Canada’s New Food Guide and Lymphedema

Canada’s New Food Guide and Lymphedema

I was asked to contribute an article to Pathways Magazine – a publication of the Canadian Lymphedema Framework. The article is on Canada’s New Food Guide and how that is applicable for people with lymphedema. This Cancer Bites blog post has been re-printed with permission from the Canadian Lymphedema Framework.

Canada’s New Food Guide and Lymphedema

Introducing new recommendations for healthy living

A dietitian’s take on this healthy approach to wellness

by Jean LaMantia, RD

After twelve years, Health Canada released its latest version of Canada’s Food Guide and I must say, I like it! The 2019 version of the guide emphasizes a plant-based diet, which backgrounders research for the guide has shown will help to protect you from disease. Like past guides, if focuses on disease prevention. Gone is the emphasis on ensuring micronutrient intake requirement form the 2007 version of the guide.

It is not without its criticism. It has been accused of being too expensive, (although researchers at Dalhousie and Guelph Universities determined that it is less expensive to follow than the 2007 version, as long as you aren’t wasting the perishable fruits and vegetables on your plate (Charlebois, 2019); out of touch with families that don’t cook all meals from scratch, (education, learning new skills and practical recipes will help with this) and being low in calcium (education about plant based calcium and vitamin D sources and supplement will be needed) (St Michael’s Hospital Dietitians).

The 2019 version of Canada’s Food Guide has a focus on a plant-based dietary pattern.

Canada's Food Guide 2019 Version
The 2019 Version of Canada’s Food Guide is an anti-inflammatory diet

Could Canada’s New Food Guide Help My Lymphedema?

As a registered dietitian, what I see when I look at our new food guide is an anti-inflammatory eating pattern. An anti-inflammatory diet is low glycemic (fewer refined foods, more whole foods), high in omega-3 fatty acids (salmon and other cold water fishes, flax and walnuts) and lower in omega-6 fatty acids (meat, eggs, dairy, corn and grapeseed oils) and rich in polyphenols (beneficial plant nutrients found in fruits and vegetables) (Ricker, 2017).  I see this as a beneficial plan for your overall health and your lymphedema.

What is Inflammation?

I think the best way to understand inflammation is with this analogy:

Let’s say, you get up in the morning and look out your window. You see a car accident on your street so you pick up the phone and call 9-1-1. The first responders all arrive – the paramedics take care of the injured parties, the firefighters clean up any spilled fuel and put out any fires, the tow truck takes away the damaged vehicle and the police get the traffic moving again. In a few hours, you look out your window and your street is back to normal. Think of this as acute inflammation, acute means ‘short term’.

 

Let’s think of how this works in your body. If you cut your finger, your body calls cellular 9-1-1 and all of the cellular first responders come to the scene. You know there are there because you see the signs of inflammation – heat, pain, redness, swelling and loss of function. After the injury heals with the help of those cellular first responders, they die or go to other areas of the body and don’t hang around. After a week or so, your finger is back to normal. This is acute inflammation – it’s a healthy functioning system and is part two in the four- part wound healing process.

 

Now let’s go back to that scenario in the street. There is a car accident in front of your house and you called 9-1-1. This time the first responders arrive but they don’t leave. Now what happens? The pedestrians slow down to take a look and the sidewalk becomes congested, same with cars that slow down to see what is going on and traffic starts to back-up. Some drivers start honking which makes the neighbours and pedestrians unhappy. When it’s garbage day, the residents put their garbage out, but because of all the congestion with the first responders that haven’t left, the garbage truck can’t get down the street to pick up. Then that garbage starts to smell and you’re getting more cockroaches, rats and racoons on the street. What was once a healthy functioning system, just be staying too long, has become a breeding ground for dysfunction and disease. Think of this as chronic inflammation, chronic means ‘long term’.

 

You may have an injury or invader somewhere in your body – it could be a sun burn, a cut, a virus and your body calls cellular 9-1-1. But if those cellular first responders come to the scene and don’t leave it creates an environment called chronic inflammation. This is an environment that cancer cells love, it is also an environment that allows heart disease, Alzheimer’s and other chronic diseases to take hold.

 

What Does Chronic Inflammation Have to do with Lymphedema?

In research published in 2015, and 2017 physicians from Memorial Sloan Kettering Cancer Center point out that not everyone who has lymph nodes removed develops lymphedema. They speculate that lymphedema develops after a sequence of events that happens after lymph node removal which leads to lymphedema. They speculate that the sequence of events is the development of inflammation (Ghanta, 2015) and (Ly, 2017).

 

In an article published in 2011, two Yale University professors proposed a model of what happens in the body when lymphatics don’t work properly in the presence of metabolic syndrome (Jones, 2011). Metabolic syndrome is a collection of risk factors including: abdominal obesity, dyslipidemia (high cholesterol), hypertension, insulin resistance and inflammation. Since being overweight can be a risk factor for lymphedema and lymphedema can lead to weight gain, it’s not uncommon to see metabolic syndrome in people who have both lymphedema and obesity. You can see in the list below that lymphedema, increased body fat and inflammation are all part of this model.

  1. Lymphatic vessels don’t function properly
  2. Lymphedema and chyle build up
  3. lymphedema developers and chyle leaks into surrounding tissue
  4. Increased growth of fat tissue
  5. Secretion of inflammatory measurements from fat tissue
  6. Cellular 9-1-1 cells arrive at fat tissue and chronic inflammation leads to lymphangiogenesis (creation of new lymph vessels)
  7. lymphatic vessels formed during inflammation are flawed
  8. Go to Step #1

Based on a proposed working model of how dysfunctional lymphatic vessels contribute to metabolic syndrome and cardiovascular disease (Jones, 2011).

What is an Anti-Inflammatory Diet?

Our food is made up of nutrients and some of these nutrients contribute more inflammation to the body and others reduce the inflammation (called ‘anti-inflammatories’). There have been a variety of studies that have shown that by changing what we eat we can change the level of chronic inflammation in our bodies – as measured by various blood tests including hs-CRP, CRP and IL-6 (Gotsis, 2015). 

What Nutrients and Foods are Anti-Inflammatory?

Anti-inflammatory nutrients include omega-3 fatty acid, antioxidants, vitamins B6, B12 and folic acid, vitamin K, selenium, zinc and various phytochemicals. Since we eat foods and not nutrients, here are some foods that are considered anti-inflammatory:

  • Omega-3 rich fish including salmon, sardines, herring, mackerel and rainbow trout
  • Vegetables, especially carrots, sweet potato kale, broccoli and leafy greens
  • Fruits, especially citrus, peppers and berries, melon and pineapple
  • Nuts, especially Brazil nuts and almonds
  • Oils high in omega-3 and 9, especially olive, canola and high oleic sunflower
  • Herbs and spices, especially turmeric, garlic, ginger, onion and chili peppers

 

What nutrients and foods promote inflammation?

Nutrients that promote inflammation include saturated and trans fats, omega-6 fatty acids, refined sugars nd high glycemic foods. Here are foods that could be contributing to inflammation (Ricker 2017, Gotsis, 2015, DiNicolantonio, 2018):

  • Meat, especially organ meats, eggs and high fat dairy
  • Processed foods, especially sugary fatty junk food
  • Oils high in omega-6 or saturated fats especially, coconut, palm oil, corn and grapeseed

With its emphasis on filling half of your plate with vegetables and fruits, choosing whole grains, less processed food and including fish and plant-based proteins, the 2019 version of Canada’s Food Guide is a great model of an anti-inflammatory eating pattern.

 

Bottom Line for Canada’s New Food Guide and Lymphedema

I love the simplicity but also amazing potential that this new food guide has for the health of many Canadians including Canadian’s with lymphedema. I believe that if you begin to make changes to your usual eating pattern that you may experience a reduction in chronic inflammation throughout your entire body and while untested as yet, this reduction in chronic inflammation may have a beneficial effect on your lymphedema and/or may help to offset other health risks posed by the inflammatory lymphedema environment.

With the publication of my latest book The Complete Lymphedema Management and Nutrition Guide, I hope that the time has now come to begin a discussion and research into diet and lymphedema. As a registered dietitian, I believe that nutrition can make a difference in your health and I believe this is true for lymphedema too.

The Complete Lymphedema Management and Nutrition Guide: Empowering Strategies, Supporting Recipes and Therapeutic Exercises

I will be speaking about this topic at the 2019 National Lymphedema Conference November 1-2, 2019 at the Toronto Marriott Airport Hotel and I look forward to meeting you there. The session that I will present will include a discussion about anti-inflammatory diet as well as other strategies that you can incorporate into your eating routine to compliment the physical therapies that you use to manage your lymphedema.

 

“Currently, lymphatic biology is experiencing an enormous renewal in interest, and the importance of lymphatics in disease is gaining recognition outside of the fields of lymphedema and cancer biology, to now include acute and chronic inflammation.”

 

– JS Alexander, VC Ganta, PA Jordan and MH Witte,

Louisiana State University Health Center and University of Arizona

If you like this article, read the article I wrote on Nutrition for Lymphedema for the 2017 edition of Pathways Magazine.

Cover of Pathways Magazine, Summer 2017
The Summer 2017 issue of Pathways Magazine featuring a Nutrition for Lymphedema article by Jean LaMantia, RD

References:

For more information on Canada’s food guide, including a history of the food guides in Canada, the evidence behind the food guide and recipes check out https://food-guide.canada.ca/en/

Alexander JS1, Ganta VC, Jordan PA, Witte MH. Gastrointestinal lymphatics in health and disease. Pathophysiology. 2010 Sep;17(4):315-35.

Charlebois, Sylvain, Smook M, Wambui B et al. Canada’s Food Guide: Awareness, understanding, affordability and barriers to adoption (preliminary results)

DiNicolantonio JJ, O’Keefe JH. Importance of maintaining a low omega-6/omega-3 ratio for reducing inflammation. Open Heart. 2018 Nov 26; 5 (2): e000946.

St. Michael’s Hospital. Understanding Health Canada’s newest food guide: a Q & A with our registered dietitians. Jan 25, 2019. Accessed May 16, 2019

Ghanta S, Cuzzone D, Torrisi J, et al. Regulation of inflammation and fibrosis by macrophages in lymphedema. Am J Physiol Heart Circ Physiol. 2015 May 1; 308(9): H1065–H1077.

Gotsis E, Anagnostis P, Mariolis A, et al. Health benefits of the Mediterranean diet: an update of research over the last 5 years. Angiology. 2015 Apr; 66 (4): 304–18.

Jones D, Min W. An overview of lymphatic vessels and their emerging role in cardiovascular disease. J Cardiovasc Dis Res. 2011 Jul;2(3):141-52.

Ly C, Kataru R, Mehrara B. Inflammatory Manifestations of Lymphedema.

Alexander JS1, Ganta VC, Jordan PA, Witte MH. Gastrointestinal lymphatics in health and disease. Pathophysiology. 2010 Sep;17(4):315-35.

Gotsis E, Anagnostis P, Mariolis A, et al. Health benefits of the Mediterranean diet: an update of research over the last 5 years. Angiology. 2015 Apr; 66 (4): 304–18.

Reinagel, M. Inflammation Free Diet Plan. McGraw Hill. 2006.

Ricker, MA and Haas WC. Anti—inflammatory diet in clinical practice: A Review. Nutrition in Clinical Practice. 2017 Jun; 32 (3):318-315.