Lymphedema Diet

Lymphedema Diet

Before I can talk about the lymphedema diet, or as it’s spelled in the U.K. lymphoedema diet…I want to begin with a quick background.

What is lymphedema?

Lymphedema is a troubling condition of chronic swelling that can either be primary or secondary. In the case of primary lymphedema it can affect babies, children and adults. It tends to affect women more than men and the onset can be around times of hormonal change.

Secondary lymphedema is the results of surgery, infections, cancer treatment or other souces of damage to the lymphatic vessels or lymph nodes.

Both types of lymphedema have a well-established treatment protocol of physical therapies called Complete Decongestive Therapy. 

What is Complete Decongestive Therapy?

Complete Decongestive Therapy is the cornerstone of treatment for lymphedema and it includes:

  1. Skin care
  2. Manual lymphatic drainage
  3. Compression
  4. Exercise

While lymphedema can occur anywhere in the body, it is most often in the arms or legs.

 

woman with arm lymphedema in one arm
Woman with lymphedema in her left arm and hand. Photo by Ann DiMenna.
woman with leg lymphedema
Woman with leg lymphedema. Photo by Ann DiMenna.

Most resources that provide information on lymphedema state that there is “no lymphedema diet for lymphedema”.


Is There Really “No Special Diet for Lymphedema”?

As a registered dietitian that works with people with lymphedema I’ve seen first hand how diet can help my clients manage their lymphedema.

This Cancer Bites blog post is a comprehensive overview of the Lymphedema Diet or Lymphedema Nutrition that I use when I work with my clients. You will find references throughout as well as a comprehensive reference list at the end of the post.

Use this TABLE of CONTENTS to help you navigate the the information in this post


What are the Components of the Lymphedema Diet?

I have detailed each of the components. I recommend that you implement each of these gradually and monitor your lymphedema. This will allow you to get to know how your lymphedema responds to various aspects of your diet.


Weight Loss

This topic has by far the most research, and most of that is based on weight loss as a risk reduction strategy. I have divided this section into i) Weight loss as Prevention for lymphedema, and ii) Weight loss as a treatment for lymphedema.


Weight Loss as Prevention for Lymphedema

The typical studies in this area are attempting to decipher why some women develop lymphedema after breast cancer surgery and others don’t. The main factors that help reduce risk of lymphedema are (1):

  1. Sentinel node biopsy instead of axillary node biopsy (the fewer the lymph nodes removed the better)
  2. Avoiding post-treatment biopsy
  3. Limiting total dose of radiation treatment to 45-50Gy
  4. Limiting radiation on patients over 55 years of age and overweight
  5. Starting physical exercises a short time after surgery
  6. Manual lymphatic drainage
  7. Compressive bandaging
  8. Daily hygiene
  9. Diet

It’s important to remember that some risk factors are within your control and some are not. Items 1-4 on this list would need to be discussed with your cancer care team. It’s important to remember, that the main aim of cancer treatment is to cure the cancer, not to prevent lymphedema, so some difficult choices need to be made that may put you at risk.

Items 5-8 should be addressed by your lymphedema therapist (make sure you work with a qualified lymphedema therapist). Item 9 is the lymphedema diet, and I will outline my recommendations for that in detail for you below.

I want to point out, that even though the majority of the research in the area of lymphedema risk reduction is done on women with breast cancer, I believe the results are applicable to others who may be at risk from other types of cancer treatment, other surgeries and injuries and possibly even those at risk of primary lymphedema, provided of course, they know they are at risk, which many don’t until lymphedema develops.

As well as the article that I referenced above there were a further 10 articles that I read when researching my book The Complete Lymphedema Management and Nutrition Guide that explored the risk factors for developing lymphedema.

The results were mostly consistent – with the majority showing that being overweight puts you at risk for developing lymphedema. When you scroll to the bottom of this post, you will see a chart that I put together that outlines these studies, I call this chart Appendix 1.

While losing weight can be a lifelong challenge, I suggest you enlist some help and work with a registered dietitian to guide, encourage and support you on your weight loss path.

To find a registered dietitian in Canada, go to the Dietitians of Canada, Find a Dietitian and in the U.S. check out the Academy of Nutrition and Dietetics Find An Expert.

But, keep in mind, both of these tools will find a dietitian that will work with you face-to-face as they search by area, many registered dietitian’s such as myself also provide service over the phone.

If you would like to work with me, either in person in Toronto, or over the phone, then I would be happy to help you achieve your weight loss goals and improve your lymphedema. Whether you work with me or someone else, you are worth this investment in your health. Keep reading to find out the other components of my lymphedema diet.


Weight Loss as Treatment for Lymphedema

What if you already have lymphedema? Will weight loss help you as well? For the answer to this question, there are two human studies that I can cite for you.

Lymphedema Weight Loss Diet Study #1. 

This study was conducted in 2007, in London, England. Twenty-one women with breast cancer related lymphedema were randomly divided into two groups. The first group received a booklet on general healthy eating, this was called the control group. The second group, received dietary advice for weight reduction and were monitored for 12 weeks (2).

In order to be in the study, the participants were overweight. The women who received instruction on a weight loss diet were targeting in the range of 1,000-1,200 calories per day. No exercise or activity instruction or guidelines were provided.

After 12 weeks, the results were tallied. The control group did not lose weight but the women in the weight loss group lost an average of 3.3 kg (plus or minus 2.6 kg) (7.3 lbs. plus or minus 5. 7 lbs.).  These results are pretty easy to understand.

Did the weight loss help the lymphedema?

The researchers calculated a measurement called ‘excess arm volume’. This is the difference in arm volume between the arm with lymphedema and the healthy arm. The group that received the low calorie, weight loss diet (and lost the weight) lost significantly more ‘excess arm volume’ compared to the women who were not on the low calorie diet.

The women in the weight loss group lost 350 ml (12 oz.) of volume from their lymphedema arm compared to their healthy arm. The women in the control group lost 11 ml (2 teaspoons) excess arm volume. You can see what those volumes look like in this picture.

1 measuring cup contains 250 ml of green water the other contains 11 ml of green water
350 ml of fluid (left side) is the amount of fluid volume reduction in the weight loss group whereas 11 ml of fluid (right side) was the amount lost in the control group. Photo by Jean LaMantia, RD

Lymphedema Weight Loss Diet Study #2. 

The second clinical trial on weight loss as a treatment for lymphedema used three different treatments: 1) control group, 2) low fat diet without calorie restriction, 3) low calorie diet (3)

The Results

After 24 weeks there was also a reduction in ‘excess arm volume’ (see above for definition).  But the difference in arm volume didn’t depend on which diet group the women were in, but it did depend on whether the women lost weight or not.

Funny thing is about this study, is that weight loss did not occur as predicted. There were 9 women (60%) in the control group who lost weight. Remember the control group were advised not to lose weight, but I suspect just the idea that they were part of a research study, made them more conscientious about what they were eating and some lost weight. Eighteen women (95%) in the weight loss group lost weight and 13 women (76%) in the low-fat group lost weight.

Weight Loss Mattered, But Diet to Achieve the Weight Loss Didn’t

There was a statistically significant difference in reduction of excess arm volume based on whether there was weight loss and this didn’t matter what diet was used for the weight loss. The bottom line here is diet can make a difference in lymphedema if it can be used to help with weight loss.

Summary for Body Weight and Lymphedema

The Clinical Practice Guidelines for the management and treatment of breast cancer summarizes this nicely “maintenance of ideal weight should be encouraged. Obesity is a contributing factor for the development of lymphedema and may limit the effectiveness of compression pumps or sleeves” (18).


Low Fat Diet for Lymphedema

In the weight loss studies, the participants had their total calories restricted to allow for weight loss and the outcome on lymphedema was measured. In this section, I want to focus on studies that changed that amount and type of fat in the diet – with and without weight loss.

Why Does Fat Matter for Lymphedema Diet?

Before I describe the studies for you, let me explain that the lymphatic system is needed for the absorption and transportation of fats and oils in the diet. After we swallow our food, our body begins to digest it. This means that is breaks it down into its smallest components. Carbohydrate is broken down into simple sugars. Protein is broken down into amino acids and fat and oils are broken down into fatty acids.

Different Types of Fatty Acids

You are probably familiar with terms like saturated, unsaturated, polyunsaturated etc. These are ways to describe the chemistry of the fatty acid chains. Another way to describe fatty acids is based on the length of the fatty acid chain.

This is pretty simple, the chain lengths are either; short, medium or long. A medium length chain is called a medium chain fatty acid, but more commonly a “medium chain triglyceride” or “MCT” for short.

Once the body breaks down the fats and oils into their fatty acids, the short and medium chain fatty acids are absorbed directly from the upper part of the small intestines into the blood stream.

The long chain fatty acids, can’t be absorbed here. They continue to travel down the intestines and are put into a fat transported sphere called a chylomicron and this chylomicron is absorbed through the lining of the small intestines into the lymphatic system.

Yes, the lymphatic system! The long chain fatty acids inside their chylomicrons then travel up the thoracic ducts and enter the blood stream at the left subclavian vein in your neck.

Now that you understand that the lymphatic system is used to transport long chain fatty acids (which is most of the fat in our diet) then these studies that used low fat diets and MCT oil, should make more sense to you.

Low Fat Diet for Lymphedema Study No 1.

Unlike the weight loss studies described above, which were clinical trials, this is a case study. As far as research goes, case studies are considered the second lowest on The Evidence Hierarchy, but they are easy to read and understand and provide a window into the usefulness of low fat diet and lymphedema.

The case study involved two women, both with primary lymphedema in their right leg. The authors were based out of the Hospital Ramón y Cajal, in Madrid, Spain and the case was published in 1994 (4).

Patient A was a 30 year old woman who was put on a weight loss, low fat diet plus MCT oil. Patient B was put on a low fat diet plus MCT oil without any calorie restriction (i.e. NOT a weight loss diet). They remained on their diets for 4 months with monthly follow-ups.

For the diet they avoided:
• Fatty meat
• Cheese
• Fatty fish
• Butter
• Oils (except for 1 tsp of sunflower oil per day)
• Other foods containing a significant amounts of long chain fatty acids

salami, cheese and butter
Salami, cheese and butter are example of foods not allowed on the low fat diet. Image by Bruno Glätsch from Pixabay

They were also advised to take a multivitamin-mineral every day. They were allowed to use MCT oil. Here are the results after 4 months on the low fat diet:

Patient A

Weight loss: lost 22 lbs (11 kg)
Reduction in the circumference of the leg without lymphedema: 2 inches (5 cm)
Reduction in the leg with lymphedema: 2.75 inches (7 cm)

Patient B

Weight loss: didn’t lose weight (didn’t need to)
Reduction in the circumference of the leg without lymphedema: 0 inches
Reduction in the leg with lymphedema: 1 inch (3 cm)

Bottom Line from Low Fat Diet Case Study: Patient A lost weight and size in the healthy leg plus lost additional size in the lymphedema leg- we can consider this to be loss of lymphedema fluid. Patient B lost size in her lymphedema  leg after 4 months on the low fat diet plus MCT oil despite no weight loss.

Pretty fruit plate
Foods allowed on a low fat diet include fruits and vegetables, legumes, lean fish and meats. Image by silviarita from Pixabay
Low Fat Diet for Lymphedema Study No 2.

This study design is a clinical trial. This one was published in 2008 in San Paulo, Brazil. Ten women with upper arm lymphedema following breast cancer surgery plus radiation and chemotherapy were included (5).

Five of the women were in the diet group and the other five served as the control group. Both groups received the same treatment from a physiotherapist three times a week for four weeks. The control group used corn oil as the main oil in their diet and the study group used MCT oil as their main oil.

The researchers compared several measurements between the two groups. The most dramatic difference was in the volume of the lymphedema arm. The women who used the MCT oil lost 200 ml of arm volume, whereas the corn oil group actually gained 75 ml of volume.

While this seems very dramatic, when I scrutinize the results, I can see that the five women who were assigned to the group that received the MCT oil, all began the study with greater circumference measurements then the five women in the control group. So, that could impact the difference between the two groups’ results.

Why Did the MCT oil Group Lose Arm Volume and the Corn Oil Group Gained?

The most obvious answer to this is that the corn oil is 100%long chain fatty acid and MCT oil is 100% medium chain fatty acids.

The corn oil would need the lymphatic system for transport and absorption into the blood stream and therefore would increase lymphatic congestion through the trunk, while the MCT oil can bypass the lymphatic system and be absorbed directly into the blood stream from the small intestines.

Bottom Line for Clinical Trial of MCT oil Versus Corn Oil

This is a very small study, only 10 women, but having said that there was a decrease in lymphedema with the MCT oil and there was an increase in lymphedema with corn oil. Of course, this needs to be studied more and repeated, but until then, I think it’s reasonable to work with a registered dietitian or read more about MCT and how to use it and see some meal plans in The Complete Lymphedema Management and Nutrition Guide. It’s important to work with a dietitian as MCT oil can have GI side-effects.

6 types of oil in clear dishes
MCT oil – pictured in the middle is 100% medium chain fatty acid. Most vegetable oils are 100% long chain fatty acid. Image by Jean LaMantia, RD

Fluid, Protein and Sodium

There is no human research to present on these topics, I think of these lymphedema diet recommendations as being based on ‘current standard of care’.

Fluid Intake

Many people with lymphedema may be advised to limit fluid intake. While this is established nutrition protocol for edema due to cardiac insufficiency, this is not the current standard of care for lymphedema management from knowledgeable practitioners.

In fact, the opposite is often recommended, namely, increase fluid intake. Here are some examples of this recommendation that are in the public sphere around lymphedema and hydration:

  • Griswold Home Care recommends “It’s important to stay hydrated…dehydration tells the body to start retaining fluid. In contrast hydration keeps flushing sodium out of the body”.
  • People with lymphedema (“lymphies”) can be seen giving this advice to each other on forums such as this one by LymphedemaPeople that advises “The consensus with the medical community who treats lymphedema is in agreement that you should be drinking the normal amount of fluids or water”
  • Bloggers like MyLymph also emphasize this by saying “it is essential to drink adequate amounts of water to make sure the lymph fluid flows easily and stays clean.”
  • In a 2019 review article on Lymphedema and Nutrition:A Review, authors state “hydration balance in lymphatic disease is considered basic to maintain tissue fluid homeostasis. Coffee and alcohol have both a mild diuretic power which may lead to a protein concentration in the interstice, and may generate edema as well.”

Most of the rationale for this seems reasonable, although, I’m not so sure about “keeping the lymph clean”, perhaps “less concentrated” might be more accurate.

While, I was not able to find any research to support recommending liberal fluid intake, the recommendation seems well established in the lymphedema community. I did find a very interesting article called “Water, Hydration and Health” that describes in detail the process that proceeds thirst, which is the following;

Water is lost in the body – the ionic concentration increases – the intracellular space yields water to extracellular space – the shrinking intracellular cells send a message to the brain – the brain signals thirst and salt appetite (17).

What does this mean? It means that when you’ve lost water from the body (you lose water by sweating, urinating, breathing etc.) that the body will release water from the space inside the cells, including inside the blood to the extracellular space. The extracellular space is the location of lymphatic fluid build-up.

You can see from this normal response to a low body fluid, how the fluid shifts towards more lymphedema. This could explain why a fluid restriction is not common practice in lymphedema.

 

glass of water
Current standard of care recommends that you do NOT restrict water intake on a lymphedema diet. Photo by Jean LaMantia, RD

Protein Intake

This is the second topic that I will place in the “current standard of care” category. But why would you restrict protein for lymphedema anyway? Once reason that people might be tempted to do this, is based on the fact that the lymphatic fluid is high in protein.

This is actually what differentiates lymphatic fluid from regular edema fluid. Knowing that lymphatic fluid is high in protein, you might be tempted so say “well, if my lymphatic fluid is high in protein, maybe if I restrict my protein, that will help reduce my lymphedema”. The current available advice, says, no, don’t do this.

What could happen if I restrict my protein intake?

The thinking is that, if you restrict your protein, your body will lose muscle, those breakdown products of the muscle must be transported by the lymphatic system, therefore increasing the work load and drawing in more fluid. Also, with a loss of blood proteins, the pressure inside the blood vessel is less and more blood fluids leaks out, which the lymphatic system must collect.

Here are some examples of websites that all recommend, NOT restricting protein with lymphedema:

  • This article from CureToday states “don’t adopt a low protein diet.”
  • Joachim Zuther, the author of  lymphemablog states “it is essential to understand that lymphedema cannot be reduced by the limitation of protein ingestion”
  • The BCCancer site echoes no protein or fluid restriction “No indication for restriction of oral fluids or protein”
  • The Wittlinger Lymphedema-clinic in Austria recommends that “muscle building proteins should not be neglected in the body”
  • The Westmead Breast Cancer Institute, in Australia tell its visitors “it’s important to ensure you eat adequate protein each day”

None of these sites cite any research for this. The recommendation not to limit protein I would consider as a “current standard of care”.

If there were to be research done to investigate dietary protein and lymphedema it would likely be to elucidate what is the ideal level of protein to help manage lymphedema.

How Much Protein Do I Need?

According to the Institute of Medicine, protein requirements are as follows:

  • Males 19+:  56 grams per day
  • Females 19+: 46 grams per day

Another way to think about protein requirements is based on body weight and activity level and this article by Texas A&M Professor G Wu outlines this as follows:

  • Healthy adults with minimal physical activity: 0.8g/kg
  • To promote muscle building and strength with minimal activity: 1.0g/kg
  • To promote muscled building and strength with moderate activity: 1.3g/kg
  • To promote muscle building and strength with intense activity: 1.6g/kg
  • Chronic protein intake more than 2g/kg per day is not recommended

Note: g/kg means grams of protein per kg of body weight

In order to determine if your protein intake is adequate, you should keep accurate food records for at least 3 days and take these records to a registered dietitian.

glass of milk and bowl of legumes
Despite the fact that lymphedema fluid contains protein, current standard of care is to NOT restrict protein. But choosing low fat proteins would be prudent. Image by rawpixel from Pixabay

Sodium Intake

Unlike fluid and protein, I did manage to find 1 study on sodium and lymphedem which is is an animal study I would consider this  recommendation to reduce sodium as a “current standard of care”.  Here the study…

Study on Low Sodium Diet for Lymphedema

In this study, researchers from the University of Tokyo, Japan used a group of 34 mice. Half the mice (17) received normal mouse chow and water for 9 weeks and the other half received a normal mouse chow and water for 5 weeks followed by a  high salt chow plus 1% salt water  drink for 4 weeks (6).

Results of the High Salt Diet on Lymphedema

The mice given the high salt food and water had higher blood pressure (as you might expect). The authors point out that a different team of investigators found that high blood pressure in mice resulted in hyperplasia of lymph capillaries, this means, the capillaries are growing in number or size.

Hyperplasia is typically thought to be a precursor to cancer development. Although the link to cancer from; high salt diet to hypertension to hyperplasia of lymph cells, at this point is not proven, it certainly raises concern.

The high salt diet also had an independent effect on the lymph nodes themselves. Specifically, it inhibited the ability of the lymph vessels going into the node to contract (these are called the afferent vessels) and it increased the number of contractions needed by the vessels leasing out of the lymph nodes (these are called the efferent vessels).

Overall, the net effect was the lymphatic fluid that passed through the node was the same, but the study does tell us that the high salt diet had a direct impact on how the lymphatic vessels function.

While this research alone would likely not compel an evidence-based professional to recommend that their client with lymphedema follow a low salt diet (also called a low sodium diet). Consider this research along with the knowledge that that salt has a strong osmotic pull (salt pulls water towards it).

There is a well established link between salt consumption and edema, anecdotal reports from people with lymphedema as well as lymphedema therapists and this recommendation is stronger than the research suggests.

Here are a couple of reputable websites that also echo this ‘current standard of care’ recommendation to restrict sodium/salt intake

  • Cure Today magazine tells readers to “reduce salt intake”
  • The Wittlinger Clinic puts a positive spin on it by advising readers to “use herbs instead of salt”which is an approach I can endorse- food doesn’t have to taste bland just because you are using less salt! In fact, onions, garlic and ginger are all anti-inflammatory – keep reading to find out why that’s important.
pretzels with salted tops
Salt and salty foods should be avoided on a lymphedema diet. Image by RitaE from Pixabay

Meal Pattern, Timing and other Important Features

These are the nutrition guidelines for lymphedema management, that I am proposing based on an understanding of nutrition science and how the body works, and how lymphedema affects the body.

Anti-Inflammatory Diet

Since finishing editing my book The Complete Lymphedema Management and Nutrition Guide  in May of 2019, I have continued to follow the research and the news on lymphedema. I was pleased to see a new 2019 publication on a lymphedema diet that echoes much of what I proposed in my book.

In the 2019 publication, entitled Lymphedema and Nutrition: A Review from authors in the coastal city of San Benedetto del Tronto, Italy, the authors make a point to recommend an anti-inflammatory diet (7).

They point out that inflammation is a basic process of lymphedema, and more specifically “low-grade chronic cellular inflammation” and they make the case, that because of this, an anti-inflammatory diet – one that is high in fibre, omega-3 fatty acids and polyphenols (fruits and vegetables) would be helpful.

There was a study published in 2018 by Stanley Rockson and colleagues that found that the anti-inflammatory drug Ketoprofen improved skin thickness compared with controls that received a placebo drug (8).

While this is a drug trial and not a diet trial, it lends support to the idea that anti-inflammatory diet for lymphedema seems reasonable, knowing that diet can also reduce blood inflammatory markers.

I began this Lymphedema Diet blog post by talking about risk reduction and how studies in women with breast cancer were done to try and predict who would develop lymphedema after cancer treatment.

In 2017 researchers from Memorial Sloan Kettering Cancer Center in NY, noted that, even when you take into account the number of nodes removed, whether the individual had radiation etc, it’s still hard to predict who will develop lymphedema and who won’t.  These authors suggest that “inflammation could be the critical component that can predict lymphedema” (9).

Do we know that an anti-inflammatory diet can help reduce risk of developing lymphedema after injury or of managing lymphedema? No, we don’t know that conclusively, but my suggestion is that the lymphedema diet, include anti-inflammatory foods and eating pattern.

Based on an understanding of the cellular goings-on of lymphedema, I am making this part of my lymphedema diet recommendation. Also, the anti-inflammatory diet, has other proven health benefits including metabolic syndrome, atherosclerosis, cancer, diabetes and more (10).


Time-Restricted Feeding

Time-restricted feeding is a form of intermittent fasting. It can also be called 16:8. This is based on 24 hours in a day. Eight of those hours are your eating window. For example, you can start eating at 10:00 am and then must finish by 6:00 pm. The remainder of your 24 hours – from 6:00 pm until 10:00 am the following morning, you don’t eat- in other words you fast.

While no research has specifically looked at this for lymphedema, for me it is one of those recommendations that make sense based on how the lymphatic system works. There are gut lymphatics (called GALT -gut associated lymphoid tissue) that transport lymphatic fluid from the gut up the central lymphatic trunks to the thoracic ducts.

Lymphatic flow increases from the GALT following each meal. It would therefore make sense, that if you limit the hours in the day that the GALT is adding more lymph to the system, this would allow your body to have less congestion through the trunk on its way to the ducts and could allow more clearance of lymphatic fluid from your lymphedema areas.

While there isn’t published evidence specifically on time restricted feeding and lymphedema there have been studies on other benefits of time-restricted feeding, namely weight loss, reduced insulin resistance, improved cardiovascular disease risk (11)

wall clock with fork, spoon and knife
Implementing time restricted feeding can reduce your eating window to 8 hours and your fasting window to 16 hours during a 24 hour period

Prevent Constipation

The main support that I have for this recommendation, comes from a report that I read called Gastrointestinal Lymphatics in Health and Disease that simply stated, that “lymph flow is also elevated by acute and chronic inflammation and by intestinal obstruction”.

This made me think that constipation (intestinal obstruction) should be considered as a possible aggravating element to lymphedema. I’ve had this confirmed by some of my clients with lymphedema who report that they do notice a worsening of their lymphedema if they are constipated (12).


Immune Supportive Diet

It is pointed out in this article by García Nores and colleagues that people with lymphedema have impaired immunity as a result and this leads to increased risk of infections (13).

This would therefore, lead me to suspect that a diet that supports immune response may be beneficial. While a person with lymphedema is immune suppressed because the lymphatic system doesn’t work properly, and not because of a poor diet, I could imagine that a poor diet could certainly compromise this further.

I provide a lot of detail on that in a Cancer Bites blog series that I call What Foods Boost My Immune System? Here is a quick summary of that…

What Nutrients Boost My Immune System?

  • Vitamin E
  • Vitamin B6
  • Soy isoflavones
  • Beta-glucan (a type of fibre found in barley, oats and mushrooms and other foods)
  • Probiotics (live bacterial culture found in some fermented foods e.g. yogurt)
  • Prebiotics (fibres that support probiotics bacteria such as those found in onion, artichoke, banana)
  • Fish oil (found in salmon, mackerel and herring and other cold water fishes)

Possible Future Lymphedema Diet Recommendations

Nitric-Oxide Rich Foods

I will be following the research and updating this post regarding the intake of nitric oxide rich foods. The benefits of nitric oxide rich foods are that they allow for dilation of vessels and can lead to an increase in new lymphatic vessels (lymphangiogenesis).

While this sounds like a good thing, I do have some concerns – which is why I’m not promoting it yet. The concern is that there is a lot published about lymphangiogenesis being a bad thing when it comes to cancer spread (metastasis) (14) (15) and (16).

For now, I will say, if you have lymphedema for reasons other than cancer, then it’s likely very safe and possibly helpful for you to consume nitric oxide rich foods like romaine lettuce, arugula and beets. If you are living with metastatic disease or are newly completed cancer treatment, I would recommend you consume only typical amounts of these foods and not overdo it in your diet.

arugula and beet salad
Arugula and beets are two foods that are high in dietary nitrates. Others include lettuce and bok choy. Image by Bernadette Wurzinger from Pixabay

Pre and Probiotics

While, I mentioned pre and probiotics earlier when I discussed foods that can improve the immune response. I think there may be a role for pre and probiotics specific to improving gut health in lymphedema.

The GALT (gut associated lymphoid tissue) that I mentioned earlier, is in the intestines. If the intestines are not healthy and there is a build-up or overgrowth of bacteria in the gut which allows a leakage of intestinal contents into the extracellular space, this could aggravate lymphedema.

I’ll be watching for more information on this as it develops and updating this blog. Specifically, I would like to be able to recommend specific strains of good/pro biotic bacteria that can help with lymphedema.

In the meantime, I think it’s wise to continue to consume probiotics in your diet such as yogurt and kefir as well as prebiotics such as bananas, onion and asparagus in your diet.

Jerusalem artichoke in a bowl with tomatoes beside
Jerusalem artichoke (pictured), onion, garlic, bananas, chicory, chickpeas, lentils and other fibre-rich foods are good sources of prebiotic fibres. Image by silviarita from Pixabay

Take-Away:

What is the Lymphedema Diet?

These are the recommendations for lymphedema diet by Jean LaMantia, RD

  1. Achieve a healthy body weight
  2. Reduce fat intake and replace some long chain fatty acids with medium chain
  3. Consume sufficient fluid and protein- do not restrict
  4. Limit sodium (salt)
  5. Implement time restricted feeding – to less than 12 hour eating window
  6. Anti-inflammatory diet
  7. Achieve a regular bowel routine
  8. Incorporate immune-supportive foods and nutrients into the diet

For additional valuable information including;

  • Detailed images
  • Lymphedema Diet Recipes
  • Meal plans
  • FAQ’s
  • Step-by-step photos on how to perform lymphedema exercises, manual lymphatic drainage, and bandaging
  • “Living with Lymphedema” focus group advice
  • Before and after photos
  • Full glossary
  • Almost 200 references
  • and more…

you should get your copy of The Complete Lymphedema Management and Nutrition Guide

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

I appreciate you purchasing the book directly from me, or using my affiliate links to amazon, which allows me to continue to produce blog content like the post.

To work with me either in person or on the phone, to discuss what specific changes to your diet will help improve your lymphedema, get in touch at jean@jeanlamantia.com 

If you would like to read more content like this, then you should read by CanceBites Diet Blogs;

Appendix 1

Studies That Examine Body Weight as a Risk Factor for Developing Lymphedema

 

Study Participant Details Results
Treves; 1957 1,007 women and men with arm lymphedema after cancer surgery Obesity is a predisposing factor: the greater the obesity, the greater percentage of patients with lymphedema
Clark; 2005 251 women who had surgical treatment for breast cancer BMI of 26 or more
Ahmed; 2011 1,287 women with breast cancer on one side Higher the BMI, the greater the risk

Higher the waist:hip circumference the greater the risk

Ridner; 2011 138 newly diagnosed breast cancer survivors BMI of 30 or more at treatment
Greene; 2012 15 obese people BMI of 54 or more showed lower leg lymphedema;
Huang; 2012 126 postmenopausal breast cancer participants with mastectomy BMI of 25 or more

 

Jammallo; 2013 787 breast cancer patients BMI of 30 or more before treatment

10 lb weight gain or loss in 1 month

Mahrara; 2014 23 articles reviewed Reciprocal relationship: lymphedema leads to obesity and obesity contributes to lymphedema
Rebegeal; 2015 305 breast cancer patients Obesity, diabetes and high blood pressure were not found be to risk factors. Follow-up term not specified.
Kilbreath; 2016 450 women who had breast cancer surgery and lymphnodectomy High body weight is a risk factor

 

DiSipio; 2013 29 studies published between Jan. 1, 2000, and June 30, 2012 Being overweight or obese identified as a strong contributing risk factor for lymphedema
Armer, 2019 486 breast cancer with surgery and lymph node dissection neoadjuvant chemo Obesity is significantly associated with lymphedema symptoms

References for Lymphedema Diet by Jean LaMantia, RD

  1. Rebegea L, Firescu D, Dumitru M, et al. The incidence and risk factors for occurrence of arm lymphedema after treatment of breast cancer. Chirurgia (Bucur). 2015 Jan–Feb; 110 (1): 33–7.
  2. Shaw C, Mortimer P, Judd PA. A randomized controlled trial of weight reduction as a treatment for breast cancer-related lymphedema. Cancer. 2007 Oct 15; 110 (8): 1868–74.
  3. Shaw C, Mortimer P, Judd, PA. Randomized controlled trial comparing a low-fat diet with a weight-reduction diet in breast cancer-related lymphedema. Cancer. 2007 May 15; 109 (10): 1949–56.
  4. Soria P, Cuesta A, Romera H, et al. Dietary treatment of lymphedema by restriction of long-chain triglycerides. Angiology. 1994 Aug; 45 (8): 703–7.
  5. Oliveira J, César TB. Influence of complex decongestive physical therapy associated with intake of medium-chain triglycerides for treating upper-limb lymphedema. Rev Bras Fisioter. 2008; 12 (1): 31–6.
  6. Mizuno R, Isshiki M, Ono N, et al. A high-salt diet differentially modulates mechanical activity of afferent and efferent collecting lymphatics in murine iliac lymph nodes. Lymphat Res Biol. 2015 Jun; 13 (2): 85–92.
  7. Cavezzi, A, Urso, S, Ambrosini L, et al. Lymphedema and nutrition: A review. Veins and Lymphatics. 2019; 8:8220, 24-29.
  8. Rockson SG, Tian W, Jiang X, et al. Pilot studies demonstrate potential benefits of anti-inflammatory therapy in human lymphedema. JCI Insight. 2018 Oct 18;3(20).
  9. Ly C, Kataru R, Mehrara B. Inflammatory Manifestations of Lymphedema. Int J. Mol. Sci. 2017,18, 171.
  10. 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.
  11. Harvie MN, Pegington M, Mattson MP, et al. The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: A randomized trial in young overweight women. Int J Obes (Lond). 2011 May; 35 (5): 714–27
  12. Alexander JS, Ganta VC. Jordan PA, et al. Gastrointestinal lymphatics in health and disease. Pathophysiology. 2010 Sep; 17 (4): 315–5.
  13. García Nores G, Ly C, Savetsky I et al. T-regulatory cells mediate local immunosuppression in lymphedema. J Invest Dermatol. 2018 Feb; 138(2):325-335.
  14. Paduch, R. The role of lymphangiogenesis and angiogenesis in tutor metastasis. Cell Onocl (Dordr). 2016 Oct;39(5):397-410
  15. Liao S, von der Weid P-Y, Inflammation-induced lymphangiogenesis and lymphatic dysfunction. Angiogenesis. 2014 Apr; 17(2): 325–334
  16. Nagahashi M, Ramachandran S, Rashid OM, et al. Lymphangiogenesis: A new player in cancer progression. World J Gastroenterol. 2010 Aug 28;16(32):4003-12. Review.
  17. Popkin B, D’Anci K and Rosenberg I. Water, Hydration and Health. Nutr Rev. 2010 Aug;68(8):439-458.
  18. Harris S, Hugi M and Olivetto I et al. Clinical Practice Guidelines for the care and treatment of breast cancer:11. Lymphedema. CMAJ. Jan 23, 2001;164 (2).