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Edema is an observable swelling from fluid accumulation in body tissues. Edema most commonly occurs in the feet and legs, where it is referred to as peripheral edema. The swelling is the result of the accumulation of excess fluid under the skin in the spaces within the tissues.

An accumulation of fluid in the air spaces (alveoli) in the lungs is called pulmonary edema. Excess fluid sometimes collects in cavities in the abdomen called “ascites”) or in the chest called “pleural effusion”). Anasarca refers to the severe, widespread accumulation of fluid in the all of the tissues and cavities of the body at the same time.

Pitting Edema

If you push your finger into the tissue in the front (or just to the side of) your shin bone and your finger leaves an indentation – almost a finger print – that takes a while to fill back in, you have pitting edema. Most overweight people experience this phenomenon late in the afternoon and/or at night after being on their feet all day. The excess fluid pools around the lower legs and seeps into the soft tissues. In the morning, after the body has been horizontal through the night, the fluid redistributes, and the pitting edema goes away but then reoccurs as the day goes on. Even people who aren’t all that overweight but who do have elevated insulin levels will have some degree of excess fluid accumulation even if they don’t experience pitting edema as evidence of it.

One of the first things that happens when people go on low-carb diets is a rapid improvement in insulin sensitivity.  Because the low-carb diet starts to quickly banish the insulin resistance, insulin levels fall quickly and as insulin falls, the stimulus to the kidneys to retain fluids goes away, and the kidneys begin to rapidly release fluid. One of the common experiences at the start of low-carb dieting is the incessant running back and forth to the bathroom to urinate this excess fluid away, which is both good news and bad news.

The good news is that it’s great to get rid of the excess fluid but it comes at a cost, which is the bad news. As the excess fluid goes, it takes with it sodium an extremely important electrolyte. When sodium levels fall below a critical threshold (which can happen within a short time), symptoms often occur, the most common being fatigue, headache, cramps and postural hypotension.

Postural hypotension happens when you stand up too quickly and feel faint. Or even pass out briefly. It’s a sign of dehydration. So if you’ve started your low-carb diet, made your multiple runs to the bathroom, and jump up off the couch to answer the phone and feel like your going to faint (or actually do pass out momentarily) and have to sit back down quickly, you’ve got postural hypotension. It’s really easy to fix – you simply need to take more sodium and drink more water. Start your morning by taking 1 tsp. of Celtic sea salt in a glass of warm water and use another 1/2 of salt throughout the day. 

“Pitting” edema is by far the most common form of edema and can be demonstrated by applying pressure to the swollen area by depressing the skin with a finger. If the pressure causes an indentation that persists after the release of the pressure, the edema is referred to as pitting edema. Any form of pressure, such as from the elastic in socks, can induce pitting with this type of edema.

Edema is often indicative of either fatty liver or heart failure or both. My feet and ankles were slightly swollen at the time I started taking all of the ShopFreeMart products and now two months later, all swelling is gone and my feet and ankles look totally normal. I believe that especially the ShopFreeMart Sugar-D has made a major difference for me personally.

In “non-pitting” edema, which usually affects the legs or arms, pressure that is applied to the skin does not result in a persistent indentation. Non-pitting edema can occur in certain disorders of the lymphatic system that may occur after a mastectomy, lymph node surgery, or congenitally. Another cause of non-pitting edema of the legs is called pretibial myxedema, which is a swelling over the shin that occurs in some patients with hyperthyroidism. Non-pitting edema of the legs is difficult to treat. Diuretic medications are generally not effective, although elevation of the legs periodically during the day and compressive devices may reduce the swelling. See Fatty Liver.

Ketogenic Diet

My latest research indicates that low protein causes the liquid to escape from the cells into the tissues and cause edema. The answer to this would be a ketogenic diet. Ramping up the fat intake as the single best way to hurry the low-carb or keto adaptation along. Another little secret is to keep an eye on the protein intake. Too much protein will prevent the shift into ketoses because the liver will convert some of the protein into glucose. This glucose will then be used first and slow down the ketogenic process. Which, of course, prompts the question, how much protein is too much? 

As long as you’re getting your protein from meat, especially fatty cuts of meat, you’re probably okay. If you go for the extremely lean cuts of meat, say, skinless chicken breasts, or if you are supplementing your diet with low-fat protein shakes, you could have a little more trouble low-carb adapting. If you’re going the shake route, I would recommend you add some coconut oil to the shakes for a couple of reasons. First, you’ll hasten the keto-adaptation, and secondly, coconut oil will help remove the fat from your liver.

As I said, you need to really crank up the fat intake to start creating ketones as quickly as possible. If you don’t like fatty cuts of meat, you can add a little medium-chain triglycerides (MCT) to your diet. MCT are absorbed more like carbohydrates and are used quickly by the body. They are almost never incorporated into the fat cells, so they burn quickly, and any extra that might be hanging around are converted to ketones. So, MCT will drive the ketone production process.    And so will virgin, cold-pressed coconut oil if you prefer that.

You can find MCT oil at most health food or natural grocery stores. It has never bothered me, but some people can get a little nauseated if they take too much of it, so if you decide to give it a try, start out slowly or go with the coconut oil.

Aside from the occasional carb cravings, the most common symptoms experienced by those getting started on low-carb diets are fatigue, headaches, light-headedness or dizziness, and cramping. Not everyone experiences these symptoms, but let’s look at what to do to avoid them or treat them should you already be experiencing one or more.

Increasing sodium is another one of the many counter-intuitive things about low-carb dieting. Just like eating more fat to lower your cholesterol, you’ve got to start thinking differently. The low-carb diet is one that absolutely requires more sodium. A lot more sodium.

If you have brutal headaches like some people get when starting on a low-carb diet, add sodium and drink extra water.

Even if you don’t have pitting edema, postural hypotension or headaches, you still need more sodium if you are starting out on or following a low-carb diet. It’s critically important that you get extra sodium. I can’t make this case too strongly.

An easy way to get extra sodium along with magnesium and potassium (two other electrolytes you need) is by drinking bone broth. Unfortunately, you typically have to make the good stuff yourself. You can get chicken broth and beef broth at most grocery stores, but it’s not nearly as good as the broth you can make yourself. It requires a little time, but you can make a bunch and freeze it in small containers.

In addition to broth, get some Celtic Sea Salt, Himalayan Salt, Real Salt or one of the other grayish, pinkish looking salts and replace your normal salt with these, and use them lavishly.

These salts have been harvested either from ancient sea beds or obtained by evaporation of sea water with high mineral content and contain about 70 percent of the sodium of regular salt (which has been heated, refined, bleached and processed until it is pretty much pure sodium chloride, often with aluminum and other anti-caking agents added). The other 30 percent of the volume is other minerals and micronutrients (including iodine) found in mineral-rich seas. I much prefer these salts taste-wise to regular salt, and I salt the heck out of all my food with it.


The most common cause of virtually all the symptoms listed above is an imbalance in electrolytes. Following a low-carb diet results in a rapid lowering of insulin levels, although a good thing, can create problems in the beginning. We’ll address the electrolytes in the order of importance.


When you are overweight and insulin resistant, you have a lot of insulin circulating in your blood most of the time. This excess insulin does a number of bad things to you. Gary Taubes wrote an entire book about how excess insulin makes you store fat in your fat cells, but the story doesn’t end there. Excess insulin also drives the kidneys to retain fluid, which is why many obese people retain a lot of extraneous fluid and experience pitting edema in their lower legs.


The low-carb diet doesn’t really cause a massive depletion of magnesium like it does with the sodium and potassium, but most people who are overweight, insulin resistant and/or hypertensive or diabetic are deficient in magnesium.

Even people with lipid problems are often magnesium deficient. In fact, even people who don’t seem to have health problems can often be magnesium deficient because most people don’t get enough. About 70 percent of people are magnesium deficient, so in my opinion, it’s important to supplement this vital mineral.

Good magnesium levels help regulate potassium as well, so keeping your magnesium adequate helps with your potassium as well. Furthermore, approximately 300 plus of our enzymes require magnesium as a co-factor to make them work properly.

Since magnesium is used in 300+ different chemical reactions in the body, a shortage of magnesium can cause problems. One of the most common ones is an increase in cravings. Often simply replenishing magnesium gets rid of many of the food cravings people have.

The best way to supplement with magnesium is transdermally as mentioned in the first chapter of this book. We’ve found it best to rub magnesium oil on your skin in the evening because it helps you relax so that you sleep better. About the only problem people ever have with magnesium is loose stools. If that happens and it is unwelcome – simply reduce your dosage until your stools normalize.


Potassium is linked to sodium and if you lose a lot of sodium through the diuretic effect of the low-carb diet, you’ll ultimately lose a lot of potassium as well. Keeping your sodium intake up as mentioned above will help preserve your potassium as well.

And keeping your potassium levels up helps to ensure that you don’t lose a lot of lean muscle mass during your weight loss. Plus, just as with sodium, adequate potassium prevents cramping and fatigue.

If you are losing enough Potassium that you are experiencing cramping or fatigue, you can purchase an over the counter Potassium supplement at your health food store and take up to 500 mg per day.

There are a couple of prescription medicines that you’ve got to be aware of if you markedly increase your potassium intake, so if you’re on blood pressure medicines, ask your doctor if it’s okay for you to take potassium.


Many people believe that coffee, tea, soft drinks, etc. are nothing but water with a little flavoring in them. After all, if you start out with a glass of water and put tea bag in it, the water doesn’t go away. It’s still there; it just becomes tea-flavored water. Well, turns out that’s not actually the case.

Dehydration can cause severe cramps in your hands, feet and legs. Your first thought may be “my potassium is too low”, so you start taking potassium. No change in the cramping situation, in fact if anything, it gets worse. So next you try calcium and still no improvement.

Finally, you start drinking water and the cramping goes away. Did you realize you can lose a couple of pounds during sleep simply by breathing water vapor away, which is why your leg cramps may be more severe in the night time? In fact you might become cramp free, just by upping your water intake.

Water also has a lipolytic (fat burning) effect. Those who drink a lot of water have increased lipolysis.

When you drink water, you also dilute your blood for a while. During the time your blood is diluted, the concentration of the various substances carried in the blood decreases, including the levels of insulin. The typical blood volume is about 5 liters, so drinking a liter of water would increase the blood volume temporarily by about 20 percent, which would mean the concentration of insulin and other molecules in the blood would fall by about 20 percent.

A 20 percent drop in insulin levels would allow fat to escape from the cells and would facilitate its transfer into the mitochondria for burning.

Those starting a low-carb diet are prone to dehydration because excess ketones are flushed out via the kidneys along with a lot of fluid, so when you start your diet, consciously increase your fluid intake. Create yourself some sort of regimen that ensures you consume plenty of water throughout the day, otherwise you probably won’t do it. 

By drinking more water, you will feel better; you will have more energy, avoid cramping and you’ll actually burn more fat. Don’t make the mistake of thinking that drinking a lot of coffee, tea, booze or other diuretic fluid is a replacement for water intake.

If you drink either distilled water or water that comes through an RO filter, both of which are depleted of minerals, add a pinch of one of the natural salts to each bottle. I add enough so that the water just barely hints of a salty taste.

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