Gout: Prevention and Maintenance Often referred to as a form of arthritis, it is characterised by redness, heat, and swelling at the affected site, commonly the first joint of the large toe in initial attacks of the condition. It can also occur in other areas such as the heel of the foot, ankles, knees, wrists, elbows and fingers. Initial attacks often occur at night and involve intense pain, with chills and fever sometimes occurring, and are usually after an event involving alcohol, rich foods, surgery or certain medications. An increased level of uric acid predisposes to gout. Genetics can also play a role in the development of the disease. Dietary factors are known to cause gout: alcohol, foods rich in purines, red meat, organ meat, yeast, chocolate, caffeinated drinks. A diet low in purines, refined carbohydates and saturated fats, low protein, reduction of weight, high-alakline foods, and high fluid intake (>2L a day purified water) will assist in prevention of attacks and long-term maintenance of the condition. While colchicine is prescribed for acute episodes of gout, it can have side-effects and does not lower uric acid but reduces the inflammatory process of the disease. Complementary medicines such as quercetain; purified fish oil; foods and herbal medicines rich in anthocyanidins and procyanidins such as cherries, blueberries, and hawthorn berries; ginger; and folic acid.