Edema

Also indexed as: Bloating, Fluid Retention, Water Retention

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
3Stars Flavonoids (courmarin, hydroxyethylrutosides)  
2Stars Flavonoids (diosmin and hesperidin combination)  
1Star Flavonoids (quercetin) Cleavers
Corn silk
Dandelion (leaves)
Goldenrod
Horse chestnut
Horsetail
Juniper
See also:  Homeopathic Remedies for Edema
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has 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.

How is it treated? Conventional 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 and water pills (diuretics) 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 2100 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

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),12 an effect that might improve edema. A similar effect has been reported with rutin at 20 mg, three times per day.13 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.14 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.15 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®).16 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.17 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.18 19 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;20 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.21 It was therefore used to relieve edema and to promote urine formation during bladder infections.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

1. Ponce P, Mello-Gomes E. Idiopathic edema, tubular metabolism of water and sodium. Acta Med Port 1991;4:236–41 [in Portuguese].

2. Becker HM, Niedermaier G, Orend KH. Benzopyrone in the therapy of postreconstructive edema. A clinical double-blind study. Fortschr Med 1985;103:593–6 [in German].

3. Casley-Smith JR, Morgan RG, Piller NB. Treatment of lymphedema of the arms and legs with 5,6-benzo- [a]-pyrone. N Engl J Med 1993;329:1158–63.

4. Chang TS, Gan JL, Fu KD, Huang WY. The use of 5,6 benzo-[alpha]-pyrone (coumarin) and heating by microwaves in the treatment of chronic lymphedema of the legs. Lymphology 1996;29:106–11.

5. Casley-Smith JR, Wang CT, Casley-Smith JR, Zi-hai C. Treatment of filarial lymphoedema and elephantiasis with 5,6-benzo-alpha-pyrone (coumarin). BMJ 1993;307:1037–41.

6. Loprinzi CL, Kugler JW, Sloan JA, et al. Lack of effect of coumarin in women with lymphedema after treatment for breast cancer. N Engl J Med 1999;340:346–50.

7. Wadworth AN, Faulds D. Hydroxyethylrutosides. A review of its pharmacology, and therapeutic efficacy in venous insufficiency and related disorders. Drugs 1992;44:1013–32 [review].

8. Renton S, Leon M, Belcaro G, Nicolaides AN. The effect of hydroxyethylrutosides on capillary filtration in moderate venous hypertension: a double blind study. Int Angiol 1994;13:259–62.

9. Piller NB, Morgan RG, Casley-Smith JR. A double-blind cross over trial of o-beta-hydroxyethyl-rutosides (benzopyrones) in the treatment of lymphoedema of the arms and legs. Br J Plast Surg 1988;41:20–7.

10. Struckmann JR. Clinical efficacy of micronized purified flavonoid fraction: an overview. J Vasc Res 1999;36 Suppl 1:37–41 [review].

11. Pecking AP, Fevrier B, Wargon C, Pillion G. Efficacy of Daflon 500 mg in the treatment of lymphedema (secondary to conventional therapy of breast cancer). Angiology 1997;48:93–8.

12. Griffith JQ. Clinical application of quercetin: preliminary report. J Am Pharm Assoc 1953;42:68–9.

13. Shanno RL. Rutin: a new drug for the treatment of increased capillary fragility. Am J Med Sci 1946;211:539–43.

14. Cluzan RV, Alliot F, Ghabboun S, Pascot M. Treatment of secondary lymphedema of the upper limb with CYCLO 3 FORT. Lymphology 1996;29:29–35.

15. Tyler V. Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York: Pharmaceutical Products Press, 1994, 74 [review].

16. Racz-Kotilla E, Racz G, Solomon A. The action of Taraxacum officinale extracts on the body weight and diuresis of laboratory animals. Planta Med 1974;26:212–7.

17. Doan DD, Nguyen NH, Doan HK, et al. Studies on the individual and combined diuretic effects of four Vietnamese traditional herbal remedies (Zea mays, Imperata cylindrica, Plantago major and Orthosiphon stamineus). J Ethnopharmacol 1994;36:225–31.

18. Dini D, Bianchini M, Massa T, Fassio T. Treatment of upper limb lymphedema after mastectomy with escine and levo-thyroxine. Minerva Med 1981;72:2319–22 [in Italian].

19. Wilhelm K, Feldmeier C. Thermometric investigations about the efficacy of beta-escin to reduce postoperative edema. Med Klin 1977;72:128–34 [in German].

20. Tyler V. Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York: Pharmaceutical Products Press, 1994, 76–7 [review].

21. Mills SY. Out of the Earth: The Essential Book of Herbal Medicine. London: Viking Arkana, 1991, 493–4.