Ginger Nash, ND

Tolle Totum

I’ve been treating women with hormone imbalances for 20 years, but it’s only within the last 7 or so years that I’ve become mildly obsessed with the lymphatic system. This began when I starting using whole-body regulation thermography and realized that almost every single chronic issue we see as naturopathic physicians is affected by the health of the lymphatic system. Read that sentence again. If we don’t address lymphatic health, we run the risk of simply moving toxins from one area of the body to another and potentially lowering the body’s inherent ability to regulate health.

Lymphatic Health

As we learned in school, the lymphatic system is a separate circulatory system that interfaces with the blood vessels to carry away fluid and waste proteins from the interstitial space or extracellular matrix (ECM). The lymph system plays a prominent role in immune function, as this fluid also carries lymphocytes, dendritic cells, and immunoglobulins to fight off pathogens or regulate the body during infection. In addition, lymphatics help with the absorption and transport of free fatty acids from the digestive system.

What I didn’t learn in school was that the web of delicate lymphatic vessels that permeate almost every part of our body, including our brains, is intimately connected with the ECM in such a way that the nervous system uses it as “command control.” The astonishing number of proteins found in the ECM have a dynamic interplay with the entire circuitry of the nervous system in both developing children and adults.¹ When the flow of lymph is impeded, edema ensues, creating a build-up of toxic wastes and potential for systemic dysregulation of the nerve synapses. In fact, research has shown that people who were diagnosed with a severe infection were more likely to be diagnosed with a subsequent autoimmune disorder and mood disorder.² Removal of excess proteins and wastes from the interstitial space is an absolutely essential function, without which severe morbidity and death can ensue within a short period of time.

Given this and also the fact that the master control system of the entire organism – the nervous system – works through the ECM to ensure that all activities of cellular metabolism are aided by healthy lymphatic function, it seems obvious that treating this system can produce a beneficial, generative effect across the entire body. Naturopathic doctors are trained to think about the body as a whole. We must therefore address the lymphatic system in order to ensure optimal health, including hormonal health in women, which will be the focus of the remainder of this article.

My Approach

The Importance of Terrain

My approach to working with women and hormonal issues is rooted in the ideas and philosophy of complex homeopathy. For me, it’s all about the terrain! Even though I evaluate patients through routine blood work and I take genetics into consideration in some cases, there is nothing more pressing than the internal milieu, or terrain, with which the patient presents. The terrain reflects our whole story, our personal history, including the insults and stressors we have endured physically, psychologically, and emotionally. It is also affected by our genetic and epigenetic trans-generational inheritances. In my opinion, the first thing to establish as a doctor is the level of each patient’s toxicity and how well the patient is able to regulate physiological functions related to elimination and detoxification. This is connected to the ideas described as bio-toxicosis by Dr Robert Cass, building upon the work of Dr Hans Reckeweg. This framework helps us understand 3 critical factors: 1) the tissue depth of toxicity in any given person; 2) what the body’s attempts to eliminate look like; and 3) whether it’s moving in a direction to help – as Hahnemann would say – to remove obstacles to cure.

All hormones, nutrients, and waste products going to and from the cells must pass through the interstitial or extracellular matrix.³ If the lymphatic channels cannot remove toxins properly, no hormone, no gene, no enzyme, and no molecule is going to work optimally, and there will be deposition of waste products into the tissues. These impediments to a clear action of our therapies must be addressed first before trying to rebuild or replace adequate glandular function. One last thought about bio-toxicosis: this perspective also acknowledges the fact that we are forced to regularly cope with exogenous toxins in today’s world. Sadly, this is only going to get worse before Mother Earth decides to get rid of us and take a long rest! The general public is more aware and more informed than ever on this topic. There are probably fewer things that drive patients into the naturopathic doctor’s office more frequently than their desire to do a “detox” or “cleanse.”

Estrogen & Progesterone

With regard to hormones, the main type of imbalance in modern women is what we commonly refer to as “estrogen dominance.” Between the inability of healthy gut flora to facilitate the removal of excess estrogens, levels of xenoestrogens found in foods and plastics, and other endocrine disruptors, and the overuse of oral contraceptives and hormone replacement therapy, most women have too much estrogen stimulation relative to progesterone. Estrogen and progesterone work so closely together that it is imperative that they stay in balance. In fact, the majority of struggles with hormonal imbalances affecting both the female brain and body may be associated with estrogen dominance. This includes everything from fibroids and fibrocystic breasts to heavy and painful menses, hormonal headaches, premenstrual syndrome, and irregular cycles.

What fascinates me about the interface of lymph and these 2 hormones (estrogen and progesterone) is that lymphatic fluid is highly non-polar and thus attracted to more fatty substances while avoiding more polar substances. All steroid hormones are somewhat hydrophobic; however, the further you get down the biochemical steroid pathway from the parent fat cholesterol, the more polar the hormones.⁴ Therefore, estrogen is more polar than progesterone, which means that the lymphatics “attract” progesterone more readily. In addition, this may be why topical application of progesterone, where the lymphatic vessels are superficially located, may result in higher than normal levels reaching the tissues. Research by a compounding pharmacy in 2014 drew exactly this conclusion about the delivery of topical progesterone.^4,5 In short, the health of a woman’s lymphatic system will have a direct impact on her ability to move progesterone around the body. Because progesterone is so critical to female hormone balance, it may be more important than ever for our lymph to be moving freely, serving as a delivery system for progesterone, to balance out estrogen. The presence of lipophilic progesterone in the lymphatics also stimulates bile salt secretion, helping the body mitigate some of the effects of estrogen excess as well.

Breast Health

Given the prevalence of hormonally-driven breast and other gynecological cancers, I would be remiss in not mentioning the importance of lymphatic health with regards to healthy breast tissue. Thousands of research articles can be found on the density of lymph tissue in the breast having an effect on the progression and severity of the disease. Breasts are composed primarily of fatty and connective tissues, but there is a tremendous amount of lymphatic tissue present as well. The lymph nodes in the axilla function as a protective barrier for the breast tissue, filtering toxins and regulating immune and inflammatory mechanisms that affect breast health.^6,7

Workup & Treatment for the Lymphatics

Evaluation

There is relatively little in the way of traditional lab tests that reflect the status of lymphatic flow, and even less that reflects how the lymphatic system is affecting overall hormonal balance. Allopathic medicine is interested in the lymphatics primarily because these vessels are a main way for cancer to metastasize.⁸ By using regulatory thermography, I am able to ascertain the general flow of lymph by measuring 18 separate points on the body. The findings reflect the level of acute inflammation versus more chronic stagnation.⁹ In other words, I can determine how much deposition of toxins is in which tissues and how much the lymphatic health is affecting the immune system.¹⁰ In addition, the points measured close to the head reflect the flow of lymph from the glymphatics (lymphatics that eliminate waste products from the brain), and asymmetry in the right and left temple readings tell me whether the pituitary function is suboptimal. Further evaluation is suggested in that scenario.

Treatment

Addressing lymph should be at the start of any treatment of hormonal issues, as well as at every stage of treatment; it also ultimately lends itself beautifully to the maintenance of good health through self-care. Amazingly, the lymphatic system has no central pump (like the heart, which pumps blood); rather, the movement of lymphatic fluid around the body depends on both smooth and skeletal muscle contraction (and manual manipulation). This is why a sedentary lifestyle impairs lymph function This is also why daily movement and/or exercise are essential for lymphatic health and why I routinely recommend dry skin-brushing as a gentle and effective home care treatment. Deep breathing is another essential way we can enhance movement of lymph, so I often teach women proper breathing techniques.¹¹ There are so many ways patients can address healthy lymph function on their own. I love this as part of the educational aspect of our work.

Home treatments can enhance lymphatic flow; however, I have also found some excellent complex homeopathic lymph remedies that are formulated on the basis of the level of “intoxication” of the tissues. One must distinguish between an acute, inflamed lymphatic system and a more chronic, stagnant lymph problem. Thankfully, the beauty of complex homeopathy allows us to address each of these levels with different support as indicated.

Summary

From beginning to end, when working with women on issues of hormonal imbalance, a component of that work will be aimed at clearing out the ECM and optimizing lymphatic function. This allows for proper nerve communication throughout the whole system, the removal of inflammatory proteins and dangerous pathogens and toxins that have myriad deleterious effects around the body, and supports proper circulation of fluids and crucial hormones, particularly progesterone. Sometimes, after a review of the most current information about the importance of a healthy lymphatic system, my obsession feels wholly justified.

References:

1. Barros CS,  Franco SJ, Müller U. Extracellular matrix: functions in the nervous system. Cold Spring Harb Perspect Biol. 2011;3(1):a005108.
2. Benros ME, Waltoft BL, Nordentoft M, et al. Autoimmune diseases and severe infectionsas risk factors for mood disorders: a nationwide study. JAMA Psychiatr 2013;70(8):812-820.
3. Schimmel HW, Penzer V. Functional Medicine: The Origin and Treatment of Chronic Diseases. Heidelberg, Germany: Karl F. Haug Verlog; 1996.
4. Zava DT. Steroid Hormone Testing in Different Body Fluids. January 2015.
   Townsend Letter. Available at: http://www.townsendletter.com/Jan2015/steroid0115.html. Accessed October 10, 2017.
5. Hargrove JT, Maxson WS, Wentz, AC. Absorption of oral progesterone is influenced by vehicle and particle size. Am J Obstet Gynecol. 1989;161(4):948-951.
6. Wiig H, Swartz MA. Interstitial fluid and lymph formation and transport: physiological regulation and roles in inflammation and cancer. Physiol Rev. 2012;92(3):1005-1060.
7. Brouillard P, Boon L, Vikkula M. Genetics of lymphatic anomalies. J Clin Invest. 2014;124(3):898-904.
8. Thiemann S, Man JH, Baum LG. Assessing the roles of galectins in regulating dendritic cell migration through extracellular matrix and across lymphatic endothelial cells. Methods Mol Biol. 2015;1207:215-229.
9. Rost Introduction to Regulation Thermography: Practical Instruction and Therapeutic Consequences.Stuttgart, Germany: Hippokrates; 1990.
10. Beilin D. Regulation Thermography: Revealing Functional Signatures of Disease Progression and Development. March 1, 2013. Semantic Scholar Web site. https://pdfs.semanticscholar.org/6533/3ed40fa7e718364eba3b70929731494919f8.pdf.
11. Abu-Hijleh MF, Habbal OA, Moqattash ST. The role of the diaphragm in lymphatic absorption from the peritoneal cavity. J Anat. 1995;186(Pt 3):453-467.

Image Copyright: <a href=’https://www.123rf.com/profile_icetray’>icetray / 123RF Stock Photo</a>

Ginger Nash, ND, is an expert in the field of women’s health and hormone balance, having lectured to both women and practitioners of natural medicine across the United States and Canada for 20 years. Dr Nash taught at the University of Bridgeport’s College of Naturopathic Medicine clinic for 6 years and has also had a thriving practice in New Haven, CT, since 1999. She is a sought-after speaker and has recently launched a comprehensive online program for menopausal women.