We invited lymphedema therapist Adie MacKenzie from Healing Arts in Nashville TN to share with us the Top 5 Questions that she gets about lymphedema nutrition and for guest blogger and registered dietitian Jean LaMantia to share her responses to these questions.
Adie Q1. Is there any particular diet that is shown to improve lymphedema symptoms (eg, keto, Mediterranean, FODMAP, etc).
Jean A1. This is a great question and the word that I will focus on in your question is ‘shown’. For me, I interpret this as…”is there any research that has shown” that one diet can improve lymphedema and the answer to that is sadly no, there isn’t.
But…without specific research we can still make diet recommendations based on an understanding of the physiology of lymphedema and nutrition science. I’ll address each of the diets that you mention.
Keto Diet and Lymphedema
There is only one study that used the keto diet with a small group of individuals with lymphedema. But this study was looking at the effects of weight loss on lymphedema it wasn’t examining the role of ketosis on lymphedema. On one hand, the ketogenic diet could be beneficial as it does generally allow for weight loss and in 4 out of 5 lymphedema weight loss studies, weight loss corresponded to a loss of lymphedema volume.
But…on the other hand…the lymphatic system is responsible for transporting fat from the intestines to the thoracic ducts and we don’t know what impact a high fat diet (keto is a high fat diet) would have on the lymphatic system. We also know that in some studies (but not all) the keto diet causes more inflammation and higher cholesterol levels, two things that are not good for lymphedema. So…I would say the jury is still out on keto diet. But, there is a keto lymphedema study underway now in Belgium that is due to finish in 2023 so I look forward to seeing the results of that.
Mediterranean Diet and Lymphedema
This is one of the most studied dietary patterns and study after study, the Mediterranean diet shows positive results. So, while it hasn’t been studied specifically in a lymphedema population, it has a lot to recommend it for this population. The fact that it reduces inflammation and cholesterol levels would be two big selling features.
FODMAP and Lymphedema
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. Essentially, it’s a diet that limits many carbohydrate containing foods and it’s used for people who have GI complaints like bloating, diarrhea, constipation, or a combination of all these symptoms.
There is definitely a link between your intestines and your lymphatic system – after all, more than 50% of the lymph that your body produces comes from your digestive system and the greatest cluster of lymph nodes in the body is in the mesentery – the lining of your intestines.
If you observe GI upset and lymphedema flare-ups happening at the same time, then you wouldn’t be the first one to make this observation. Will a FODMAP diet help? Possibly. But, keep in mind the FODMAP is a protocol that you do to help identify and reduce food intolerances and not a diet that you get on and stay on. If you are having GI issues, it’s best to work with a registered dietitian that understands lymphedema and bowel issues to help you get sorted out.
Adie Q2. Are there any specific foods or beverages I should avoid (eg, sugar, salt, soft drinks) if I have or am at risk for lymphedema?
Jean A 2. I think ‘avoid’ is a strong word…to me, that means “avoid!” But, I would say that limiting sugar, salt and soft drinks are all excellent ideas if you have lymphedema. Sugar can be limited as it is inflammatory and linked to weight gain – especially to visceral fat which is the fat that increases inflammation. But…I wouldn’t take this to the extreme…to be clear, I would limit added sugars. This means sugar that you add or sugars that are added by the food manufacturer. There are lots of foods that contain naturally occurring sugars like fruit, peas, carrots, sweet potatoes, squash, chick peas, lentils etc. that are very healthy foods. I would suggest you focus your energy on limiting the added sugars, this would include soft drinks (which you may actually want to avoid all together 😉
With regard to salt, it’s a good idea to limit this. While there aren’t any human studies on lymphedema and salt, it is commonly understood that salt increases fluid retention and that’s the last thing you want to do when you have lymphedema. If you read your labels, then a good upper limit target would be 1500 mg per day. This can also help to lower your blood pressure and there are some indications that high blood pressure is a risk factor for lymphedema too.
Regarding lymphedema risk, like any condition that you are at risk for, for example, diabetes, heart disease or cancer, the best way to eat to reduce your risk is to eat as if you have the condition already. So, eating a diabetic diet can help reduce the risk of diabetes, eating a heart healthy diet reduces the risk of heart disease and very likely eating as if you already have lymphedema may help reduce your risk of developing it. But…like other areas of lymphedema, we don’t actually have research on this. My best recommendation for those at risk of developing lymphedema who want to reduce their risk would be to avoid weight gain, limit salt, keep the blood pressure and cholesterol within normal limits, keep inflammation low and maintain or build your muscle mass.
Adie Q3. What are the best beverages and/or foods to maximize hydration, other than water?
Jean A3. Another great question, no one has ever asked me that before. Unless you are electrolyte depleted, I’m not convinced any fluids maximize hydration any better than water. But here are some fluids that can provide some additional benefits; drinks with anti-inflammatory nutrients, like ginger tea and turmeric tea would likely be beneficial. Drinks that help to settle bloating like mint tea or fennel tea or ones that are high in potassium or calcium that can help manage blood pressure like citrus juice, green juice and of course milk which is not only high calcium but high protein. This gives you some ideas of considerations you can make when choosing a beverage.
Adie Q4. How do alcoholic beverages affect lymphedema?
Jean A4. Based only on what my clients and students have told me and not any research, alcohol seems to be a trigger for lymphedema. It could be that it is dehydrating. It’s important to pay attention to what you are eating and drinking to see what effect is has on your lymphedema.
Adie Q5. How does weight loss improve lymphedema symptoms?
Jean A5. There are several theories to explain how weight loss helps improve lymphedema symptoms and they are:
- Weight loss allows for greater mobility and the increase in mobility allows for more muscle pump action
- Loss of fat reduces the insulating effect around the muscle and there is more effective muscle pumping action against the lymph vessels and nodes
- Weight loss allows for an increase in effectiveness of compression garments and bandaging
- Weight loss can also allow you to breathe more deeply (which can help move the lymph) as a large girth can push the diaphragm above its normal position which compromised the ability take a deep breath
- Deeper lymphatics that are buried below a thicker layer of fat are able to be more effective after weight loss
If readers have more questions about lymphedema nutrition, then I have several resources that I can recommend. First, I write a blog that includes many lymphedema topics. I’ve written a book that includes detailed information on lymphedema nutrition as well as recipes and I run an on-line program called Lymphedema Nutrition School. You can sign-up for my email to stay up-to-date on the latest blogs and programs.