Gout Sufferers: Don't Just Focus on "Lowering the Numbers"! Save This Health Management Guide —— From Diet to Exercise!

You may have heard of "gout" — when it attacks, the joints become red, swollen, and painful, and you may even wake up in pain in the middle of the night. But did you know? The "behind-the-scenes driver" of gout is actually hyperuricemia ( HUA), and it doesn't just cause joint pain; it may also quietly damage your kidneys and blood vessels...

Data from the Chinese Center for Disease Control and Prevention shows that the prevalence rate of hyperuricemia among adults in China has reached 14%, which means 1 out of every 7 adults is affected by the disease. What is even more worrying is that the incidence rate among young people and even children is also on the rise. The prevalence rate among people aged 3 to 19 in China is as high as 23.3%, which is significantly higher than that in other countries.

Since hyperuricemia often has no symptoms in the early stage, many people are unaware that their uric acid levels have long been exceeding the standard. It is only when gout attacks and their feet swell so much that they can't walk that they regret it deeply! The new edition of Guidelines for Health Management of Hyperuricemia and Gout ^[1] (hereinafter referred to as the Guidelines) points out that uric acid management is not a single issue of "pain relief", but an all-round health management. On the occasion of the release of the new edition of the Guidelines,“Yisheng Online” — a chronic disease popular science column, specially invited Associate Professor Tang Wenbin, Deputy Director of the Health Management Center of Xiangya Hospital, Central South University, to bring you a practical comprehensive prevention and control strategy for patients.

1、 Who needs uric acid screening? Is it only unhealthy eating that causes high uric acid?

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Serum uric acid (SUA) is one of the most critical indicators in the management of hyperuricemia and gout. Whether it is to determine if uric acid is high or to assess the effectiveness of treatment, it relies on SUA. Guidelines point out that uric acid screening is not only necessary for gout patients; many "people who seem very healthy" may have already been in a borderline state of high uric acid.

The main risk factors for hyperuricemia and gout include: genetics (family history of gout), gender (males, postmenopausal females), age (after 30 years old), overweight/obesity, unhealthy dietary patterns, sedentary lifestyle, excessive alcohol consumption, smoking, poor sleep patterns, concurrent metabolic diseases or kidney diseases, use of drugs that affect uric acid metabolism (such as diuretics), and environmental and occupational exposures (living or working in environments with factors that cause hyperuricemia, such as exposure to arsenic, calcium, cadmium, and lead).

As long as any of the above situations occurs, one can go for regular uric acid testing. Detecting and intervening early is helpful for preventing the occurrence of gout and can also help improve overall health conditions.

It should be emphasized that uric acid monitoring is not a "one-time check" but should be used as a regular health management method, with dynamic monitoring conducted in combination with an individual's lifestyle and risk factors. Only by identifying danger signals as early as possible and adjusting behavioral habits can hyperuricemia be nipped in the bud "silently and without notice".

2、 All the uric acid-related indicators in my physical examination are normal. However, I have high work pressure, lack of exercise, and pay no attention to my diet. I want to know how to adjust to better prevent high uric acid?

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For healthy people, it is recommended to maintain a diverse and balanced diet, prioritizing whole grains, beans, and foods with a low glycemic index, while reducing the intake of refined sugars and ultra-processed foods. One should avoid long-term and excessive consumption of high-purine foods, such as animal offal, seafood, and thick meat broths. Additionally, controlling salt intake and ensuring adequate water consumption can help with the excretion of uric acid. Strictly control alcohol intake, especially beer and spirits.

In terms of exercise, it is recommended to accumulate 150-300 minutes of moderate-intensity aerobic exercise per week, such as brisk walking or cycling, or 75-150 minutes of high-intensity exercise, or an equivalent combination. Additionally, perform resistance training at least 2 days a week to enhance muscle strength. It is also necessary to pay attention to regularly interrupting prolonged sitting: stand up and walk for 3-5 minutes every 30 minutes of sitting.

Body weight is also closely related to uric acid levels. Even if the current uric acid value is still within the normal range, people who are overweight or obese are still more likely to develop hyperuricemia and gout. Therefore, paying attention to body weight itself is only the starting point. To achieve long-term and scientific weight management, it is also necessary to comprehensively evaluate indicators such as body mass index (BMI), waist circumference,and body fat rate, so as to understand one's own metabolic health status from multiple dimensions:

BMI: If you are an adult under 65 years old, your BMI should be controlled within 18.5–23.9 kg/m²; if you are an elderly person aged 65 or above, the standard can be relaxed, and a BMI of 20.0–26.9 kg/m² is acceptable;

Waist : The unified target in the guidelines is less than 90 cm for men and less than 85 cm for women (exceeding this range is considered central obesity).

3、 If my uric acid level is a bit high in the test, but I have no symptoms, does that mean I don't need to worry too much?

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High uric acid is actually a manifestation of metabolic disorder. Even if there is no gout attack for the time being, it may quietly damage the body. Therefore, for patients with asymptomatic hyperuricemia, a comprehensive assessment of individual risks should be conducted to decide whether drug intervention is needed. Among them, the level of serum uric acid is a key reference indicator:

• Serum uric acid level ≥ 540 μmol/L;
• Serum uric acid level ≥ 480 μmol/L combined with cardiovascular and cerebrovascular diseases/metabolic syndrome/renal complications, etc.

If any of the above situations occur, one should promptly visit a specialist clinic and receive standardized treatment under the guidance of a doctor.

It should also be reminded that uric acid levels are fluctuating. A single "normal" test result does not mean long-term safety; only continuous monitoring can reveal the true trend. Now, with portable uric acid testers, patients can easily monitor changes in uric acid at home, promptly identify abnormal trends, achieve early detection, early management, and early protection, ensuring that health is free from hidden risks!

4、  I have been found to have high uric acid in two consecutive physical examinations, and I am in the high-risk group. I have been eating very lightly, but my uric acid hasn't decreased. Am I not doing enough?

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For patients with long-term high uric acid levels, who are on the verge of a gout attack, their diet should mainly consist of low-purine foods (<75 mg/100 g), such as grains and tubers, dairy products, eggs, and most vegetables. Medium-purine foods (75–150 mg/100 g), such as poultry and livestock meat, should be blanched first before cooking, and the soup should be discarded before consumption. Additionally, the frequency and total intake should be controlled. High-purine foods (>150 mg/100 g), such as animal offal, fish, shrimp, shellfish, and thick meat soups, should be strictly restricted.

Weight management is also crucial. Even with a light diet, if one is overweight, abnormal fat metabolism and insulin resistance will still promote uric acid synthesis and reduce its excretion. For high-risk patients with hyperuricemia/gout who are overweight or obese, it is recommended to lose 0.5 to 1 kilogram per week. This can be achieved by controlling total calorie intake combined with moderate-intensity aerobic exercise and resistance training, so as to avoid the negative effects caused by excessive weight loss.

5、 I know that managing uric acid is really important, but it's such a hassle to go to the hospital every time I need to test my uric acid. Are there any more convenient methods?

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• Uric Acid Test: It's Important to Know Your Target Uric Acid Level!

First, it should be clear that not all patients with high uric acid have the same goals. Guidelines have set different standards based on specific situations, and you can check which category you fall into by comparing them:

• Only high uric acid, without other diseases such as kidney disease or diabetes: uric acid should be controlled below 420μmol/L;
• High uric acid & other underlying diseases: uric acid should be controlled below 360μmol/L;
• Basic goal for gout patients: uric acid should be controlled below 360μmol/L;
• Gout & presence of tophi or persistent joint pain: uric acid should be controlled below 300μmol/L, and adjusted to 360μmol/L after the tophi are completely dissolved and joint pain symptoms improve.

Why be so strict? Because the higher the uric acid level, the greater the probability of developing gout and the higher the risk of complications. However, many people find it too troublesome to have their uric acid tested by having blood drawn at the hospital, so they simply don't monitor it. As a result, they regret it only when a gout attack occurs. The new guidelines clearly recommend the use of portable uric acid testers that meet medical standards, enabling people to easily test their uric acid at home. It is simple, convenient, safe and reliable, and can also help develop the good habit of regular monitoring.

• How Often Should it Be Tested?
• Healthy people: Check once a year during the annual physical examination.
• High-risk groups (such as those who are obese/overweight, love drinking beer and eating seafood, or have a family history of gout): Test once every 6 to 12 months.
• Patients with already high uric acid (not taking medicine, only controlling through lifestyle such as diet and exercise): Test once every 1 to 3 months.
• Taking medicine to lower uric acid: When first starting to take medicine, test once every 2 weeks to 1 month; after uric acid reaches the standard and stabilizes, test once every 2 to 3 months.
• Patients with combined cardiovascular and cerebrovascular diseases/metabolic diseases/chronic kidney diseases: Test once every 1 to 3 months.

6、 I have been diagnosed with gout. What are the special precautions I need to take in my daily life?

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Gout is a chronic inflammatory disease caused by the deposition of urate crystals in the joints, which can lead to gouty arthritis and even permanent joint damage. Therefore, gout patients need to pay special attention to lifestyle management in their daily lives, especially exercise intervention.

Appropriate Exercise: Avoid strenuous physical activity! Patients with gout and hyperuricemia should reduce exercise intensity to low to moderate levels, while incorporating resistance training and flexibility exercises.

Avoiding "Minefields": During acute gout attacks, refrain from exercise and ensure adequate rest. In cold environments, prioritize indoor activities and avoid low temperatures. Even during stable gout phases, avoid intermittent high-intensity exercises, sprinting, jumping, and other high-impact activities. Wear athletic shoes with good cushioning and use protective gear when necessary. Replenish fluids promptly after exercise. If joint pain or blood in urine occurs, immediately stop exercising and seek medical attention.

Summary

Hyperuricemia and gout are not "incurable diseases." By implementing "active monitoring & healthy lifestyle & combined therapy," disease control can achieve optimal results with minimal effort. Key points to remember include: First, regular uric acid monitoring—portable uric acid meters can save time and enhance motivation. Second, understanding your target uric acid level and striving to meet and maintain it long-term. Third, dietary adjustments such as consuming low-purine foods, avoiding sugary beverages, engaging in moderate-intensity exercise, and ensuring adequate sleep without staying up late. Fourth, individuals with diabetes should not neglect regular follow-up tests for fasting blood glucose, glycated hemoglobin (HbA1c), and lens advanced glycation end products（L-AGEs）to comprehensively safeguard health.

Reference：

[1]National Clinical Research Center for Geriatric Diseases (Xiangya Hospital), Editorial Board of the Chinese Journal of Health Management, Chinese Medical Association. Guidelines for Health Management of Hyperuricemia and Gout. Chinese Journal of Health Management, 2025,19(09):669-692. DOI: 10.3760/cma.j.cn115624-20250223-00158