Lymphedema is a frequent condition among cancer patients, especially those who have had surgery or radiation therapy. It is marked by the buildup of lymphatic fluid, leading to swelling, commonly in the arms or legs.
Effective management of lymphedema and overall health in cancer patients is significantly influenced by nutrition. Maintaining a healthy weight, adopting an anti-inflammatory diet, eating enough protein, lowering fat intake, staying well-hydrated and reducing sodium and processed foods can all help manage symptoms and enhance overall well-being.
1. Explaining Macronutrients
Nutrients are substances found in food that are needed for energy, metabolism, and other body functions. Since "macro" means large, macronutrients are nutrients needed in large amounts.
| Nutrient | Description | Examples | Image |
|---|---|---|---|
| Carbohydrate | Main source of fuel for daily activities, exercise, and brain function. | Starchy foods (whole grains, quinoa, potatoes, brown rice), fruits, milk, yogurt, starchy vegetables, legumes, beans, nuts, seeds. |  |
| Protein | Essential for tissue and cell repair, immune system, hormones, enzymes, and muscle preservation. | Lean meats, skinless poultry, fish, turkey, eggs, tofu, cheese, low-fat milk, yogurt, unsalted nuts and seeds, legumes. |  |
| Fat | Highest energy source, essential for vitamin absorption and cushioning organs. | Meats with skin, butter, margarine, avocado, nuts, seeds, dairy products, oils, lard, dressings, processed products. |  |
2. My Plate and Portion
Obesity and being overweight are linked to many chronic diseases, increased inflammation and added stress on the lymphatic system, which can raise the risk of getting lymphedema.
Effective weight management can be achieved through a combination of proper nutrition and regular exercise. Focus on portion control and maintaining a balanced diet to maintain a healthy weight.
Below find a portion size guide and how to build your plate according to USDA MyPlate.
3. Anti-Inflammatory Approach
Inflammation can worsen lymphedema. Following an anti-inflammatory diet can help reduce swelling and improve lymphatic function.
Foods that increase inflammation:
- Added sugars and refined grains contribute to increased inflammation and weight gain. Limiting the intake of sugary drinks, desserts, white bread, pasta and sugary cereals is recommended.
- Saturated and trans fats promote inflammation and hinder the lymphatic system's function. It is best to limit fried foods, fatty cuts of meat, full-fat dairy products and commercially baked goods.
- Ultra-processed and packaged foods contain additives, preservatives, unhealthy fats and additional salt that can worsen inflammation and fluid retention. Potato chips, muffins and donuts are examples of ultra-processed foods. It is best to opt for fresh, whole foods whenever possible, like baked potatoes with fish, mixed vegetables and whole fruit for dessert.
- Alcohol can have negative effects on both lymphedema and overall health. Per the American Cancer Society (ACS) and the American Institute for Cancer Research (AICR) guidelines, if possible, avoid alcohol. If not, limit to 1 drink per day for females or 2 drinks per day for males.
You can identify added sugars in products by checking the food label on the back.
Foods that can reduce inflammation:
- Fresh products and whole foods, such as whole fruits and veggies and whole wheat grains (whole wheat bread, brown rice, whole wheat pasta, whole wheat crackers, oats, quinoa, barley, buckwheat, farro and millet).
- Increase fruit and vegetable consumption. Aim for 5-6 servings daily per American Cancer Society guidelines. These foods have phytochemicals and antioxidants that help reduce inflammation and lymphedema.
- Eat plenty of healthy protein foods, such as eggs, chicken, fish, lean cuts of meat or plant-based proteins such as beans, nuts, seeds, and lentils. Lean proteins have lower amounts of saturated fats, and plant-based sources have unsaturated fats, which offer protective benefits.
- Healthy oils and fats such as nuts, seeds, salmon, avocado and olive oil, which contain omega-3 fatty acids and anti-inflammatory properties.
4. Fluids
Proper hydration supports lymphatic fluid movement and overall health. Follow these tips to meet your hydration goals:
- Drink sufficient fluids: Aim for approximately 64 ounces (~2 liters) daily. Water is the preferred fluid.
- Keep fluids accessible: Place a bottle or glass in plain sight.
- Set reminders: Use alarms or apps to track fluid intake.
- Consume hydrating foods: Include bouillon, broth-based soups, gelatin, fruit ices, popsicles, sherbet, milkshakes and nutritional supplements.
- Limit caffeine and alcohol: Reduce intake of caffeinated and alcoholic beverages.
- Avoid fluid restriction: Only limit fluids if directed by your doctor.
5. Salt/Sodium
Excess salt can lead to water retention in your body. Follow these tips to manage your sodium intake:
- Choose fresh foods: Opt for fresh or frozen fruits and vegetables without added sauces. Rinse canned items to reduce sodium.
- Select fresh meats: Fresh meats generally contain less sodium than processed options like bacon, sausage and hot dogs.
- Reduce salt use: Cut back on adding salt at the table and during cooking. Use lemon juice, lime juice, vinegar or fresh herbs for flavor.
- Use sodium-free seasonings: Buy or make sodium-free seasoning blends and condiments.
- Read labels: Choose foods with less than 140 mg of sodium per serving. Look for low-sodium options.
- Limit dining out: Restaurant dishes often contain extra sodium. When eating out, request sauces and dressings on the side to control portions.
6. Fat
Reducing dietary fat lightens the load on your lymphatic system, which helps process fat. Eating less fat daily can also support weight loss.
There are three main types of fat:
- Saturated fat: Found in animal foods like meat, butter, lard and cream.
- Trans-fat: Found in baked goods, snack foods, fried foods and margarines.
- Unsaturated fats: These have anti-inflammatory properties. They are high in omega-3 fatty acids (eicosapentaenoic acid, or EPA, and docosahexaenoic acid, or DHA) and low in saturated fat.
Food sources of healthy omega-3 fatty acids (from both plants and fish/seafood) include:
Sources of ALA (alpha-linolenic acid) from plants:
- Ground flaxseed and flax oil
- Pumpkin seeds and chia seeds
- Walnuts and walnut oil
- Soybean and canola oil
Fish and Seafood High in EPA and DHA
- Wild caught/Alaskan salmon
- Pacific oysters
- Tuna
- Trout
- Mackerel (not King)
- Herring
- Sardines
- Anchovies
Tips to reduce fat:
-
Read the fat content in labels:
- Less than 5 grams of total fat per serving is considered "low-fat."
- Avoid items with trans-fat and limit saturated fat.
-
Use MCT oil as a replacement for other fats.
MCT oil, or medium-chain triglyceride oil, is a fat derived from coconut or palm kernel oil. It is quickly absorbed and metabolized by the body, which can lessen the burden on the lymphatic system. Its anti-inflammatory properties may also help reduce swelling and support lymphatic health. Using MCT oil as a replacement for other fats in a low-fat diet can be beneficial for managing lymphedema.
How to use MCT oil:
- Start with a small amount to minimize gastrointestinal symptoms.
- Limit intake to a maximum of 7 tablespoons per day.
- Avoid heating above 300°F (150°C).
- Use it for frying only at low heat.
By following these guidelines, you can better manage symptoms of lymphedema such as swelling, discomfort and fluid retention. Proper nutrition can help reduce inflammation, improve lymphatic function and enhance overall health. For personalized advice and recommendations, consult with a healthcare provider or a registered dietitian.
To consult with a dietitian, start by discussing it with your doctor. They can refer you directly for a one-on-one consultation.
Alternatively, you can contact Cancer Survivorship and Supportive Care at 305-243-4922 for assistance.
References:
- Rock, C. L., Thomson, C., Gansler, T., Gapstur, S. M., McCullough, M. L., Patel, A. V., Andrews, K. S., Bandera, E. V., Spees, C. K., Robien, K., Hartman, S., Sullivan, K., Grant, B. L., Hamilton, K. K., Kushi, L. H., Caan, B. J., Kibbe, D., Black, J. D., Wiedt, T. L., McMahon, C., Sloan, K., Doyle, C., ... & Shih, M.-C. (2020). American Cancer Society guideline for diet and physical activity for cancer prevention. CA: A Cancer Journal for Clinicians, 70(4), 245-271. https://doi.org/10.3322/caac.21591
- U.S. Food and Drug Administration. How to understand and use the nutrition facts label. U.S. Food and Drug Administration. fda.gov
- Academy of Nutrition and Dietetics. (n.d.). Eat Right. eatright.org
- Shaw C, Mortimer P, Judd, PA. Randomized controlled trial comparing a low-fat diet with a weight-reduction diet in breast cancer-related lymphedema. Cancer. 2007 May 15; 109 (10): 1949-56.
- Gotsis E, Anagnostis P, Mariolis A, et al. Health benefits of the Mediterranean diet: an update of research over the last 5 years. Angiology. 2015 Apr;66 (4):304-18.
- Cavezzi, A, Urso, S, Ambrosini L, et al. Lymphedema and nutrition: A review. Veins and Lymphatics. 2019; 8:8220, 24-29.
- Rockson SG, Tian W, Jiang X, et al. Pilot studies demonstrate potential benefits of anti-inflammatory therapy in human lymphedema. JCI Insight. 2018 Oct 18;3(20).
- Shaw C, Mortimer P, Judd PA. A randomized controlled trial of weight reduction as a treatment for breast cancer-related lymphedema. Cancer. 2007 Oct 15; 110 (8): 1868-74.