Gut Lymphatics

This blog is not meant to diagnose or treat conditions. References are contained at the bottom of the article .

What is the Gut?

The gut is the common word for the lower gastrointestinal tract or GI tract specifically, the intestines. There are a small and large intestines – also called the small and large bowel. The “gut” usually refers to the small intestines, in particular. It is used in common language such as “gut punch”, “gut feeling” and if you laugh really hard, you might say that you’ve “busted a gut”. But, to be clear, the “gut” is not the stomach.

What are the Gut Lymphatics?

If I were using more formal language, I would refer to this as the intestinal lymphatics. The gut lymphatics are the parts of the lymphatic system that are located throughout the intestines. The gut lymphatics play a very significant role in the health and functioning of the lymphatic system.

Why Care About the Gut?

More than 50% of the lymph fluid in our body comes from our intestines (Alexander, 2010). So, if you are living with lymphedema and want to improve your lymphedema management, then it’s very likely a healthy gut can help. In addition, we have about 400-700 lymph nodes throughout the body and the largest cluster is in the mesentery – the membrane that holds the intestines in place.

Components of the Gut Lymphatics

The three main components of the gut lymphatics are:

1. The villi
2. The lacteals
3. The microbiota

I’ll speak about each one of those separately and then how they work together.

The Villi

If you were to stretch out your small intestines, they would be 16 to 20 feet long. But, they are able to fit neatly within your lower abdominal area because they are in a wavy, up and down configuration. The “up and down” parts of the intestines are called villi. Each villi, then has microvilli, and these millions of microvilli give the surface of the intestines the appearance of a fine brush.

The villi and microvilli help to increase the absorptive capacity of the small intestines. After you eat your food, the body first needs to break that food down into its smallest components – this is called digestion.

Then these small nutrients are moved through the intestines, into the blood stream and then the cells of the body – this is called absorption.

Together, digestion and absorption are the processes that allow our bodies to receive nutrients from our food – this includes macronutrients carbohydrate, protein and fat as well as micronutrients – vitamins, minerals and other nutraceuticals.

It’s important to have a healthy intestinal villi to have excellent absorption of important nutrients. The villi are also important for the lymphatic system as they can contract and move lymph fluid and they also secrete vascular endothelial growth factor-C (VEGF-C), which is a growth promoter for lymphatic vessels.

The Lacteals and Collecting Lymphatics

Lacteal is the name given to the lymphatic capillaries in the intestines. They were discovered by Italian physical Gaspare Aselli in 1622. Because the liquid that was coming out of these vessels looked like milk he named them lacteals. That’s because the Latin work for milk is lac (French lait, Italian latte).

The reason that the liquid that collects in the lacteals looks like milk is because these specialized lymphatic capillaries are responsible for absorbing fat from the diet. When you eat some fat or oil – for example, salad dressing, mayonnaise, avocado, peanut butter, salmon or beef, the fat or oil contained in these foods eventually makes its way to the small intestines.

Once in the small intestines, all food is broken down into their smallest components. Carbohydrates are broken down into single sugars – like glucose and galactose. Proteins are broken down into amino acids, and fats are broken down into fatty acids.

The chemistry of fatty acids are chains of carbons with hydrogens attached. Some of these are short chains – six carbons or less, some are medium chain- twelve carbons or less and some are long chains – more than twelve carbons in the chain.

The short and medium chain fatty acids can be absorbed directly from the small intestines into the blood stream, but the long chain fatty acids are put into a fat transporter sphere – called a chylomicron and absorbed into the lacteals.

These long chain fatty acids mixed with lymph fluid give a milky appearance. The name of this milky lymph fluid is chyle (pronounced like “Kyle”). In addition to long chain fatty acids, the chyle also contains fat-soluble vitamins – A, D, E and K.

Each villi contains one single lacteal and the villi secrets vascular endothelial grown factor-C. Because the lacteals are constantly remodeling, they need the VEGF-C to promote regrowth to maintain a healthy population of lacteals.

The Microbiota

The microbiota are the population of live bacteria that lives in your intestines. They are important for the health of the gut lymphatics.

Probiotics

You can alter the composition of gut microbiota with diet including probiotics. Probiotics are defined as; “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host” (Hill et al. 2014).

While many sources will tell you all fermented foods contain probiotics, not all of them fit the definition. For example, some fermented foods may not have a large enough amount of probiotic bacteria, or the right strain to survive the stomach acid, or enough live bacteria that arrive in the intestines to provide a health benefit.

Countries regulate which specific strains of bacteria need to be present for a food product to have the word “probiotic” on the label. For example, in Canada, Health Canada regulates which bacteria need to be present for the claim “probiotic” to be used on the label. Some examples are:

• Bifidobacterium adolescentis
• Bifidobacterium animalis
• Bifidobacterium bifidum
• Lactobacillus acidophilus
• Lactobacillus casei
• Lactobacillus fermentum

For a full list read the Health Canada website 

While all fermented foods are made with live bacterial culture, not all fermented foods are probiotics. However, until more research is done and food labelling is clarified to match, your best bet to receive true probiotics in your food is choosing yogurts that are labelled ‘probiotic’.

While you can still enjoy your favorite fermented foods like sauerkraut and kimchi, the level and type of live bacteria may not meet the definition of a true probiotic. To improve your gut health even more, you can feed these healthy bacteria with prebiotics.

Prebiotics

Prebiotics are fibers, defined as “selectively fermented ingredients that allow specific changes, both in the composition and/or activity in the gastrointestinal microflora that confers benefits upon host well-being and health” (Gibson et al. 2017).

Fibres need to meet three criteria to be considered a prebiotic:

1. They don’t break down during digestion
2. They are fermented by intestinal microorganisms
3. They feed and support growth of the “good bacteria” that supports health and wellness (Gibson et al. 2017).

Examples of foods that are considered prebiotics are (Slavin, 2013):

• Asparagus
• Banana
• Chicory
• Jerusalem artichoke
• Oats
• Onion, garlic, leeks
• Soybeans
• Wheat

Synbiotics

Synbiotic is the term for supplements that contain both prebiotic fibers and live probiotic bacteria. It comes from ‘symbiosis’ meaning that the benefit of being taken together is greater that the sum of the two individual benefits.

Can synbiotics help lymphedema? This was the question that researchers in Iran set out to answer when they put overweight women with lymphedema on a weight loss diet with either a synbiotic supplement or a placebo. The results found that the women on the synbiotic supplement lost more lymphedema and reduced inflammation, more than women on a similar diet on the placebo. Read more about the research on lymphedema and probiotics.

The Villi, Lacteals and Microbiota

The villi, lacteals, and microbiota need to work together. The microbiota interacts with the villi to control the amount of VEGF-C which in turn allows for a stabilization of the lacteals in the intestines. The lacteals are non contracting and rely on the villi to move the chyle via contraction.

How to Have Healthy Gut Lymphatics

One way to have healthy gut lymphatics is to have a healthy gut. This means an anti-inflammatory diet, a diet rich in fibre, especially prebiotic fiber, a diet rich in probiotic bacteria, sufficient of water and activity to have a regular bowel routine.

If you have issues with your bowel routine, then it’s important to keep some records and track your symptoms by using a lymphedema journal. This can help you determine if there are foods that don’t agree with you.

It’s important to note though, if you suspect that gluten is a problem for you, then do NOT remove gluten from your diet until you speak with your doctor about a tissue Transglutaminase IgA (tTG-IgA) test (Celiac Disease Foundation, 2024).

The tTG-IgA is the first step in diagnosing Celiac disease. The reason I don’t recommend a gluten free diet until you have the test is that you must be consuming gluten to get an accurate result. If you remove gluten first, then take the test, you may be a false negative. There is a lot of misinformation out there in the lymphedema community – so please take this warning and don’t remove gluten until you’ve had the blood test!

It’s important to find out if you have Celiac disease for several reasons:

1. Firstly, the diet for Celiac disease is a strict gluten free diet for life. But, without the diagnosis, most people aren’t so strict and small amounts of gluten are still in their diet – but with Celiac disease this gluten can do damage to your gut, even if you don’t feel symptomatic.
2. Secondly, having a proper diagnosis will allow you to get the medical follow-up you need, including regular endoscopies to inspect the health of your intestines.
3. Thirdly, there may be financial implications – in some jurisdictions, people on government assistance will receive more money for food, but only if they have a diagnosis. Some countries (Canada for one) offers tax deductions for gluten free foods, but only when it is based on a medical diagnosis.

Bottom line: if you suspect you have a problem with gluten get the blood test BEFORE you begin the gluten free diet.

Bottom Line on Gut Lymphatics

This is what I think is important for you to know about gut lymphatics, especially if you have lymphedema:

1. Your gut lymphatics are a super important part of the your lymphatic system
2. What you eat matters for a healthy gut and healthy gut lymphatics
3. Eating a diet rich in fiber, probiotics and fluid is important for healthy gut lymphatics
4. Allowing your gut time to process the lymph after eating is important: read intermittent fasting for lymphedema
5. Paying attention to the amount of fat in your diet can influence the amount of chyle that is produced
6. If your gut is not happy – your lymphedema may act up
7. A healthy bowel routine may help your lymphedema – fluid, fiber and exercise are the three keys to healthy bowel routine
8. If you are are having an unexplained flare-up of lymphedema, consider if constipation may be a cause
9. Small research supports the use of a synbiotic supplement along with healthy diet
10. If you think certain foods are not agreeing with you and you need to figure out which ones, start tracking your food and symptoms with a lymphedema journal

If you like this blog, then you may also like to read:

Serrapeptase for Lymphedema and Lipedema

Is infrared sauna good for lymphedema?

Fasting and Lymphedema

Get your own copy of the FREE PDF download of Healthy Eating for Lymphedema.

References for Gut Lymphatics

Alexander JS, Ganta VC, Jordan PA, Witte MH. Gastrointestinal lymphatics in health and disease. Pathophysiology. 2010;17(4):315-335. doi:10.1016/j.pathophys.2009.09.003

Celiac Disease Foundation. Testing. Accessed Feb 18, 2024.

Gibson, G. R., Hutkins, R., Sanders, M. E., Prescott, S. L., Reimer, R. A., Salminen, S. J., Scott, K., Stanton, C., Swanson, K. S., Cani, P. D., Verbeke, K., & Reid, G. (2017). Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nature Reviews. Gastroenterology & Hepatology, 14(8).

Health Canada. Accepted Claims about the Nature of Probiotic Microorganisms in Food. April 2009

Hill, C., Guarner, F., Reid, G. et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 11, 506–514 (2014). https://doi.org/10.1038/nrgastro.2014.66

Slavin J. Fiber and prebiotics: mechanisms and health benefits. Nutrients. 2013 Apr 22;5(4):1417-35. doi: 10.3390/nu5041417. PMID: 23609775; PMCID: PMC3705355.