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Dr Kristina Janson
Dr Kristina Janson
The Janson Plan: Health, fitness, and wellness advice from a podiatrist in practice for over 30 years.
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Dr Kristina Janson

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“No More Swollen Feet!!”

Disclaimer: These healthy lifestyle tips do not substitute for a medical diagnosis or treatment. You should not use this information to diagnose or treat a health problem or condition. Do not stop taking the medication prescribed by your doctor. Always check with your doctor before changing your diet, altering your sleep habits, taking supplements, or starting a new fitness routine. You may want to discuss the advice in this blog with your doctor. If your doctor requests it, we would be happy to send the blog link. 

Lately, you may have noticed that your feet and ankles are swollen. There may be a mark at the ankle from your socks. The skin of your feet may be shiny, itchy and uncomfortable. If you press your finger for a few seconds into the ankle region, you may see a pitting depression.  In the afternoon, shoes can feel tight. You may have ingrown toenails, athlete’s foot fungal infection, corns, callus and other painful conditions of the feet that are a result of tight shoes. 
Swollen feet can be a dangerous forewarning

Swollen feet are heavy and make walking tiresome, carrying an extra 5 or 10 pounds of fluid in each foot. This can discourage walking, lead to lowered activity level, becoming more home bound, gaining weight, or just a sense of having no energy anymore. The swelling leaves less room for arteries and there is less blood delivered to the feet. The feet may feel cold, numb, or weak. Less blood flow means less oxygen and can lead to cramping.

Over time, swelling in the feet can cause a number of problems.
·         The nerves can be pinched when there’s a lot of swelling, leaving feet feeling numb, 
          an impairment of sensation, or tingling. Over time, the problem with the nerves can 
          become quite painful and increase the risk of falling.
·         Difficulty walking
·         Stiffness
·         Stretched skin, which can become itchy and uncomfortable
·         Increased risk of infection in the swollen area
·         Scarring between layers of tissue
·         Decreased blood circulation
·         Decreased elasticity of arteries, veins, joints and muscles
·         Increased risk of skin ulcers

Swelling in the feet, without proper treatment, gets worse over time. It is an important thing to treat and the sooner, the better. If you haven’t already, be sure to tell your primary physician about this situation. The “No More Swollen Feet” program is for patients who have already been working with their doctor to manage this problem and the underlying causes have already been discovered. 
The medical word for swelling is edema and you can understand how edema leads to problems down the road. Basically, edema makes it harder to walk and hard to get things done. 

Standard Medical Treatment for Ankle Edema: 
The typical medical treatment for edema is tight, medical grade socks or stockings that come in numbers indicating how tight they are. The higher the number, the tighter they are. 
Medical grade socks
Another medical treatment is diuretic medicine that makes you urinate a lot. 
Diuretic Medicine for swollen feet, ankles and legs.
You also may have been told to elevate your feet. When I meet a new patient with swollen feet, they often say something like, “I’m supposed to take a diuretic every day, but I have to skip it if I go out because otherwise, I am searching desperately for a bathroom.” Or they say, “I’m supposed to be wearing tight medical stockings, but they are hard to get on and by the afternoon, they really hurt!” And few patients want to sit around all day with their feet up in the air. Not only is that not practical, the minute you put them down, the swelling is right back. 

After 30 years of private practice, I have collected together a set of useful tips and treatments that help reduce quite a bit of edema. I have helped thousands of patients with my “No More Swollen Feet!” plan. I have lectured on this in community and senior centers, as well. 

Most patients see results fairly quickly and I often see patients only a few weeks into the program, and they are already amazed. They signed up, but their expectations were still skeptical. “Wow! This really works!” And the more you stick to the plan, the better the result you will see. It may not be possible to get rid of all the swelling, especially if the problem has existed for some time, or because it comes from something that cannot be fixed, but the goal is to get to the point where you have reduced the swelling enough to be able to walk around comfortably and you feel like you are more your old self again. 

Nothing in my plan is harmful. It couldn’t hurt to try. My hope is that you can walk more which will improve your general health, and you get back to living a life where you are flourishing and happy, going out, having fun, and seeing your friends and family. 

The Science of Edema:
Edema is fluid leaking out from the blood vessels and entering the space between cells. This is actually a normal process. It’s how cells get nutrients and oxygen. The problem is that under certain conditions, the fluid is not going back into the blood vessels, there’s too much fluid coming in, or not enough going out. You end up with a chronic inflammatory condition. 
In the case of not enough fluid going out, there is usually a problem with veins and the valves inside them. Some valves may be mildly injured or severely injured as in varicose veins. You may be able to see or feel these valves in your legs, they stand above the level of the skin and may have a bluish color. 
Too much fluid coming in, or water retention, can be a side effect of a medication, from heart disease, kidney disease, or liver disease. 
Walking less is another reason for swelling. You know that your heart pumps the blood to your feet, but what pumps it back to the heart again? The answer is voluntary skeletal muscles. The muscles push against veins and the blood moves. Valves inside veins, like salmon traps, keep the blood moving in only one direction (unless they are damaged as I mentioned above.)
No matter what the cause for edema, whether it’s water retention, faulty veins, or lack of motion, there are simple things that you can do to improve the situation. 

The first and most important thing to do is to change your diet. The goal is to reduce or eliminate foods that stop your kidneys from working. As you know, the job of your kidneys is to eliminate water out of your bloodstream. If you eat foods that slow kidney function, the result is water retention. 
The culprit in foods that slow kidney function is something called linoleic acid. You must get this out of your diet so that your kidney function goes back to normal and the water in your blood stream can exit into the bladder. When you stop eating foods with linoleic acid, you will immediately lower the amount of fluid going into your ankles. 
Forms of Linoleic acid
Another name for linoleic acid is Omega 6. You have probably heard of it, but most people are unaware of how toxic it is. A little bit is not harmful to you, but the problem is that the American diet is swimming in it. It is the cause of most health problems in this country. Doctors don’t talk about it much yet, but soon they will, probably in the next 5 to 10 years. I am hoping my patients stay ahead of the curve and start getting linoleic acid out of their diet today and don’t wait for the medical community to catch up on this. I have been telling patients this for over 20 years now, and have helped thousands of people. I read about the early research 25 years ago and have seen this in private practice for 2 decades now. In other words, try this now and see what happens. It couldn’t hurt to try.
What foods have this toxic compound? Grains. What are grains? They are the seed heads on top of grass plants. Examples of plants in the grass family are wheat, corn, rice, oats, barley, rye, quinoa, buckwheat, etc. You need to get this out of your diet. This includes oils made from these grains. The oil is particularly toxic because the levels of linoleic acid are even higher in the liquid form.
                                                      “Stop eating grass seed.”
Caveman diet
Before modern agriculture, seeds of grass plants (grains) were only ripe for about 2 weeks out of the year. And you had to walk far and wide to find these plants here and there. When you found some grain, it had a thick outer coating that made it very difficult to chew. The amount of grain that people ate before modern agriculture in a whole year is the amount that people eat now in one day. People eat a year's worth of grain every single day of the year for years, and years, and decades. That means they are getting far too much linoleic acid. The human body was not designed to handle the mass production of grain that is the result of modern agriculture. 

Why is linoleic acid so bad for you? When you eat grain, linoleic acid levels go up. Cell walls in the body are normally tight and round, like a balloon. But linoleic acid has a strange effect on cells, making them look like a half-deflated balloon, wrinkled and misshapen. The cell walls are involuted instead of smooth. Receptors or “doors” in the cell wall that allow substances to enter the cell should be sticking out of the tight cell wall, but now become buried in the folds and wrinkles of the cell wall. Receptors become inaccessible. 
Pathway of becoming insulin resistant.
Now things floating out in the bloodstream cannot enter the cell. 
The most important receptor in the cell wall is the insulin receptor. Insulin floating in the blood stream connect with the insulin receptor acting like a key in a lock. After they connect together, the “door” of the cell wall opens allowing sugar from the blood stream to enter the cell to be used as energy or stored as body fat. Sugar cannot get through the doorway of a cell unless insulin (the key) and its receptor (the lock in the door) link together. But in the presence of linoleic acid, the configuration of the cell wall changes and the insulin receptor is hidden and inaccessible in the folds and wrinkles- there is no way for insulin to connect to the insulin receptor. They are physically kept apart. The door stays locked and the sugar remains in the blood stream. 
Meanwhile, the pancreas keeps producing insulin even though there’s plenty of it already, because the blood sugar never goes down. The poor pancreas keeps pumping insulin out because it can only detect blood sugar level, not blood insulin level. The pancreas does not get the message. Because the pancreas keeps pumping out the insulin, the result is sky high insulin levels. Insulin acts directly on the kidney to slow kidney function down resulting in water retention. And, you guessed it, swollen ankles.
You can eat grains when you are young and the body can compensate. You can exercise and run like a maniac to try to burn off all the extra blood sugar. That will lower the insulin levels. But after your joints are shot from all this wear and tear, you can’t keep it up. After age 40, it’s time to cut back. And by the time you are 60, you must get linoleic acid and therefore, grains, out of your diet entirely. When you do, your health will improve radically. Patients are always so amazed at how they feel when they do this. 
The most important thing to stop today, right now, is bread. Pasta is also bad, but easier to give up. 
Items that have Omega 6 acid in them.
Whole grain bread is not a good source of fiber compared to vegetables, not to mention that there is no such thing. Whole grains are hard as rocks. Instead, there is white bread which is extremely processed and “whole” grain bread which is highly processed white bread with a tiny amount of fiber. 
 Flour is so devoid of nutrients that the government has to force commercial bread makers to add vitamins. But Americans are very addicted to bread and other products made with flour and there’s no money to be made in advising people to stop.  The government is very invested in the grain industry, so I don’t see the FDA telling anyone about the toxic effect of grain anytime soon.

Otto gives up bread.
Before I go on, I’ll tell you a quick story. One day, about 20 years ago, a new, elderly patient came in, sent from the endocrinologist. His name was Otto. He was told that he needed foot surgery for a very painful lesion on the bottom of his foot that had been there for years, getting worse and worse until he couldn’t walk and was desperate. The orthopedic surgeon had booked him for heel bone surgery in a few weeks. Luckily, he saw Dr. Smith, the endocrinologist, before the surgery. Dr. Smith wasn’t happy to hear about the upcoming foot surgery because Otto had multiple health problems including diabetes and heart disease. Dr. Smith sent the patient to me for a second opinion.
Otto had very swollen feet and ankles and a corn on the bottom of the heel from too much pressure of the swollen feet against his sturdy, Norwegian shoes. I trimmed off the corn, put on a bandage, and told him that he needed to get rid of some of the edema and in order to do that he should stop eating bread. “WHAT?!! I’m Norwegian! We eat bread with every meal! I could NEVER give it up. What would I eat otherwise?” So, I told him some things he could eat, I didn’t tell him the whole plan; he was overwhelmed and unhappy just from hearing that he had to stop eating bread. 
He wasn’t sold on the quitting bread idea sitting there in the chair, but when he stood up, he couldn’t believe that for the first time in many years, he could walk with no pain. To him, it was a miracle. He was so happy to be able to cancel the heel bone surgery he became more willing to consider quitting his bread habit. I told him to come back in three months, just to make sure that the corn didn’t come back.
Three months later, I saw Otto again. A lot of the swelling in his feet was gone, the corn had not come back, and he had lost a lot of weight. He told me that he had just come directly from Dr. Smith’s office. He told me that Dr. Smith was pretty amazed with the weight loss and Otto gave me the following report: 
Dr. Smith had said, “Otto, I have been treating you for over 20 years and nothing I could say to you could get you to lose weight and today you come in 30 pounds lighter in three months. What the heck happened? How did you do it?”
 “Oh, it was simple, Dr. Smith, I went on the Dr. Janson diet.” 
“What? What is the Dr. Janson diet?”
“You sent me to Dr. Janson.”
“Wait, you mean the foot doctor, Dr. Janson? So, what is this diet?”
“Oh, it’s a fantastic diet because you can eat anything you want but the only thing you can’t eat is bread.” 
“Otto, are you kidding me? You lost THIRTY pounds by just giving up bread?!”
Otto repeated this whole conversation to me. We both were laughing at how shocked the endocrinologist was. I thought it was so funny, because the plan involves more than just giving up bread, but with Otto, that’s all it took. I’m telling this story to make a point, that giving up bread is the most important thing (bread being slices, and muffins, bagels, pasta, and pretzels.)
I’ve explained how linoleic acid makes you insulin resistant, but another problem is that flour is a form of starch and starch is a long, long chain of sugar molecules bound tightly together. Starch has so much sugar, so tightly, densely packed, that you can no longer taste the sweetness of it. If you eat regular sugar, your blood sugar goes up, but in an hour or two, it’s going back down again. But if you eat starch, it will take many hours for your blood sugar to go down. The long chain of thousands of sugar molecules has to peel off each molecule of sugar, one by one, from the mile long chain before your blood sugar finally goes back down. 
There is a way to compare all foods in this regard, it’s called the Glycemic index. 
Glycemic index reader
Glycemic index is a percentage of the rise in blood sugar 2 hours after eating a particular food. The rise in blood sugar after drinking pure glucose sugar drink is given the index of 100%. Broccoli, for example has a glycemic index of 15. That means your blood sugar 2 hours after eating broccoli is only 15% of the rise in blood sugar compared to drinking the sugar water. Another example: A big Snickers candy bar has a glycemic index of 45%, so about half of the pure sugar drink. But now.... are you ready? Can you guess the glycemic index of white bread? You know where I am going- it's 100%! As a matter of fact, too bad they can’t give a number higher than 100% because the blood sugar will STAY up longer after eating bread while blood sugar goes down in 2 hours after drinking the sugar water. Even the “healthiest” whole grain bread has a whopping glycemic index of 85%. “Whole” wheat bread has more fiber than white bread, but it’s not really very different. They both have a lot of sugar. One slice of the healthiest bread has twice the sugar effect of a big candy bar. Think about it, candy bars are healthier for you than the healthiest “whole” grain bread. 

Now, let’s look at exactly how bread makes your feet swell. When you eat bread, the individual sugar molecules are peeled off the long chain of starch. These sugar molecules join a long procession that files into your blood stream. The buildup of sugar causes a process called oxidation and too much oxidation (oxidative stress) is not healthy, it is a destructive process causing arteries to plaque up with cholesterol, heart disease, and cancer. The body needs a way to decrease the oxidative stress of sugar. 
Here’s an example you will be familiar with: When you peel and slice potatoes, but then leave them out on the counter for a couple of hours and come back, what has happened to the potato slices? They have turned brown. That is an example of the oxidation of sugar. What can you do with those potato slices for a few hours to prevent them from turning brown? You can put them into a bowl of water. Your body does the same exact thing when blood sugar is going way up for hours. Your body retains water. All that extra water can dilute the sugar and reduce the toxic effects of oxidative stress. Water retention is an adaptation to lower the unhealthy effect of high blood sugar. 
How does high blood sugar make you retain water? Insulin does this. Insulin is a hormone produced by your pancreas when blood sugar goes up. Insulin helps sugar leave the blood stream and enter cells where the sugar can be used for energy or be stored as body fat. Insulin also has a direct effect on your kidneys, slowing kidney function down. Normally, the kidney removes water from your blood stream, but when Insulin hits the kidney, the kidney function goes down, and the water stays in the blood stream, diluting the sugar with all that extra water and this lowers the oxidative stress. This is just like putting the potatoes in water. Retaining water is a survival tactic against the onslaught of toxic levels of sugar. 

        “If you were a camel, your hump would be your ankles.”

The extra water in the blood stream pushes out from capillaries, the tiny arteries in your feet and ankles. The fluid is pushed between the cells and cannot exit as quick as it comes in, so you begin to have swelling, like Otto. To review, bread equals tons of sugar into your blood stream for hours, insulin levels go through the roof, insulin shuts down the kidneys, the water that should have left via the kidney starts building up in the blood stream until it starts leaking out of the capillaries of the feet and ankles. You can understand that sugar is bad, but starch is worse because it stays in your blood stream converting into sugar for hours and hours. 
You can recall that I was telling you that grains have linoleic acid which hides the insulin receptors, making you insulin resistant. Now, keep in mind that grains also have an enormous sugar load that lasts for hours. Two things are happening at the same time. Sugar in your blood stream is going way up while at the same time, the way out of the blood stream is blocked. The result is very high insulin levels. High insulin levels, pre-modern agriculture, were never normal. 
While bread is the biggest source of toxic levels of linoleic Acid, all grains should be avoided. Instead of eating grass seed, which is what grains are, eat food. Food is something that you can find on a farm that you pick and can put right in your mouth and eat, like broccoli, spinach, eggs, berries, yogurt, meat, nuts, avocado, olives, and a thousand other things. What can you eat? You can eat real food. There are no bread trees in nature. Leave the cereal and oatmeal for the horse. The crows can eat the corn and rice. In fact, birds are the only animals on the planet that can metabolize grains. 

Summarizing the effect of bread on your body:
1)  Oxidative stress- Sugar is toxic so your body retains water to dilute it.
2)  Glycemic Index- Bread is starch and delivers sugar into your blood stream for hours. This 
     makes insulin levels skyrocket. 
3)  Linoleic acid- AKA Omega 6 deforms cells to make them insulin resistant resulting in high 
     levels of insulin in your blood stream. The high level of insulin stops your kidneys from 

Foods made from grain to start cutting back on and eventually avoid: 
Bread, bagels, muffins, cake, cookies
Pasta, macaroni, couscous
Crackers, pretzels, wheat chips, pita, wraps
Breakfast cereal
Granola, granola bars
Corn, corn oil, corn chips, popcorn, tortilla
Rice, rice cakes, rice pudding, brown rice, rice-like grains
Oats, oatmeal
“Vegetable” oils like soybean, sunflower, corn, and peanut

Breaking the Addiction:
Now, I know what you are thinking: you are thinking the same thing that Otto was thinking 20 years ago. What? Those are all my favorite foods! They are starchy, which means they are dense forms of sugar and sugar is just as addictive as cocaine. The Romans knew this. The Romans knew that the crowds could not be controlled with “Broccoli and Circus”. The leaders of the church in the Middle Ages could not influence people with a prayer for our daily broccoli. 
The sustained sugar that comes from starch causes the addiction center of your brain, the GABA receptor to switch on and give you some happy hormone reward in the form of dopamine.
GABA Receptor
Yep, you’re probably addicted to dope if you find the idea of giving up bread a horrifying one. You will have to reduce the amount of bread you are eating a little bit each day and don’t beat yourself up if you slip up and succumb to it. It is very difficult to kick the bread habit. Just do the best you can to get all grains out of your diet little by little. Even cutting back a little will have a good effect on the ankle swelling and when you see this, it will give you the courage to keep at it. You will see the edema going away and you will believe this, and it will give you conviction. Eventually, you will keep grains out of your diet and stick with old fashioned food that humans have eaten long before the commercial industry of grains got us hooked.  

Just a spoonful....
You have probably surmised that sugar is also bad, it’s the simpler form of starch, so not as bad, but far from good. Sugar takes the form of cake, cookies, candy, donuts, ice cream, and cupcakes. Don’t ever have this stuff in your house. It’s so addictive, there is no willpower on earth that can stop you from grabbing some cookies around 10 PM. Try to get family members to keep the sweets out of the house. It’s not good for them, either. 
The insulin resistant cycle
Replace sugar with healthy treats like green grapes, green apple slices, low-salt cheese, no salt nuts, a veggie tray with low fat Ranch dressing, a slice of cantaloupe, or sliced strawberries with a big dollop of whipped cream. 
A book I highly recommend is “60 Ways to Lower your Blood Sugar” by Dennis Pollack. That book is great. As you read it and start adopting some of the 60 tips, you will begin to lower your blood insulin level which will restart your kidneys, they go back to pumping the water out, and lower the water retention. Get the sugar and grains out of your diet, and your kidneys will love you for it!
Please buy the real book(not the e-book): “60 Ways to Lower your Blood Sugar”, so you can write in the margins, make notes, and underline things that will help you. That’s a fantastic way to help in reducing the edema. Getting the three “White Powders” (starch, sugar, and salt) out of your diet will help your kidneys function better and give your poor feet a chance.

The last thing to avoid is salt. You probably already know this. Salt slows kidney function and causes water retention. You may not have noticed that bread causes swelling because it happens slowly, but you have probably noticed the effect of salt on the swelling of the ankles because you see it right away. Your shoes feel really tight and you realize that you shouldn’t have had that pastrami sandwich. 
What you may not know is that salt can be hidden in a number of foods. Try not to eat processed food, deli meat, canned soup, processed meat like hot dogs and bacon. When you go grocery shopping, stick to the outer most aisles where the fresh, non-processed foods are. 
Eat fresh meat and fish. Avoid commercial sauces, dressings, and condiments. Instead use olive oil and apple cider vinegar, lemon juice, garlic powder, and pepper. 
Replace salt with other flavors. Fresh basil is always delicious. You can buy these little plants in the grocery section of the supermarket. Fresh lemons are great, adding fresh lemon juice to salads and steamed broccoli, and fish, and chicken instead of using salt. Experiment with different spices to bring out the flavor of food while cutting back on salt. 

Exercise and Motion:
Dr. James Levine, from Texas is a well-known proponent of a healthy lifestyle.  He coined the phrase that I hear so much at medical conferences: 
 “Sitting is the new smoking.”
What that means is that, in the past, everyone knew that smoking was bad for your health. The new research shows that, believe it or not, sitting too much will shorten your lifespan more than smoking will! Dr. Levine noted that humans never had chairs until recently in history. There are people on the earth now that live in habitats with no chairs. They squat, sit on a rock, or sit on the ground. None of those things are particularly comfortable and after a short while, you would want to stand up and maybe walk around. But now we have comfy chairs and televisions and computers so we can sit all bent up all day.  
Recall that I asked you, if the heart pumps the blood to your feet, what pumps it back up? The answer is skeletal muscles. These are called ‘voluntary’ because you have to think about making them work. Involuntary muscles, like those in your heart, work without needing you to think about it. You have to have a plan to keep those skeletal muscles working. If you don’t think about moving around, you can sit for hours binge watching Star Trek. 
I recommend a FitBit. 
FitBit example
This is an inexpensive device (about $70) that you wear on your wrist all the time, even when you are sleeping. From 9 AM to 6 PM, every hour, the Fitbit will vibrate if you have been sitting too long. When you feel the vibration, it reminds you to stand, up and move around. You can actually just walk in place. After you have hit the 250-step mark, the Fitbit will again vibrate to tell you that you have reached this goal. This happens to me almost every day, I’ve been sitting too long. I am very appreciative to my FitBit, and when it vibrates, I stand up and march in place, or take a little walk in the hallway. 
When you walk and move around, the skeletal muscles push on your veins, getting blood moving. There are valves inside the veins that keep blood moving in one direction, back up the leg. This creates a negative pressure that sucks blood up. Think of it like a vacuum cleaner for your ankles. This is how walking makes swelling go down. 
There’s an added benefit. The heart does not need to work as hard when your leg muscles are working. Your heart gets a well-deserved break. Your blood pressure becomes better regulated when the heart has this mechanical advantage. 
So please get a FitBit. The Apple watch doesn’t seem to inspire the amount of compliance that the FitBit does. Also, I can look at your phone to check your progress. The FitBit app is very easy to use, and easy for me and the patient to check the results. 
If you are sitting, try not to cross your legs. The best position is straight out in front of you. I don’t really like reclining chairs. They are a little too comfortable! Remember, the best thing is to get up periodically, every 15 minutes or so, and walk around, even if it’s only for a few minutes. Tapping your foot while sitting is better than not moving. Tap the left foot, then right, then left, etc.
stationary bike is very good. Perhaps you can consider getting one. Remove the big reclining chair and put a bike there. Pedal at a low, easy setting for at least 10 minutes a day, every day. No exercise beats this, rotating around the pedal and pushing. See if you can find a bike in your local community center or in your apartment building, or maybe at a friend’s house. You using your friend’s dusty bike will make them do it, too. Win win. 
An exercise that I like is to hold on to the counter or a chair, and flex one leg behind you, like a horse kicking. Put it down and then do the other leg. Do each leg 10 times. Then, while still holding on to the counter, stand on tippy toe 10 times, holding it up for about 5 seconds each time. Try to do these exercises at least twice a day, but 3 times is better, say just after each meal so you don’t forget. The idea is that you are helping pump that blood back up against gravity and creating the negative pressure at the ankle that helps soak up the swelling. Any time you move your legs is a big help. Make up your own exercise plan. 
Stretching can help, too. Reach down while sitting with your legs straight out and bend over, stretching out your calf and hamstring muscles. This tension can also get blood moving like squeezing a sponge. 
I also have a YouTube video specifically for edema exercises:
Click here for "Edema exercises YouTube video":

Drinking Water:
There isn’t a hard answer as far as how much water to drink in a day. Most doctors say at least 8 glasses of 8 ounces of water. I would say, try to drink at least 8 big glasses of water a day, about 16 ounces or better per glass. I realize that this will make you urinate more, but that will make you walk more! If you’re going out, drink less and drink more when you come back. Drinking more water is not as bad as the urgency caused by taking a diuretic.  
Keep Hydrated!
Of course it seems counterintuitive to drink a lot of water when you are retaining water! But what you are doing is making it easy for your kidneys to work. Plain, clean water is an easy job for your kidneys. They work more efficiently and blood flow is better. Again, you are creating this negative pressure that vacuums the swelling out of your ankles. You may also find that your blood pressure is better regulated as well. Your doctor may notice this at your next checkup and be very pleased. 
It helps to avoid diuretic beverages. Minimize caffeine- coffee and tea, keeping it to two cups or less a day. Avoid alcohol all together or at least try to drink as little as possible. Alcohol is a diuretic, and also it is fermented sugar which is unhealthy. At some point, consider the inevitability that you need to quit alcohol. I recommend a Soda Stream device, carbonated water with sugar free flavors and put in a mess of ice cubes and a slice of lemon. That’s a delicious, healthy drink. 

We need to sleep at least 8 or 9 hours per night. If you are over 70, you will need more sleep- at least 10 hours. While you sleep, healing takes place. You are fasting and the kidney has the chance to “clean house” rather than processing food all the time. You detox while you sleep. Your brain produces a hormone called melatonin from your pineal gland. 
Sleep for your immune system.
The amount of melatonin produced goes up and down in cycles. The fluctuating amount controls the 5 phases of sleep, REM, NREM, etc. During each phase, a different thing happens. For example, during REM (Rapid Eye Movement) sleep, you are dreaming, but paralyzed so that you don’t act things out and wake up or hurt yourself. When you are paralyzed, you cannot move, muscles cannot contract. This is when metabolites and broken cells can be reabsorbed by the blood stream and muscles can heal. 
Be careful not to take melatonin pills because it will ruin the up and down cycles of your own melatonin produced by the pineal gland. When that rhythm is lost, immune cells, such as NK (natural killer) cells, do not proliferate, and this will interfere with healing. 
The function of natural melatonin!
The pineal gland works on a circadian rhythm, the rhythm of sunrise and sunset, the time between night and day. It’s best to go to bed no later than 10 PM. If you are over 70, I would recommend a 9 PM bedtime. It’s also important to go to bed at the same time every day to help your pineal gland know when to start making Melatonin. Get up by 8 AM because sleeping later can make you auto immune, I.e., your immune system goes into hyperdrive when melatonin quits because it is daylight, but you are still asleep. 
If you have the FitBit you can check the app on your phone to see how much sleep you got. The goal is at least 8 hours, 9 is better, and over 70 years old, try to get 10 hours of sleep per night. If you can’t sleep, just lie there and count while you breathe in a regular rhythm. You don’t need to be fast asleep to get rest and for the immune response that to take effect. Don’t get up other than to go to the bathroom, and don’t put on any lights, no TV, no cell phone, and no computer. 
Make sure your bedroom is pitch black. This will encourage your pineal gland to produce the maximum amount of Melatonin for the maximum healing effect. Cover all those little lights on the computer or device. Night lights in the hall and bathroom should be red so you can trick your pineal gland, “What light? This is just sundown!” This is why digital clocks have red numbers. 
A good night’s sleep will help your kidneys work better, and have your legs heal and reabsorb the fluid between cells in your feet and ankles. You have probably already noticed that your ankles are smaller in the morning. It’s partly because of lying down and reducing the effect of gravity, but if that’s all there was to it, the swelling would be back in a few minutes after walking around. But you have probably noticed that it takes several hours for the feet to return to the maximum size. So, try to get a good night’s sleep, go to bed by 10 PM, and let nature heal your legs while you are sleeping. 

 Medical grade socks are tight and hard to get on. Patients have to use silk scarves and special rubber gloves to get them on. It’s a real ordeal that can take 10 minutes just to get your socks on- very aggravating. In the afternoon, they can become uncomfortable. They are not cheap. Jobst stockings are about $70 for a pair. 
Almost all patients that come in with ankle edema have tried the medical stocking, but almost no one keeps wearing them. 
Instead, I recommend what’s called “airplane socks”
Airplane socks
You can get these in any pharmacy. These are very mild compression and work, not by being tight, but by having a varied level of compression from toe to knee, (tighter near the toe and getting quite loose as they go up.) Airplane socks are in a box and at the top there is usually a little emblem of an airplane. Obviously, they are designed for flying on an airplane, to prevent swelling, but they will work great for you on the ground.
The mild compression is really all you need to support your veins as long as you are not sitting all day. Remember to get up and walk around about every 15 to 30 minutes.
Airplane socks are easy to get on. You should put them on as soon as you wake up and wear them all day until you go to sleep. 
They don’t hurt in the afternoon, instead, patients tell me that they feel like they can walk further in these socks. This is probably why the Hanes product is called “Sheer energy”. 
Airplane socks are not expensive compared to medical socks. Instead of paying $70 per pair, the airplane sock is about $10. 
Please try to buy at least 6 or 7 pairs. They come in different colors and thicknesses so you can find some that you like. 

Fish oil capsules are very good, salmon oil being the best. They contain linolenic acid or Omega 3. Omega 3 helps make your insulin receptors more sensitive. That means that insulin can leave your bloodstream before it shuts down your kidney function. Remember that Omega 6 which is in high quantities in grains, makes you insulin resistant, which is very bad. Omega 3 does the exact opposite. Keep your Omega 3 level high and your Omega 6 level as low as possible. This will encourage kidney function and flush away the swelling in your ankles. 
Omega 3 in fish and fish oil capsules has another benefit- it reduces your body’s inflammatory response which is what the swelling is. Swelling can go down in joints, too, lessening pain while walking, which encourages walking. And when you walk, you push the swelling out. You see the picture, one thing adding to the next to get rid of the swelling. 
I also like to prescribe a specialty vitamin for inflammation. 
EBM Vitamins
The company I like is EBM Supplements. The vitamins are high quality and made in the US under strict guidelines. After I write the prescription, it comes in the mail to your house and you can refill it on your own. 
The supplement I prescribe has turmeric, SAM-e, hyaluronic acid, collagen, and Boswellia. Because this supplement lowers the inflammatory swelling of the ankles, it can, of course, help with the swelling in your joints. This will decrease arthritic pain making it easier to walk. The idea is to decrease the need for Tylenol and ibuprofen, Motrin, and Advil, which slow kidney function, and actually can damage your liver as well. I have given this supplement to many patients and seen great results, the patient went from taking pain killers every day, to taking them rarely, maybe once or twice a month. Taking less medicine decreases the workload of the kidney. The better your kidney function- the less swelling in the ankles.
Swollen feet cannot be fixed overnight, but each step you take is another step towards a longer life. We hope you find these tips helpful!
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