Edema: Also Indexed as Bloating, Fluid Retention, Water Retention

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Edema: Also indexed as: Bloating, Fluid Retention, Water Retention

Dietary changes -Supplements -Herbs

 

Abnormal accumulation of fluid beneath the skin is known as edema. This

leads to a puffy appearance, often to a limb, most commonly a leg.

 

There are many causes of edema. In some cases, the underlying problem (for

example, congestive heart failure or preeclampsia of pregnancy) must be

medically treated in order for the edema to resolve. In other cases (such as

chronic venous insufficiency, edema following minor trauma, or lymphedema

resulting from damage to lymphatic vessels caused by surgery and other

medical treatments), it is possible with both conventional and natural

approaches to focus specifically on the edema. Unless edema is clearly due

to minor trauma, it should never be treated until the underlying cause has

been properly diagnosed by a healthcare professional. The discussion below

deals only with situations in which it is safe to focus on the edema itself

and not the underlying cause.

 

Checklist for Edema (Water Retention)

 

Rating Nutritional Supplements Herbs

Flavonoids (courmarin, hydroxyethylrutosides)

 

Flavonoids (diosmin and hesperidin combination)

 

Selenium (for lymphedema)

 

Flavonoids (quercetin)

Cleavers

 

Corn silk

 

Dandelion (leaves)

 

Goldenrod

 

Horse chestnut

 

Horsetail

 

Juniper

 

See also: Homeopathic Remedies for Edema

Reliable and relatively consistent scientific data showing a substantial

health benefit.

Contradictory, insufficient, or preliminary studies suggesting a health

benefit or minimal health benefit.

For an herb, supported by traditional use but minimal or no scientific

evidence. For a supplement, little scientific support and/or minimal health

benefit.

 

What are the symptoms of edema?

People with edema may notice that a ring on their finger feels tighter than

in the past, or they might have difficulty in putting on shoes, especially

toward the end of the day. They may also notice a puffiness of the face

around the eyes, or in the feet, ankles, and legs. When edema is present,

pressure on the skin, such as from the elastic band on socks, may leave an

indentation that is slow to disappear. Edema of the abdomen, called ascites,

may be a sign of serious underlying disease and must be immediately

evaluated by a doctor.

 

Medical treatments

Over the counter diuretics containing ammonium chloride and caffeine

(Aqua-Ban®) may be used to relieve symptoms related to edema or water

retention when taken five to six days before menses. More severe edematous

conditions require medical attention.

 

Treatment of edema with prescription medications is limited to the use of

diuretics, commonly referred to as " water pills. " Agents often used include

the thiazide diuretics, such as hydrochlorothiazide (HydroDIURIL®),

indapamide (Lozol®), and metolazone (Zaroxolyn®); loop diuretics including

furosemide (Lasix®), bumetanide (Bumex®), and torsemide (Demadex®); and

potassium-sparing diuretics, such as spironolactone (Aldactone®),

triamterene (Dyazide®, Maxzide®), and amiloride (Midamor®).

 

Commonly, treatment consists of managing the underlying condition, which may

include inadequate nutrition; liver, heart, and kidney disease; or

obstruction of blood or lymph flow. In some cases, a salt-restricted diet

may be recommended.

 

Dietary changes that may be helpful

High salt intake should be avoided, as it tends to lead to water retention

and may worsen edema in some people. A controlled trial found that a

low-salt diet (less than 2,100 mg sodium per day) resulted in reduced water

retention after two months in a group of women with unexplained edema.1

 

Lifestyle changes that may be helpful

If the edema is affecting one limb, the limb should be kept elevated

whenever possible. This allows fluid to drain more effectively from the

congested area. To decrease fluid buildup in the legs, people should avoid

sitting or standing for long periods of time without moving.

 

Nutritional supplements that may be helpful

Several double-blind trials2 3 4 5 have found that 400 mg per day of

coumarin, a flavonoid found in a variety of herbs, can improve many types of

edema, including lymphedema after surgery. However, a large double-blind

trial detected no benefit using 200 mg coumarin twice daily for six months

in women who had arm edema after mastectomy (surgical breast removal).6

(Coumarin should not be confused with the anticlotting drug Coumadin®.)

 

A group of semi-synthetic flavonoids, known as hydroxyethylrutosides are

also beneficial for some types of edema.7 One double-blind trial found that

2 grams per day of hydroxyethylrutosides reduced ankle and foot edema in

people with venous disorders after four weeks.8 Another double-blind trial

found that 3 grams per day of hydroxyethylrutosides significantly reduced

lymphedema of the arm or leg and lessened the associated uncomfortable

symptoms.9

 

A combination of the flavonoids diosmin (900 mg per day) and hesperidin (100

mg per day) has been investigated for the treatment of a variety of venous

circulation disorders.10 However, in a double-blind trial, this combination

was not effective for lymphedema caused by breast cancer treatments.11

 

In a preliminary study, individuals with lymphedema of the arm or

head-and-neck region were treated with approximately 230 mcg of selenium per

day, in the form of sodium selenite, for four to six weeks. A

quality-of-life assessment showed an improvement of 59%, and the

circumference of the edematous arm was reduced in 10 of 12 cases.12

 

Because coumarin, hydroxyethylrutosides, and diosmin are not widely

available in the United States, other flavonoids, such as quercetin, rutin,

or anthocyanosides (from bilberry), have been substituted by doctors in an

attempt to obtain similar benefits. The effect of these other flavonoids

against edema has not been well studied. Also, optimal amounts are not

known. However, in one study, quercetin in amounts of 30-50 mg per day

corrected abnormal capillary permeability (leakiness),13 an effect that

might improve edema. A similar effect has been reported with rutin at 20 mg

three times per day.14 Doctors often recommend 80-160 mg of a standardized

extract of bilberry, three times per day.

 

Whereas vitamin B6 is sometimes recommended for reducing edema, no research

has investigated its effectiveness.

 

Are there any side effects or interactions?

Refer to the individual supplement for information about any side effects or

interactions.

 

Herbs that may be helpful

A double-blind trial found that a formula containing butcher's broom

extract, the flavonoid hesperidin, and vitamin C, which is used in Europe to

treat venous and lymphatic system disorders, was superior to placebo for

reducing lymphedema.15 The amount of butcher's broom extract typically used

is 150 mg two or three times per day.

 

Herbs that stimulate the kidneys were traditionally used to reduce edema.

Herbal diuretics do not work the same way that drugs do, thus it is unclear

whether such herbs would be effective for this purpose. Goldenrod (Solidago

cnadensis) is considered one of the strongest herbal diuretics.16 Animal

studies show, at very high amounts (2 grams per 2.2 pounds of body weight),

that dandelion leaves possess diuretic effects that may be comparable to the

prescription diuretic furosemide (Lasix®).17 Human clinical trials have not

been completed to confirm these results. Corn silk (Zea mays) has also long

been used as a diuretic, though a human study did not find that it increased

urine output.18 Thus, diuretic herbs are not yet well supported for use in

reducing edema.

 

Aescin, isolated from horse chestnut seed, has been shown to effectively

reduce post-surgical edema in preliminary trials.19 20 A form of aescin that

is injected into the bloodstream is often used but only under the

supervision of a qualified healthcare professional.

 

Horsetail has a diuretic (urine flow increasing) action that accounts for

its traditional use in reducing mild edema. Although there is no clinical

research that yet supports its use for people with edema, the German

government has approved horsetail for this use. The volatile oils in juniper

cause an increase in urine volume and in this way can theoretically lessen

edema;21 however, there is no clinical research that yet supports its use

for people with edema.

 

Cleavers is one of numerous plants considered in ancient times to act as a

diuretic.22 It was therefore used to relieve edema and to promote urine

formation during bladder infections.