour cream, boiled meat stew with milk sauce, mashed potatoes, lemon jelly
Dinner. Cheesecakes baked with sour cream, vegetable stew, fruit jelly.
For the night. Fresh apples.
1st breakfast. Cabbage and apple salad, buckwheat milk porridge, tea with lemon, soft-boiled egg.
2nd breakfast. Carrot-apple cutlets, rosehip decoction
Dinner. Rassolnik with vegetable broth with sour cream, pancakes with cottage cheese, blackcurrant jelly.
Dinner. Apples stuffed with cottage cheese, pumpkin baked in sour cream, apple juice.
For the night. Curdled milk
1st breakfast. Fresh tomato salad, cottage cheese with sour cream, fruit jelly
2nd breakfast. Cabbage cutlets with sour cream, rosehip broth
Dinner. Milk soup with homemade noodles, cabbage rolls with buckwheat porridge and cottage cheese with sour cream sauce, watermelons or fresh grapes
Dinner. Curd pudding with sour cream, carrot cutlets, fresh fruit compote
For the night. Fresh apples
1st breakfast. Salad of mixed vegetables, millet porridge with milk, tea with jam, natural omelet from 1 egg
2nd breakfast. Carrot zrazy with apples and raisins, rosehip decoction
Dinner. Vegetarian cabbage soup, cottage cheese pudding with raisins and apples, milk jelly
Dinner. Baked protein omelet, zucchini baked in sour cream, fruit juice
1st breakfast. Salad of tomatoes, cucumbers and apples with vegetable oil, cottage cheese with milk, fresh fruit compote
2nd breakfast. Cabbage baked in white sauce, fruit jelly
Dinner. Okroshka, boiled chicken with rice, baked apples
Dinner, Cheesecake with fruit, vegetable stew, tea with milk
For the night. Fresh apples or a glass of kefir
All day. Butter 20 g, sugar 30 g, black bread 300 g, white bread 100 g.
3. Folk remedies and herbs for gout
In folk medicine, there are a huge number of both internal and external remedies for the treatment of gout. Helpful advice: do not start treatment during an attack. Follow your doctor's instructions. The choice of plant depends on the nature of the disease: acute attack or inter-attack period. Plants used: physalis, burdock, birch, borage, heather, cherry, chicory, colchicum, fennel, ash, dandelion, sarsaparilla, hawkweed, hydrangea, chickweed, chasteberry, etc.
1. Treatment with plants consumed as food.
A) Oats. Alcohol tincture: 15 drops per glass of warm water 5 times a day.
B) Garlic infusion. Take 4 pitted lemons and 3 heads of garlic, grind through a meat grinder, pour in 7 cups of boiling water, stir, let stand for a day, strain and drink 40 g before meals once a day. [6]
C) Grind 200 g of garlic, 300 g of onions and combine with 0.5 kg of mashed cranberries. Mix everything thoroughly and leave for 24 hours in a container with a tightly closed lid in a dark place. Then add 1 kg of honey and mix. Take 1 teaspoon 3 times a day 15–20 minutes before meals. [8]
2. Treatment with herbs (flowers, roots and shoots). Inside: [4]
A) Nettle (leaves, 10 g), meadowsweet (tops, 15 g), black currant (leaves and fruits 30 g), ash (leaves 50 g): infusion, 1 teaspoon of mixture per 1 cup of boiling water, 3 cups per day before meals.
B) A classic remedy against gout is celery seed; it can be used in the form of tea (1 tsp of seeds per 300 ml of boiling water). 2-3 cups of this tea daily are recommended for acute gout attacks. Along with celery, you can use meadowsweet, white willow bark, and devil's claw.
C) A general cleansing herb that is useful to use regularly for chronic gout is stinging nettle. (tea, 2-3 cups per day for a month).
D) Harpagophytum (adventitious roots 12.5 g), linden (flowers 12.5 g), olive (leaves 20 g), artichoke (leaves 25 g), hibiscus (calyxes 50 g): infusion, 1 tablespoon per 500 ml boiling water, 2-3 times a day.
E) Agrimony (leaves and flowers): infusion, 30 g per 1 liter of boiling water, 3 cups per day.
E) Canadian small petal, due to its ability to remove uric acid, can prevent gout attacks. It is not addictive and there are no known side effects. The flowers are collected in early autumn and dried in the shade. Infusion: 20 g of dried plant per 1 liter of boiling water, leave for 10 minutes. 3 cups per
Gout occurs as a result of the accumulation of uric acid salts in the body. Most often, the attack occurs unexpectedly, at night. At this time, the symptoms of gout are as follows: severe pain in the area of the inflamed joints (usually the big toes), swelling and redness of the joints themselves, as well as general disorders - fever, weakness, abdominal pain.
Gout, diet, treatment - all this is interconnected. Treatment of gout is a lengthy process, however, the priority is stopping the attack itself and relieving pain. In the future, proper nutrition is very important, since reducing the consumption of foods containing uric acid salts (urates) leads to a slowdown in the development of the disease. Nutrition for gout is an issue that deserves close attention, since it is the normalization of nutrition that promotes a speedy recovery and increases the time interval between relapses of the disease. Only certain foods can be consumed for gout, so there are many rules that you need to know regarding the menu and nutrition of patients.
First of all, let's look at the main points of nutrition and find out what kind of diet a patient should have for gout. Doctors recommend that patients exclude animal proteins from their diet, but they are not only dangerous for people with gout - animal fats and easily digestible carbohydrates are also dangerous.
Meals for gout should be frequent, but food should be consumed in small portions. Thus, during the day the patient should eat five to six times, and at least once a week he should have a fasting day.
On fasting days you can eat fresh vegetables and fruits. Moreover, they can be either raw or boiled (but without salt). The important thing to remember here is that you should only eat one type of vegetable or fruit during the day, such as baked potatoes or raw apples.
In addition, there is a very popular option for a fasting day - rice and apples. From the name it is clear that on this day the patient should eat rice and apples, but the rice porridge itself must be properly prepared.
So, to cook rice porridge for a fasting day, you need to cook 75 g of rice in 750 ml of milk - this is a portion of food for one day. The porridge should be eaten a day in three doses. Apples can be eaten up to 250 g, and it is best to boil them or make compote without sugar.
Of course, despite many exceptions, which will be described below, the menu for gout should still not be monotonous and this is very important, because the body must receive all the necessary substances. Therefore, you need to take care of a balanced diet.
Here are some gout recipes that are not only healthy, but also delicious.
VEGETARIAN BORSCH. To prepare borscht you need the following products: 160 g beets, 160 g potatoes, 60 g carrots, 140 g white cabbage, 40 g onions, 100 g fresh tomatoes, 25 g parsley, 40 g sour cream.
Separately, cook the beets until half cooked and grate them on a coarse grater. Then put all the vegetables (including beets) in one container, add water and cook until everything is ready. When serving the borscht, season it with sour cream and add chopped parsley.
Another recipe that the diet allows for gout is a recipe for potato soup. So, POTATO SOUP is prepared from the following products: water, potatoes,? eggs, butter, flour, sour cream (25 g), herbs.
The cooking process is very simple - peel and boil the potatoes, drain the water from them into a separate container and rub through a sieve. Next, you need to prepare the sauce, for which you dry the flour in the oven and dilute it in 40 g of potato broth, and then boil. Mix together the potato broth, mashed potatoes and prepared sauce, add the egg and butter. Boil everything again and serve, top with sour cream and add herbs.
Of course, the diet for gout is not at all monotonous and, according to it, patients can eat not only liquid dishes, but also various cereals and side dishes. Here are a few examples of second courses that can be included in the diet of patients.
VEGETABLE STEW. To prepare you need to take 6 potatoes, 3 carrots, 1 onion, 1 cup green peas, 1 tbsp. a spoonful of butter, 100 g of sour cream and a pinch of salt.
Finely chop the onion and fry it in oil, then add the diced carrots to the frying pan and simmer. When the carrots become soft, you need to add boiled green peas, boiled and diced potatoes, sour cream and salt and simmer all the ingredients for about 15 minutes. When serving the dish, pour butter over it.
Nutrition for gout allows patients to eat porridge. For example, buckwheat. So, you can prepare BUCKWHEAT PORRIDGE as follows: pour 50 g of buckwheat into 100 g of water, add a pinch of salt, stir and, closing the pan with a lid, place on medium heat. After the porridge has absorbed all the water, continue to cook it over low heat for 20-30 minutes. Add 4 g of butter to the finished porridge.
Mineral water, especially medicinal water, has a very good effect in the treatment of gout. Mineral water for gout can be consumed both daily, as a drink, and as a fasting day - during the day you should drink only medicinal mineral water.
There are many other recipes for dishes for gout, and they can be easily found on the Internet or in literature. However, this shows that the menu is very diverse and you can choose the appropriate nutrition for any person. But there are still prohibited foods for gout, and you should always remember this.
So, let’s first consider what you can eat if you have gout, and then we will list the foods you can’t eat if you have gout.
Patients with gout can eat any vegetables in their diet with virtually no fear. The only exceptions are spicy ones (for example, radish and horseradish), as well as sorrel, celery, spinach and cauliflower.
Also, the gout diet allows you to eat any fruit, including exotic ones (grapefruits, oranges, tangerines). You can eat low-fat dairy and fermented milk products (low-fat cottage cheese and kefir). Chicken and, especially quail eggs are very useful.
From fats, you can use a little butter and any kind of vegetable oil. Whole grain porridges, natural bee honey and nuts are highly recommended.
To summarize, we can:
Knowing what foods you can eat if you have gout, let’s now consider what you can’t eat if you have gout.
So, it is strictly forbidden for people with gout to consume any type of smoked meat. Meat and fish are allowed in very small quantities, but salt should be completely excluded from the diet as much as possible.
Diet for gout also completely excludes foods such as:
It is also not allowed to drink tea or coffee, alcoholic beverages, or sparkling water. Meat soups and even broths, as well as chocolate and cocoa, are prohibited.
Thus, by following all nutritional recommendations, you can improve the patient’s condition and stop the development of gout.
Detailed video about diet No. 6 for gout and urolithiasis:
Why is nutrition for gout so important? It is considered as a treatment for this disease. It develops due to the deposition of salts that are released from such a natural waste product of the body as uric acid. Proper nutrition for gout is of great importance. If you do not take the necessary measures, your kidneys and liver will be at risk.
Among the products there are those that contain urate. is important for gout in the legs and other extremities. These are uric acid salts, due to which the disease is activated. Normalizing metabolism through improved nutrition speeds up recovery and mitigates upcoming attacks.
Doctors recommend, first of all, to remove animal proteins, animal fats, and foods with easily digestible carbohydrates from the diet.
You should also organize your meals. They should become frequent, divided into small portions. When planning your diet for gout and arthritis , you need to think about 5-6 meals, not forgetting about fasting days. You need to arrange at least one in a week, eating only vegetables and fruits.
1. Nutrition for gout involves limiting protein per kilogram of optimal body weight to 0.8 - 0.9 g. Vegetable protein in the diet for gout should be at least 30% of the total daily amount of protein. Along with proteins, the amount of fat in the diet for a patient with gout is also limited (per kilogram of optimal body weight to 0.9 - 1.0 g) by excluding fats of animal origin. About 35% of the daily amount of fat in the diet for patients with gout should be of plant origin; fatty acids in vegetable fats have a good effect on the metabolism of patients with gout. Due to the restriction of fats and proteins in the diet of patients with gout, it is necessary to bring the energy value of the diet to a physiological level by increasing the amount of carbohydrates.
2. In the diet for patients with gout, it is necessary to significantly limit and even exclude foods that are rich in oxalic acid and purines. Fish and meat should be consumed boiled, since when boiled, most of the purines go into the broth. Broths should not be consumed.
3. To successfully remove uric acid from the body of patients with gout, urination per day should be approximately 1.5 liters. Drinking plenty of fluids is recommended, taking into account the condition of the heart, blood vessels and kidneys (at least 2 liters). If you become dehydrated in hot weather or after a sauna, gout may worsen. For drinking, citrus fruit juices, vegetable juices, fermented milk drinks, rosehip decoction, diuretic teas, and alkaline slightly mineral waters are recommended. At the same time, it is recommended to limit the amount of salt in the diet of gout patients to 8-9 g per day.
4. Avoid alcoholic beverages, especially red wine and beer. The ethanol contained in these drinks inhibits the excretion of uric acid from the body by the kidneys and to some extent increases its formation. A single intake of alcohol and a large amount of fatty fish or meat food can trigger an attack of gout.
5. For gout, it is useful to have a fasting day once a week, regardless of weight. Fasting days can be spent on dairy products, permitted vegetables, fruits, berries, and juices. When unloading free fluid, you need at least 1.5 liters per day. Fasting for gout is contraindicated, since during fasting the level of uric acid in the body increases, and this contributes to the exacerbation of the disease.
6. If gout is combined with obesity, then it is advisable to base diet therapy on the principles of combating obesity, but limit fish and meat in the diet and increase the amount of dairy products. The rate of weight loss for gout should not be high (1-1.5 kg per week).
7. If the kidneys are damaged, changes are made to the diet depending on the state of their functions.
8. Eating for gout should be regular, at least 4 times a day.
According to the medical nutrition system adopted in Russia, a diet for gout No. 6 has been compiled.
When following diet No. 6, the metabolism of purines in the body is normalized, the synthesis of uric acid and its salts is reduced.
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You need to remember about foods prohibited for gout . This includes not only meat, but also:
In the normal diet of people there are many items from the prohibited list. It is important not only to remember which foods are strictly forbidden for gout . By eating food according to recommendations, patients get rid of the disease or alleviate symptoms. In case of an acute attack, medications will help. Such as fullflex, you can learn more about this in the article: Fullflex for gout. As soon as the rest period begins, you need to immediately begin treatment, including diet.
For variety and additional cleansing of the body, you can spend a fasting day according to the famous recipe. It is based on such permitted foods as rice and apples. For the whole day in 750 ml. 75 grams of regular milk is boiled. rice cereal. The resulting mixture is eaten in three doses; you can also eat 250 g during this day. It is better to cook them in the form of compote, do not add sugar.