Nutritional Considerations for Lymphedema

Posted April 19th, 2012 in Breast Cancer, Cancer Surgery, Recipes by Rebecca Lane

The function of a healthy lymphatic system is to collect
excess fluid, proteins, fats, inorganics and organics from the tissues, filter
it and return it to the bloodstream. Through its capacity as a filter, it protects
our body against disease and illness.

With lymphedema, excess protein-rich fluid leaks from the
lymph causing swelling, which decreases the oxygenation of tissues and
interferes with normal cell function. If the lymph stagnates, there is
potential for infection to occur (since the lymph contains bacteria) and excess
protein which remains in the tissues can begin to align and cause fibrosis.

Nutritional considerations for lymphedema include the
following key factors:

CALCIUM

The healthy flow of lymph is dependent on the presence of free calcium for good peristaltic action of the smooth muscles.  We have a tendency to look to milk as a good source of calcium (Ca), however milk contains too much protein to be an adequate supply of Ca. In fact, one of the key factors influencing Ca loss is high protein intake since protein creates an acidic environment in the body (the body constantly seeks to maintain blood pH at about 7.35). When the blood becomes too acidic it takes calcium from the bones and pulls it into the bloodstream where it acts to restore the proper balance.

Good food sources:

  • Green vegetables – spinach, collard greens, swiss chard, kale, romaine lettuce,
    celery, broccoli, cabbage, green beans, Brussels sprouts, asparagus
  • Citrus fruits
  • Herbs – basil, cinnamon, rosemary, garlic, mustard seeds
  • Nuts and seeds – steel cut oats, sesame seeds, almond
  • Sea vegetables

PROTEIN

Lymphedema is associated with the accumulation of protein in
the interstitial spaces. At the same time, protein is essential for repairing
and replacing tissues and muscles and building hormones, chemical messengers
and antibodies (to name only a few roles) in your body. Your body requires
protein with every meal.

Consider:

  • Choose healthy lean meat and fish protein – just one serving per day.
  • Use nuts, seeds, and legumes as alternative protein sources. Add them to
    salads, whole grains and steamed veggies for new taste options.

WATER

Water is an important component of lymph and is the
transport medium of the lymph system. It is very important to stay well
hydrated when dealing with lymphedema. Cutting back on fluid intake in an
effort to reduce the swelling can actually increase the swelling.

Consider:

  • Here’s a good rule of thumb to determine proper hydration levels: Drink enough water to turn your urine
    a light-coloured yellow
    – no odour and very little colour!
  • Avoid caffeine and alcohol which are mild diuretics. You can enjoy 1 to 2 cups
    of green tea which is full of antioxidants and anti-inflammatory
    compounds.

FATS

Since the lymph is also responsible for removing fats from the tissues and bloodstream, it is important to choose your fats wisely. Reduce the amount of saturated fat (from animal
protein), polyunsaturated fats and completely eliminate hydrogenated and trans fats from your diet (found in margarine and fried foods).

Choose good fats:

  • All of the hype about omega-3 fatty acids is completely valid. You need these
    essential oils for healthy cell membranes and brain health. They are found
    in fish oils, flax oil, hemp oil, walnut oil. I supplement my fish intake
    with EPA/DHA capsules, then use the nut and seed oils as dressing for
    salads, and steamed vegetables. They cannot be heated without going
    rancid.
  • For low heat cooking (less than 350 degrees F) you can use olive oil combined
    with vegetable or chicken stock to keep it cool – for steaming vegetables
    and light sautéing. For higher heat cooking used small amounts of coconut
    oil or butter.

SODIUM

Excess salt intake can increase the swelling of lymphedema as well as cause other health issues within the
body. High intake of sodium can lead to dehydration and is linked to high blood
pressure and heart disease. At the same time, sodium is an important mineral
necessary for the regulation of blood pressure and fluid volume to name just a
few of its roles.

Consider:

  • Consume no more than 1,500 milligrams of salt per day.
  • Take the salt shaker off the table, instead flavour with herbs, spices, seaweed
    and lemon juice
  • Limit the amount of processed foods you eat. When you do, read food labels
    carefully to determine the amounts of sodium and learn to recognize
    ingredients that contain sodium: a food with salt, soy sauce, salt brine,
    or any ingredient with sodium, such as monosodium glutamate, or baking
    soda (sodium bicarbonate).
  • In reading menus, look for words that signal a high sodium content, such as
    barbecued, broth, marinated, pickled, smoked and tomato base.
  • Fresh vegetables and fruits are a good source of appropriate amounts of sodium.

BODY WEIGHT

Excess body mass creates more work for the lymphatic system,
further with excess weight can come limited mobility, which reduces the
movement of the lymph and leads to stagnation and more swelling.

Consider:

  • Maintain a healthy, active body weight
  • Eat a balanced, healthy diet.  We strongly
    recommend eating 6 to 9 cups of vegetables and fruits per day, one to two
    servings of whole grains, and only one serving of animal protein per day –
    make that fish two to three times each week.
  • Make exercise an important part of your everyday routine. Whether walking,
    dancing, visiting the gym or enjoying fitness classes – find time to move
    and sweat every day.

Herbal Salt Substitute Recipe

Source: http://www.tasteofhome.com/Recipes/Herbal-Salt-Substitute

1 tablespoon dried basil

1 tablespoon dried thyme

1 tablespoon ground coriander

2 teaspoons onion powder

2 teaspoons dried parsley flakes

2 teaspoons ground cumin

1 teaspoon garlic powder

1 teaspoon ground mustard

1 teaspoon cayenne pepper (I use less – my family finds this a little too picante!)

1 teaspoon paprika

In a small bowl, combine all ingredients. Store in an airtight container in a cool
dry place for up to 1 year. Yield: 1/2 cup.

I also use Dulse or Kelp flakes instead of salt – or add large pieces of seaweed (Nori) to cooking water of soups, stews, and to flavour
pasta and rice.

 

Thanks to the following resources:

http://www.nhlbi.nih.gov/hbp/prevent/sodium/tips.htm

http://lymphalexa.com/2011/03/08/nutrition-lymphedema/

http://whfoods.org

The Encyclopedia of Healing Foods by Michael Murray, ND pp. 27-28

Lymphedema: Finding the Holistic Approach by Phillip J. Pollot, LMT

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Becoming your Health Advocate

Posted December 21st, 2011 in Cancer, Cancer Prevention Strategies, Cancer Surgery by Rebecca Lane

Helen and I have just started helping a client recently diagnosed with cancer. We wanted to outline the steps that we take as we go, so that everyone has access to the information.

The most important thing to do is to go online and do some preliminary research about your cancer, so that you understand what’s going on in your body and can formulate questions for when you next see your doctor. My go-to place is www.lef.org and in the search box, I type in Protocol for … Cancer. Usually I get lots of information. Print it out and put it aside.

Next, pick up a 2 or 3″ binder and many tabs to go inside it. This will become your Wellness Binder and it’s where you’ll keep everything you’ll need to reference along your journey. You’ll put your preliminary research here (okay, you can put it in the binder now), information about diets, supplements, lifestyle changes, detoxification strategies, contact information about your cancer care team, questions that come up between appointments and whatever else you can think of.

The article below is the next piece that you’ll add to your binder. You’ll find it a valuable tool for helping you to keep track of your health care (especially when visiting the hospital).

10 WAYS TO PREVENT MEDICAL ERRORS
by Karen Garloch, The Charlotte Observer, N.C.
10-17-11
 
  1. Expect mistakes and have an advocate with you in the hospital.
  2. Check every medicine. Make sure the dose is right. If you don’t know the correct dose – ASK.
  3. Be assertive. “Being nice can get you killed.”
  4. When in doubt, “say No.” Demand an explanation.
  5. Be vigilant during transitions, from one floor to another, or when shifts change.
  6. Alert the nurse or “rapid response team,” if something seems wrong.
  7. When discharged from the hospital, get detailed instructions and contact information. Know what symptoms might signal a worsening situation or infection.
  8. Hospital doctors may never speak to your primary care physician. Take your records and don’t assume doctors already know what’s in them.
  9. Double-check everything. Don’t assume no news is good news or that test results are always correct. Get copies of lab results in a timely fashion. If something seems wrong, request a repeat.
  10. Take a friend or family member to doctor’s visits. Nearly every error made in the hospital can also be made in the outpatient setting. A second pair of eyes and ears can be very useful in getting instructions and spotting problems.
 
PATIENT CHECKLIST
  • Take a list of your top health concerns/symptoms.
  • Ask your doctor for a recap to make sure you’ve been heard.
  • Take notes or record the conversation so you can remember.
  • Carry a list of all your medicines and supplements.
  • Find out about the most common and serious side effects your medicines may cause (a great resource for chemotherapy drug information is www.chemocare.com).
  • Ask the doctor how confident he is about your diagnosis. Find out what else could be causing your symptoms.
  • Get a second opinion.
  • Ask health care providers to wash their hands before they examine you.
  • Keep track of your progress: Keep a diary of relevant measurements such as weight, blood pressure, blood sugar.
  • Be vigilant when moving from one health care setting to another. Mistakes and oversights are especially common during transitions.
  • Ask how to get in touch with health care providers. Get phone numbers or email addresses, and learn when to report problems.
(c)2011 The Charlotte Observer (Charlotte, N.C.) Distributed by Mclatchy-Tribune News Service.
 
I realize these lists make it seem like the medical establishment is out to get you. That  isn’t the case at all. Most medical staff really care about your health and well-being. But in a hospital there are so many people working with you that important pieces of information can be lost in the shuffle.
 
You are the only one who can be responsible for yourself. And for keeping track of all of the information you need to return to health.
 
Be your own advocate. Make sure that your needs are met however uncomfortable it makes you feel to ask for clarification. Studies have found that the patient who refuses to take NO for an answer is the one most likely to get better (see #3 above).

Cancer Surgery – What you need to know ahead of time

Posted May 31st, 2011 in Angiogenesis, Breast Cancer, Cancer Surgery by Rebecca Lane

My view as I write this!

Yesterday I was flipping through my binder of cancer articles that I have collected, intending to read when I have the chance, and came across this article written by Dr. Steven Nemeroff, Oncology Health Advisor to Life Extension Foundation. Click here for the full article.

I am not a doctor, but I can give a ‘Coles Notes’ version of this article so that you can decide whether or not it contains information you would be interested in researching further and discussing treatment options with your MD, ND and oncologist. Knowledge is power!

As you probably know, the surgical removal of the primary tumor is the first treatment option for many cancers. The reason behind surgically removing the tumor is that once the tumor has been removed, then the body can be returned to health. Unfortunately this approach doesn’t take into account the reality that, in many instances, after surgery the cancer frequently metastasizes (spreads to another organ). This metastasis can be more serious than the original tumor – and can often prove fatal.

Metastasis of the tumor may occur after surgery as a result of cancer cells splitting off from the tumor and dispersing into the bloodstream or seeding directly into the chest or abdomen. To form a new tumor, that cell must first adhere to the lining of the blood vessel where it secretes powerful enzymes that break down the epithelial lining and basement lining of the blood vessel and allow the cell to burrow through the surrounding connective tissue and arrive at the organ that is its final destination. Here the cancer cell can multiply and form a new colony.

Given this information, what can individuals undergoing surgery to removal a tumor do to protect themselves against an increased risk of metastasis?

Cancer cell adhesion

Cancer cells that have broken away from the primary tumor utilize adhesion molecules – called galectin-3 – to adhere to clump together and thereby form colonies. These molecules are present on the surface of cancer cells and work like Velcro to allow free-standing cancer cells to stick together. Galectin-3 is also used by cancer cells circulating in the bloodstream to latch onto the lining of the blood vessels. This adhesion is a critical step in the tumor forming process.

According to Dr. Nemeroff, a natural supplement called modified citrus pectin (MCP) can inhibit cancer cell adhesion by binding to the galectin-3 adhesion molecules on the surface of cancer cells, thereby preventing cancer cells from sticking together and forming a cluster. MCP can also inhibit circulating tumor cells from adhering to blood vessel linings. There’s a lot of research that has been done to determine the efficacy of MCP and it’s available in this article. Most trial dosages have been 14.4 grams/day for one year.

In addition to modified citrus pectin, studies using Cimetidine (common name is Tagamet, an over the counter medication for heartburn) have shown that it inhibits cancer cell adhesion by blocking the expression of an adhesion molecule – called E-selectin – on the surface of cells lining blood vessels. This blocks the ability of cancer cells to latch on to the blood vessel walls.

The combined data suggests that at least five days prior to surgery, to ingest 800 mg of cimetidine daily and at least 14 grams of modified citrus pectin daily. According to Dr. Nemeroff, this regimen can be followed for a year or longer to reduce metastatic risk.

Preventing Surgery-induced Immune Suppression

The immune system plays an essential role in healing cancer. An important white blood cell to be aware of is the Natural Killer cells (NK). It’s role is to seek out and destroy cancer cells. However, surgery itself reduces NK activity! So without question, it is critical to actively strengthen the immune function by enhancing NK cell activity in the period before surgery.

One prominent natural supplement that can increase NK cell activity is PSK, a specially prepared extract from the Coriolus mushroom. Other supplements that have been documented to increase NK cell activity are garlic, glutamine, IP6 (inositol hexaphosphate), AHCC (active hexose correlated compound) and lactoferrin.

Pharmaceuticals used to increase NK cell activity include interferon-alpha and granulocyte-macrophage colony stimulating factor, as well as interleukin.

At least five days prior to surgery, institute a natural killer cell enhancing program involving PSK, lactoferrin, glutamine, garlic, IP6, and AHCC.

Cancer Vaccines

Produced from a person’s own cancer cells removed during surgery, these highly individualized cancer vaccines greatly amplify the ability of the immune system to identify and target any residual cancer cells present in the body. Cancer vaccines provide the immune system with the specific identifying markers of the cancer that can then be used to mount a successful attack against metastatic cancer cells.

Angiogenesis

Angiogenesis is the process by which new blood vessels are formed from pre-existing blood vessels. Cancer cells use this normal and necessary wound healing process in order to increase blood supply (and thereby oxygen and nutrients) to the tumor. The formation of a blood supply allows tumors to grow beyond the size of a pinhead – without angiogenesis they must remain 1-2mm.

The presence of the primary tumor serves to inhibit the growth of metastatic cancer elsewhere in the body. The primary tumor produces anti-angiogenic factors which restricts the growth of metastases. Surgical removal of the primary cancer results in the removal of these anti-angiogenic factors, and the growth of metastasis is no longer inhibited.

In fact, after surgery levels of factors that increase angiogenesis (to heal the wound) – called vascular endothelial growth factor (VEGF) – are significantly elevated. This can result in an increased formation of new blood vessels supplying areas of metastatic cancer – whether from newly formed colonies or from the activation of dormant micrometastases (those pinhead sized tumors that were before angiogenesis unable to be nourished by a blood supply).

Various nutrients have been shown to inhibit VEGF. These include soy isoflavones (genistein), silibinin (a component of milk thistle), chrysin, green tea (EGCG), and curcumin (also see other posts about angiogenesis).

Five days prior to surgery, the patient may consider supplementing with standardized green tea extract, curcumin, soy genistein extract and silibinin.

Surgical Anesthesia can influence Metastasis

The conventional medical approach to surgical anesthesia has been to use general anesthesia during surgery followed by intravenous morphine after surgery for pain control. The may not be the optimal approach.

Morphine weakens the immune system by diminishing NK activity. Studies on mice actually found that morphine increased angiogenesis and stimulated the growth of breast cancer.

One new approach is the use of conventional general anesthesia combined with regional anesthesia (only affects a specific part of the body). The use of regional anesthesia reduces the amount of general anesthesia required during surgery as well as decreasing the amount of morphine needed after surgery for pain control – especially for nausea and vomiting.

Those requiring morphine for pain control post surgery can consider asking for Tramadol instead. Unlike morphine, tramadol does not suppress immune function and has actually been shown to stimulate NK cell activity.

Less Invasive Surgery

Surgery places an enormous physical stress on the body. Surgeries that are less invasive, therefore less traumatic and less stressful, pose less risk of metastasis, compared to more invasive. An example of a less traumatic surgery for the abdomen, and pelvis is laparascopic surgery – where small incisions rather than large, are used.

For lung cancer, video-assisted thoracic surgery (VATS) is a minimally invasive surgery that you might want to consider.

Inflammation

Cancer surgery causes an increased production of inflammatory chemicals. These chemicals increase the activity of cyclooxygenase-2 (COX-2), a highly potent inflammatory enzyme which plays a pivotal role in promoting cancer growth and metastatis. It fuels cancer growth by stimulating the formation of new blood vessels feeding the tumor, by increasing cancer cell adhesion to the blood vessel walls, and enhances the ability of the cancer cells to metastasize.

Initially, COX-2 inhibitor drugs were designed to alleviate inflammatory conditions such as arthritis, but they have been shown to possess powerful anti-cancer activity.

A number of nutritional and herbal supplements are known to inhibit COX-2. These include curcumin, resveratrol, vitamin E, soy isoflavones (genistein), green tea (EGCG), quercetin, fish oil, feverfew, and silymarin (milk thistle).

Pharmaceutical COX-2 inhibitors include Celebrex and NSAIDS, such as aspirin and ibuprofen.

Conclusion

Since cancer-related death is most commonly the result of metastatic disease, it is crucial to minimize this facilitation. Therefore it is essential to be informed and employ preventative interventions during this critical time in order to minimize recurrence and metastatic spread.

I hope that you have found the key points of this article as interesting and important as I did. If you have any questions, please discuss this article with your MD, ND, oncologist – or give me a call and I can point you in the direction of answers.

Click here to link to the Life Extension Cancer Surgery Special Report with supplement guidelines.