Lymphoedema Naturopathic Protocol
Lymphoedema Naturopathic Protocol
This Lymphoedema Naturopathic Protocol is provided as information for patients of HealthMasters Naturopath Kevin Tresize ND as part of a treatment plan to assist patients with understanding of their treatment plan. It is important to note that this is a summary only and is intended to assist discussion between practitioner and patient as part of consultations and should not be substituted for medical advice, diagnosis or treatment. This Lymphoedema Naturopathic Protocol may be changed to suit the individual requirements of the patient and should not be substituted for medical advice, diagnosis or treatment.
HealthMasters Naturopath Kevin Tresize ND
2.0 Aetiology (Cause) and Risk Factors
3.0 Signs and Symptoms
4.0 Core Treatment
5.0 Alphabetical Reference of Nutritional Support
6.0 Supportive Lifestyle Programs
7.0 Diet and Lifestyle
9.0 Pharmaceutical Treatments
Lymphoedema is a condition of localised fluid retention caused by a compromised lymphatic system. There is an accumulation of excessive lymph fluid and consequently a swelling of subcutaneous tissues due to obstruction, destruction and/or hypoplasia of lymph vessels.
When lymphatic impairment becomes so great that the lymph fluid exceeds the lymphatic system's ability to transport it, an abnormal amount of protein-rich fluid collects in the tissues of the affected area.
Left untreated, this stagnant, protein-rich fluid causes tissue channels to increase in size and number, reducing the availability of oxygen. This interferes with wound healing and provides a rich medium for bacterial growth that can result in lymphangitis.
Lymphoedema develops in a number of stages, from mild to severe:
- Grade 1 (mild oedema): involves the distal parts such as a forearm and hand or a lower leg and foot. The difference in circumference between affected limb and unaffected limb is less than 4 centimetres, and other tissue changes are not yet present. The lymphatic vessels may have sustained some damage which is not yet apparent and lymph is still efficiently moved.
- Grade 2 (moderate oedema): involves an entire limb or corresponding quadrant of the trunk. The difference in circumference between affected limb and unaffected limb is more than 4 but less than 6 centimetres. Tissue changes, such as pitting, are apparent – i.e., when pressed by the fingertips, the affected area indents and holds the indentation. Upon waking in the morning, the limb or affected area is normal or almost normal in size.
- Grade 3 (severe oedema): present in one or more limbs and its associated trunk quadrant. The difference in circumference is greater than 6 centimetres. Significant skin alterations, such as cornification or keratosis, cysts and/or fistulae, are present. Additionally the patient may experience repeated attacks of erysipelas. The tissue now has a spongy consistency and is non-pitting – i.e., when pressed by the fingertips, the tissue bounces back without any indentation.
- Grade 4 (gigantic oedema): also known as elephantiasis. In this stage of lymphoedema, the affected extremities are huge due to almost complete blockage of the lymph channels. At this stage, the swelling is irreversible and usually the affected area is very large. The tissue is hard (fibrotic) and unresponsive.
2.0 Aetiology (Cause) / Risk factors:
Major causative factors and risk factors that can contribute to the incidence of lymphoedema include the following:
- Genetics – inherited (primary) lymphoedema.
- Injury to the lymphatic vessels (secondary) – e.g., after lymph node dissection, surgery and/or radiation therapy.
- Damage to the lymphatic system may be due to treatment of cancer, most notably breast cancer.
- Parasitic infections (e.g., toxoplasmosis, tropical filariasis).
- Vascular abnormalities.
- Aircraft flight (likely due to decreased cabin pressure).
- Some medications (e.g., Tamoxifen)
- Thrombosis and deep vein thrombosis (DVT)
3.0 Signs and Symptoms:
Common signs and symptoms of lymphoedema include:
- Heavy swollen limb or localized fluid accumulation in other body areas
- Swollen lymph nodes
- Frequent infections, colds and flus – i.e., weakened immune system
- Chronic fatigue
- Skin ulceration and cellulitis
- Discoloration of the skin overlying the lymphoedema
4.0 Core Treatment:
Primary treatment should include specialised massage and movement to support lymphatic drainage and flow.
4.1 Support healthy lymphatic circulation
Blood and Lymphatic Detoxification - 1 tablet twice daily
4.2 Support diuresis, improve detoxification and support urinary waste elimination
4.3 If associated with heart disease and poor circulation
High Potency Taurine, Glycine and Magnesium for Cardiovascular Health - 1 serve twice daily
4.4 If overweight – reduce insulin resistance, support adrenal function and manage appetite
Shake It Practitioner Weight Management Program
Cocoa, Cinnamon and Chromium for Metabolic Syndrome - 1 capsule twice daily
4.5 Manage systemic inflammation
BCM-95 Turmeric & Devil's Claw to Treat Chronic Inflammation - 3 capsules twice daily
Specialised Pro-Resolving Mediators[*] - 1 capsule twice daily
4.6 If with digestive infection (dysbiosis or SIBO) or environmental toxicity
Metagenics Clinical Detoxification Program
4.7 If swelling is associated with auto-immunity / allergy
Elimination and Rechallenge Program
4.8 Provide nutritional and phytochemical support for cardio-metabolic health
Wellness and Healthy Ageing Program
5.0 Alphabetical Reference of Nutritional Support:
|Formula Catch Phrase||Key Benefits|
|BCM-95 Turmeric & Devil's Claw to Treat Chronic Inflammation||A combination of herbs to provide powerful synergistic anti-inflammatory and analgesic effects by inhibiting RAGE, COX-2 expression, TNF-α and NFkB. This herbal combination is safe for long-term use.|
|Blood and Lymphatic Detoxification||Lymphatic and blood purifying herbs cleavers, burdock, nettle and blue flag, combined with danshen, essential oils and selenium reduce inflammation, balance oxidative stress and address gut dysbiosis – factors traditionally referred to as blood and lymphatic stasis.|
|Cocoa, Cinnamon and Chromium for Metabolic Syndrome||Cocoa, cinnamon and gymnema blend with nutrients for early or advanced stages of insulin resistance to support cardio-metabolic health. Cocoa (45% polyphenols) enhances glucose uptake, insulin responses and mood balance, whilst antioxidant cinnamon reduces post-prandial blood sugar levels. B vitamins, zinc and chromium support glucose transport and overall energy metabolism. Gymnema is included to manage sweet cravings and taste.|
|Detox Greens||This powdered formula supports kidney, lymphatic and gut detoxification pathways. Alkalising the system with potassium citrate assists the urinary clearance of toxic molecules. Additional support for the clearance of toxic metals is provided, as well as much needed gastrointestinal mucosal integrity, lymphatic and antioxidant support.|
|High Potency Taurine, Glycine and Magnesium for Cardiovascular Health||Magnesium with activated B vitamins and chromium combine to support blood sugar regulation, enhance detoxification and protect the CV system. These nutrients support healthy circulation.|
|Lactobacillus paracasei LP-33® and Lactobacillus rhamnosus GG (LGG®) for Immune Control||Two probiotic strains which help restore immune control and moderate over-active immune responses. These strains assist immune regulation by supporting T-reg cell function and increasing anti-inflammatory cytokines such as IL-10.|
|Nutritional Support for the Kidneys||An anti-inflammatory antioxidant focused to support kidney and bladder health, including cleavers, bearberry and horsetail combined with quercetin, B1, B6 and vitamin E.|
|Specialised Pro-Resolving Mediators||SPMs are lipid mediators that promote resolution, reduce pain, encourage clearance of pathogens and mitigate pathological inflammation, without immunosuppression. SPMs regulate macrophage polarisation; triggering the switch from M1 (proinflammatory) to the M2 (anti-inflammatory) phenotype, therefore promoting resolution.|
6.0 Supportive Lifestyle Programs:
|Supportive Lifestyle Program||Description|
|Elimination and Rechallenge Program||This elimination diet with food challenges is an effective way to identify dietary induced allergies, intolerances and sensitivities. The program systematically initially eliminates leading suspect foods and digestive support, before eliminating the main food groups associated with reactivity (General level), with further restrictions to consider in extremely sensitive individuals (Sensitive level). Full instructions, food shopping lists and symptom diaries are all available for free download.|
|Shake It Practitioner Weight Management Program||This carbohydrate-restricted Ketogenic diet is a hypocaloric fat loss program for those with insulin resistance, who will usually also be overweight or obese. Reducing dietary glycaemic load will reduce insulin release and help patients lose fat, particularly visceral adipose tissue, thus helping to minimise the risk of many chronic illnesses, such as cardiovascular – metabolic diseases|
|Metagenics Clinical Detoxification Program||
The Metagenics Clinical Detoxification Programs are designed to address the primary source of toxicity in patients, and encourage elimination of and protection against these toxins. A questionnaire is available for patients to complete which assist the Practitioner in determining the most appropriate program. There are three programs available:
|Wellness and Healthy Ageing Program||This program recommends a low-reactive, low glycaemic load diet with lifestyle recommendations for exercise, relaxation, intellectual stimulation and effective stress management.|
7.0 Diet and Lifestyle:
Dietary and lifestyle guidelines may assist in the management of lymphoedema:
- Drink plenty of water – at least 2-3L per day.
- Manual lymphatic drainage drains excess fluid.
- Short stretch compression bandaging – during activity, the short-stretch bandages provide increased resistance against the affected areas and, therefore, help to soften fluid-swollen areas.
- Therapeutic exercise assists in moving lymph fluid through musculature contractions.
- Skin care – important to minimise risk of skin ulceration.
- Eliminate exacerbating foods from the diet – i.e., caffeine, saturated fats, and salt.
- Eat a high-fibre, low fat diet, including many plant-based foods, fruits and vegetables, beans and peas, raw seeds and nuts, and whole grains.
|Lymph node biopsy||Fine needle aspiration biopsy or open surgical biopsy can be done to determine if lymphoedema is caused by inflammatory conditions, infections or malignancy.|
|VLA - Quadscan||Segmental bioimpedance analysis can be used to monitor fluid changes within the limbs|
|Omega-3 Index Test||A validated test that measures red-blood cell (RBC) EPA and DHA status to personalise supplemental and diet prescriptions, as well as identifying those at risk of health conditions associated with omega-3 deficiency. An Omega-3 Index in the desirable range of 8%-12% is an indicator of better overall health.|
9.0 Pharmaceutical Treatments:
These medications remove excess water from the body. They do not, however, eliminate the protein associated with accumulated lymph fluid. This results in rebound oedema between doses as the osmotic pull of the protein draws water back into limbs.
It has been proposed that benzopyrones would be beneficial for lymphoedema patients because of their ability to breakdown the proteins in the excess lymph fluid and stimulate lymphatic activity. These drugs bind to accumulated interstitial proteins, inducing macrophage phagocytosis and proteolysis. As a result the resulting protein fragments pass more readily into the venous capillaries and are removed by the vascular system.
[*] Ensuring patients maintain an omega 3 index above 8% is essential to SPM production. Omega-3 status can be evaluated/monitored using the Omega-3 Index Test (refer to pathology testing section). In the instance of deficiency, consider co-prescribing an omega-3 essential fatty acid supplement.