There are conditions common enough like heart disease or frightening enough like cancer that they exist in our collective awareness. Conditions that cause pain, swelling, and limited mobility in the lower extremities are fairly common–they just don’t have the cachet. They are are on the rise with our penchant for gaining weight, taking medications, lack of exercise, and overconsumption of sugar, red meat, and dairy.
Edema
Edema is swelling of tissue due to inflammation, usually a necessary response since the extra venous blood is bringing immune system cells to fight the infection. Most forms of edema are relatively benign, such as swollen ankles in pregnancy. Others are life-threatening, such as pulmonary edema in the lungs. Other causes of edema include allergic reactions such as to bee stings, a clot or tumor, critical infections or illnesses, congestive heart failure, liver and kidney disease, high altitudes, medications (“Edema overview”), high or low blood pressure, being overweight, immobility in hot weather, diabetes, overeating, high sodium, and poor circulation (“Edema”).
In addition to swelling, the cause of edema can be diagnosed with urine or blood tests, x-ray, or electrocardiogram. Additional symptoms like shortness of breath or chest pain can indicate a more serious problem (“Edema”).
Edema is usually treated with diruetics, elevating the limb, and addressing causality if known. In general, many people with non-threatening edema just adapt, perhaps with medications and compression garments. There are conventional preventative measures that fall under a whole health purview, such as avoiding salt, losing weight, elevating the affected limb, exercise, and massage (“Edema”).
Because edema can indicate a life-threatening condition, it seems wise to include it in our repository of important signs and symptoms.
Lymphedema
The lymphatic system is the body’s sewer system–a network of tiny plumbing that collects and removes metabolic waste. It contains nodes or key collection sites, such as the glands in the neck that swell with extra fluid during a cold. The nodes filter the fluid with lymphocytes, sending clean fluid back into the bloodstream.
Lymphedema is excessive collection of lymphatic fluid, not venous blood, where the plumbing can’t handle the fluid–like a clogged drain. Fortunately, our pipes expand to hold the fluid. Unfortunately, the lack of fluid movement can cause an infection (“What Is Lymphedema?”), and it eventually becomes chronic and difficult to treat.
There are two kinds–less common is primary lymphedema, typically congenital. Secondary lymphedema is acquired, most commonly worldwide due to parasites and is a main cause of permanent disability (Stoppler). In the U.S. it mostly results from procedures that require removal of tissue and allow the possibility of removing lymph nodes, most commonly in breast cancer treatments, Other causes include post-surgery air travel, radiation, severe injuries (“What Is lymphedema?”), tumors, and burns (Stoppler).
Although it can develop anywhere, lymphedema usually occurs in the extremities. If swelling persists and muscle tissue becomes “spongy” or “non-pitting,” it’s time to get medical attention. Eventually the limb could harden into a “fibrotic” state which is essentially irreversible. Untreated, an infection called lymphangitis can develop with a number of possible results: skin conditions, pain, fever and chills, loss of function or limb, or even cancer (“What Is lymphedema?”).
In diagnosis, venous edema has to be ruled out first. Prior medical treatments such as radiation are usually the indicators, and sometimes the cause is unclear. There are tests such as MRI scans and a lymphoscintigraphy, the injection of tracer dye (Stoppler).
Lymphedema is considered incurable, possibly due to vessel damage. Pre-infectious lymphedema treatment, called Complex Decongestive Therapy (CDT), falls within a whole health paradigm–lymphatic drainage massage, compression garments and devices, elevating limbs, skin care, exercises, good diet, and bandages. If lymphangitis is suspected or diagnosed, these treatments are discontinued and antibiotics prescribed (“What Is lymphedema?”).
Preventative measures should be taken after a trauma, including surgery: hydration, elevating the limb, and avoiding tight garments, lifting, and extreme heat (Stoppler).
Gout
Gout is an arthritic condition where swelling and pain occur in a lower extremity joint. Attacks are inconsistent and typically occur at night. The cause is usually an excess of uric acid in the blood, commonly from consuming a “rich diet” with purines such as red meat. Purines produce uric acid, which breaks down in the blood and passes through the kidneys into the urine. If the kidneys cannot handle the levels of uric acid, it forms crystals in the lower extremities or the kidney itself as a “stone” (“Questions and answers about gout”).
Additional causes include drinking alcohol, being overweight (“Gout – topic overview”), genetics, lead exposure, kidney problems, medications such as diuretics (“Questions and answers about gout”), fructose and drinks with sugar, shellfish, and aspirin. Gout seems to occur more in people with high blood pressure, high lipids, and diabetes (“Gout”).
Treatments include pain pills, resting, NSAIDs, corticosteroids, uric acid reduction medications, weight control, avoiding rich foods, and hydration. Current research is looking at how the immune system plays a role, the inflammatory process, specific dietary measures like using low-fat dairy, and genetic factors (“Questions and answers about gout”).
Calcium Pyrophosphate Deposition
Just to complicate matters, there is pseudogout or Calcium Pyrophosphate Deposition (CPPD), where symptoms are similar to gout, but the cause is calcium phosphate crystals deposited in the joints. Like uric acid crystals, these can cause inflammation, swelling, and pain.
The causes are very different from gout–excess iron, low magnesium, overactive parathyroid, underactive thryroid, and possible excess calcium. However, conventional treatments are the same as for gout, and experts do not yet know how to prevent or dissolve the crystals (“Calcium pyrophosphate deposition”).
Whole Health Care–Applying Functional Medicine and TCM
Exact diagnosis of swollen extremities is difficult. A physician can extract fluid from the swollen joint and examine it under a microscope to determine the type of deposit, if there is one. Uric acid in the blood can be measured but results are inconsistent and unreliable. X-rays, ultrasound, and dual energy computer tomography can be used if available and affordable (“Gout”), but these tools rely on interpretation.
In cases of lower extremity pain, especially with “unclear” or “unknown” causes, Functional Medicine and TCM paradigms become useful. It may not be the diagnosis that matters, as much as the treatment. If possible, it does seem important to distinguish if crystals are present and what kind, which would indicate different upstream causality. If this is unavailable or unaffordable, there are common lifestyle changes that can support healing.
To review, there are four possible culprits in lower extremity pain and swelling–edema, lymphedema, gout, and psuedogout. They all are forms of inflammation and can be addressed accordingly. With the possible exception of lymphedema, they share upstream causality related to blood pressure, lack of movement, being overweight, medications, kidney issues, and diabetes. It seems important here to address all these possibilites, beginning with diet, as Functional Medicine and TCM both recommend.
Edema is treated In TCM as a as a “damp” condition. Other symptoms include feeling heavy, fatigue, and infections related to yeasts and fungi. Causes of damp include prolonged exposure to wet environments, Candida or yeast overgrowth; weakened immune and digestive systems; antibiotic use, including commercial animals; overthinking; and overconsumption of sugar, yeasted breads, dairy, and fermented foods (Pitchford, 2002). Damp has a heavy quality, so “it tends to move things downward” and become chronic (Kaptchuk, 1983, pg. 125). It can specifically present symptoms in the legs with water retention and sore joints. Damp is a spleen condition, so it has a direct relationship with digestion.
Candida is treated with a very specific dietary regime that features fresh, sprouted grains and beans such as barley, millet, and mung beans. It strictly avoids the problem foods, especially sugar and dairy. Salt and oils are also contraindicated except for EFAs (Pitchford, 2002). There are elaborate variables based on constitution and symptoms that recommend the support of a TCM practitioner.
Lower extremity problems in general are treated as kidney disorders in TCM, usually kidney yang deficiency. The symptoms and treatments complement those of damp, and edema is usually present. TCM understands the kidneys as holding life force, which we understand in western medicine as adrenal function. Kidney Yang deficiency symptoms include coldness, fatigue, a weak immune system, lower back and leg pain, and low spirits (Kaptchuk, 1983). Treatment includes warming foods and adrenal support. A TCM practitioner would also include acupuncture, cupping, and moxibustion.
We can apply TCM damp and kidney yang deficiency protocols to our four culprits of lower extremity conditions. The protocols acknowledge, then strengthen a weak immune system. They are aimed at improving digestion, eliminating pathogens, and supporting bones–all key to immune health to reduce inflammation and resultant crystal formation, vessel damage, and swelling.
TCM Damp protocols expressly prohibit sugar, dairy, and yeast, contributors to diabetes and weight gain. The fresh vegetables, grains, and legumes such as mung beans help detoxify the liver and kidney, balance lipids, and reduce weight.
The contraindication of salt in the damp protocol addresses water retention, high blood pressure, kidney and stomach conditions, and weakened structural tissues. Sodium (Na) can be kept in balance with potassium foods such as greens, legumes, grain, and certain fruits (Pitchford, 2002). High levels of Na in processed and restaurant food are endemic.
Excess salt will also contribute to Ca and magnesium (Mg) deficiencies (“Examples of minerals”). Addressing Ca deficiency is a priority. It is essential to immune system function in that white blood cells are produced in healthy bones. Examples of Ca-rich foods are seaweeds, almonds, and green vegetables.
Having too much Ca is yet another problem. Excess Ca has a range of adverse effects specific to this discussion, including disrupting lymphocyte function and contributing to calcified arteries (Pitchford, 2002) and crystal formation. It plays a role in CPPD where the parathyroid may be producing too much Ca. Since Ca supplements commonly cause excess Ca, these should be discussed and moderated with a healthcare provider.
Mg is critical for dozens of metabolic functions and commonly deficient in the SAD. Plants rich in Mg have anti-inflammatory properties, anti-oxidant properties, and strengthen muscle tissue, blood vessels, lymph vessels, and joints. Mg is necessary for Calcium uptake from tissue into bone, where we want it. Mg-rich foods are seaweeds, sardines, almonds, amaranth, hazel nuts, and parsley (Pitchford, 2002). Trans-dermal Mg therapy, such as salt soaks, are easily done and often give immediate relief for lower extremities.
The last interesting application of TCM in this context are the mental and emotional aspects of damp. The stomach and spleen meridians move through the legs, holding digestion and immune points. Disharmony or imbalance in these paired systems also reflect worry and overthinking. Energetically we can imagine heaviness, having weight, feeling pressure. It isn’t a stretch to imagine how stress related to worry and overthinking might contribute to any of the causes related to edema, lymphedema, gout, or psuedogout.
Whole Health Care–Other Considerations
Cherry juice is a tried and true home remedy for gout. Daily servings of juice help dissolve the crystals–use 1/3 organic sugar-free cherry juice to 2/3 water.
Another tried and true remedy for inflammation and swelling is RICE–rest, ice, and elevation. This simple cure is often forgotten in times of pain and distress.
There are specific, effective herbs that support the systems involved in these conditions. It may be helpful to consult with a local herbalist or acupuncturist.
As with other conditions, movement is important, especially to help drain lymph and move venous blood. In these cases, gentle movement sitting down and drainage massage may be an appropriate start. Any kind of lymphatic drainage would help the other three conditions–if lymph isn’t moving well, the fluid in gout or CPPD crystals isn’t going anywhere.
One elephant in the room is weight. It may be simple mechanics and physics explaining why many overweight people have lower extremity pain. They may appreciate the honesty and support of a health care provider willing to co-create a weight-loss program.
Finally, address any upstream causes that are potential suspects. If not for the health of your legs, for the rest of your life.
Sources
Calcium pyrophosphate deposition (CPPD). American College of Rheumatology. Retrieved April 5, 2013 from http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/pseudogout.asp
Edema. Native Remedies. Retrieved April 7, 2013 from http://www.nativeremedies.com/ailment/nonpitting-and-pitting-edema.html
Edema overview. WebMD. Retrieved April 7, 2013 from http://www.webmd.com/heart-disease/heart-failure/edema-overview
“Examples of minerals out of balance.” NIWH Nutrition–Food Biochemistry Course.
Gout. American College of Rheumatology. Retrieved April 6, 2013 from
http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/gout.asp
Gout – Topic Overview. WebMD. Retrieved April 5, 2013 from http://arthritis.webmd.com/tc/gout-topic-overview
Kaptchuk, T. (1983). The web that has no weaver. Chicago: Congdon & Weed.
Questions and answers about gout. April 2012. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Retrieved April 5, 2013 from http://www.niams.nih.gov/health_info/Gout/
Pitchford, P. 2002. Healing with whole foods. 3rd Ed. Berkeley: North Atlantic Books.
Stoppler, M. Lymphedema. Medicinenet.com. Retrieved April 5, 2013 from http://www.medicinenet.com/lymphedema/article.htm
What is lymphedema? National Lymphedema Network. Retreived on April 4, 2013 from http://www.lymphnet.org/lymphedemaFAQs/overview.htm