Treat the Causes of Edema, Not Just the Symptom

Dr. Frank Shallenberger, MD

April 13, 2020



One of the most common problems I see is water retention. I’ll bet that 20-30% of the population has it to one degree or another.

And the most common remedies, whether they’re conventional or alternative, are diuretics. Examples of the prescription diuretics include Lasix or Diuril.

The alternatives usually include herbs like dandelion root and Uva Ursi.

But it really doesn’t make much difference what the diuretic is. The truth is that diuretics only treat the symptom, while ignoring the cause.

If you have water retention, your body is talking to you. Most likely, it’s telling you that something is out of balance. Don’t just take an herb or a drug to treat the symptom. Listen to your body, and determine what the imbalance is, so you can correct it before it causes a more serious problem. So let’s take a systematic look at what kinds of imbalances typically lead to water retention, and what to do about them.

Your body also may be telling you there’s a disease you need to treat. If you have water retention, you need to visit a doctor to determine if there’s a disease causing it. The doctor should look specifically for any evidence of cancer, heart failure, liver disease, varicose veins, or kidney disease. And then there is some lab work.

The lab work should include a CBC (complete blood count), chemistry panel, and electrolytes. These tests are easy to do and very inexpensive. Once your doctor has excluded disease as a cause for the water retention, then we can look for the more common causes of edema.

One of the most common, for instance, is prescription medications. Blood pressure drugs are the biggest offenders. But there are a lot of drugs that can cause edema. If your edema started three to six months after you started any medication no matter what it is, ask your doctor or pharmacist if it can cause edema.

If disease or drugs aren’t causing your water retention, you’ll have to dig deeper to find out the cause of your benign (non-disease-related) edema. Benign edema often goes on for years. It does not make us sick, but it can be very aggravating. And, as I mentioned above, it indicates that the body is out of balance. So it’s important to find out the cause and correct it. There are two versions of benign edema: generalized edema and dependent edema.

Generalized edema refers to water retention that shows up all over the body. This often includes the eyes, face, hands and fingers, and abdomen. Dependent edema usually stays in one area – the legs. Of course, it’s not all that unusual for someone to have a little bit of both kinds. The same imbalances can cause both types, so we’ll focus on how to correct the most common ones.

Think Hormones

Water retention, especially the generalized water retention, is almost always a complaint that women have. Not very many men have this problem. That should be a big clue already. Because most cases of generalized edema are the result of an imbalance of the female hormones estradiol and progesterone.

When the ratio of estradiol to progesterone is too high, it causes water retention. It usually occurs during a woman’s menstrual cycle. However, it also can occur in postmenopausal women who are on hormone replacement. In this case, it indicates that they are either taking too much estradiol or too little progesterone.

The Correction Is Twofold

Whenever there’s a hormonal imbalance, start by treating the liver. That’s because the liver is the organ that maintains the balance for all of the hormones. So how do you treat the liver so it will balance out the hormones? First, it means a diet high in vegetables, especially the leafy vegetables, along with low-glycemic fruits like berries, grapefruit, cherries, apricots, and grapes. Next, it means avoiding too much coffee and too much alcohol. Don’t drink more than 8 oz of coffee per day or two drinks of alcohol.

The third thing you need to do to support your liver is take some herbal and nutritional supplements every day.

Next, correct the hormonal imbalance directly. If you are a menstruating woman, this means taking some progesterone during the second half of your cycle. Fortunately, you can buy progesterone cream over the counter.

Start off by applying 20 mg (usually 1 pump) to your skin, just as you would with any lotion. Do this for two weeks, starting 10 days after the first day of your menses. Depending on your level of water retention, you can adjust this dose upward or downward. You should see a correction of your water retention within three months.

If you are a postmenopausal woman on hormone replacement therapy, you need to talk to your doctor about decreasing the estrogen to progesterone ratio that you’re taking. Also consider this: Many doctors prescribe progesterone as a pill or capsule. But progesterone is notorious for creating some problems when taken as a pill. This is why I always prescribe it as a cream. So if you’re taking it orally, talk to your doctor about switching to a cream.

Women aren’t the only ones who suffer from water retention. Occasionally men can have an estradiol excess leading to generalized water retention as well. There are three causes for an estradiol imbalance in men. One is having birthdays. For reasons that are less than fully understood, as men get older (typically older than 50), their body starts converting the male hormone testosterone into estradiol.

Next is drinking. Excessive alcohol intake (greater than two drinks per day) can cause an increase in this conversion rate.

The third cause is testosterone replacement therapy. All men who are taking testosterone replacement should have their estradiol levels checked before starting the testosterone, and then after taking it for several months. It is very common to see an increase in estradiol. If that happens, there are several ways to deal with it without having to stop the treatment.

Watch Your Sodium to Potassium Ratio

Everybody knows that eating too much salt will cause generalized water retention. Sodium attracts and holds on to water. The more sodium you have in your body, the more water you will retain. Sodium in other forms such as soy sauce, sodium glutamate, and sodium bicarbonate can do the same thing. But here’s something you might not know. Your sensitivity to the water-retaining effects of sodium is directly dependent on how much potassium you have in your system. The more potassium, the less water retention.

And here’s the other part of the problem. The more sodium you have in your diet, the more your body will become depleted of potassium. So if a salt imbalance is what’s causing your water retention, do two things.

Besides decreasing your salt/sodium intake, take 200-300 mg of potassium every day. After about one to two weeks, if this is the imbalance that is causing your water retention, you will see a big improvement.

Mitochondrial Fitness

As I’ve told you in previous issues, there’s nothing more important to your health than how well your cells produce energy. Thousands of tiny bubbles in the cells called mitochondria produce cellular energy. A decrease in mitochondrial fitness leads to decreased energy production. And this is the primary cause for all of the symptoms of aging as well as the very process of aging itself.

About 60% of all of the energy that your cells make goes to one and only one purpose – pushing sodium out of your cells and preventing water retention. So it goes without saying that a major cause of generalized water retention is decreased mitochondrial fitness.

If you have water retention and are not a regular exerciser, you can just about assume that your mitochondria are not fit. If they were, your cells would be pushing the sodium out, and you would not have the water retention. So exercise is crucial for preventing and getting rid of edema. The other remedies I’ve discussed can be very helpful, but are close to worthless without exercise. Power Plate exercise is great for this problem in particular.


The next cause of water retention is hypothyroidism, or low thyroid function. This is closely related to the above cause of decreased mitochondrial fitness, since the chief action of the thyroid hormones is to stimulate mitochondrial function. In general, the treatment for low thyroid function is natural thyroid hormone replacement combined with iodine supplementation. Look for other causes, too, such as mercury toxicity, muscle loss, and lack of adequate sleep.

Doctors who prescribe thyroid based only on blood tests are going to miss the diagnosis a lot. That’s because these tests are not reliable most of the time. The best way to diagnose low thyroid function when the blood tests are normal is with Bio-Energy testing. You can find a practitioner who does this at

Decreased Albumin

One cause of edema that doctors might miss is decreased albumin. Albumin is the primary protein in the bloodstream. Although any level of albumin that is greater than 3.2 gm/dl is normal, optimal levels are above 4.0 gm/dl. Albumin is important because it’s the primary way that the body uses to prevent water from pooling in the tissues. When the levels are low, water tends to leave the bloodstream and stagnate in the tissues. The result is edema.

Albumin is made in the liver. There are two ways to develop low albumin levels.

The first is failure to make it adequately. This can happen with excessive alcohol intake, and any one of several liver diseases. Since your liver makes albumin from the protein in your diet, a deficiency can also happen as a result of a protein- poor diet. Another cause would be maldigestion. This typically happens in various bowel diseases, including gluten allergy (celiac disease), colitis, and Crohn’s disease. 

My hope is that if you have a degree of water retention, you will look at it as a message from your body telling you that something is out of balance. If you think of it that way, you will correct the imbalance long before it has a chance to lead to more serious problems.

Yours for better health,

Frank Shallenberger, MD

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