Pillar 5: Basic dietary rules and influence of nutrition on lymphedema

The currently most effective conservative therapy for lymphedema is Combined Decongestive Therapy or CDT. It consists of Manual Lymph Drainage (Dr. Vodder Method), compression bandaging, special skin care and accompanying physical therapy regime.  Nutrition plays an important medium and long term role within this CDT approach. 

Dietary change to assist therapy “The only thing you are going to lose in a diet is your good mood”, said the German actor Gert Fröbe. If you go about a diet the wrong way, this statement hits the nail on the head. Those persons affected by lymphedema are often and for various reasons not able to select nutrition which would support successful edema management. Instead, they choose nutrition which has the opposite effect. 

The first steps

A long term solution can only consist in a change of diet. First and foremost, there is a need to identify the root causes of lymphedema in each patient and explore whether existing "diet mistakes” prevent optimal therapy. In most cases wrong nutritional habits are due to eating being associated with “rewarding oneself” or "providing relaxation”. It is important to find out about a patient’s eating habits and to identify where to start changing them, as the patient should not return to his or her previous pattern of nutrition. 

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An end to excess weight Roughly 1.5 Million out of 8 million people in Austria are overweight and roughly 700,000 are obese. Around 1 billion people worldwide are overweight, which is why the World Health Organization has classified obesity as a pandemic.

Overweight is one of the main reasons for the development of edema. The accumulated excess fatty tissue allows more body water to be stored. Hence a first step in disease management should be to achieve an appropriate degree of targeted weight loss. 

In concrete terms this means that patients should plan to lose around two kilograms of body fat each month. 2 kg of body fat correspond to roughly 15,000 kcal. Hence they need to reduce their daily caloric intake by 500 kcal. Slightly more than half a pint of beer (0.33 l) and a small roll with slices of meatloaf contain 500 – 600 kcal. 

Enjoy a healthy diet

A positive attitude and an I’m-doing-something-for-myself mindset are the best preconditions for dietary change. Learning more about one’s own eating habits offers the opportunity to change them effectively and durably. Lose fat while retaining muscular strengthDuring weight loss muscles need to be kept in shape or built up. This is how your Basal Metabolic Rate (BMR, i.e. the number of calories your body burns to sustain vital functions) is maintained, thus avoiding the yo-yo cycle. Moreover, trained muscles support the venous and lymphatic system and thus help drain excess fluid accumulated in the body. Hence muscle building proteins should not be neglected in your daily diet: The ideal ratio is 0.34 g of protein per kg of body weight plus a 30% “safety margin” (to account for stress and physical activity) plus another 30% (to account for reabsorption loss). Minimum protein demand is 0.6 g per kg of body weight.

Example: the daily minimum for a woman weighing 65 kg is 39 g of protein.    

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Use herbs instead of salt

Common salt contains sodium, which binds water in the body. In other words: if you consume too much salt, your body will retain unnecessary body fluid and therefore enhance edema formation.

A high salt diet also increases blood pressure, no matter whether you use table salt, herb salt, sea salt or Himalayan salt.

1 teaspoon of salt per day (approx. 5 g) corresponds to the recommended daily amount.

Cheese or convenience food, ready made sauces, etc., contain a lot of salt. Hence make an effort to eat fresh natural food as often as possible. Use generous portions of herbs and spices as an alternative to salt.

Two liters a dayIf you drink a lot of water or other liquids, your body will not automatically store more water, quite the contrary. A sufficient quantity of daily liquid intake of roughly 2 liters “rinses” your kidneys and keeps you healthy. You want to enjoy the occasional drink? Don’t worry!

A small glass of wine (1/8 liter) or beer (0.3 liter) once in a while have no negative effect on your lymphatic disease. 

The nutritional cornerstones for edema patients

Targeted weight loss - Low sodium diet

Daily max 5 g of table salt 2 – 2.5 liters of non-alcoholic, largely sugar-free liquid intake per day
Appropriate protein consumption / high grade protein – 0.6 to 0.8 g of protein per kg of body weight per day MCT fats (i.e. fats with medium chain fatty acids)

Example for such a daily regime:

- Breakfast: 1 slice of wholemeal bread and 2 slices of cheese (15% fat content by weight in dry matter), 1 slice of wholemeal bread and MCT margarine, jam, 1 cup of coffee

- Lunch: 1 portion of spaghetti with tomato sauce (basil, oregano, little salt), a small bowl of salad (half a table spoon of MCT oil, garlic instead of salt)

Dinner: cold cuts including 2 slices of bread, 2 slices of ham sausage, 1 tomato, 1 teaspoon of spreadable MCT fat, 1 glass of buttermilk. 

For nutrition of patients following cancer surgery we refer you to the recommendations of the Austrian Society for Oncology (ÖGO), as well as the recommendations for a balanced diet of the Austrian Society for Nutrition (ÖGE) and the Austrian Academic Institute for Nutritional Medicine (ÖAIE).At the Lymphedema Clinic Wittlinger in Walchsee we take great care to ensure the gentle preparation of balanced, low salt and tasty dishes. 

Alexander Osl, Diätologe, www.eat4fun.at