Do our lymphatic systems need a detox? The short answer is No.

What's Up Docs?

https://www.bbc.co.uk/sounds/play/m002wxsx

the podcast where identical twin doctors Chris and Xand van Tulleken cut through the confusion around every aspect of our health and wellbeing.

In this episode, Chris and Xand explore the lymphatic system, from its vital everyday functions supporting fluid balance and immunity to its more mysterious roles. They look at what happens when things go wrong, examine popular wellness claims around draining and detoxing our lymphatic system, and find out what actually supports good lymphatic health.

 

Joining them to discuss this is Professor Kristiana Gordon, a Consultant in Dermatology and Lymphovascular Medicine. She’s Clinical Lead at the National Lymphedema Clinic at City St George's, University of London, and is also a certified lymphedema therapist.

 

What is the lymph system?

Most doctors, nurses and physios would struggle to answer that.

We could say maybe three things about it.

Which would be two more than most doctors.

It’s the see-through system. It’s hard to visualise and it doesn’t turn up on an X-Ray or readily on a CT or MRI.

Research has kicked off in the last 20 or 30 years. We’re learning more about it.

Vital for health. This network of tiny vessels that drain interstitial fluid.  The water, the fluid, that bathes all of our cells in between cells. The fluid is made from our blood plasma. We’ve got arteries pumping blood to our tissues. And the plasma, the water between blood, gets pushed out to the interstitial spaces between cells in all of our tissues. And that fluid just keeps being made as our heart keeps pumping blood. So it has to go somewhere.

Why are we bathing ourselves in this fluid?

Because we’re delivering goodness. Nutrients to our cells.

Once it’s done its job. All the goodness to the tissue, where’s all that fluid going to go? The textbooks are wrong. They all say it’s the venous system, the veins that drain the lymph fluid to the heart, but it’s wrong.

Revised in 2010. Not the veins that drain fluid but the lymph system. Everything drained via lymphatic system.

What is the lymphatic system that removes fluid?

It starts as blind-ended capillaries. Little vessels. And the fluid is absorbed into those blind-ended capillaries. We call them initial emphatics. Tiny tubes.

And then they drain to deeper ones called the cholesteric lymphatic vessels?

And these vessels have ability to contract and pump. It gets pumped towards a lymph node and then joins with a bigger lymph vessel and finds its way back to the heart. It is the lymph system that’s doing all the hard work.

How much is the lymph system carrying?

About 40 litres a day of this fluid.

Why do we need to get rid of this fluid and what’s in it?

The lymph system has lots of jobs.

First job- fluid balance.

If we didn’t have a lymph system sucking up all this interstitial fluid then we’d swell up.

Our whole immune system lives with our lymphatic system.

So you get a cold and the doctor feels under your neck. Glands are lymph nodes aren’t they? Yes. Talk us through what’s going on.

The lymph nodes will be up when the lymphatic system is recognising theirs a virus, or maybe bacteria that’s caused a sore throat.  

Your immune system has recognised there are bugs. The lymph nodes will increase as the lymph nodes within the system try to fight it.

So having large lymph node in your neck is not necessarily a bad thing. It’s actually a sign your immune system is fighting this bug.

Another job the lymph system has is to absorb the fat we take into our body. And along with that there are fat-soluble vitamins. Without a healthy lymph system in the gut, you could run into problems with malabsorption.  Diarrhoea after eating fatty foods. Potential vitamin deficiencies.

What about toxins?

Does the lymphatic system help us drain toxins from our system?

I have colleagues who jokingly refer to the lymphatic system as the sewerage system.

Which I think is a big unfair to the lymph system but what city isn’t a great city if it doesn’t have a great sewerage system.

Everything will be potentially absorbed and drained by our lymphatic system.

Tell us about lymphatic diseases.

Lymphedema.  That’s the medical term for when the lymphatic system isn’t working properly and you get swelling.

Broadly split into two different types.

Primary lymphedema and Secondary lymphedema

Secondary is by far the commonest.

Primary is a genetically concerned weakness of the lymphatic system. Underlying genetic mistake caused by a developmental abnormality of that person’s lymph system.

The more common, secondary lymphedema?  Where it has been caused by something else.

There are so many different causes. If somebody gets secondary lymphedema they were born with a health lymphatic system.

Something happened that damaged their lymph system. For example, post-cancer treatment. Having a lymph node removed as part of their cancer treatment really does increase their risk of that person developing lymphedema.

What that lymphedema means to a patient?

Something like breast cancer removal of lymph nodes and patient will notice almost immediately, and their watch is slightly tighter or rings on that side. Or they might see some significant swelling pretty quickly. But usually it creeps up on you.

How common is lymphedema?

We don’t know for sure. No one has done any proper studies.  I think that’s because the majority of doctors lack the confidence to diagnose it. And so in GPs and hospitals we’re not coding for it. But we estimate there is around 400 000 people living with lymphedema in the UK alone. 140 to 150 million, world-wide.

Persistent swelling for three months of more, official definition. But obviously, there’ll be that grey area where the swelling might fluctuate. Many of us might have a mild case of lymphatic insufficiency were we’ve got swelling of the ankles at the end of the day, but it’s mild. But if someone has persistent swelling and it means they can’t get their shoes on and got an episode of cellulite infection then we’re definitely saying you’ve got lymphatic oedema. And you need treatment here.

Is it a good idea to take action early, to notice why your ring is bit tighter than wait until it develops?

Yes.

Early intervention with someone with a struggling lymphatic system is really important.

  

 

 

 

 

Compression, movement and skin care. Weight management.

Being fat can cause lymph problems. Lympedema can cause fat problems?

So if you are overweight and you lose weight, that’s really good for your lymph system.

Skin care

It may sound ridiculous, moisturisers being a key part of treatment. But it’s so important. If you have dry skin it’s going to have splits, which is going to let bacteria in and cause a cellulitis infection.  

Manual lymphatic massage, used to be on my list. (Inference, it doesn’t work).

Therapist applying gentle pressure on tissue in certain movements to open up the lymphatic vessels *(in theory) and encourage that fluid to drain quicker?

Very little peer-reviewed evidence it works.

Benefits last a couple of hours (at best)? As a stand-alone treatment not efficient or greatly beneficial.

Though it feels wonderful.

It’s not a bad thing. But the majority of people don’t need it on a regular basis.

General things to do to care for our lymphatic system.

Very similar to the advice we give our patients.

Move. Be active.

Be a healthy weight.

If you have a little ankle swelling, consider getting some compression ankle socks and wear them during the day.

Is it caring for yourself in this way of caring for yourself when older?

We have no data.

We’re still in the infancy of lymphatic research.

Wellness hacks. Does our lymphatic system need a detox?

What does detox mean?

You’re unsure of what we’re talking about indicates to me the likely answer is ‘no’.

We’ve got some celery juice. This is one popular lymphatic detox here.

No thanks. You drink it. How does it taste? Rotten.

You haven’t heard of it?

I’ve heard of it, but there’s no science to say it does anything good.

Celery isn’t bad for you. A bit of fibre.  Whatever.

Infrared sauna—was the next one? Do you want a piece of the action?

Please, no.

I would say, saunas might exacerbate lymphedema. When we’re hot our body tries to cool us down by dilating our arteries. When you dilate an artery it’s going to become more leaky—fluid. So you’re going to be making more lymphatic fluid. Perhaps you don’t want to go down that route.

What about trampolining?

It has been said by many people online, trampolining is good for you lymphatic system.

I wouldn’t disagree. It’s a form of exercise where your calf muscles pump up and down. That’s going to stimulate lymph drainage. I’m all for it.

No reason to believe that trampolining would be better than say skipping or jogging or anything else?

Yes, no reason.

I personally believe that the lymph system is involved in so many diseases. Crohn’s disease. Dementia. The lymph system plays a role. I believe we should be more open-minded about what we don’t know yet.

https://www.amazon.co.uk/dp/B0CVBVVGD6