This blog on chyle leak diets does not replace an individualized nutrition assessment by a registered dietitian. To book a nutrition assessment, click here. I’ll be discussing chyle leaks, what they are, how they appear and what to do about them, specifically what to eat if you have a chyle leak. Much of the information in this blog comes from the publication by McCray, 2011, see the reference section at the bottom of this page.
What is Chyle?
Chyle, (pronounced like “Kyle” the name), is one of the liquids carried by the lymphatic system. While lymphatic fluid or lymph is what we often think of when it comes to the lymphatic system, chyle has a different composition that regular lymph fluid as it comes from the intestines and is high in fat and fat-soluble vitamins.
Why is it Called Chyle?
Chyle comes from the Greek word chymós or which translates as “juice”. I don’t know about you, but I am not interested in drinking this juice.
What is in Chyle?
Chyle is composed of lymph fluid, plus fat from the intestines, protein, electrolytes, lymphocytes (white blood cells made in the bone marrow ) and other substances. It is odorless and has an alkaline pH. About 70% of chyle is fat from the diet and it contains 20-30 grams of protein per liter. Chyle contains about 200 calories per liter from the protein and fat. It also has electrolytes, similar to that in blood plasma. In addition to fat, it contains some fat-soluble vitamins, namely vitamins A, D, E and K.
What is a Chyle Leak?
A chyle leak is, as the name implies a leakage of chyle fluid. Depending on the amount of fluid that drains from the leak they are classified as low-output (less than 1 liter per day), high-output (1 liter or more) and massive leaks (more than 4 liters per day) (Ganesan, 2024). There are common locations where they chyle accumulates and these conditions given names based on that, such as:
Chylothorax – chyle fluid in the thoracic cavity – between the lungs and the chest wall
Chyloperitoneum or Chylous Ascites – chyle fluid in the abdominal cavity
Chylopericardium – chyle fluid around the heart
Chyloptysis – chyle in the sputum
Chyluria – chyle in the urine
Chylocolporrhea – chyle discharge from the vagina also just called chylous vaginal discharge
Causes of Chyle Leaks
Chyle leaks can be primary, or secondary. Primary chyle leaks occur with conditions such as congenital lymphangiectasia, in which there is a dilation of the intestinal lymphatics and a loss of chyle into the GI tract. Secondary chyle leaks, are leaks that are due to damage to the lymphatics, this could be a complication from surgery, such as radical neck dissection or cardiothoracic surgery.
In my case, the chylothorax that I developed while I had lymphoma it was due to a large tumor growing in the middle of my chest allowing chyle to accumulate in and around my lungs and which made breathing very labored Read more about my story.
Signs and Symptoms of Chyle Leaks
A give-away of chyle leaks is the appearance of chyle liquid which is typically milky white, but could also be clear to reddish-brown in color due to the presence of red blood cells. I met a couple at a lymphedema conference whose son had leakage of chyle liquid that they described as a pale pink color.
While you can’t always see the tell-tale milky white color of chyle, the liquid can be tested for the presence of triglycerides. If the result is more than 110 mg/dl of triglyceride, then that is indicative of a chyle leak. If the results is 50-110 mg/dl then more testing is needed to assess if chylomicrons are present. If the result is less than 50 mg/dl then a chyle leak is ruled out. But, this is just a guideline, be sure to consult a doctor if you suspect a chyle leak.
What are Triglycerides?
Triglycerides are fats that the lymphatic system absorbs from the diet. After you eat, your body stores any excess fat it doesn’t need into a storage form of fat called triglycerides.
What are Chylomicrons?
Chylomicrons are fat transporters that form in the mucosal lining of the jejunum (the second section of the small intestines). They are formed with the combination of single fats (monoglycerides), fatty acids, cholesterol and protein. They can move through the small intestinal wall into lacteals – the lymphatic vessels in the intestines. Once in the lacteals, they continue to travel through the lymphatic system until they reach the thoracic ducts where they enter the blood stream.
GI system and lymphatic systems
How Much Chyle Do I Have?
An individual will produce approximately, two to four liters of chyle each day. Nearly 70% of this fat from our diets, in the form of triglycerides.
What Increases Chyle Flow?
Eating anything, but especially fat in the diet will increase chyle flow. This includes all fats and oils such as olive oil, nuts, seeds, avocado, as well as the fat on meats and in diary products. Activity will also increase chyle flow especially upper body or core exercise or anything that adds to intra-abdominal pressure, such as coughing or straining.
How To Treat a Chyle Leak?
Chyle leaks can be treated by drainage, surgery, medication and diet. I’ll discuss each of these separately.
Drainage to Treat Chyle Leaks
In some cases the chyle fluid is drained to eliminate the accumulated fluid. I had this done myself shortly after being diagnosed with Hodgkin’s lymphoma – cancer of the lymph nodes. My lungs were filling up with lymphatic fluid and I was basically drowning in my own body, which left me very short of breath and with a very heavy feeling in my chest. My doctor drained the fluid out of my lungs from my back. What a weird sensation that was – I felt like I was getting too much air and I couldn’t process it all. That procedure was called a thoracentesis. When the fluid build-up is in the abdominal area, then the procedure to drain it is called a paracentesis.
Medications to Treat Chyle Leaks
Somatostatin
Somatostatin is a growth hormone inhibitor. In a review of research on chyle leaks, seven studies used somatostatin, on average of 100 mcg every eight hours for five to 24 days. Most of the leaks were contained within 10 days (Ganesan, 2024).
Octreotide
Octreotide is a medication available as an injection via subcutaneous (under the skin) or IV (into the vein) in short or long acting forms. It is FDA has approved octreotide to treat acromegaly (a condition of excess growth hormone) and thyrotrophinomas (a benign tumor on the pituitary gland). Octreotide is a derivative of somatostatin and It is used more often than somatostatin as it can be administered via injection, while somatastatin uses a continues infusion (Ganesan, 2024). It is thought that both somatostatin and octreotide work by altering gastrointestinal blood flow to reduce the flow of chyle (Ganesan, 2024).
There is limited research using octreotide to reduce fistula output (Debnath, 2024). In a study of eleven patients with chyle leaks followed neck dissection surgery they received octreotide plus a fat restricted diet. Dosages varied, but the most common dosage was 160 mcg subcutaneously every eight hours and given between two to twenty days in hospital and for two to fifteen days after discharge home.
In addition to the octreotide, the diet was restricted to either nothing by mouth, in which case the patient would be fed through their veins with or an oral intake of low fat plus MCT oil. In all eleven patients the chyle leak resolved with diet plus octreotide without the need for surgery.
Orlistat
Orlistat is another drug that has been used for chyle leaks (Belloso, 2006). This is a pancreatic lipase inhibitor, which means that it blocks the break down of fats from the diet. It is typically prescribed as a weight loss drug as it prevents fat from being absorbed by the body and it therefore leaves the body via the stool.
By using orlistat for chyle leaks, it prevents chylomicrons from forming in the intestines and being absorbed by the lymphatic system. Less absorption into the lymphatics means, means less chyle flow, and this allows the leak to heal and close. But, like octreotide, orlistat should be given with a low fat diet. Too much fat in the diet will result in fatty diarrhea and fatty leakage from the body.
The dosage of orlistat documented in four patients was 120 mg three times a day 30 minutes before each meal. After one to two weeks, the chyle leak dried up and was able to heal (Belloso, 2006).
Etilefrine
Etilefrine is a drug that can encourage smooth muscle contraction. It was thought that when given as an IV it could encourage the contraction of the thoracic duct. But, it is not widely used as the side effects include high blood pressure, ventricular arrhythmias, headache and urinary retention (Ganesan, 2024).
Chyle Leak Diet
Diet for chyle leaks is very important. The main goals of nutrition intervention are to decrease the production of chyle, replenish body fluids and electrolytes and prevent malnutrition (Ganesan, 2024). The diet prescribed is a fat free or very low fat diet with medium chain triglyceride oil (MCT oil) and essential fatty acids. Sometimes, oral intake is stopped completely, and patients are fed through the vein using total parenteral nutrition (TPN) to achieve a zero long chain fatty acid diet.
By restricting the fat intake, you are limiting the amount of chyle produced which reduces the accumulation and leakage and can allow healing to take place. Sometimes, the diet can be used alone, other times, the very low fat diet is combined with drainage, and/or medication. If these don’t work to resolve the issues, then surgery will be needed.
While being on a low fat diet, it’s important to allow for sufficient low fat proteins and calories to meet nutrient needs that will assist in healing.
Surgery to Repair Chyle Leaks
Surgery for chyle leaks is considered the last resort treatment (Ganesan, 2024). During surgery, the goal is to identify the duct and the site of the leak. Once identified, the duct is sewed with a non-absorbable suture. Techniques such as muscle flaps, and tissue glue can be combined with surgery (Ganesan, 2024).
Summary on Chyle Leaks
Chyle leaks are not very common, they can be primary or secondary, resulting from injury or surgery that affects that lymphatic system. It is a leakage of a fat-rich lymph fluid called chyle that comes from the intestinal lymph vessels. If you suspect you have a chyle leak, be sure to make note of the color of the discharge. You should see your physician and they may want you to collect a sample or the discharge in a sterile container for analysis to confirm the presence of triglycerides or chylomicrons.
If you have a chyle leak, you will need a very low fat diet, with MCT oil or potentially no food by mouth at all and all food given through total parenteral nutrition. If the low fat diet does not allow the leak to close, then medications can be given and if those fail then surgery is the final treatment option. Drainage of the pooled chyle fluid can help to relieve pressure and reduce symptoms.
For more on Lymphedema Diet and Gut Lymphatics Read
References for Chyle Leak Diet
McCray S, Parrish C. Nutritional Management of chyle Leaks: An Update. Nutrition Issues in Gastroenterology, series 94. April 2011.
Debnath D, Cheriyath P. Octreotide. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
Ganesan A, Singh NC, Khatri NP, Madaan CS, Kaur S, Kaur A. Chyle leak after head and neck surgeries: a comprehensive review of diagnosis and management strategies. J Korean Assoc Oral Maxillofac Surg. 2024 Feb 29;50(1):3-12. doi: 10.5125/jkaoms.2024.50.1.3. PMID: 38419516; PMCID: PMC10910005.
