Nutritional aspects and obesity in lymphedema
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Obesity contributes to the onset of lymphedema and often worsens the
symptoms of already existing lymphedema. Depending on the degree of
obesity, it may seriously hamper treatment progress. It is often
difficult to apply bandages, especially in cases of lymphedema
affecting the lower extremities. Furthermore, the compressive materials
(bandages, garments) applied to the affected extremities have a
tendency to slide in obese patients. Compression garments may have to
be custom ordered, creating an additional financial burden to the
patient. Exercise protocols used in CDT often have to be modified
accordingly. Patients suffering from lymphedema should try their best
to achieve and maintain normal weight in order to reduce the risk
factors associated with obesity, and to improve compliance.
Treatment of lymphedema
Complete Decongestive Therapy (CDT) is the therapy of choice for most
patients suffering from primary and secondary lymphedema. The goal in
lymphedema management is to reduce the swelling and to maintain the
reduction by removing excess plasma proteins and water from the
tissues. CDT with its four components (Manual Lymph Drainage (MLD),
compression therapy, decongestive exercises and skin care) is designed
to achieve this goal if it is applied by a skilled and specially
trained therapist.
Nutritional aspects
There is no special diet for lymphedema. An accepted approach in
lymphedema management is to follow a low-salt and low-fat diet, which
also positively contributes to weight control. Although lymphedema is
defined as an accumulation of water and protein in the tissues, it is
essential to understand that lymphedema cannot be reduced by the
limitation of protein ingestion. It is also important not to limit
fluid intake. Good hydration (water) is essential for basic cell
function. There are no vitamins, food supplements or herbs that have
been proven to be effective in the reduction of lymphedema. In the
United States, dietary supplements are regulated as food, not drugs.
Premarket approval by the Food and Drug Administration (FDA) are not
required unless specific disease prevention or treatment claims are
made. Because there is no requirement to review dietary supplements for
manufacturing consistency, and no specific standards for dosage or
purity exist, there may be considerable variation within the products
marketed as dietary supplements. Lymphedema patients who are willing to
experiment with these products should consult with their physicians
and/or lymphedema therapists and use common sense and caution,
especially if these products are taken in large quantities. Types of
lymphedema
Lymphedema is very common and serious condition, affecting at least
three million Americans. Lymphedema is classified as either primary or
secondary.
Primary lymphedema is caused by congenital malformations of the
lymphatic system. It usually affects the lower extremities and may be
present at birth but more often develops later in life, often in
puberty or during pregnancy.
Secondary lymphedema is much more common; most patients in the western
hemisphere develop lymphedema after surgery and/or radiation therapy
for various cancers (breast, uterus, prostate, bladder, lymphoma,
melanoma). Other patients develop lymphedema after trauma or deep vein
thrombosis. In certain countries, parasites (filariasis) account for
millions of cases of lymphedema. Its cosmetic deformities are difficult
to hide, and complications (fibrosis, cellulitis, lymphangitis,
lymphorrhea, etc.) do occur frequently. Lymphedema may be present in
the extremities, trunk, head and neck, abdomen and the external
genitalia as well as in inner organs; its onset is gradual in some
patients and sudden in others.
Lymphedema is serious due to its long-term physical and psychosocial
consequences for patients; it continues to progress if left untreated.
Lymphedema frequently combines with other pathologies (cardiac and
venous insufficiencies, chronic arthritis, etc.) or obesity. These
conditions may worsen the symptoms associated with lymphedema or
complicate the treatment protocol by presenting additional obstacles.
The pathophysiological effects in lymphedema are further exacerbated
due to the additional stress placed on the already compromised
lymphatic system. It will become necessary to incorporate modifications
in the treatment protocol for lymphedema to appropriately address signs
and symptoms associated with any additional pathologies or obesity.
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About the Author:
Joachim E. Zuther
Joachim E. Zuther is a certified instructor in Manual Lymph Drainage
and Complete Decongestive Therapy. He is the founder and director of
the Academy of Lymphatic Studies, and the author of the recently
published textbook Lymphedema Management (Thieme Medical and Scientific
Publishers, NY - ISBN: 1-58890-284-6). He is also an active member of
the International Society of Lymphology and the German Society of
Lymphology. The Academy of Lymphatic Studies offers certification
classes in Lymphedema Management throughout the year in the U.S. Mr.
Zuther can be reached at 772-589-3355
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Lymphedema People