The Complete Lymphedema Management and Nutrition Guide by Jean Lamantia, RD and Ann DiMenna, PT, CDT

Lymphedema is abnormal swelling that is caused by a build-up of lymph fluid.  It occurs most frequently in the arms and in the legs and is commonly caused by the removal of or damage to lymph nodes as a part of cancer treatment.  In this scenario, the onset of lymphedema can occur during treatments, days, months or even years after the treatment protocol is completed.

According to the World Health Organization there are over 170 million people world-wide who suffer from secondary lymphedema.  It affects approximately 15% of all cancer survivors and an estimated 30% of those treated for breast cancer after surgery to remove lymph nodes.

Lymphedema is a chronic condition that, if not cared for, can lead to infection, thickening of the skin, pain and loss of proper function.  But with the help of professionals in the field and by learning techniques for self-care it can be managed.

Unfortunately lymphedema is poorly understood and researched.  For this reason the new book entitled:

The Complete Lymphedema Management and Nutrition Guide

Empowering Strategies, Supporting Recipes & Therapeutic Exercises

by Jean Lamantia, RD and Ann DiMenna, PT, CDT

is a great resource for both those suffering from lymphedema and for practitioners.

A Great Resource for those Suffering from Lymphedema and for Practitioners

Scientifically researched and thoughtfully put together, the book is divided in to four sections.

Parts 1 & 2 are authored by Ann DiMenna, PT, CDT.  Parts 3 & 4 by Jean Lamantia, RD.

Part 1: Understanding Lymphedema

This section beautifully lays out the physiology and biology of the lymphatic system as well as addressing Lymphedema Risk Reduction by using an easy to understand narrative coupled with informative visuals.

Part 2: Self-Care for Lymphedema

Self-care management is vital for those with lymphedema.  This section covers the key areas of skincare, self-taping, self-massage and exercise.  It also covers the topic of compression garments very well.

The next 2 sections cover the importance of nutrition for lymphedema management.

Part 3: Nutrition for Lymphedema

This is a very informative section of the book that covers these important topics for lymphedema management:

  • Bodyweight
  • The role of the lymphatics in digestion
  • Reducing Chronic Inflammation
  • Fluids, protein and sodium
  • Supplements
  • Meal Planning

Of note here as well, most of you know that I am a proponent of intermittent fasting.  Included within this section is an interesting notation from Jean about her thoughts on intermittent fasting and possible benefits for managing lymphedema.  She is very clear that her thoughts are speculative, not researched based, but I find the notion thought provoking at the very least.

 Part 4: Recipes for Lymphedema

And to wrap it up, the book contains some wonderful recipes to help the reader implement the nutritional advise that Jean Lamantia  has provided.

As a practitioner who works with patients suffering from lymphedema, I find this book to be a valuable reference.  As a sufferer of lymphedema myself, I know that this book will be of great benefit for those trying to manage this condition.






Tips for Reading Nutrition Labels

Sticking to the perimeter of the grocery store is the ideal way to shop. But when the ideal meets the real and we find ourselves nose to label with packaging we need to be armed and ready.

Let’s face it, reading labels can be confusing.  But it is a necessary evil when you want to eat healthy.

With a few tips however you will be able extrapolate the important information that you need to make good decisions in the grocery aisles.

First off avoid the propaganda on the front of the product and go right to the good stuff on the back.  Companies can free wheel with what they say on the front of the packaging but there are real guidelines for what’s on the back.  For example a label may say that a food product is reduced in fat or reduced sodium. What this means is that the amount of fat or sodium has been reduced from the original product amount. It doesn’t mean, however, that the food is low in fat or sodium.

Here are My 3 Top Things to Look For on a Product Label

1. Check out the Ingredients

Check out the ingredient list.  Product ingredients are listed by quantity, from highest to lowest amount

2. Understand the serving size

It is really important that you understand that all of the nutrition information shown is based on serving size.

And don’t be deceived by this.  A single serving may not be what you think.  For instance, a serving size may be half a cup where as you might logically think it would be whole cup.

3. Know the Different Names for Sugar

We know by now the dangers of over consuming added sugars.  With this in mind, it is very important that you become aware of the fact that there are many, many different names for sugar on a food label.  Some of them end in –ose such as Sucrose, Maltose and Dextrose.  Others like Barley Malt, Turinado and Molasses do not.

Click here for my list of Different Names For Sugar

On the right side of a food label, you’ll see a column that lists the percent daily values (%DV). Percent daily values tell you how much of a the particular nutrient one serving will give you compared to how much you need for the entire day. It helps you gauge the percentage of a nutrient requirement met by one serving of the product.

Nutrition Facts Tables

Do you ever look at the Nutrition Facts tables? Do they help you decide which foods to buy or not? Do the numbers even make sense?

To be honest, I don’t think it’s that the most user-friendly or helpful tool. But it’s good to understand it since it’s here to stay.

Let me give you a super-quick crash course on reading the Nutrition Facts tables.

Then, try my delicious and super-easy snack recipe that’ll blow your pre-packaged granola bars out of the water.

How to Read the New Nutrition Facts Tables

The Nutrition Facts table is on the side of most packaged foods. It’s often found close to the ingredient listing.

The purpose of it is to help consumers make better nutrition decisions. When people can see the number of calories, carbs, sodium, etc. in food, they should be able to eat better, right?

Whether you like the Nutrition Facts table or not, let’s make sure you get the most out of it, since it’s here to stay!

Here’s my four-step crash course on reading the Nutrition Facts table.

Step 1: Serving Size

The absolute most important part of the Nutrition Facts table is to note the serving size. Manufacturers often strategically choose the serving size to make the rest of the table look good. Small serving = small calories/fat/carbs. So, it’s tricky.

All the information in the table rests on the amount chosen as the serving size. And, since every manufacturer chooses their own, it’s often difficult to compare two products.

In Canada, in the next few years (between 2017-2022), serving sizes will be more consistent between similar foods. This will make it easier to compare foods. The new labels will also have more realistic serving sizes to reflect the amount that people eat in one sitting, and not be artificially small.

Let’s use an example – plain, unsalted walnuts from Costco.

Right under the Nutrition Facts header is the serving size. That is a ¼ cup or 30 g. This means that all the numbers underneath it are based on this amount.

FUN EXPERIMENT: Try using a measuring cup to see exactly how much of a certain food equals one serving. You may be surprised at how small it is (imagine a ¼ cup of walnuts).

Step 2: % Daily Value

The % Daily Value (%DV) is based on the recommended daily amount of each nutrient the average adult needs. Ideally, you will get 100% DV for each nutrient every day. This is added up based on all of the foods and drinks you have throughout the day.

NOTE: Since children are smaller and have different nutritional needs if a type of food is intended solely for children under the age of 4, then those foods use a child’s average nutrition needs for the %DV.

The %DV is a guideline, not a rigid rule.

You don’t need to add all of your %DV up for everything you eat all day. Instead, think of anything 5% or less to be a little; and, anything 15% or more to be a lot.

NOTE: Not every nutrient has a %DV. You can see it’s missing for things like cholesterol, sugar, and protein. This is because there isn’t an agreed “official” %DV for that nutrient. The good news is that the new Nutrition Facts tables will include a %DV for sugar. Keep your eyes out for that.

Step 3: Middle of the table (e.g. Calories, fat, cholesterol, sodium, potassium, carbohydrates, and protein)

Calories are pretty straight forward. Here, a ¼ cup (30 g) of walnuts has 200 calories.

Fat is bolded for a reason. That 19 g of fat (29% DV) is total fat. That includes the non-bolded items underneath it. Here, 19 g of total fat includes 1.5 g saturated fat, (19 g – 1.5 g = 17.5 g) unsaturated fat, and 0 g trans fat. (Yes, unsaturated fats including mono- and poly-unsaturated are not on the label, so you need to do a quick subtraction).

Cholesterol, sodium, and potassium are all measured in mg. Ideally, aim for around 100% of potassium and sodium each day. It’s easy to overdo sodium, especially if you grab pre-made, restaurant foods, or snacks. Keep an eye on this number if sodium can be a problem for you (e.g. if your doctor mentioned it, if you have high blood pressure or kidney problems, etc.).

Carbohydrate, like fat, is bolded because it is total carbohydrates. It includes the non-bolded items underneath it like fiber, sugar, and starch (not shown). Here, 30 g of walnuts contain 3 g of carbohydrates; that 3 g are all fiber. There is no sugar or starch. And as you can see, 3 g of fiber is 12% of your daily value for fiber.

Proteins, like calories, are pretty straight forward as well. Here, a ¼ cup (30 g) of walnuts contains 5 g of protein.

Step 4: Bottom of the table (e.g. vitamins & minerals)

The vitamins and minerals listed at the bottom of the table are also straightforward. The new labels will list potassium, calcium, and iron. Yes, potassium will drop from the middle of the table to the bottom, and both vitamins A & C will become optional.

Manufacturers can add other vitamins and minerals to the bottom of their Nutrition Facts table (this is optional). And you’ll notice that some foods contain a lot more vitamins and minerals than others do.


I hope this crash course in the Nutrition Facts table was helpful because it is important to be informed about what you are eating.

Proper nutrition is a key piece of cancer prevention so understanding what you choose to put in to your shopping cart is key.

Do you have questions about it?  If so, leave me a comment below.


Delicious and Super-Easy Walnut Snack Recipe

Serves 1


8 walnut halves

4 dates, pitted


Make a “date sandwich” by squeezing each date between two walnut halves.

Serve & enjoy!

Tip: Try with pecans instead.















Coping with Post-Mastectomy Pain Syndrome

It is certainly well within the level of expectation to have some pain and/or discomfort after a mastectomy or lumpectomy. But when pain continues for more than a few months post surgery and begins to impact quality of life, this is very likely Post-Mastectomy Pain Syndrome (PMPS).

Studies have shown that between 20 and 30 percent of women who have breast surgery develop PMPS.

What is Post-Mastectomy Pain Syndrome?

Post-mastectomy pain syndrome (PMPS) is chronic nerve (neuropathic) pain after lumpectomy or mastectomy…The classic signs of PMPS are chest wall pain and tingling down the arm. Pain can also be felt in the shoulder, scar, arm, or armpit. Other common complaints include numbness, shooting or pricking pain, or unbearable itching

The exact cause of PMPS is unknown.  A strong theory however is that during surgery damage is caused to the intercostobrachial nerve.  This nerve extends from the outer edge of the breast and runs along the underside of the arm.

Treatments for Post-Mastectomy Pain Syndrome

There are treatments to help relieve PMPS.  This often starts with the use of ibupofen and/or other nonsteroidal anti-inflammatory drugs.

The application of topical anesthetics can be effective for treatment in many cases.

Steroid injections or local anesthetic can be helpful for those who suffer from pain around the scar area.

As well as medical interventions, Integrative therapies can also be of help for those suffering with PMPS.  These include massage therapy, reflexology and acupuncture.

Why Seek Help?

In light of the toll that cancer therapies can have on the body, it may seem somewhat trivial to question your doctor about aches and pains. But it is not.

Pain not only has a physical impact, it can also have a mental one.

Research has demonstrated that the pain women experience suffering from PMPS has been linked to fear of recurrence.  This can be a paralyzing feeling.

Depression, as well, is strongly associated with pain.


Post-Mastectomy Pain Syndrome is real.

Do not dismiss symptoms or concerns that you are experiencing.  Consult your doctor and get relief.

We must be advocates of our own health.







Forest Bathing

The Healing Power of Forest Bathing

A new study released in June 2019 determined that spending at least two hours a week in nature seems to be the crucial threshold for promoting health and wellbeing.

The research was led by the University of Exeter, published in Scientific Reports and funded by NIHR.

The study found that:

people who spend at least 120 minutes in nature a week are significantly more likely to report good health and higher psychological wellbeing than those who don’t visit nature at all during an average week

These findings play very well in to the established health benefits of a practice called Forest Bathing.

What is Forest Bathing?

Forest bathing is based on the Japanese practice of ‘Shinrin-yoku’.  This translates in to “taking in the forest atmosphere.”

It is most certainly an easy practice to follow and the benefits reaped are substantial.

Forest bathing simply involves taking contemplative walks through the woods. The intention is to connect with nature. You leave the hustle and bustle of your daily life behind taking your time to breathe deeply while paying great attention to the sights, sounds and smells around you.

This ‘taking in nature’ with our senses has been shown to lead to decreased stress, improved immunity and an overall sense of well-being.

forest bathingFurthering this, it has been shown that the natural chemicals secreted by evergreen trees, called phytoncides, have been associated with improvements in the activity of our immune system.  This is aromatherapy at its finest!

The very essence of integrative cancer care is the enhancement of the 3 basic notions of self; the body, the mind and the soul.

Forest bathing can offer a very effective method of supporting all 3 of these aspects of self and can be practiced all year round.

For those of us who are blessed with 4 very different seasons the beauty of nature is dynamic.

Forest bathing has become very popular. There are certified forest therapy guides popping up everywhere to help people connect with their practice.

Take advantage of the healing power that nature has to offer!








Benefits of Whey Protein Powder for Cancer Patients

Whey protein powder is most commonly associated with post workout routines but it has many benefits for cancer patients.


Whey is a protein derived from milk and contains powerful immune-enhancing nutrients such as lactoferrin, branched-chained amino acids and immunoglobulins. Whey protein is considered a complete protein containing all essential amino acids.


Glutathione is one of the body’s most important free radical scavengers and very important for our mitochondrial health. Undenatured Whey protein improves the production and availability of glutathione primarily by the intracellular conversion of the amino acid cysteine to glutathione.  This is significant for cancer patients undergoing chemotherapy as they have high levels of oxidative stress within their cells.  The production of glutathione is important for reducing the toxic and damaging effects of chemotherapy.

In a different capacity, results from one study indicated that whey protein concentrate may deplete tumour cells of glutathione and render them more vulnerable to chemotherapy.

Recovery and Repair

Patients undergoing chemotherapy require high quality protein for recovery and repair as a result of treatment.  Whey protein helps to reduce muscle loss and is a very absorbable form of protein.

Anti-Tumour Effect

Studies have shown that dietary supplementation of whey protein powder may exert an anti-tumour effect in some cancers.

How to Choose a Good Whey Protein Powder

All whey protein powders are not created equal.  There are factors that you need to consider when choosing a high-quality whey protein powder.

  • The whey protein powder that you choose should come from organically-raised, grass-fed cow’s.  This is to ensure that the whey is free of GMOs, pesticides and hormones.
  • Ensure that the whey protein powder that you choose is cold processed. Heat destroys whey’s molecular structure.
  • Your whey protein powder should be sweetened naturally and not with artificial flavour.

One final consideration is taste.  Many companies offer trial sizes of their product.  Take advantage of these and chose a product that you can enjoy!