Why Am I Holding Extra Water? And Can Lymphatic Drainage Actually Help?

Feeling puffy after a salty meal, a higher-carbohydrate weekend, a long flight, a hard workout, or around your menstrual cycle is common. It’s also one reason people seek out manual lymphatic drainage (MLD). But here’s an important distinction:

Not all “water weight” is lymphatic fluid sitting in your tissues waiting to be drained.

Water exists throughout the body in different compartments and is regulated by several systems—including the kidneys, hormones, blood vessels, muscles, and lymphatic system.

Depending on why your body is holding additional water and where that water is located, MLD may help with movement of interstitial fluid—or may have very little effect at all. Let’s talk about common reasons for extra fluid and which can be helped by MLD.

Carbohydrates and Glycogen

One of the best examples is carbohydrate intake. When we eat carbohydrates, they are broken down into simple sugars such as glucose:‍ ‍Some glucose is used immediately for energy. Some can be stored primarily in the muscles and liver as glycogen. Glycogen storage is associated with increased water storage.

Human carbohydrate-loading studies commonly report several grams of additional water for every gram of glycogen stored, with approximately 3 grams of water per gram of glycogen often used as a general estimate. This is one reason body weight can increase rapidly after increasing carbohydrate intake—especially if you were previously eating a low carb diet. That doesn’t mean you’ve suddenly gained several pounds of body fat, rather an increase in glycogen stores and their associated water.

Can MLD remove it?

MLD would not be expected to meaningfully alter glycogen-associated intracellular water as much of the associated change in water occurs within muscle tissue and cells. MLD primarily influences lymph transport from the interstitial space—the space between cells. It doesn’t deplete glycogen stores or directly remove the water associated with glycogen storage. Decrease stored glycogen to remove that fluid.

Sodium

Sodium is one of the major factors involved in regulating extracellular fluid volume. Your kidneys, along with several hormonal systems, continuously adjust sodium and water excretion to maintain the body’s fluid balance.

Changes in sodium intake and sodium balance can therefore produce temporary changes in body water and body weight.

Can MLD help?

MLD may temporarily influence the movement of interstitial fluid, but it doesn’t remove a high sodium load or override the kidneys’ regulation of sodium and water. For a healthy person, the kidneys ultimately restore sodium and water balance. Returning to your usual sodium intake, drinking normally according to thirst, moving regularly, and allowing time for the kidneys to rebalance sodium and water are generally all that's needed. However, if you have an important event or photoshoot that day, MLD wouldn’t hurt.

Hormonal Changes and the Menstrual Cycle

Many women notice changes in body weight, bloating, breast fullness, or puffiness at different points in their menstrual cycle.

Reproductive hormones influence several systems involved in fluid regulation, including mechanisms controlling sodium and water balance. The relationship between individual hormones and actual fluid retention is complex, but studies have documented measurable changes in body water across the menstrual cycle.

Can MLD help?

If increased interstitial fluid is contributing to the sensation of puffiness, someone may temporarily feel less swollen after MLD. But MLD doesn’t change the underlying hormonal processes responsible for the fluid shift. As those hormonal signals change, fluid balance generally changes as well.

Long Periods of Sitting or Standing

After a long flight, road trip, or day spent standing, you may notice that your shoes feel tighter or that your socks leave deeper marks around your ankles. Normally, the venous system, muscle contractions, and lymphatic system work together to return this fluid toward the circulation. When you’re barely moving for hours, those mechanisms aren’t getting as much assistance from the muscle pump.

Can MLD help?

Yes—this is one situation in which MLD would make physiological sense for temporary puffiness. Some of the accumulated fluid is in the interstitial space—the compartment from which lymph originates. Some of the additional fluid is actually located in the interstitial space—the compartment from which lymph originates.

But don’t discount the other beneficial tool. Movement. Walking and contracting the calf muscles support venous return and lymphatic transport. But if you’re exhausted from the travel and want to have a lymphatic massage to de-puff and promote relaxation, I say go for it.

Heat

Heat causes blood vessels near the skin to dilate dramatically as the body attempts to release heat. These circulatory changes can contribute to increased dependent swelling, particularly in people who are already prone to swelling.

Can MLD help?

MLD may temporarily assist with movement of interstitial fluid when that fluid is contributing to swelling, but it doesn’t eliminate the physiological reason the swelling developed. Cooling down, movement, and allow the body to regulate.

Exercise: A hard workout can temporarily make your weight go up.

Exercise can alter muscle glycogen, cellular hydration, extracellular fluid, and plasma volume. Challenging or unfamiliar exercise can also produce a temporary inflammatory response within exercised muscle as part of the normal recovery process.

Can MLD help?

MLD isn’t necessary to correct the normal fluid changes associated with exercise. Exercise-related changes in body water can involve muscle cells, glycogen-associated water, plasma volume, and temporary inflammatory fluid shifts—not simply an accumulation of excess interstitial fluid that needs to be “drained.” Your body is already equipped to regulate these changes as part of normal recovery.

Inflammation, Injury and Surgery

After tissue injury or surgery, the inflammatory response can increase movement of fluid and proteins from blood vessels into the surrounding tissues. Now we’re talking more directly about interstitial fluid. The lymphatic system plays an essential role in collecting excess interstitial fluid, proteins, and other substances and eventually returning them to the circulation.

Can MLD help?

This is a situation in which lymphatic transport is directly involved in managing excess interstitial fluid, making lymphatic-based treatment physiologically relevant when clinically appropriate.

Understanding MLD And The Fluid it Moves

MLD doesn’t simply “remove water from the body, “ rather it collects excess fluid and proteins from the interstitial space and eventually returns them to the bloodstream.

That’s why MLD shouldn’t be marketed as something that simply “flushes out water weight.”

Not All Swelling Is Normal Water Retention

There is another important distinction. New or unexplained swelling shouldn’t automatically be assumed to be harmless “water weight.”

Swelling can sometimes be associated with medications, venous problems, blood clots, heart conditions, kidney or liver disease, infection, or other medical conditions.

New, persistent, rapidly worsening, painful, or one-sided swelling warrants appropriate medical evaluation rather than simply being treated with massage.

The Bottom Line

If you feel puffy, the first question shouldn’t necessarily be: “How do I drain this fluid?”

A better question is: “Why am I holding more water today, and where is that water?”

MLD can be a useful tool when the physiology makes sense.

References:

Fernández-Elías VE, Ortega JF, Nelson RK, Mora-Rodriguez R. Relationship between muscle water and glycogen recovery after prolonged exercise in the heat in humans. European Journal of Applied Physiology. 2015;115:1919–1926. doi:10.1007/s00421-015-3175-z.

Yoshimura M, et al. Muscle glycogen assessment and relationship with body hydration status: A narrative review. Nutrients. 2023.

Giersch GEW, Charkoudian N, Stearns RL, Casa DJ. Fluid and electrolyte balance considerations for female athletes. European Journal of Sport Science. 2021.

Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2023 Consensus Document of the International Society of Lymphology. Lymphology. 2023;56(4):133–151.

Liang M, Chen Q, Peng K, et al. Manual lymphatic drainage for lymphedema in patients after breast cancer surgery: A systematic review and meta-analysis of randomized controlled trials. 2020.

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