QI am a 34 year old man suffering from what I think is normally a female complaint water retention. I feel puffy and bloated much of the time. Can diuretics help and can you explain something about what causes water retention? ZB, Chichester……..

A-Anyone can suffer from water retention (or oedema). The body is around 50-60 per cent water and water is necessary for many physiological functions. Normally, the fluids we take in are used, then excreted by the kidneys but, in some individuals, the system fails and water is retained. Fluid retention is a result of abnormal changes in pressure inside capillaries tiny blood vessels in the body which can cause fluid to leak into the surrounding tissues, where it accumulates in the tissue spaces around and between your cells. According to nutritionist Linda Lazarides, author of The Waterfall Diet (Piatkus, 2000; £6.99), these tissues are like sponges. It is not unusual for a person with fluid retention be holding on to 7-20 pounds of excess water in this way.

Fluid retention brings a number of symptoms, including bloating, muscle aches, fatigue and other flu like symptoms. Anxiety and depression are also common (Lancet, 1986; ii: 999-1002).

Extreme cases of oedema are called idiopathic fluid retention syndrome. (‘Idiopathic’ means doctors don’t know what causes it.) This syndrome is almost exclusively attributed to women and linked to their monthly cycles, although it has been noted in men as well (Eur J Med, 1992; 1: 376-7). Holistic practitioners believe that there are several reasons why the body retains fluid. Sometimes it is medically induced. The Pill and HRT, over the counter painkillers such as paracetamol and aspirin, steroids and blood pressure medications are well known culprits. High intake of natural remedies such as liquorice can also cause the condition (N Engl J Med, 1991; 325: 1223-7).

Dr John Briffa believes that a polluted body is more likely to hold onto water (WDDTY, vol 10 no 10) because the body can’t process and eliminate all the toxic substances it is exposed to. Instead, it may retain water to dilute these toxins. According to Lazarides, cellulite is a form of water retention caused by internal pollution. Similarly, food allergies and sensitivities may cause the body to retain excess fluid to dilute the allergens and toxins in the diet.

Water retention is also caused by a sluggish lymphatic system. This system’s job is, in part, to collect fluid and return it to the blood. Without the efficient involvement of the lymphatic system, fluid may accumulate.

Fluid retention may also be due to nutritional deficiencies. Caffeine containing drinks and alcohol dehydrate the body and may lead to fluid imbalance. Although it would seem sensible to restrict your fluid intake when you feel you are retaining water, this is unlikely to result in less fluid retention, and may even make the problem worse. Diuretics, too, are unlikely to be of any real help and can make the problem worse in the long run. Diuretics stimulate the kidneys to draw more water from the blood and not the release of more water from the tissues, which is where the problem lies. Diuretics can also cause sodium/potassium imbalances in the body. One study of 30 fluid retaining patients showed no significant differences between diuretics and placebo, suggesting that diuretics should not be prescribed for patients with oedema (Q J Med, 1995; 88: 49-54). Other evidence suggests that diuretics can, in fact, cause oedema through rebound sodium retention (Lancet, 1992; 339: 1546; BMJ, 1979; 2: 131-2). If your body is not eliminating water efficiently, it may be that your kidneys are sluggish; mild herbal diuretics can be a useful short term support (long term, they can cause the same problems as conventional medicines). The safest herbal diuretics are thought to be dandelion leaf (Taraxacum officinale), elderflower (Sambucus nigra, S. canadensis), dill (Anethum graveolens) and celery seed (Apium graveolens). When the latter two were tested, dill showed only a mild diuretic effect and celery seed, no effect at all (Phytother Res, 1991; 5: 169-72).

Protein deficiency is a known cause of oedema (J Nutr, 1986; 116: 1209-24). There is also merit in the age old advice to reduce your salt intake, as salt acts like a water magnet in the body. Vitamin B6 helps regulate oestrogen and may benefit women who find they retain fluids cyclically. Flavonoids can reduce the swelling in lymphoedema (Angiology, 1997; 48: 87-91). Vitamin E can help strengthen capillaries (Vitamins, 1961; 28: 129), thus preventing leakage. Increased intake of bioflavonoids may also reduce capillary permeability [Int Angiol, 1989; 8 (4 Suppl): 27-9]. Hesperidin deficiency is associated with altered capillary permeability and, taken daily with vitamin C, may improve capillary function (Exp Med Surg, 1955; 12: 563-9). Bilberry, a rich source of anthocyanosides, has also proved to be effective in reducing capillary permeability (J Minerva Med, 1977; 68: 3565-81).

Massage, or manual lymphatic drainage, is a traditional way of relieving fluid retention and has been much studied as a therapy for oedema (Rev Prat, 2000; 50: 1199-203; Z Lymphol, 1981; 5: 107-11).

Like all conditions with multiple origins, it may take a combination of treatments and a bit of patience to deal with your fluid retention. If the problem is diet related, it may also require a change in your eating habits in the long term (such as that recommended by Ms Lazarides).

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