Lower Your Salt Intake to Bring Down Swelling

Published by Contra Costa Times

Posted on Sun, Jul. 11, 2004

By Dr. Stephen Daniels

MS. NIX'S FEET are so swollen she can't fit in her shoes. I suggested that the salt in her diet might be contributing to her swelling (edema), but she doesn't think they are related.

"Oh, doctor, I don't eat salt anymore. I haven't used a salt shaker in years. And my ankles are still swollen."

Swelling usually comes from a combination of things that can include poor heart function, being overweight, weak leg veins, prolonged sitting, liver or kidney disease, certain medicines and salty food.

"Let's talk about your diet. What did you have for dinner last night?"

"Well, for dinner I had some greens and some delicious ham my sister sent from Virginia. My neighbor brought over biscuits and gravy. But I didn't add salt to any of it."

Ms. Nix doesn't realize that much of the food she eats already has salt in it. Certainly the ham and probably the biscuits and gravy have enough salt to cause her swelling.

We discuss some ways to reduce her ankle swelling, so she doesn't have to take more medicine:

REDUCE SALT INTAKE: If food tastes strong, it's probably too salty (for someone with swollen legs). At first, a low-salt diet is pretty bland to most people. After a while, though, it usually tastes fine, and most "normal" food, especially from restaurants or fast-food outlets, will taste too salty.
WALK, ELEVATE YOUR FEET: In general, lying down with your feet elevated and walking are both good, while sitting and standing are bad. Lying down with your feet above the level of your heart will help drain excess fluid from your ankles and feet. Walking is good for your general health and uses your leg muscles, which helps pump excess fluid out of your legs.

Sitting and standing worsens ankle swelling. Sitting with your legs elevated on an ottoman doesn't help because it tends to kink your hip veins and doesn't elevate your legs enough. Of course you have to sit and stand sometimes, but do each as little as possible if you suffer swollen joints.

WEAR SUPPORT STOCKINGS: Thick, tight support stockings from your toes to your knees or thighs can help reduce swelling. These may require a prescription or instructions from your doctor.
CONSULT YOUR DOCTOR: Your doctor will probably order diagnostic tests to determine the cause of the swelling and may prescribe diuretics (often called "water pills").

Swelling and pain in one leg can be caused by a blood clot, so talk to your doctor right away if you see an imbalance in the swelling.

After Ms. Nix agrees to see a dietitian to talk about her diet, her swelling and shortness of breath improve for a while. But it is difficult for her to avoid salt because it appears in excess in everything she likes: soup, mayonnaise, French fries, salsa, ketchup, pickles, lunch meats, tuna, chips, salad dressing and Chinese food.

She doesn't want to give up the foods she enjoys, so we discuss her options. On a combination of medications plus a reduced-salt diet and leg elevation, she improves. She has an especially difficult time during holidays. Ankle swelling can be a hard problem to fix, but reducing salt intake usually helps.

Dr. Daniels practices family medicine at the Pittsburg Health Center.