Pathways Spring 2023
REFERENCES
Breast edema/lymphedema during and after breast cancer treatment Identification and treatment
By Lesli Bell
References
1. American Cancer Society. https://www.cancer.org/cancer/breast-cancer, https://www.cdc.gov/cancer/breast/basic_info/index.htm
2. Verbelen, Hanne, Nick Gebruers, Tinne Beyers, Anne-Caroline De Monie, and Wiebren Tjalma. “Breast Edema in Breast Cancer Patients Following BreastConserving Surgery and Radiotherapy: a Systematic Review.” Breast cancer research and treatment 147, no. 3 (2014): 463–471.
3. Mortimer, P.S. (1998), The pathophysiology of lymphedema. Cancer, 83: 2798-2802. https://doi.org/10.1002/(SICI)10970142(19981215)83:12B+<2798::AID-CNCR28>3.0.CO;2-E
4. Stout, N.L., Binkley, J.M., Schmitz, K.H., Andrews, K., Hayes, S.C., Campbell, K.L., McNeely, M.L., Soballe, P.W., Berger, A.M., Cheville, A.L., Fabian, C., Gerber, L.H., Harris, S.R., Johansson, K., Pusic, A.L., Prosnitz, R.G. and Smith, R.A. (2012), A prospective surveillance model for rehabilitation for women with breast cancer. Cancer, 118: 2191-2200. https://doiorg.ezproxy.library.tufts.edu/10.1002/cncr.27476
5. Levenhagen K, Davies C, Perdomo M, Ryans K, Gilchrist L (2017) Diagnosis of upper quadrant lymphedema secondary to cancer: clinical practice guideline from the oncology section of the American Physical Therapy Association. Phys Ther 97:1–17
6. Ridner, S.H., Dietrich, M.S., Cowher, M.S. et al. A Randomized Trial Evaluating Bioimpedance Spectroscopy Versus Tape Measurement for the Prevention of Lymphedema Following Treatment for Breast Cancer: Interim Analysis. Ann Surg Oncol 26, 3250–3259 (2019). https://doi.org/10.1245/s10434-019-07344-5
7. Koehler, Linda A., and Harvey N. Mayrovitz. “Tissue Dielectric Constant Measures in Women with and Without Clinical Trunk Lymphedema Following Breast Cancer Surgery: A 78-Week Longitudinal Study.” Physical therapy 100, no. 8 (2020): 1384–1392.
8. Rafn, Bolette S, Margaret L McNeely, Pat G Camp, Julie Midtgaard, and Kristin L Campbell. “SelfMeasured Arm Circumference in Women With Breast Cancer Is Reliable and Valid.” Physical therapy 99, no. 2 (2019): 240–253.
9. Verbelen, H., Tjalma, W., Dombrecht, D. et al. Breast edema, from diagnosis to treatment: state of the art. Arch Physiother 11, 8 (2021). https://doi.org/10.1186/s40945-021-00103-
10. Brandon Dixon, J., and Michael J. Weiler. “Bridging the Divide Between Pathogenesis and Detection in Lymphedema.” Seminars in cell & developmental biology 38 (2015):75
11. Toyserkani, Navid Mohamadpour, Mads Gustaf Jørgensen, Karen Haugaard, and Jens Ahm Sørensen. “Seroma Indicates Increased Risk of Lymphedema Following Breast Cancer Treatment: A Retrospective Cohort Study.” Breast (Edinburgh) 32 (2017): 102–104.
12. Smoot, Betty, Laura Chiavola-Larson, Jeannette Lee, Hidelisa Manibusan, and Diane D. Allen. “Effect of Low-Level Laser Therapy on Pain and Swelling in Women with Breast Cancer-Related Lymphedema: a Systematic Review and Meta-Analysis.” Journal of cancer survivorship 9, no. 2 (2015): 287–304.
13. Canadian Cancer Society Statistics, 2023.
FULL UNEDITED BIOGRAPHY
Lesli Bell received a BSc in PT (California State University) and a doctorate in PT (Regis University). She has owned a private practice since 1987, which now specializes in orthopedics, chronic pain and swelling disorders in Winooski VT. She received her lymphedema certification with the Lerner Lymphedema Services Academy of Lymphatic Studies in1997 and since then has been devoted to treating the complications that cancer and lymphedema patients have. Lesli has a very special interest in the breast cancer population and the edema that occurs in the chest wall and breast. She co-developed the Bellisse Compressure Comfort Bra in 1999, to improve the quality of life of patients who have breast and chest wall edema/lymphedema.
KETOGENIC DIET FOR LYMPHEDEMA
By Dr. Anna TowersIn addition to the POINT and COUNTERPOINT article printed in Pathways Spring 2023, we encourage readers to further their knowledge of the ketogenic diet pros and cons by visiting various websites and resources about medical studies and clinical trials on this topic. Here is an example of an excellent article entitled “What Does the Science Say About a Ketogenic Diet? from OpenEvidence that highlights evidence from the most frequently cited clinical trials in leading medical journals.
https://www.openevidence.com/nutrition/ketogenic-diet?twclid=2cbdtd5b06caraane0vky0whl
POINT
By Dr. Leslyn Keith, in collaboration with Dr. Eric WestmanReferences
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2. Amato, ACM, & Benitti, DA (2021). Lipedema can be treated non-surgically: A report of 5 cases. The American Journal of Case Reports, 22, e934406-1.
3. Apkhanova, TV, Sergeev, VN, Krukova, MM et al. (2021). Influence of Ketogenic Diet and Nutraceutical Correction in the Complex Treatment of Lower Limbs Lipedema. Bulletin of Rehabilitation Medicine, 20(5), 26-36.
4. Athinarayanan SJ, Adams RN, Hallberg SJ, et al. (2019). Long term effects of a novel continuous remote care intervention including nutritional ketosis for the management of type 2 diabetes: a 2year non-randomized clinical trial. Frontiers in Endocrinology, 10(348).
5. Bertsch, T., & Erbacher, G. (2018). Lipoedema–myths and facts Part 1. Phlebologie, 47(02), 84-92.
6. Cannataro, R, Michelini, S, Ricolfi, L, et al. (2021). Management of Lipedema with Ketogenic Diet: 22Month Follow-Up. Life, 11(12), 1402.
7. Casanueva, F.F, Castellana, M, Bellido, D et al. (2020). Ketogenic diets as treatment of obesity and type 2 diabetes mellitus. Reviews in Endocrine and Metabolic Disorders, 21, 381–397. https://doi.org/10.1007/s11154-020-09580-7
8. Crichton, GE, Howe, PR, Buckley, JD, et al. (2012). Long-term dietary intervention trials: critical issues and challenges. Trials, 13(111). doi: 10.1186/1745-6215-13-111.
9. Danan A, Westman EC, Saslow LR, & Ede G. (2022). The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients. Frontiers in Psychiatry, 13. doi: 10.3389/fpsyt.2022.951376.
10. Duhon, BH, Phan, TT, Taylor, SL, et al. (2022). Current mechanistic understandings of lymphedema and lipedema: Tales of fluid, fat, and fibrosis. International Journal of Molecular Sciences, 23(12), 6621.
11. García-Caballero, M, Zecchin, A, Souffreau, J, et al. (2019). Role and therapeutic potential of dietary ketone bodies in lymph vessel growth. Nature Metabolism, 1(7), 666-675.
12. García Nores, GD, Cuzzone, DA, Albano, NJ, et al. (2016). Obesity but not high-fat diet impairs lymphatic function. International Journal of Obesity, 40(10), 1582–1590. doi:10.1038/ijo.2016.96
13. Gousopoulos, E, Karaman, S, Proulx, ST, et al. (2017). High-Fat Diet in the Absence of Obesity Does Not Aggravate Surgically Induced Lymphoedema in Mice. European Surgical Research, 58(3-4), 180–192. doi:10.1159/000461579
14. Greene, AK, Grant, FD, Slavin, SA, & Maclellan, RA. (2015). Obesity-Induced Lymphedema. Plastic and Reconstructive Surgery, 135(6), 1715–1719. doi:10.1097/prs.0000000000001271
15. Helmholz HF. (1927). The treatment of epilepsy in childhood: Five years’ experience with the ketogenic diet. JAMA, 88(26), 2028–2032.
16. Jeziorek, M, Szuba, A, Kujawa, K, & Regulska-Ilow, B. (2022). The Effect of a Low-Carbohydrate, High-Fat Diet versus Moderate-Carbohydrate and Fat Diet on Body Composition in Patients with Lipedema. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2545-2561.
17. Keast, DH, Moffatt, C, & Janmohammad, A. (2019). Lymphedema Impact and Prevalence International Study: The Canadian Data. Lymphatic Research and Biology, 17(2), 178–186. doi:10.1089/lrb.2019.0014
18. Keith, L, Rowsemitt, C, & Richards, LG. (2017). Lifestyle modification group for lymphedema and obesity results in significant health outcomes. American Journal of Lifestyle Medicine, 14(4), 420428.
19. Lipski, E. (2010). Traditional non‐Western diets. Nutrition in Clinical Practice, 25(6), 585-593.
20. Ludwig, DS. (2020). The ketogenic diet: evidence for optimism but high-quality research needed. The Journal of Nutrition, 150(6), 1354-1359.
21. Ludwig DS, Aronne LJ, Astrup A, et al. (2021). The carbohydrate-insulin model: A physiological perspective on the obesity pandemic. American Journal of Clinical Nutrition, 114(6), 1873-1885. doi: 10.1093/ajcn/nqab270.
22. Mansoor, N, Vinknes, KJ, Veierød, MB, & Retterstøl, K. (2016). Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. British Journal of Nutrition, 115(3), 466-479.
23. Moriconi, E, Camajani, E, Fabbri, A, et al. (2021). Very-Low-Calorie Ketogenic Diet as a Safe and Valuable Tool for Long-Term Glycemic Management in Patients with Obesity and Type 2 Diabetes. Nutrients, 13, 758. https://doi.org/10.3390/nu13030758
24. Norwitz, NG, Mindrum, MR, Giral, P, et al. (2022). Elevated LDL-cholesterol levels among lean mass hyper-responders on low-carbohydrate ketogenic diets deserve urgent clinical attention and further research. Journal of Clinical Lipidology.
25. Paoli, A, Rubini, A, Volek, J, et al. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition, 67, 789–796. https://doi.org/10.1038/ejcn.2013.116
26. Sørlie, V, De Soysa, AK, Hyldmo, AA, et al. (2022). Effect of a ketogenic diet on pain and quality of life in patients with lipedema: The LIPODIET pilot study. Obesity Science & Practice, 8(4), 483-493.
27. Surampudi, V, Biggs, K, & Li, Z. (2019). Weight loss and transient LDL increase (P12-057-19). Current Developments in Nutrition, 3(Supplement_1), nzz035-P12.
28. Stierman, B, Afful, J, Carroll, M, et al. (2021). National Health and Nutrition Examination Survey 2017–March 2020 Prepandemic Data Files Development of Files and Prevalence Estimates for Selected Health Outcomes. National Center for Health Statistics (U.S.)
29. National Health Statistics Reports No. 158, https://stacks.cdc.gov/view/cdc/106273
30. Teo, K, Lear, S, Islam, S, et al. (2013). Prevalence of a healthy lifestyle among individuals with cardiovascular disease in high-, middle-and low-income countries: The Prospective Urban Rural Epidemiology (PURE) study. Jama, 309(15), 1613-1621.
31. Thomis, S. (2019, May 13 – 2023, January 7). Ketogenic Diet: a Novel Metabolic Strategy to Treat Lymphedema Patients? (KETOLYMPH). Identifier: NCT03991897. https://www.clinicaltrials.gov/ct2/show/NCT03991897
32. Tondt, J, Yancy, WS, & Westman, EC. (2020). Application of Nutrient Essentiality Criteria to Dietary Carbohydrates. Nutrition Research Reviews, 1–36. doi:10.1017/s0954422420000050
33. Trumbo P, Schlicker S, Yates AA, & Poos M. (2002). Food and Nutrition Board of the Institute of Medicine, The National Academies. Dietary reference intakes for energy, carbohydrate, fiber, fat,
fatty acids, cholesterol, protein and amino acids. Journal of the American Dietetic Association, 102(11), 1621-30. doi: 10.1016/s0002-8223(02)90346-9.
34. Westman, EC, Tondt, J, Eberstein, J, & Yancy, WS. (2018). Use of a Low-carbohydrate, Ketogenic Diet to Treat Obesity. Primary Care Reports, 24(10).
35. Wong, BW, Wang, X, Zecchin, A, et al. (2017). The role of fatty acid β-oxidation in lymphangiogenesis. Nature, 542(7639), 49-54.
36. Yurista, SR, Chong, C-R, Badimon, JJ, et al. (2021). Therapeutic Potential of Ketone Bodies for Patients With Cardiovascular Disease. Journal of the American College of Cardiology, 77(13), 1660–1669. doi:10.1016/j.jacc.2020.12.065
KETOGENIC DIET FOR LYMPHEDEMA COUNTERPOINT
By Cate Ward, PhD, in collaboration with Dr. Christopher Gardner
References
Gardner, C. D., et al. Effect of a ketogenic diet versus Mediterranean diet on glycated hemoglobin in individuals with prediabetes and type 2 diabetes mellitus: The interventional Keto-Med randomized crossover trial. AJCN. 2022.
Landry, M., et al. Adherence to Ketogenic and Mediterranean Study Diets in a Crossover Trial: The Keto–Med Randomized Trial. Nutrients. 2021.
SELF-CARE TIPS FOR LYMPHEDEMA
Our favourite top ten
By Lori RadkeReferences
1. Damstra RJ, Halk AB. The Dutch lymphedema guidelines based on the International Classification of Functioning, Disability, and Health and the chronic care model. J Vasc Surg:Venous and Lym Dis 2017;5:756-65.
2. Executive Committee of the International Society of Lymphology (2020) The diagnosis and treatment of peripheral lymphedema: 2020 consensus document of the International Society of Lymphology. Lymphology 53(1):3-19.
3. Lymphedema/Chronic Edema: What every physician should know. https://www.canadalymph.ca/physician-card/
4. Queensland Health. Lymphoedema clinical practice guideline 2014: the use of compression in the management of adults with lymphoedema [Internet]. Brisbane (AU): Queensland Health; 2014 [cited 2017 Apr 21].
5. Tidhar D, Hodgson P, Shay C, Towers A. A Lymphedema Self-Management Programme: Report on 30 cases. Physiotherapy Canada. 2014: 66(4): 404-412.
6. McNeely ML, Dolgoy ND, Rafn BS et al. Nighttime compression supports improved selfmanagement of breast cancer-related lymphedema: A multicenter randomized controlled trial. Cancer. 2022 Feb 1;128(3):587-596. doi: 10.1002/cncr.33943. Epub 2021 Oct 6. PMID: 34614195.
7. Robyn Bjork and Suzie Ehmann, S.T.R.I.D.E. Professional Guide to Compression Garment Selection for the Lower Extremity. Journal of Wound Care 2019 28: Sup6a, 1-44.
8. Webb E, Neeman T, Bowden FJ. Compression therapy to prevent recurrent cellulitis of the leg. N Engl J Med 2020; 383:630-9.
9. Campbell KL, Winters-Stone K, Wiskermann J, et al. Exercise guidelines for cancer survivors: consensus statement from the international multidisciplinary roundtable. Med Sci Sports Exerc. 2019; 51:2375–2390.
10. Omar, M.T.A., Gwada, R.F.M., Omar, G.S.M. et al. Low-Intensity Resistance Training and Compression Garment in the Management of Breast Cancer–Related Lymphedema: Single-Blinded Randomized Controlled Trial. J Canc Educ 35, 1101–1110 (2020).
11. Putting the “self” into self MLD. by Lisa Mckhann.
https://issuu.com/canadianlymphedemaframework/docs/b1653_clf_pathways_winter_2020_nov24 _finalproof_ak
12. De Vrieze T, Gebruers N, Nevelsteen I et al (2022) Manual lymphatic drainage with or without fluoroscopy guidance did not substantially improve the effect of decongestive lymphatic therapy in people with breast cancer-related lymphoedema (EFforT-BCRL trial): a multicenter randomised trial. J Physiother 68(2): 110–22.
13. Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, Bao T, Bily L, Tuppo CM, Williams AF, Karadibak D. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev. 2015 May 21;(5):CD003475. doi: 10.1002/14651858.CD003475.pub2. PMID: 25994425; PMCID: PMC4966288.
14. “Hints and Tips: Compression Garments for Lymphedema” by Mona Al Onazi and Rachel Wang.https://issuu.com/canadianlymphedemaframework/docs/b1653_clf_pathways_winter_2020 _nov24_finalproof_ak