Your Health

Edema Is a common problem often ignored

W. Gifford-Jones MD & Diana Gifford-Jones

March 8, 2023

BY W. GIFFORD- JONES MD & DIANA GIFFORD-JONES

What is one of the most common health problems that develop in people as they age, and also one of the least discussed? The answer is chronic swelling of the legs. At best, it’s a natural consequence of aging, but also known as peripheral edema, there can be: medical, nutritional, or lifestyle causes and serious health consequences.

Edema is a general term meaning swelling. Peripheral edema occurs in the: legs, ankles, feet, as well as arms and hands. Swelling in other parts of the body include: pulmonary edema (in the lungs), cerebral edema (in the brain), and macular edema (in the eye). It’s a medical emergency when the lungs or brain are affected, and a life-altering condition when vision is impacted.

In the legs, while victims must deal with pain, weakness, and limitations on mobility, for many, there is a sense of stigma, when once shapely or muscular legs have become less sightly. That’s at least one reason why there’s not a lot of information about how many people are suffering from the condition. In the minds of sufferers, it doesn’t warrant a visit to the doctor, and clothes can help conceal the issue, if not make it go away.

One research team at the University of Rochester used data from the American Health and Retirement Study, a nationally representative longitudinal survey of about 20,000 U.S. adults over the age of 51, to estimate prevalence of the condition, which they found to be 19-20% of survey respondents.

They also found social disparities among those reporting lower limb edema. Blacks/African Americans and other racial minorities, women, and less wealthy individuals were more affected. As is the case with many other health conditions, the researchers reported, “Minority racial status and lower wealth could be associated with peripheral edema for multiple reasons, including higher rates of other chronic health conditions as well as lower access to healthy foods and preventive care services.”

What is causing edema is not always easy to determine. For the individuals involved, it can be hard to know if the swelling is the result of fluid gathering in the tissue. Or is it from the build-up of fat? Known as Lipedema, it is fat, not fluid, that occurs in the limbs, and in the early stage, people do not typically have: diabetes, high cholesterol, or high blood pressure, but peripheral edema is an accumulation of fluid.

Causes of fluid build-up can be long periods of sitting or standing. Pregnant women can develop the condition, as can people with low levels of protein in the diet.

More sinister causes are also common, including chronic lung diseases or congestive heart failure, when the heart muscle doesn’t pump well. Chronic venous insufficiency occurs when leg veins fail to carry blood back up to the heart. When valves that normally ensure blood flows toward the heart don’t work well, gravity takes over, causing blood to pool in the legs.

Depending on the cause, the treatment should be tailored. This is not the time for armchair medicine. An accurate diagnosis depends on a full medical history and potentially a battery of tests to pinpoint the issue.

Keep in mind; it’s better to treat the underlying cause than the symptom. Raising the affected limbs will help. Diuretics can also help but need to be used with care as removing too much fluid too quickly can, among other things, impair kidney function.

Attention to diet, consistent moderate exercise, and maintenance of a healthy weight should be the goal – early in life, and all lifelong.

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Written By W. Gifford-Jones MD & Diana Gifford-Jones

Dr. W. Gifford-Jones, MD is a graduate of the University of Toronto and the Harvard Medical School. He trained in general surgery at Strong Memorial Hospital, University of Rochester, Montreal General Hospital, McGill University and in Gynecology at Harvard. His storied medical career began as a general practitioner, ship’s surgeon, and hotel doctor. For more than 40 years, he specialized in gynecology, devoting his practice to the formative issues of women’s health. In 1975, he launched his weekly medical column that has been published by national and local Canadian and U.S. newspapers. Today, the readership remains over seven million. His advice contains a solid dose of common sense and he never sits on the fence with controversial issues. He is the author of nine books including, “The Healthy Barmaid”, his autobiography “You’re Going To Do What?”, “What I Learned as a Medical Journalist”, and “90+ How I Got There!” Many years ago, he was successful in a fight to legalize heroin to help ease the pain of terminal cancer patients. His foundation at that time donated $500,000 to establish the Gifford-Jones Professorship in Pain Control and Palliative Care at the University of Toronto Medical School. At 93 years of age he rappelled from the top of Toronto’s City Hall (30 stories) to raise funds for children with a life-threatening disease through the Make-a-Wish Foundation. Diana Gifford-Jones, the daughter of W. Gifford-Jones, MD, Diana has extensive global experience in health and healthcare policy. Diana is Special Advisor with The Aga Khan University, which operates 2 quaternary care hospitals and numerous secondary hospitals, medical centres, pharmacies, and laboratories in South Asia and Africa. She worked for ten years in the Human Development sectors at the World Bank, including health policy and economics, nutrition, and population health. For over a decade at The Conference Board of Canada, she managed four health-related executive networks, including the Roundtable on Socio-Economic Determinants of Health, the Centre for Chronic Disease Prevention and Management, the Canadian Centre for Environmental Health, and the Centre for Health System Design and Management. Her master’s degree in public policy at Harvard University’s Kennedy School of Government included coursework at Harvard Medical School. She is also a graduate of Wellesley College. She has extensive experience with Canadian universities, including at Carleton University, where she was the Executive Director of the Global Academy. She lived and worked in Japan for four years and speaks Japanese fluently. Diana has the designation as a certified Chartered Director from The Directors College, a joint venture of The Conference Board of Canada and McMaster University. She has recently published a book on the natural health philosophy of W. Gifford-Jones, called No Nonsense Health – Naturally!

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