One of the most common complaints and concerns I see these days is edema, but specifically, leg edema. [The] conventional approach is testing for congestive heart failure, [and] maybe prescribing prednisone antibiotics and more Lasix, [and] less salt. What’s the Functional Medicine approach to helping patients with edema? I realize these patients often have complicated comorbidities, but where would you start if they don’t?

You know, that’s a really interesting question. It’s a tough one because it’s one of those very non-specific symptoms like fatigue that can be caused by just about anything, maybe not anything, but by a lot of things, for sure. For example, my patients with CIRS, chronic inflammatory response syndrome, which is biotoxin illness, which we haven’t covered in this course, but hope to in the future, will often have leg edema. What’s happening there is, they have low VEGF [vascular endothelial growth factor], and that leads to capillary hypoperfusion, which then can lead to an accumulation of fluid in the small vessels, particularly in the lower legs. You often see hair loss, too, in that part, like on the lower legs for both men and women because of that, and poor circulation like cold feet, cold lower calf, [and] you’ll see pitting edema. I’m not going to suggest that everybody who has edema but doesn’t have hypertension, metabolic syndrome, congestive heart failure, or other more common issues does have chronic inflammatory response syndrome. I’m just illustrating the range of things that can cause this presentation. If the patient is overweight and has any kind of features of metabolic syndrome like hypertension or insulin resistance, definitely a lower-carb, higher-protein approach with adequate physical activity is helpful.

As a sort of more non-nutritional interventions, you could consider near-infrared phototherapy, so getting, like, a single light from ​SaunaSpace​ or a couple lights and putting those on the lower leg area to improve microcirculation because that’s almost certainly impaired with edema there. I’ve actually heard stories of patients with full-on type 2 diabetes who have significant swelling in the lower legs and even neuropathy where they’ve lost almost all their feeling in that part of the body, and using the SaunaSpace near-infrared treatment has restored feeling, blood flow, and circulation there. Another option is pulsed electromagnetic field therapy, or PEMF, like the ​BEMER​ device or ​BioBalance​ is another good one. There are a lot of studies that show that PEMF increases microcirculation and also increases mitochondrial function, as does near-infrared light. Those are some good options for that particular problem.