Oct - Dec 2014: Lymphedema Aging/Frailty

By: Sue Ansari, RN, BS, CLT-LANA, Founder and Director of The JOYFIT Project, Redwood City, CA

Q:  I have heard that laughing would be good for my lymphedema (LE), is that true?  If so, should I try something being offered at a local yoga studio called “Laughter Yoga”? 

A: Although no specific research is currently available regarding laughter and its effects on LE, we do know that using laughter as a decongestive exercise can only affect LE in a very positive way. Before addressing the value of laughter and LE, a brief description of the lymphatic system is necessary for you to fully understand how the two interact. The lymphatic system is composed of a mesh-like network of very fine vessels located immediately beneath the skin and above the muscles, as well as a deep system that drains lymph from bones, muscles, and joints. Unlike the circulatory system, which has the heart as its pump, the lymphatic system has no pump, but moves by inertia in a semi-circular motion, always moving fluid upward toward the heart.

Basically, the lymphatic network is a highly efficient cleaning conglomerate that is the backbone of the immune system. It continuously collects waste materials from all over the body that are deposited into the tissues via blood capillaries. It then cleans that fluid and returns it back into the circulating blood via vessels located on either side of the neck, just above the collar bone.  

So what does laughter have to do with it? Very simply, although the lymphatic system has no pump, it is capable of being manually moved. Research has shown that diaphragmatic breathing creates a negative pressure within the thorax, literally sucking lymph into the thoracic duct (the largest lymphatic collecting site in the body), which then shoots it out to the rest of the body at a rate of 10-15 times the normal flow of lymph. Laughter is an easy, simple, and effective form of diaphragmatic breathing.1 The idea is to move... move your body, move your breath, thus moving more lymph. Any muscular movement will stimulate and increase the flow of lymph, but laughter just might prove to be one of the most painless and beneficial techniques for accomplishing that goal. 

Another question is, “What makes you laugh, and can you count on ordinary, everyday laughter as an ongoing decongestive exercise?” The answer is likely “no” because typically laughter is a matter of perception; one must evaluate humor before deciding to laugh. On the other hand, Laughter Yoga is a physically-oriented exercise routine, not a mental process, allowing anyone to laugh without using jokes, humor, or comedy.2

Laughter Yoga follows a series of simple yet structured laughter and yogic breathing techniques, combined with simple stretching exercises that not only increase lymphatic flow and oxygenation, but additionally improve overall health and happiness. No special equipment is needed. No prior yoga experience is necessary. A willingness
to laugh is all you need.3

Research has shown that laughter effectively decreases stress,3 strengthens the immune system,5 increases endorphins (the “feel good” chemicals in the brain),6 decreases and controls blood pressure, decreases heart rate,7 and fights depression.8 Obviously, any form of laughter is beneficial, but the sustained laughter that is experienced in Laughter Yoga is that much better.9 Ten to fifteen minutes of laughter exercises really gets the lymph moving. As I tell my Laughter Yoga clients, let’s Live, Love, Laugh . . . and Let the Lymph Flow!

Remember, before engaging in any exercise program, even Laughter Yoga, please get written approval from your physician.

Q: Do I need to be on any kind of special diet following my LE diagnosis? 

A: As of yet, there are no specific guidelines for an optimum LE diet, although nutrition plays an undeniably important role in the maintenance and management of LE. Repeatedly, lymphedema clients have related their own stories of how decreasing their weight reduced their LE and eased the management of their symptoms. 

Studies have shown that secondary LE occurs perhaps not simply as an unfortunate byproduct of cancer treatment, but possibly in conjunction with a chronic inflammatory state.10-13  As such, it would seem only reasonable to follow an anti-inflammatory diet, which will not only reduce inflammation, but also more easily control weight.

An anti-inflammatory diet strives to balance omega-3 and omega-6 fatty acids. Since the majority of Americans consume an excessive amount of omega-6 fatty acids, an inflammatory state is promoted by eating a diet bombarded with oil-rich seeds whose oils are heavily used in most snack and fast foods, those foods being staples of the Standard American Diet. Foods containing omega-3 fatty acids have an anti-inflammatory effect and are found in oily fish, walnuts, flax, hemp, and to a smaller degree in soy and canola oils and sea vegetables. In addition to correcting the balance between omega-6 and omega-3 fatty acids, all trans fats, which promote inflammation, should be entirely eliminated.

The inflammatory process is also triggered by carbohydrate-rich foods. This process can be reduced by maintaining a low and constant blood sugar level, which translates to avoiding processed foods (snack foods, pastries, sweetened drinks, crackers, chips) and instead eating more whole grains, beans, sweet potatoes, other vegetables, and fruits.

Protein choices should be more concentrated on vegetable protein (GMO-free soy products, beans, seeds, whole grains ,and nuts) and less on red meat and poultry, which contain excessive amounts of pro-inflammatory fats. If fish is eaten, the oily varieties provide omega-3s (wild salmon, sardines, herring, black cod) and should be eaten sparingly.14

Dr. Weil’s book, Healthy Aging, provides an understandable explanation of the role of inflammation and its part in promoting disease, as well as easy, anti-inflammatory guidelines for your diet.

Or, as Michael Pollan succinctly puts it, “Eat food. Not too much. Mostly plants.”

joyfitproject [at] gmail.com


  1. Kataria, Madan MD. Why Laughter Yoga - 3 Reasons. Laughter Yoga University. Bangalore, India. http://www.laughteryoga.org/english/laughteryoga/details/224
  2. Kataria, Madan MD.  Concept and Philosophy. Laughter Yoga University. Bangalore, India.http://www.laughteryoga.org/english/laughteryoga/details/223
  3. Cheer and Joy Emerge from an Unexpected Place. (News Release, 1/2009). MD Anderson Cancer Center, The University of Texas. http://www.mdanderson.org/newsroom/news-releases/2009/cheer-and-joy-emerge-from-an-unexpected-place.html
  4. Berk, Lee S. DHSc, MPH, et al. Neuroendocrine and Stress Hormone Changes During Mirthful Laughter, American Journal of the Medical Sciences: December 1989. http://journals.lww.com/amjmedsci/Abstract/1989/12000/Neuroendocrine_and_Stress_Hormone_Changes_During.6.aspx
  5. Berk, Lee S. MPH, DrPH, et al. Modulation of Neuroimmune During the Eustress of Humor-Associated Mirthful Laughter. Alternative Therapies, March 2001, Vol. 7, No. 2, pp. 62-76  http://web.missouri.edu/~segerti/3830/Humorhealth.pdf
  6. Cheer and Joy Emerge from an Unexpected Place. (News Release, 2009). MD Anderson Cancer Center. http://www.mdanderson.org/newsroom/news-releases/2009/cheer-and-joy-emerge-from-an-unexpected-place.html
  7. Miller, Michael MD. University of Maryland Medical Center, School of Medicine. Study Shows Laughter Helps Blood Vessels Function Better. http://umm.edu/news-and-events/news-releases/2005/school-of-medicine-study-shows-laughter-helps-blood-vessels-function-better
  8. Provine, Robert. The Science of Laughter, Psychology Today, November 1, 2000. http://www.psychologytoday.com/articles/200011/the-science-laughter
  9. Kataria, Madan MD. Five Benefits of Laughter Yoga. Laughter Yoga University. Bangalore, India. http://www.laughteryoga.org/english/laughteryoga/details/225
  10. Rockson SG. The lymphatics and the inflammatory response: lessons learned from human lymphedema. Stanford University School of Medicine , Stanford, California. Lymphat Res Biol. 2013 Sep;11(3):117-20. doi: 10.1089/lrb.2013.1132. Epub 2013 Sep 11.
  11. Tabibiazar R, Cheung L, Han J, Swanson J, Beilhack A, et al. (2006) Inflammatory Manifestations of Experimental Lymphatic Insufficiency. PLoS Med 3(7): e254. doi:10.1371/journal.pmed.0030254 
  12. Véronique Angeli and Gwendalyn J. Randolph. Inflammation, Lymphatic Function, And Dendritic Cell Migration. Lymphatic Research and Biology. December 2006, 4(4): 217-228. doi:10.1089/lrb.2006.4406.
  13. Weil, Andrew. Healthy Aging. Anchor Books, New York NY. 2005, pp 303-308.
  14. DeNoon, Daniel J. 7 Rules for Eating. (March 23, 2009). WebMD Health News. http://www.webmd.com/food-recipes/news/20090323/7-rules-for-eating