Yvonne van Stigt researches how to defeat lipedema

By Tatjana van der Krabben

October 2012 I attended a conference on lipedema. A very energetic lady delivered a lecture with a fellow researcher. I struggled to follow her on the topic of the leaky gut – then an only vaguely familiar concept to me. She got me when she mentioned low-grade inflammation related to lipedema. Bam! Yes, everyone, less than a year ago that was still news and at Lipese we were searching high and low for more information on the subject. And there was Yvonne van Stigt, not only on board with that, but also touching upon a sore point as how to fight the inflammation: with food - our enemy, our Nemesis. Van Stigt is a Paleo advocate, but a change of diet is only part of what she has to say. I recently had the honor of interviewing her on her views and plans.

Van Stigt has firsthand experience with lipedema
Yvonne van Stigt, specialized in clinical psycho neuro immunology, has an interesting history. She had, as she puts it, lipedema and started to study clinical psycho neuro immunology to help heal herself, as she couldn’t find the help she felt she needed in the traditional medical field. Unfortunately, her claim to have healed from lipedema sometimes yields adverse reactions. It is, however, not as controversial as it seems. She is currently free of symptoms. She described her legs as pain-free, no longer swollen, of a more modest size, but hardly perfect. Being symptom-free does not equal killer legs, unfortunately. I’ve met others coming pretty darn close to being free of symptoms. So her claim doesn’t offend me. More so, I find it inspirational.

Clinical psycho neuro immunology
Clinical psycho neuro immunology is described by Van Stigt as ‘system thinking’. Finding a correlation does not suffice: clinical psycho neuro immunology seeks to understand the underlying processes. When you hear her string her theories it’s like listening to someone describing domino chain reactions, one stone after the other going, coming full circle in the end.

When treating patients she lets them fill out a questionnaire first. During the initial session she observes people and goes over the questionnaire. She provides them with a set of rules regarding diet and exercise. Generally, the younger people change their habits, the faster and the better the result. In case of persisting health issues there may be (some) irreversible damage. She also says 75% can be sufficiently helped with these guidelines only. About 25 percent needs additional tests. A blood test seems like the next step, but Van Stigt isn’t necessarily keen on standard blood tests. “For instance: just because the blood has high levels of a vitamin, doesn’t mean there is no shortage on a cellular level. A blood test doesn’t tell that.” Instead, Van Stigt also uses urine tests or, when testing blood, zooms in on the red blood cell.

Thinking outside the box
Although she continuously speaks of causes for lipedema and doing something about it, she acknowledges it’s genetic. “A good genetic package would have left you with a solid foundation of muscle, naturally capable of burning fat. When you have lipedema, you lack these genetic benefits, making it challenging to burn fat.”

She doesn’t believe it’s hormones only. Like many of us already experienced, the early onset can predate puberty. Van Stigt identifies three triggers: stress, hormones and the immune system. Which one will tip you over the edge and will bring on obvious lipedema signs, is personal. Which triggers will continue to haunt you with symptoms is personal as well. This rules out a standard approach for each and all. “After the balance is gone and your poor genetic package is becoming a factor, your body reacts with a survival strategy,” explains Van Stigt. “This could be, for instance, diabetes, fibromyalgia or lipedema.” Lipedema here qualifies as a survival strategy, because the body is looking for a way to cope with the lack of balance. In case of lipedema, the body has issues disposing of toxicity. The lymph shutting down is a strategy of the body to prevent toxins from reaching vital organs via the lymph circulation, but it shutting down also hinders the disposing of the toxins. This also explains why, when reducing toxicity levels, the lymph start to function better, unlike for those with lymphedema. Technically, the lymph can do the job, provided it hasn’t gotten damaged over time.

As for treatment, Van Stigt works closely with a gynecologist who tests hormone levels. Bio-identical hormones are recommended when deficiencies turn up. To state the obvious: that would not be a deficiency of estrogen. Mostly, in case of lipedema, there’s estrogen dominance. As for the immune system – it’s often under pressure because of a poor diet. “Modern eating habits are poor eating habits by definition”, she says. Van Stigt, being a Paleo advocate, does sympathize with those dreading the transition to a different lifestyle, although she wouldn’t want it any other way for herself, knowing the consequences. “Commonly it takes 7-10 days to adjust to the changes. After that, you already start experiencing the benefits, which usually acts as a great incentive.”

Although not focusing exclusively on lipedema, it’s obvious she’s passionate when it comes to fighting this condition. She now has her heart set on a 10 day therapeutic retreat for lipedema patients coming winter. Van Stigt wants to give people all the tools and help them to learn to eat differently, safely start up with special exercise and stimulate the lymph through osteopathy, among other. She’s eager to prove that’s all it takes to get properly started with the rest of a better, more comfortable life.

I was jumping on my seat when I found out. I can’t make it on this trip, but someone out there wants to do something that could be the closest thing to a clinical trial that we currently have regarding lipedema, exercise and diet. To be continued!

Obviously, I’ve given a very brief and incomplete description of Yvonne van Stigt’s work. Her new book, which will describe her theories and findings regarding lipedema in great detail, is due mid-November in the Netherlands. An English translation will follow. I’ll keep you posted.

 

Is a high protein diet adding to lymph problems?

By Tatjana van der Krabben
In our efforts to manage our weight, we eventually leaned towards high-protein, low-carb. We are also picky about the protein: low in or, if possible, free of toxins and from organically raised and/or grass-fed animals. Polluted foods only lead to inflammation. But sometimes we also hear advice against a high-protein diet. It supposedly adds to the buildup of protein in the lymph fluid, further hindering the lymph flow.

I had to expand my search a little and found more information through lymphedema. We do have a thing or two in common, like lymph fluid high in protein.

Dr. Vodder’s Manual Lymph Drainage: A Practical Guide by H. Wittlinger, D. Wittlinger, A. Wittlinger and M. Wittlinger (2011) talks elaborately about nutrients being stored in our connective tissue. The short version, as quoted from Vodder (2005) is this: “All protein molecules leave the bloodstream within 24-48 hours, enter the connective tissue, and most of them are returned to the bloodstream via the lymphathic vascular system, so the term “protein circulation” is justified.”

Wittlinger et al continue to explain the problem with high levels of protein: “..the protein circulation needs a properly functioning lymphatic vascular system: otherwise there will be blockages and build-ups in the connective tissue, that is, the concentration of protein in the tissue will rise. This will lead to chronic inflammation, which in its turn will result in cell proliferation (fibrosis).”

Protein in your diet is blamed as a contributing factor: “If the blood protein concentration is too high, e.g., due to a protein-rich meal, various mechanisms of the endothelial cells of the blood capillaries will cause the protein to be released into the tissue in order to maintain homeostasis.”

By implying that molecules of the protein you digest go to the connective tissue via the bloodstream and are next absorbed by the lymphatic system, I get that some warn against high-protein diets.

There are two sides here. The other side being that the protein you digest does not become part of your lymphatic fluid:

Ray (2004) says this on the subject: “Although lymph fluid is high in protein, the protein is derived from the blood, not directly from the diet. Consuming less protein does not affect lymphedema and can have serious health consequences.” (http://www.amylhwilliams.com/Lymphedema.pdf)

Cornely (2006) quoting Földi and Földi says: “Lymphatic edema is rich in protein and arises from the reduced transport capacity of the lymphatic system despite normal protein load.” And: “Lymph transported from the periphery to the center in this semicircular system essentially consists of products which cannot be transported via the venous system. Among these products plasma proteins represent the main protein load.” (http://link.springer.com/content/pdf/10.1007/3-540-28043-X_3.pdf#page-1)

Two views and a need for useful advice on protein-intake
The Recommended Dietary Allowance (RDA) for protein for the average, sedentary adult is at 0.8 grams per kilogram of body weight. Recommended amounts found online vary greatly. Depending on age, gender and lifestyle (bodybuilding, attempting weight loss, Paleo, food pyramid etc.). So, your recommended protein-intake, when assuming this element of your diet does not interfere with your lymphatic system, depends on the health or diet guru of your choice.

When assuming dr. Vodder and those who follow his teachings, Wittlinger et al, are correct, this does have potential implications for your protein-intake. When you look at what the Wittlinger Lymphedema Clinic does recommend, you find a food pyramid style plan: http://www.lymphedema-clinic.com/oedemarten/5-saeulen-der-behandlung/ernaehrung.html
The base is fruit and veg and second are sources of protein. Yes, second. The single largest source of nutrition would have to be protein-based.

The Wittlinger Lymphedema Clinic even speaks of a minimum protein demand of 0,6 grams per kilogram of body weight. Their example of a 65 kilogram or 143,3 pound woman states she should have 39 grams of protein minimum. Since weighing 143 pounds would be something many of us can’t image ever weighing (again) and the sum of 0,6 grams per kilogram would add up unrealistically for many, I’ve contacted the Wittlinger Lymphedema Clinic to elaborate on their recommended diet.

Dr. Christine Heim, Director of the Dr. Vodder Akademie Walchsee, was kind enough to explain in more detail.

The 0,6 grams of protein per kilogram is related to a normal body weight. For your point of reference it is best to calculate from a normal height: you don’t add up 0,6 grams per kilogram indefinitely. That would imply that if you are a bit taller than average you would need more than the 39 grams from the example.

To my question what the maximum protein-intake should be, she replied that would be 1 gram per kilogram of body weight, related to a normal body weight. This allows for a substantial protein-intake.

So, whether you do or do not believe your diet contributes to your blood protein levels, it takes a lot before your protein intake is too high. It also doesn’t hurt to take a peek at the base of their pyramid: fresh veggies and fruit. Fruit has issues with (blood) sugar, but it’s also the thought that counts here. Grains and even more really starchy foods and sweets should be consumed in smallest quantities in comparison. First and foremost you need to work on your veg (and fruit) and protein intake. A modern perspective that doesn’t clash with the average dietary recommendations going round among lipedema patients. That’s reassuring.

Some have translated the potential impact of protein-intake into a low-protein recommendation. As you can read above, this is not what those following Vodder imply.  A word of caution: Dawson and Pillar (2011) state that low-protein diets are dangerous and quote Mahan and Escott-Stump (2007): “Proteinaceous foods are high in amino acids that are essential for the body. If protein is not acquired in the diet, the body begins to catabolise its own protein stores, resulting in muscle wastage and malnourishment.”