Starving yourself is not the answer

By Tatjana van der Krabben

Starving yourself, starvation, fasting: these words seem to pop up everywhere these days in relation to lipedema. And not just with respect to lipedema. There’s talk of ‘starving tumors’, resetting and/or cleansing your body by fasting, skipping meals like a caveman etc. The emphasis is shifting to what is not ingested, instead of what you should or could ingest. Before you know it the (presumed) science behind these tools is translated into numbers of calories and ways to cut calories, as we are all drilled with the low-calorie myth.

With doctors still (!) recommending gastric surgery for lipedema, the fad of the hCG diet which was paired with extremely low calorie food plans, the popularity of juice detox-fasting and the presumed beneficial effects of (intermitted) fasting, the extreme low calorie theories as somehow being beneficial for lipedema after all keep creeping into conversation. I don’t buy that. Plus, this line of reasoning is creeping me out. It creeps me out because it’s a slippery slope: if you don’t lose weight at, say, 1500 calories a day, they drop the recommendation to 1200, then 1000. Where does it end? With hCG they dropped to 600 calories. That’s incredibly low, to put it mildly. Just because we need to fit the calories in and calories out myth.

Weight-loss is not simply about calories in and calories out. Yes, a lot of doctors still say that, but that’s because they didn’t keep up with research on this topic since medical school. A frustrating example in my own household: my son has to eat like crazy just to maintain a healthy weight, my husband was the same and can still eat an insane amount of calories without showing it, but my daughter and I have to really watch what we eat. There is no general standard in metabolism which you can quantify with a number of calories per day, even though this is being done anyway. We simply are all different and don’t process food alike.

On top of that, lipedema is not caused by overeating. It can be aggravated by overeating, but that’s another story. As lipedema is not caused by overeating, it seems farfetched that eating (extremely) little could fix it. I know many of you are familiar with the images of women with anorexia, who still displayed clear signs of lipedema. Sadly, these women prove that point.

Starving yourself is not the answer. Food is not the enemy. Good food provides nutrients, the stuff that keeps you strong and healthy. You can’t build muscles on air. You can’t maintain strong bones and teeth, and have enough energy to face your day by limiting yourself to a few mouths-full of food day in day out. Food is sustenance.

Moreover, lipedema appears to coincide with deficiencies in essential vitamins and minerals. Vitamin B12 and D deficiency is notorious among lipedema patients, as low levels further undermine energy levels. Some say it’s because we already tend to eat too little as it is. Others speculate it’s something in our metabolism. I don’t know what it is, as lipedema metabolism has never been studied. I only know that if you’re already prone to deficiencies it’s not particularly helpful to deprive yourself of sufficient quantities of foods containing essential vitamins and minerals.

There’s no nice way to put it. Lipedema in itself already can already affect quality of life. Deficiencies only make you feel worse. It’s a sign your body doesn’t get enough of what it needs to keep the system running smoothly. It’s not just a matter of discomfort: deprivation leads to health problems and in the long run to permanent health damage.

I know many of us have to use supplements or get for instance B12 shots to compensate regardless, but access to supplements cannot justify deprivation. My two cents: even if modest (!) fasting or throwing in a liquids-only day is said to be beneficial, it should be nothing but a tool in the bigger picture, never a goal in itself.

Lipedema and Low Impact Exercise

By Maggie McCarey

     Contrary to popular belief, exercising to lose weight and to stay healthy is not a new idea.  Folks have been promoting exercise since I was a kid six decades ago. President Eisenhower established the President's Council on Youth Fitness on July 16, 1956 with a committee recommendation that all Americans be state mandated to exercise.

      Most of us from 1956 on engaged and continue to engage in physical fitness endeavors. Go Baby Boomers! Unfortunately, America has been on a slow learning curve regarding how much and what kind of exercise is needed to maintain health.  More was always thought to be better. On this curve,   I depended on a ridiculous amount of exercise and starvation to maintain a semblance of normalcy for most of my adult life.  Many of my friends, who don’t have lipedema,  also used over-exercising, particularly running,  to maintain their vast calorie intake and at the same time to remain thin.  All of us, male and female, thin and fat, over the age of 50,  have reached the same conclusion. We have had to relearn, rethink, and rebuild our exercise plans to compensate for our bodies’ aging process.

       Doing lots of exercise is great until your first serious injury occurs or your worn-out knees finally refuse to be abused. Everyone who depends on over-exercising to maintain weight is one twisted ankle away from total collapse of  his/er way of life.  I know. I and most of my friends have been there.  My best skinny friend, ran 5 miles a day for years.  In her mid-50’s, her back wore out.  She had disc surgery and then rotor cuff surgery.  She then moved to low impact swimming and bicycling 20 miles a day in order to eat all of the sugary desserts, pastas, and rolls she wanted.  Her back went out again and her leg with it. Now she can no longer ride her bicycle and she is a Joan Osborn cliche: Just like us because she used exercise to maintain an unhealthy lifestyle until her body gave out. Food intake and exercise are not synonymous. The reason  compulsive exercise is not okay is because you don’t get to the finish line with it…ever…  and then you still have to learn to eat what your body needs.  

     The same day you learn that you have lipedema, you learn there are only two things that medical professionals agree on about lipedema. You learn that you cannot exercise or diet your lipedema fat away and you learn that you must continue to diet and exercise to maintain what health you have. You also learn on every site about lipedema that exercise MUST be low impact. This is logical since our knees are often damaged and worn away from puberty onward with hyper mobility and connective muscle tissue that does not properly protect our joints. 

     So what are low impact exercises?  Generally, they are walking, cycling, rowing, swimming, and elliptical training.  Running is not on the list.  Now to really blow our minds, some exercise gurus are beginning to agree that exercising is fun, if that’s what you like to do, but it doesn’t do much for weight loss beyond a given point. Two experts, British medical doctor Michael Mosley and Australian exercise physiologist and associate professor at University NSWS, Steve Boucher agree that limited, targeted exercise 3 times a week is best. Mosley recommends intensity exercise bursts of 20 second intervals for one minute, three times a week to increase aerobic fitness and ability to process glucose. Boutcher’s clinical trial concludes 20 minutes of intense pedaling on an exercise bike three times a week is the best exercise for good health.  He says:

"Diets do not work in the long term for the great majority of people; the stuff we want to lose is the stuff we can't feel - it's devilish," Boutcher says, “of the insidious visceral fat that surrounds our organs but doesn't always protrude externally as a worrisome girth."

He suggests that removing stress and sleeping better are just as important as exercise and diet in maintaining weight¹.

      Of course, every article I read while researching for this blog suggests that walking at a good clip is the best exercise for everyone. For me, even my walking days are over thanks to my compulsive, high impact exercising, but I still exercise, because when I stopped walking well, I was taught by a physical therapist to exercise every day before I get out of bed.  I target the areas I want to exercise, tighten my muscles for ten seconds in those areas and then release. Belly, thigh, knee, full body presses: tighten and release  You can do leg lifts, stretches, and side rolls.   You can sit at your computer, lean back slightly and exercise your butt and upper legs, ten count, release, and then take a deep slow breath in and out.  You can move any muscle in your body, including your heart to increase cardio-vascular strength via deep breathing and yoga techniques. You just tighten your target muscles the count of 5 and release, repeat 3 times and move on. It gives the same return as regular exercise because these intense bursts release glucose effectively and they aid NO (Nitric Oxide) production and flow, which is nectar for the muscles.

     You don’t need to push body weight down, around and over your muscles to properly exercise them, and now, apparently, this no/low impact exercise also helps you to lose weight. You can gain the same results on low impact and keep your body intact into old age, something I wish I had been told in time.

 

¹) http://www.dailylife.com.au/health-and-fitness/dl-fitness/how-much-exercise-do-you-really-need-20140207-325qw.html

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.”