DR CABOT: Hello, everyone. Welcome to our Weight Loss Detective podcast with myself, Dr Sandra Cabot, and naturopath and author Margaret Jasinska.
MARGARET: Hi, Dr Cabot. Great to be here with you.
DR CABOT: Yes. And we’re talking about fluid retention, which is a big problem for a lot of women. They puff up and they think, “Oh, what’s happening? Why is this happening to me?” So, there’s some really practical things you can do, if you suffer with fluid retention. Now, if you do, it could be all over your body, where you puff up like a jellyfish. Or it could be just localized, so just your feet and your ankles or your hands.
MARGARET: Yes, or bags under your eyes.
DR CABOT: Yes, that’s right. Well, that’s allergies, isn’t it? And sinus.
MARGARET: Or kidney problems in older people, also.
DR CABOT: Yes. So, it’s important to note where the fluid retention is. Most of the time, it’s not serious and it’s just a nuisance. And it’s a functional problem, which can be fixed. But in a small percentage of cases, it’s due to an underlying medical disease, such as heart failure or kidney disease or liver failure or some type of cancer. So, you obviously need to check with your doctor and have a physical examination, if it’s severe.
But it’s normal for fluid to leak into your body tissues all the time. It leaks into the tissues from the blood circulation. And in the tissues, we have a system of tiny little vessels called lymphatic vessels, and they attract that extracellular fluid and return it to the heart by the thoracic duct. So, the lymphatic fluid returns into the systemic blood circulation. And it should all work hunky dory and you shouldn’t have fluid retention. But it can be quite uncomfortable, if you do. You could have swelling of different parts of your body – most commonly, the areas affected by gravity, like your feet and your ankles. A lot of people get it in their hands, too. Can be part of carpal tunnel syndrome. We wake up in the morning, your hands are all tingly and stiff.
Fluid retention can cause your body to ache, your joints to be stiff. And if it happens suddenly, you get rapid weight gain or unexplained fluctuations in your weight and it’s really annoying. Because there you are, trying to follow a good diet and everything, and you think, “What’s happening?”
MARGARET: Yes, exactly. So, people who weigh themselves regularly when they’re trying to lose weight; one week they may get on the scales and they’re 2 kilos heavier. But it’s not fat, it’s just the fluid. And the next day, is a low-fluid day. So, those 2 kilos might not be there.
DR CABOT: Yes, that’s right. But when they’re there, they’re annoying because your clothes don’t fit. And you just feel uncomfortable.
If it’s really bad fluid retention, it can be what we call “pitting edema”. So, when you press firmly on the swollen tissue, it leaves a dent, and that’s more of a worry. But that can be when your lymphatic system is really not working well. Or you could also have an underlying medical problem.
So, things that can make it worse is hot weather, standing up all day because gravity takes its toll. Hormonal imbalances during the menstrual cycle, such as premenstrual syndrome or around menopause, when you’re still making estrogen but you’re not making enough progesterone and that can cause a lot of premenstrual fluid retention.
Similarly, pregnancy – that’s a big hormonal jump in your body. So, the huge amount of hormones during pregnancy, particularly towards the latter stages of pregnancy, can cause fluid retention.
Some women get a lot of fluid when they’re on the pill because it’s not that good for their liver. They might do better on the progestogen only pill, which is a mini pill. And then there’s a lot of medications that can cause fluid retention, including some high blood pressure medication and steroids and anti-inflammatory drugs.
And another common cause is poor venous circulation. So, the deep veins in the legs and their smaller subsidiaries, they may have valves in them that don’t work – so incompetent valves. And then you can get venous fluid retention. And then your lymphatic system has to work a lot harder to return the fluid.
Also, your diet is important. And we know people who are deficient in iodine or vitamin B1 can get fluid. And protein is important, isn’t Margaret? A lot of people are protein deficient and don’t realize it.
MARGARET: Yeah, that’s right, particularly women.
So, another major cause of excess fluid is insulin resistance, because if you’ve got more insulin in your bloodstream than ideal, it tells your kidneys to retain salt and water. And so, you’re going to look and feel more puffy. And so, the cure for insulin resistance is to have less carbohydrate and more protein and natural fats. And a lot of our patients, particularly women, don’t eat as much protein as is recommended for their height and weight, every day.
Now, a lot of our patients will just, like for breakfast, they’ll have some fruit with maybe a couple of dollops of yogurt. For lunch, there’ll be some crackers with a thin smear of tuna on there. And for dinner, there might be some pasta and some vegetables with something like 50 or 80 grams of, like, chicken breast. And so, throughout the day, they’re just not eating enough protein. And so, of the 3 macronutrients – so carbohydrate and protein and fat – the carbohydrate is the dominant macronutrient. They’re not eating much fat, because they’re often trying to lose weight. And so, they’re mostly eating carbohydrate, which is non-satiating food. So therefore, they feel hungry all the time. They have cravings for carbohydrate all the time and will often beat themselves up from not being able to stick to a diet, just because they’re not eating enough food and not enough protein to sustain a human being. And that will make it much, much harder to eat well. And they won’t be able to overcome the insulin resistance.
DR CABOT: That’s right. And if their insulin level stays up high, they’re going to keep retaining fluid. So, yeah, you’ve sometimes got to eat more, that’s for sure!
MARGARET: Well, it’s the type of food you eat, rather than the quantity.
DR CABOT: Yes, it is. Yeah. More protein!
MARGARET: Which is satiating, and so therefore, it’s a lot easier to stick to a healthy diet, because you won’t be as hungry. Not on day one of changing your diet. But after several weeks of having more protein and less carbohydrate, everyone feels a lot less hungry.
DR CABOT: And we’ve also got to mention gut health because it plays a role in everything – gut and liver health. And people with allergies are often bloated and that goes up and down, depending on their exposure to the allergens. But it could be environmental allergen or it could be a food allergen.
MARGARET: Yes. So, dairy products for a lot of people, dairy products will make them quite puffy and bloated. So, whether it’s a food allergy or a food intolerance, they are quite common causes of fluid retention, particularly in people who are trying to do the right thing and are eating well. If it’s not dairy products for some people, it’s things like eggs or soy or corn or nuts. So, foods that are ordinarily considered to be healthy can lead to a food sensitivity in some people and make them bloated and puffy.
DR CABOT: That’s right. And the clue is, if you take an antihistamine, the bloating and swelling goes away. But that’s a medication. But some people have such severe allergies that they have to take it every day. So, allergies can cause that fluid retention and puffiness in all different parts of your body. It’s often associated with a leaky gut. So, you need to improve your gut health. So, on sandracabot.com, we have a free e-book called Ultimate Gut Health, which is quite helpful, if you want to get help for your gut with that problem.
The other thing that can cause fluid retention is just a dysfunctional lymphatic system, where we mentioned that little network of vessels that exist between your cells that is there just to soak up the excess fluid and take it back to the heart. While some people inherit a lymphatic system, which is not that good, they may see and their parents that they had puffiness in their limbs and that can be partly genetic. But there’s still a lot that you can do to offset that. And Margaret did mention dairy products. And for people who have a dysfunctional lymphatic system, they often do better on a dairy-free diet.
DR CABOT: So, they can have coconut cream and almond milk. What other milks do you like Margaret?
MARGARET: They could drink black tea and coffee and not eat breakfast cereal. And now milk is superfluous.
DR CABOT: Yeah. But coconut cream, if you dilute coconut cream, it’s yummy and it gives you healthy fats. It’s not going to cause food retention.
MARGARET: Oh, yeah, totally! I agree. Yes.
DR CABOT: Yeah. Some people love it. Some people hate it. But it’s good to know alternatives.
So, the standard treatment for fluid retention is to give people a low-salt diet. But that’s an awful diet because the food doesn’t have much flavor. And often people who have a low-salt diet feel dizzy. You’ll often find that the sodium level in their blood is too low. Particularly older women, they feel really dizzy from that.
MARGARET: Absolutely. And then when they feel dizzy, they go and eat carbohydrate, which worsens the problem.
DR CABOT: So, a low-salt diet is really only indicated if you have heart failure or kidney failure or liver failure, because your organs aren’t working. But if your organs are working normally, you don’t need a low-salt diet. And you’ll often get sugar cravings from a low-salt diet and that will make the fluid retention worse.
DR CABOT: Yeah. So that’s a real old fashioned.
MARGARET: It depends on the context of the diet. If a person is having a lot of sugar and junk food and carbohydrate and alcohol and you give them a lot of salt, they’re going to look even puffier and more bloated. But if it’s a meal of something like freshly cooked fish with a salad; if you eat that way regularly and you don’t add salt, then you guess you can feel dizzy. You can get cramps in your muscles. You might get a broken, unrefreshing sleep. So, salt is necessary.
DR CABOT: Yeah, it is. Sodium chloride. Good old salt, sea salt all right. So, the conventional treatment is a bit old fashion with a low-salt diet. Also, there’s diuretic drugs like Lasix or the thiazide drugs, and they work quickly and effectively. But the fluid comes back. It always comes back. And some diuretics can have side effects. And the thiazide diuretics can increase insulin resistance and the risk of diabetes. So, it’s not something I prescribe regularly.
Also, you need to reduce alcohol, if you are drinking excessively. And that will help your liver function and that will reduce fluid retention. You may need to talk to your doctor about using different medications that don’t cause fluid retention. And you can also use support stockings. They’re very helpful if you’re standing up all day. And that can prevent a lot of the retention in the lower limbs. Or if you’re sitting down all day, it’s not healthy having an office job, sitting in front of a computer.
MARGARET: Well, yeah. Humans weren’t designed to sit all day.
DR CABOT: No. So, you need to get up and have a regular walk every 45 minutes. Get up and do some exercises.
MARGARET: Grab a glass of water. Go and give someone a message, rather than emailing them.
DR CABOT: Yes. Email hasn’t been good for our physical fitness. Modern lifestyle, really. And you sit in the car for too long. So, you need to get up and move your legs. And there’s an increased risk of blood clots for people who sit all day, as well. It’s not good for you. So, get those legs moving!
A supplement that can help a lot with fluid retention is magnesium because it’s a vasodilator and improves the peripheral circulation. So, you get better blood flow to the limbs. So, magnesium can help a lot with the fluid retention. Also, vitamin C because it improves the fragility of the capillaries, so there’s not so much fluid that leaks out and also helps to strengthen the lymphatic vessels. So, vitamin C is great. And then there’s another formula that’s helpful called Kidney Health capsules and they’ve got a herbal ingredient, plus NAC and some selenium.
So, those simple things can make a big difference. Exercise, as we said, is super important. Getting an exercise bike is a fantastic idea or a treadmill and doing half an hour a day, even half an hour twice a day would be fantastic.
So, there’s a lot that you can do to reduce fluid retention. And if it persists and you think you’ve got a serious problem, go and have a check-up for your kidney function. That’s a simple blood test and a urine test. Great!
So, if you have any questions, just ask your Weight Loss Detective or feel free to email us and we hope you’ve enjoyed the podcast. Thanks for listening!
MARGARET: Thank you. Goodbye!