Healthy Beginnings

EDEMA – Treating Water Retention Naturally

Written by Frank Shallenberger, MD, HMD
Clinical Clues That You Can Use
In the $10 language of medicine, water retention is called edema. Edema refers to an accumulation of water in the legs that “pits” when pressed on. You can recognize edema by using your finger to push on the area around your ankles or just above them for several seconds. If you remove your finger and notice a depression or “pit” where you just pressed, you have edema.
Another common way to diagnose edema is by noticing the same kind of pitting at the top of your socks toward the end of the day. Many people will notice that after being on their feet for several hours their legs will start to swell up. This is the classical way many people describe edema.
The conventional treatment for edema is diuretic or “water” pills. These are pills that force your kidneys to alter their function, and cause them to inappropriately pull water from your body. The ultimate result of the pills is that they cause the body to become dehydrated. Of course this will reduce the edema, but at the same time, it creates the problem of dehydration. And that leads to other problems.
Common symptoms of dehydration are dry mouth, dry eyes, muscle cramps, nausea, increased heart rate, confusion and weakness. Some of the other side effects of diuretic pills are low potassium levels, arrhythmias , pancreatitis, jaundice, renal failure, interstitial nephritis and low white cells levels.
Fortunately, most people don’t get any of these symptoms or side effects if they only use the diuretics occasionally, but that’s not the point. The point is that when edema is present, it is there for a reason. It’s okay to take diuretics while you’re a busy figuring out what is causing the edema, but it is more important to find and correct the cause.
When you first consult your doctor about edema, the main causes that he has been trained to discover are heart failure and kidney disease. Kidney disease can usually be ruled out if the edema is limited to the legs, because the edema caused by kidney disorders is typically present not only in the legs but also in the face, arms and hands. The doctor can usually determine if the cause is heart failure based upon examining the patient, and ordering appropriate tests like a chest x-ray and echo cardiogram.
The problem is that about 90% of the time, edema, even pitting edema, is not caused by either of these conditions, in which case many doctors just stop looking for the real cause, and simply offer the patient a diuretic for the symptom. So let’s look at the most common causes of edema that a doctor may miss, and what you can do about them.
Weight Gain – Frequently the development of edema is caused by excessive weight. The weight increases the gravitational pull on the fluid in the legs, and causes the legs to retain fluid. During sleep, since the body is in a horizontal position, the gravitational pull is gone, and the water will move back into the general circulation. In many cases this newly acquired water during sleep will mean that you will need to get up and go to the bathroom several times during the night.
It also means that when the morning comes around, all or nearly all of the edema has gone away. This is a classic way to recognize edema caused by excessive weight. Lose the weight and the edema goes away. Another symptom of edema caused by weight is that it is worse when the weather is hot.
Low Thyroid Function – The medical word for low thyroid function is “hypothyroidism.” Hypothyroidism is extremely common. It is one of the few hormonal deficiencies that can occur even in young people. Estimates are that it is present in over 80 percent of all patients over the age of 50.
Many doctors will miss the diagnosis, however, because we were all mistakenly taught in medical school that the only way to diagnose hypothyroidism is when the thyroid blood tests are abnormal. This turns out to be completely untrue. There are many articles in the medical literature that explain how hypothyroidism can be present even when all of the thyroid blood tests are in the “normal range.” This is particularly true for the most common test used to diagnose hypothyroidism, the TSH test.
The only 100 percent reliable way to be sure that the body has normal thyroid function is to measure basal metabolic rate (BMR). This test is easy to do, is well validated in the scientific literature, and often indicates hypothyroidism when all of the blood tests are normal. The best way to determine BMR is with Bio-Energy Testing. This is a testing procedure that measures BMR and then compares the result to what would be optimal for the weight, height, and sex of the person taking the test. You can learn more about Bio-Energy testing and find a clinic near you that offers it by going to www.bioenergytesting.com.
The way that many alternative doctors diagnose edema caused by hypothyroidism that do not have access to Bio-Energy Testing is by a physical examination, a symptom check, and a trial of thyroid hormone supplementation. In other words, if the patient looks like someone with hypothyroidism, and has some of the symptoms commonly seen in hypothyroidism (such as edema), they give them a trial of thyroid hormone. If the symptoms and the edema go away, then the diagnosis of hypothyroidism can be made. If there is no improvement, then it’s back to the drawing board.
Protein Deficiency – Another common cause of edema is a diet deficient in protein. If edema exists in a patient who is a vegan or a vegetarian, this is always a possible cause. Other indicators are if there are symptoms of poor digestion.
A good way to determine protein deficiency is to get a blood test called a serum albumin. In healthy patients the serum albumin is over 4 grams/dl. If the value is lower than this, the odds are pretty good that either the patient is not eating enough protein, or that they have a digestive disorder that interferes with the proper digestion and assimilation of protein. Correct the disorder and the edema will go away.
Sodium – Of course one of the most common causes of edema is excessive use of either salt or foods high in sodium. This is very individual. Some peoples’ bodies do very well with handling sodium, and others’ do not. If you suspect this to be the cause, then simply go on a two gram sodium diet for three weeks, and take some additional magnesium supplementation as described below. The edema will go away if excessive sodium is the cause. Besides salt, sodium is found in a great many foods. To find out how to go on a two gram sodium restricted diet, go to http://www.med.umich.edu/1libr/aha/2gSodiumDiet.pdf
Female Hormones – In women, a common cause of edema is estrogen excess. During hormonal replacement therapy, edema can occur either as a result of a dose of estrogen that is excessive, or an insufficient dose of progesterone. Keep in mind that the drug Provera®, which is still used by some doctors as a substitute for progesterone is a very poor substitute. It is known to cause cancer, strokes, heart disease, and osteoporosis, and is also a common cause of fluid retention.
The other cause of estrogen excess, one that is often seen in menstruating women, is a result of an insufficient amount of the hormone progesterone being produced by the body. In these cases, the woman will often notice the edema in the two weeks before she has her menstrual period. The treatment for this cause of edema is to use progesterone cream during the two weeks before menses is due. The problem will typically disappear after one to two months of therapy.
Three other factors that might need attention in women with edema are B6 deficiency, magnesium deficiency, and hypothyroidism. All three of these conditions result in an estrogen excess. So if you notice that your edema is definitely worse in the days leading up to your period, then try taking 100mg of vitamin B6 along with 300mg of magnesium glycinate for few cycles and see if this doesn’t help to solve the problem. These nutrients work really great with progesterone cream.
Whatever the cause of your water retention is, don’t just accept it as natural, and don’t just blindly rely on water pills. Find and treat the cause, and you will be much better off.
References:
1. Current medical and Treatment Guidelines – 43rd Edition. Tierney LM, McPhee
S, and Papadakis MA. 2004. Lange Medical Books/McGraw Hill, NY.NY
2. Textbook of Medical Physiology – 10th Edition. Guyton and Hall. 2000.
W.B.Saunders Company, Philidelphia, Penn.
For more info contact Dr. Frank Shallenberger at The Nevada Center, specializing in comprehensive alternative medicine, (775) 884-3990.

Clinical Clues That You Can Use

In the $10 language of medicine, water retention is called edema. Edema refers to an accumulation of water in the legs that “pits” when pressed on. You can recognize edema by using your finger to push on the area around your ankles or just above them for several seconds. If you remove your finger and notice a depression or “pit” where you just pressed, you have edema.

Another common way to diagnose edema is by noticing the same kind of pitting at the top of your socks toward the end of the day. Many people will notice that after being on their feet for several hours their legs will start to swell up. This is the classical way many people describe edema.

The conventional treatment for edema is diuretic or “water” pills. These are pills that force your kidneys to alter their function, and cause them to inappropriately pull water from your body. The ultimate result of the pills is that they cause the body to become dehydrated. Of course this will reduce the edema, but at the same time, it creates the problem of dehydration. And that leads to other problems.

Common symptoms of dehydration are dry mouth, dry eyes, muscle cramps, nausea, increased heart rate, confusion and weakness. Some of the other side effects of diuretic pills are low potassium levels, arrhythmias , pancreatitis, jaundice, renal failure, interstitial nephritis and low white cells levels.

Fortunately, most people don’t get any of these symptoms or side effects if they only use the diuretics occasionally, but that’s not the point. The point is that when edema is present, it is there for a reason. It’s okay to take diuretics while you’re a busy figuring out what is causing the edema, but it is more important to find and correct the cause.

When you first consult your doctor about edema, the main causes that he has been trained to discover are heart failure and kidney disease. Kidney disease can usually be ruled out if the edema is limited to the legs, because the edema caused by kidney disorders is typically present not only in the legs but also in the face, arms and hands. The doctor can usually determine if the cause is heart failure based upon examining the patient, and ordering appropriate tests like a chest x-ray and echo cardiogram.

The problem is that about 90% of the time, edema, even pitting edema, is not caused by either of these conditions, in which case many doctors just stop looking for the real cause, and simply offer the patient a diuretic for the symptom. So let’s look at the most common causes of edema that a doctor may miss, and what you can do about them.

Weight Gain – Frequently the development of edema is caused by excessive weight. The weight increases the gravitational pull on the fluid in the legs, and causes the legs to retain fluid. During sleep, since the body is in a horizontal position, the gravitational pull is gone, and the water will move back into the general circulation. In many cases this newly acquired water during sleep will mean that you will need to get up and go to the bathroom several times during the night.

It also means that when the morning comes around, all or nearly all of the edema has gone away. This is a classic way to recognize edema caused by excessive weight. Lose the weight and the edema goes away. Another symptom of edema caused by weight is that it is worse when the weather is hot.

Low Thyroid Function – The medical word for low thyroid function is “hypothyroidism.” Hypothyroidism is extremely common. It is one of the few hormonal deficiencies that can occur even in young people. Estimates are that it is present in over 80 percent of all patients over the age of 50.

Many doctors will miss the diagnosis, however, because we were all mistakenly taught in medical school that the only way to diagnose hypothyroidism is when the thyroid blood tests are abnormal. This turns out to be completely untrue. There are many articles in the medical literature that explain how hypothyroidism can be present even when all of the thyroid blood tests are in the “normal range.” This is particularly true for the most common test used to diagnose hypothyroidism, the TSH test.

The only 100 percent reliable way to be sure that the body has normal thyroid function is to measure basal metabolic rate (BMR). This test is easy to do, is well validated in the scientific literature, and often indicates hypothyroidism when all of the blood tests are normal. The best way to determine BMR is with Bio-Energy Testing. This is a testing procedure that measures BMR and then compares the result to what would be optimal for the weight, height, and sex of the person taking the test. You can learn more about Bio-Energy testing and find a clinic near you that offers it by going to www.bioenergytesting.com.

The way that many alternative doctors diagnose edema caused by hypothyroidism that do not have access to Bio-Energy Testing is by a physical examination, a symptom check, and a trial of thyroid hormone supplementation. In other words, if the patient looks like someone with hypothyroidism, and has some of the symptoms commonly seen in hypothyroidism (such as edema), they give them a trial of thyroid hormone. If the symptoms and the edema go away, then the diagnosis of hypothyroidism can be made. If there is no improvement, then it’s back to the drawing board.

Protein Deficiency – Another common cause of edema is a diet deficient in protein. If edema exists in a patient who is a vegan or a vegetarian, this is always a possible cause. Other indicators are if there are symptoms of poor digestion.

A good way to determine protein deficiency is to get a blood test called a serum albumin. In healthy patients the serum albumin is over 4 grams/dl. If the value is lower than this, the odds are pretty good that either the patient is not eating enough protein, or that they have a digestive disorder that interferes with the proper digestion and assimilation of protein. Correct the disorder and the edema will go away.

Sodium – Of course one of the most common causes of edema is excessive use of either salt or foods high in sodium. This is very individual. Some peoples’ bodies do very well with handling sodium, and others’ do not. If you suspect this to be the cause, then simply go on a two gram sodium diet for three weeks, and take some additional magnesium supplementation as described below. The edema will go away if excessive sodium is the cause. Besides salt, sodium is found in a great many foods. To find out how to go on a two gram sodium restricted diet, go to http://www.med.umich.edu/1libr/aha/2gSodiumDiet.pdf

Female Hormones – In women, a common cause of edema is estrogen excess. During hormonal replacement therapy, edema can occur either as a result of a dose of estrogen that is excessive, or an insufficient dose of progesterone. Keep in mind that the drug Provera®, which is still used by some doctors as a substitute for progesterone is a very poor substitute. It is known to cause cancer, strokes, heart disease, and osteoporosis, and is also a common cause of fluid retention.

The other cause of estrogen excess, one that is often seen in menstruating women, is a result of an insufficient amount of the hormone progesterone being produced by the body. In these cases, the woman will often notice the edema in the two weeks before she has her menstrual period. The treatment for this cause of edema is to use progesterone cream during the two weeks before menses is due. The problem will typically disappear after one to two months of therapy.

Three other factors that might need attention in women with edema are B6 deficiency, magnesium deficiency, and hypothyroidism. All three of these conditions result in an estrogen excess. So if you notice that your edema is definitely worse in the days leading up to your period, then try taking 100mg of vitamin B6 along with 300mg of magnesium glycinate for few cycles and see if this doesn’t help to solve the problem. These nutrients work really great with progesterone cream.

Whatever the cause of your water retention is, don’t just accept it as natural, and don’t just blindly rely on water pills. Find and treat the cause, and you will be much better off.

References:

1. Current medical and Treatment Guidelines – 43rd Edition. Tierney LM, McPhee

S, and Papadakis MA. 2004. Lange Medical Books/McGraw Hill, NY.NY

2. Textbook of Medical Physiology – 10th Edition. Guyton and Hall. 2000.

W.B.Saunders Company, Philidelphia, Penn.

Written by Frank Shallenberger, MD, HMD at The Nevada Center.