Water Retention

Water Retention

Help for That Bloated Feeling

Water: It's the essence of life.

Without it, your body could not regulate its temperature or deliver nutrients to your cells. Water lubricates your joints and acts as a built-in shock absorber for your eyes and spinal cord. In fact, your body is about 60 percent water.

If you're bloated, it can feel more like 100 percent.

Your fingers swell and your rings get stuck. Your ankles look and feel like a pair of mighty tree trunks. Pants fit tighter, and your bra may become uncomfortably snug. Even the headaches and back pain of premenstrual syndrome (PMS) are associated with water retention and have been traced to excess fluid in the disks between the vertebrae and the spine, as well as inside the skull.

What's going on? Occasionally the cause is a life-threatening heart or kidney disorder. More often, though, the cause is a high-sodium diet packed with processed foods and salty snacks.

Women are at added risk for water retention, doctors say, because of the rise and fall of hormone levels. The drop in progesterone the week before menstruation can make your body retain water. So can estrogen replacement therapy.

Often dietary changes and a little exercise are enough to relieve the bloating and swelling--even when the cause is hormonal, says Suzanne Trupin, M.D., head of the Department of Obstetrics and Gynecology at the University of Illinois College of Medicine at Urbana-Champaign.

"Across the board, most Americans tend to retain fluid because of the American diet," she says. "We're accustomed to too much salt. The first thing I tell women with a water-retention problem is to take the salt shaker off the kitchen table."

Why We're Waterlogged

Like water balloons in a swimming pool, your cells are filled with water and surrounded by it. Normally the amount is controlled by sodium and potassium levels and by your kidneys and hormones. But many factors--from diet to disease--can knock this system out of kilter, leaving excess fluid in your tissues and causing a condition called edema.

A high-salt diet pumps extra sodium into your blood and body fluids, gumming up the mechanism that pushes water out of your cells. "The cells will hold onto extra water and will enlarge," says Dr. Trupin. "This will cause water retention whether there's a hormonal imbalance or not, and whether you're a woman or a man. About 20 percent of the population is very sensitive to sodium and may therefore suffer from high blood pressure in response to a high intake of sodium."

Heart failure is a more serious cause of retention in which the pressure of blood backing up in the veins forces more fluid into tissues. Kidney problems can lead to water retention in two ways: If the kidneys fail, salt can accumulate in the body and attract water. Or a kidney malfunction called nephrotic syndrome can contribute to low protein levels in the blood, which weaken the blood's ability to draw water out of tissues. Protein deficiencies, tumors and cirrhosis of the liver may also lead to bloating and swelling.

All these problems require immediate professional care, says Susan Thys-Jacobs, M.D., assistant professor of medicine at Mount Sinai Hospital in New York City, particularly if you can poke the swollen skin and leave a dent.

"If a woman comes in with severe swelling of her legs and complaining of shortness of breath or chest pains, this may be a heart, lung or metabolic condition," she says. "Or if she has a bloated abdomen, she may have fluid in the abdomen." That might be associated with any one of a variety of causes, such as malnutrition, liver or kidney disease or even a malignancy, according to Dr. Thys-Jacobs.

Some medications, including steroids and birth control pills high in estrogen, may also cause water retention because they act on the kidneys to retain more sodium.

The Food Connection

Doctors are less sure why women with PMS retain water. British physician Katharina Dalton, who has researched PMS for 45 years, has suggested that the problem is related to the fact that when women have PMS, their blood sugar levels may fluctuate abnormally--which indirectly leads to bloating.

What does this mean? In her book, Once a Month, Dr. Dalton says that when a person doesn't eat for many hours, blood sugar gets very low. This causes the body to release adrenaline, which signals the body to let go of some of its stored sugar from cells in order to balance out the blood sugar. When sugar is taken from the cells, they fill up with water, and this is what causes the bloating, weight gain and water retention symptoms in those with PMS. In women with PMS, the body reaches the point when it will release adrenaline a lot sooner than it does in other women, Dr. Dalton notes.

Other experts see a sodium link. When your blood breaks down progesterone--as it does a week before your period--your kidneys are prompted to retain both water and sodium. At the same time, a powerful water-retaining substance called anti-diuretic hormone may also be released, further influencing your body to hold onto fluids.

Water, Water Everywhere

Experts say the following tips will help ease that waterlogged feeling.

Reduce sodium. "I suggest women try to bring their daily sodium intake down to 1,000 milligrams," says Dr. Trupin. This is a drastic reduction from the recommended level of 3,500 milligrams a day. "That means not eating most canned foods with salt added and staying away from any prepackaged food that's high in salt--like potato chips, snack foods and preserved meats like bacon, ham and bologna." Snack on fresh fruits and vegetables instead. Avoid processed foods, particularly canned and frozen foods. Besides cutting the sodium, you will reduce the fat in your diet and add fiber and nutrients.

Read the label. Packaged foods carry labels that will tell you how much sodium is in a serving, says Dr. Trupin. Pay attention and tally your intake through the day.

Stall the shaker. Don't salt food while cooking and tasting it. And stay away from the salt shaker when you're at the table. Try a salt substitute or experiment with herbs and spices for added flavor, recommends Dr. Trupin.

Shake it. Exercise widens blood vessels, increasing the amount of fluid that goes to the kidneys to be excreted, says Dr. Thys-Jacobs. A half-hour of exercise three times a week will help your body get rid of excess water.

Take calcium. In a 1992 study of ten women at the U.S. Department of Agriculture Grand Forks Human Nutrition Research Center in North Dakota, researchers found those who took 1,336 milligrams of calcium a day had fewer water retention and other PMS symptoms. An earlier study at Metropolitan Hospital in New York City found that 33 women who took 1,000 milligrams of calcium daily experienced a 50 percent reduction in bloating and complained less about breast tenderness.

"I don't think we know at this time why calcium works this way," says Dr. Thys-Jacobs. "There are so many good reasons women should take calcium every day. This is one more."

Eat small meals. If water retention is a problem in the days before your period begins, try eating small meals spaced about three hours apart. These meals should be rich in starchy foods like breads, crackers, pasta, cereals, potatoes and rice. According to Dr. Dalton, this maintains steady blood sugar levels so your body doesn't rob cells for stored sugar and thus keeps the cells from filling with extra water.

Try a natural diuretic. "Have some pink grapefruit juice or some lemon in water," suggests Dr. Trupin. This will get your cells to let go of extra water.

Another well-known diuretic is caffeine, but most experts don't advise it as a weapon against water retention because too much can make you jittery, and it can rob your body of calcium and iron.

Beware of drugstore diuretics. Over-the-counter diuretics may offer fast relief, but they may also drain potassium from your system and cause some side effects like weakness, confusion, heart palpitations and increased blood sugar levels. Also, some diuretic drugs may raise the level of uric acid in the blood, increasing the risk of gout.