What to do about moisture retention?

Geschatte leestijd: 11 minuten What can you do against retaining water? And why do you retain water in the first place? We discuss here the different types of fluid retention, causes, and possible solutions.

Retaining Water

Water retention simply occurs when more fluid enters your body than leaves. What happens to this ‘excess fluid,’ where it is retained, depends on the circumstances and the individual. Therefore, different conditions can be meant when one complains about water retention, or ‘fluid retention.’ Fluid can be retained in three different places in the body.

1. In cells (‘intracellular fluid’)
2. Extracellular: in tissue, between cells (‘interstitial fluid’)
3. Extracellular: in blood vessels (‘intravascular fluid’)

Why Retain Water?

It is the interstitial fluid that ultimately forms the symptoms of the two different conditions that are often meant in practice with fluid retention.

1. Subcutaneous fluid retained locally. Think, for example, of swollen hands, fingers, and feet.
2. Fluid retained throughout the body subcutaneously in tissue between cells

Various causes can lead to these different complaints although there is often a connection. Therefore, you must first specify which type of fluid retention you mean when wondering why you retain water.

What is Edema?

A local accumulation of fluid (outside the cell) is also called edema. Think, for example, of a swollen face, hands, fingers, and/or feet, but also the lungs or brain. We see this develop under various different circumstances. From severe medical complications to temporary, cosmetic complaints.

How Does Edema Develop?

Blood vessels contain fluid. This is separated from the surrounding tissue by the wall of the blood vessels. Fluid can be ‘pushed’ from the blood vessels into surrounding tissue. That fluid then resides between the cells of that tissue where it can be utilized by those cells. Intravascular cells (in the blood vessel) then become interstitial cells (between the cells) and possibly intracellular cells if taken up by cells. The fluid can leave the blood vessels through a wall that allows water to pass but proteins (such as albumin in blood) to a lesser extent. There are opposing forces that determine whether fluid flows from the vessels into surrounding tissue or vice versa fluid from the tissue is pushed back into the blood vessels (‘Starling equation’). These forces are respectively blood pressure and oncotic pressure. The lymphatic system acts as a sort of overflow here. When there is too much fluid in the tissue threatening to build up, the lymphatic system can return excess fluid to the bloodstream. When the lymphatic system has to process too much fluid or cannot function properly, fluid accumulations occur in the tissue between the cells.

Blood Pressure vs Oncotic Pressure

Blood pressure acts as a force that pushes fluid out of the blood vessels. However, proteins in the blood have difficulty passing through this wall. When fluid is pushed out of the blood vessels, a higher concentration of these proteins remains in the blood vessels. This creates oncotic pressure which acts as the opposing force. This is a form of osmosis/osmotic pressure caused by differences in concentrations of proteins (especially albumin) on either side of the walls of blood vessels. The fluid outside the blood vessels has a lower concentration of proteins and therefore wants to work its way back into the blood vessels to balance.

Fluid in Blood Vessels or Tissues

Which of these forces works harder determines whether the amount of fluid in tissues and under the skin increases or decreases. How quickly the fluid then flows in one direction or another also depends on the permeability of the walls of the blood vessels. Greater permeability also allows more proteins to leave the blood vessels. The concentration of proteins in the blood vessels then remains lower, causing fluid outside the vessels to return less quickly due to osmotic pressure. The pressure in the vessels and the osmotic pressure in surrounding tissue are influenced by different factors. Edema is often the result of a condition. For example, kidneys that are less able to perform their filtering function or impaired blood drainage, such as through thrombosis. A failing liver can also be the cause. This is responsible for producing proteins needed for a healthy fluid balance.

6 Causes of Water Retention

There are 6 ways in which more fluid can flow from the blood vessels into surrounding tissue than in the reverse direction:

1. Increased blood pressure
2. Decreased oncotic pressure in blood vessels (less proteins in blood vessels)
3. Increased oncotic pressure in surrounding tissue (more proteins in tissue)
4. Increased permeability of walls of blood vessels (more proteins from blood vessel to tissue)
5. Blockages in the drainage of water through the lymphatic system
6. Changes in the fluid retaining properties of the tissues themselves.

Local Edema

In addition to these forms of ‘generalized’ edema, the cause can also be local and temporary. Think of such local edema as, for example, an allergic reaction and an inflammatory reaction. Causes of local edema can also be more innocent. For example, well-known are the swollen ankles after standing for a long time. This is a consequence of fluid in the blood vessels being pushed out at the lowest point and ending up between the cells. A part of the intravascular fluid that was first distributed throughout the body then accumulates in this one place. The same can happen when you have let your arms hang alongside the body for a long time, or during walking. Due to the low point of the hands and fingers (and the centrifugal forces of the swinging arms), fluid can be squeezed out of the blood vessels here.

Swollen Ankles Due to Water Retention

Specifically in the legs, retaining fluid can also be a consequence of lack of physical activity. Training enables the muscles to better fight against gravity in the veins. Blood can thus be better sent back upwards towards the heart. When the muscles are less able to do this, more blood accumulates in the veins of the legs (risk of varicose veins). The pressure then increases and more water seeps through the vessel walls into the surrounding tissue. The muscles in the legs are not only needed to return the blood to the heart. The use of muscles is also necessary for the ‘overflow’ function of the lymphatic system. Prolonged lack of use of these muscles also increases the chance of swollen ankles and legs. Support stockings can help the muscles by providing extra pressure. Sitting for long periods, such as during a flight, but also if you are bedridden due to illness for a while, can also cause edema. Specifically retaining fluid in the legs and ankles. However, you can prevent this with just light movements and exercises. Turning your feet a few times, for example, every few minutes.

How do you recognize edema?

If you press your finger into the skin at such a local accumulation of fluid, the impression of the finger will temporarily remain in the skin. Normally, the skin should almost immediately return to its old shape. With edema, this takes longer.

Medicines that can cause fluid retention

Unfortunately, various types of medicines can also cause higher fluid retention. Think among others of:

• Estrogens (female sex hormone)
• Hormone therapy
• NSAIDs (non-steroidal anti-inflammatory drugs, such as ibuprofen)
• Birth control pill
• beta-blockers

What to do against edema?

What you can do against local fluid retention also differs per cause. With temporary causes such as an infection, allergy, insect bites, or long days standing behind the counter, the edema will (normally) also disappear by itself. Simply sitting with your feet up for a while, for example, can make swollen ankles disappear faster. But you may be able to do more than just symptom management. The local accumulation of fluid may indeed be the result of a general difference in the fluid that enters and leaves your body. This immediately brings us to the type of fluid retention that cannot be considered a medical complaint, but rather a cosmetic one.

Fluid retained throughout the body under the skin

As a fitness photographer, I deal with half-dehydrated people almost weekly. Clients want to be captured as ‘dry’ as possible. A low body fat percentage is of course the first requirement for this. When that is low enough, a low moisture content can then make a big difference in appearance. Little subcutaneous moisture between the cells makes the skin thinner, making veins and muscles more visible. For many fitness models, bodybuilders, but also actors, draining moisture is therefore an important part of appearing as dry as possible. The ‘right fluid balance’ is then not assessed in medical terms, but in aesthetic ones. First of all, one tries to avoid retaining unnecessary moisture.

Dehydration

In addition, efforts are made to achieve the opposite of fluid retention; bringing the body into a state where more fluid is lost than enters. This of course leads to dehydration, not only in those areas where you want less moisture. Such dehydration can of course have serious consequences. There have been bodybuilders who died of dehydration around a competition. In addition, seizures can occur on stage while cramps due to dehydration are common at competitions. That is probably the reason why some organizations take harsher action against the use of diuretics (water pills) than against the use of anabolic steroids.

How do you prevent fluid retention?

Although you can certainly make some critical comments about protocols for consciously dehydrating yourself, it is only healthy to prevent unnecessary fluid retention. Looking back at the 6 causes of fluid retention, we can already come up with a preventive measure. To prevent fluid retention, you can work on the balance between blood pressure and oncotic pressure, among other things. After all, a higher blood pressure causes more fluid to be pressed between the tissue and under the skin, while the osmotic pressure pushes the fluid back into the blood vessels. Preventing high blood pressure is important for a healthy cardiovascular system but can also reduce fluid retention.

Salt and fluid retention

Too much salt in a diet is one of the common causes of high blood pressure. Moreover, sodium binds to water in the body. Various studies have shown that more salt in the diet leads to retaining more fluid [1,2,3,4]. The amount of salt in your diet is therefore one of the easiest factors to influence if you want to do something about fluid retention (or its prevention). Many processed foods contain relatively high amounts of salt/sodium. So, teach yourself to check the amount of salt in such products at least. Then you can make a judgment instead of automatically adding even more salt.

Diuretics, water pills

Sometimes diuretics, water pills, are prescribed in case of fluid retention. However, it is important to know what causes the imbalance in fluid (between intravascular and interstitial) to be disrupted. Diuretics are not the solution when the retention of fluid in tissue between cells is caused by increased permeability of the walls of blood vessels. When this permeability increases, more proteins will also be moved to the tissue outside the blood vessel. This reduces the oncotic pressure in the blood vessel. If you use water pills in this situation, something very dangerous can happen; dehydration of the blood. The amount of fluid in the blood then decreases while the high concentration of proteins in the tissue also draws fluid from the bloodstream. Your body then tries to be as economical as possible with fluid, causing you to retain even more fluid.

Drinking water and fluid retention

The opposite applies to drinking water. Drinking plenty of water tells your body that fluid is abundant. You are as it were opening the tap further, causing your body to automatically open the drain further [5]. For this, drink water or tea. Drinks with a lot of sugar and/or caffeine can actually dehydrate.

Refined carbohydrates increase fluid retention

Refined carbohydrates increase fluid retention

Refined carbohydrates cause a rapid increase in available glucose in your bloodstream. To regulate this blood sugar, insulin is released. Insulin causes the kidneys to reabsorb more sodium. Sodium thus remains in the body longer and therefore also contributes to retaining fluid for a longer period [6,7]. When talking about refined carbohydrates, think of processed sugars and grains such as table sugar and flour.

Fluid retention during menstruation, pregnancy, and menopause.

Around menstruation, but also during pregnancies, hormonal shifts can often lead to fluid retention. Hormones have an influence on fluid balance. Fluctuations in hormones can result in fluctuations in fluid balance. Such fluctuations are common in women. Women first experience menstruation, during which we see an increase in the hormones estrogen and progesterone. This is (physically) a preparatory phase for pregnancy. Especially just before menstruation, women often retain more fluid in the abdomen and breasts. Therefore, many studies on fluid retention have been conducted with women with PMS (see further). The same hormones can be seen to an even greater extent during pregnancy, and even then, they can cause increased fluid retention. Often, this is accompanied by swollen legs, ankles, and feet. Finally, menopause can once again cause significant disruptions in hormone levels, resulting in increased fluid retention.

Magnesium against fluid retention

In a study among women with PMS, intake of 200 mg of magnesium per day was found to reduce those symptoms [8]. Similar results with magnesium were seen in two other studies with women with PMS [8,9]. You can buy magnesium as a supplement. In nature, you mainly find it in nuts, green leafy vegetables, and whole grains.

Vitamin B6 against fluid retention

In research, vitamin B6 was also found to reduce fluid retention in women with PMS [9]. Vitamin B6 is involved, among other things, in the production of red blood cells. You can find vitamin B6 in bananas, meat, walnuts, and potatoes, among other sources.

Potassium against fluid retention

The mineral potassium may possibly help against fluid retention in two ways [11]:

• Potassium reduces the amount of sodium
• Potassium increases urine production.

Diuretic foods

But there are even more types of food that (possibly) help you expel more fluid.

• Horsetail (the plant) [12]
• Parsley [13]
• Hibiscus [14]
• Fennel [15]
• Nettle [16]
• Garlic [17,18]

Summary:

‘Fluid retention’ can refer to different conditions. In practice, it usually means fluid retained outside the cells and blood vessels in tissues. These accumulations of fluid, edema, can occur locally. They are mainly the result of an imbalance in the fluid pressed out of blood vessels and the fluid brought back into circulation. Women may experience fluid retention more often due to hormonal fluctuations during menstruation, pregnancy, and menopause. High amounts of salt and refined sugars in the diet can increase fluid retention. Salt does this, among other things, by raising blood pressure. Drinking enough water ensures that the body continues to expel enough water. Additionally, there are some vegetables that research has shown to have diuretic properties.

References:

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