There are many over-the-counter supplements and several medications available by prescription which have been found to aid in the treatment of lymphatic diseases. I have researched many of them to save time for my clients.
Index
N-acetylcysteine
NAC – see N-acetylcysteine
Nattokinase
Nicotinamide Riboside
Noni
Omega-3
Palmitoylethanolamide
Phentermine – see Amphetamine
Pine bark extract – see Pycnogenol
Potassium
Pregabalin
Prescription Savings Programs
Probiotics
Pycnogenol
Quercetin
Rhodiola
Rutosides
Selenium
Serrapeptase
Spirulina
Statins
Supplements A-M
Terbutaline
Thiazolidnediones
Thyroid Hormone
Turmeric
Ubiquinol
Vasculera
Vitalyzyme
Wobenzyme
Omega-3 fatty acids, found in fish oil, have well-documented anti-inflammatory effects. They can be beneficial in managing chronic inflammatory conditions like rheumatoid arthritis. Studies indicate that omega-3 supplements can reduce the need for NSAIDs in these patients.
Turmeric, specifically its active compound curcumin, has powerful anti-inflammatory and pain-relieving properties. Numerous studies have shown its efficacy in managing conditions like osteoarthritis and rheumatoid arthritis. One study found that turmeric extracts can be as effective as ibuprofen in reducing pain and inflammation in knee osteoarthritis patients.
Learn More
Bad Mix: Blood Thinners And NSAIDs | Harvard Health Publishing
Cancer Therapy Interactions With Foods And Dietary Supplements – Health Professional Version | National Cancer Institute
Cancer Therapy Interactions With Foods And Dietary Supplements – Patient Version | National Cancer Institute
Caution With These Supplements When You Have A Heavy Metal Burden | Naturheilpraxis
Dietary Supplement Fact Sheets | National Institutes Of Health
Ginger Should Be Avoided When Taking Certain Medications Or Having Certain Health Conditions | Healthy and Natural World
Prostate Cancer, Nutrition, and Dietary Supplements – Health Professional Version | National Cancer Institute
Prostate Cancer, Nutrition, and Dietary Supplements – Patient Version | National Cancer Institute
Recommended Supplements And Medications PDF | Dr. Karen Herbst, May 2019
U.S. National Library Of Medicine Database | National Institutes Of Health
Supplements And Medications To Avoid With Lipedema
Beta blockers are used in the treatment of cardiac health but can cause fluid retention.
Calcium channel blockers are used in the treatment of hypertension but can cause fluid retention.
Clonidine is used in the treatment of hypertension but can cause fluid retention.
Furosemide is used in the treatment of edema but concentrates proteins in interstitial organs, eventually halting fluid flux. Aldactone and hydrochlorothiazide have less adverse effects in women with lipedema.
Gabapentin is used for pain control but can cause fluid retention.
Non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain control but can cause fluid retention.
Oral corticosteroids are used to reduce inflammation but can weaken tissue and cause fluid retention and rebound inflammation. Oral corticosteroids should be used when medically necessary. Nasal or inhaled corticosteroids have less effect on lipedema tissue.
Sex hormones are used for hormone replacement but can cause fluid retention and are implicated to effect the development of lipedema.
Thiazolidinediones are used in the treatment of diabetes but can cause increases in subcutaneous fat tissue and fluid retention.
Herbst, K. (2019, December 13). Subcutaneous adipose tissue diseases: Dercum disease lipedema, familial multiple lipomatosis, and Madelung disease. EndoText, 1-46.
Where to Purchase
Beyond Health
Marine Minerals
Professional Supplement Center
Pure Encapsulations
Thorne
About Supplements In The US
US supplements are poorly standardized, often contaminated, usually not evidence based, and unregulated. Herbs and other supplements are not required to meet standards of safety, efficacy, and consistency, and their use has important implications for clinical care. The continuing availability of such products in the United States results in large part from the 1994 Dietary Supplement and Health Education Act, which created a protective new category for the approximately 20,000 vitamins, minerals, herbs, and other agents sold as supplements before October 1994. Spurred by supplement industry lobbying, the act protects supplements from government scrutiny and mandates that the US Food and Drug Administration prove harm before distribution of a product can be regulated.
Cassileth, B., and Vickers, A. (2005, Apr 20). High prevalence of complementary and alternative medicine use among cancer patients: Implications for research and clinical care. Journal of Clinical Oncology, 23(12):2590-2.
N-acetylcysteine
N-acetylcysteine (also known as NAC or acetylcysteine) is used to help break up mucus and is used by the body to build antioxidants. NAC is used to treat acetaminophen overdose. NAC is also marketed for its liver-protective properties and to support healthy immune functioning, and there is evidence it can help prevent kidney or neurologic damage caused by some drugs. It has also been studied for several psychiatric disorders with limited success.
NAC can dissolve and loosen mucus caused by some respiratory disorders by reducing protein bonds (disulphide bonds to sulfhydryl bonds) which reduces mucus formation. This mechanism of action is thought to help reduce the thickness (viscosity) of lymph in lipedema patients so that it will move more freely within the body.
NAC also helps facilitate essential biological functions by bonding with two other amino acids–glutamine and glycine–to create glutathione, a powerful antioxidant that plays a key role in regulating numerous cellular activities and helps keep the immune system in check. Glutathione helps neutralize free radicals that damage cells and tissues at the molecular level.
Only minute amounts of NAC are found in food; it is derived from the amino acid L-cysteine. Cysteine is both naturally produced in the body and obtained from animal-based and plant-based foods. These foods are excellent food sources of the amino acid: poultry, eggs, dairy, red peppers, garlic, onions, broccoli, Brussels sprouts, oats, and wheat germ.
Side effects include nausea, vomiting, stomach upset, diarrhea, fatigue, eye irritation, and skin rash. Less common side effects include asthma attack, anaphylactic shock, low blood pressure and headache (due to vasodilation). For those patients with mast cell activation syndrome, it should be noted that NAC is a diamine oxidase inhibitor.
Do not take NAC if you are taking nitroglycerin; NAC can further reduce blood pressure and cause severe headaches. NAC can slow blood clotting and should be avoided in people with bleeding disorders, such as hemophilia or Von Willebrand disease. NAC should be stopped at least two weeks prior to any elective surgery. Caution should be exercised in people with kidney disease; metabolized NAC is excreted via the kidneys and has been known to cause kidney stones in rare cases–even in people without kidney disease. Get emergency medical help if you have signs of an allergic reaction: hives, difficult breathing, or swelling of your face, lips, tongue, or throat.
Recommended by Dr. Karen Herbst at 500 mg to 600 mg once or twice daily.
Griffin, R. (2020, Mar 3). N-acetyl cysteine. Web MD. https://www.webmd.com/vitamins-and-supplements/n-acetyl-cysteine-uses-and-risks
N-acetylcysteine. (2020, Oct 1). Memorial Sloan Kettering Cancer Center. https://www.mskcc.org/cancer-care/integrative-medicine/herbs/n-acetylcysteine
NAC. (2020, Jan 3). Drugs.com. https://www.drugs.com/mtm/nac.html
NAC contraindications. (n.d.). Glutathione Disease Cure. https://www.glutathionediseasecure.com/NAC-contraindications.html
Wong, C. (2021, Nov 14). What is N-acetylcysteine? Very Well Health. https://www.verywellhealth.com/the-benefits-of-n-acetylcysteine-89416
Learn More About N-acetylcysteine
N-acetylcysteine Fact Sheet For Consumers | National Institutes Of Health
N-acetylcysteine Fact Sheet For Health Professionals | National Institutes Of Health
NAC – see N-acetylcysteine
Nattokinase
Nattokinase is a natural enzyme extracted from natto, a popular Japanese breakfast dish made from fermented soybeans. Natto has long been used in folk medicine to treat cardiovascular diseases, and nattokinase is believed to possess the same properties.
In alternative medicine, it is believed to benefit people with heart and vascular diseases, in part by breaking down blood clots that can impede circulation. Among the conditions nattokinase is purported to prevent or treat are: angina, atherosclerosis, deep vein thrombosis (DVT), hemorrhoids, high blood pressure, heart attack, peripheral artery disease (PAD), stroke, and varicose veins.
Because nattokinase can influence blood circulation and chemistry, it should be used with caution in certain groups, namely:
People with bleeding disorders, such as hemophilia, in whom nattokinase may make symptoms worse
People who take blood thinners, including warfarin, in whom nattokinase may promote bleeding and easy bruising
People with low blood pressure, also known as hypotension, in whom nattokinase may cause lightheadedness, headaches, dizziness, and fainting
People on antihypertensive drugs, like ACE inhibitors and calcium channel blockers, in whom nattokinase may intensify the drug’s effect, triggering hypotensionNattokinase should be stopped at least two weeks prior to a scheduled surgery to reduce the risk of excessive bleeding.
Why do people take nattokinase?
There’s some early evidence that nattokinase may have benefits for heart and artery health. One study shows that a nattokinase supplement lowers the risk of blood clots after long plane flights. It may help reduce narrowing of the arteries.Other studies show that nattokinase may help lower blood pressure. However, we need more research to see if it is effective.
Optimal doses of nattokinase have not been set for any condition. Quality and active ingredients in supplements may vary widely from maker to maker. This makes it very hard to set a standard dose. Ask your doctor for advice.
Researchers first found nattokinase in the Japanese food natto, made with fermented soybeans. It seems that the fermentation process makes nattokinase. You can’t get nattokinase from other soy foods.
Risks. If you have any blood clotting disorders, don’t take nattokinase supplements unless a doctor says it’s safe. You may need to stop taking nattokinase if you’re planning to have surgery.Given the lack of evidence about its safety, doctors don’t recommend nattokinase for children or for women who are pregnant or breastfeeding.
Interactions. If you take any medications regularly, talk to your doctor before you start using nattokinase supplements. The supplements could interact with blood thinners and other drugs that reduce clotting, like aspirin and ibuprofen. They could cause excess bleeding and bruising.
The U.S. Food and Drug Administration (FDA) does regulate dietary supplements; however, it regulates them under a different set of regulations than foods and drugs. It is up to the manufacturers to assure safety and accurate labeling.
Recommended by Dr. Karen Herbst, 2000 units daily on an empty stomach.
Brennan, D. (2020, Nov 06). Health Benefits of Nattokinase. Web MD. https://www.webmd.com/diet/health-benefits-nattokinase#1
Griffin, R. (2021, Sep 24). Nattokinase. Web MD. https://www.webmd.com/vitamins-and-supplements/nattokinase-uses-and-risks
Hills, J. (n.d.). Ginger should be avoided when taking certain medications or having certain health conditions. Healthy and Natural World. https://www.healthyandnaturalworld.com/ginger-should-be-avoided-by-these-people/
Nattokinase. (2020, Jun 22). Drugs.com. https://www.drugs.com/npp/nattokinase.html
Wong, C. (2021, Apr 28). What is nattokinase? Very Well Health. https://www.verywellhealth.com/what-is-nattokinase-89831
Nicotinamide Riboside
Coming soon!
Recommended by Dr. Karen Herbst at 150 mg to 250 mg daily.
Bauer, B. (n.d.). Chronic fatigue: Can a natural remedy boost my energy? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome/expert-answers/chronic-fatigue/faq-20058033
Noni
Coming soon!
Noni has anti-inflammatory and antioxidant properties. It may inhibit the formation of blood vessels that contribute to lipomatosis, a condition in which benign tumors of fat tissue appear throughout the body.
Learn More About Noni
Noni | National Center For Complementary And Integrative Health
Omega-3
Coming soon!
Omega-3 (also known as fish oil)
Recommended by Dr. Karen Herbst.
Omega-3. (2018, May). National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/omega3-supplements-in-depth#what-do-we-know-about-the-safety-of-omega-3s
Learn More About Omega-3
Omega-3 Fact Sheet For Consumers | National Institutes Of Health
Omega-3 Fact Sheet For Health Professionals | National Institutes Of Health
Palmitoylethanolamide (PEA)
Coming soon!
For mast cell disorder.
Learn More About Palmitoylethanolamide
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157570/
https://www.webmd.com/vitamins/ai/ingredientmono-1596/palmitoylethanolamide-pea
Phentermine – see Amphetamine
Pine bark extract – see Pycnogenol
Potassium
A WARNING ABOUT POTASSIUM SUPPLEMENTATION: It’s extremely important to ensure that your blood potassium level remains between 3.5 to 5 mmol/L. Unlike sodium and chloride, potassium’s ideal level is in a very small range, and the heart’s function is controlled primarily by potassium. For potassium levels under 3.5 or over 5, dangerous arrhythmias can occur, so please be very cautious when using these supplements.
Learn More About Potassium
Potassium Fact Sheet for Consumers | National Institutes Of Health
Potassium Fact Sheet For Health Professionals | National Institutes Of Health
Pregabalin
Coming soon!
Recommended by Dr. Karen Herbst at 150 mg to 600 mg daily.
National Library of Medicine. (2021, Jan 22). Pregabalin. Medline Plus. https://medlineplus.gov/druginfo/meds/a605045.html
Probiotics
Coming soon!
Recommended by Dr. Karen Herbst.
Probiotics: What you need to know. (2019, August). National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know#can-probiotics-be-harmful
Learn More About Probiotics
Probiotics Fact Sheet for Consumers | National Institutes Of Health
Probiotics Fact Sheet For Health Professionals | National Institutes Of Health
Pycnogenol
Pinus pinaster is a type of pine tree native to the Mediterranean; these trees are commonly called maritime or cluster pines. The bark of maritime pines is sold under a variety of names: flavangenol, oligopin, and pycnogenol. The most notable nutrients in pine bark extract are the antioxidants procyanidins, catechins, and phenolic acids. These compounds are believed to be what makes pine bark useful as an herbal supplement, giving it antioxidant, antimicrobial, and anti-inflammatory properties.
Maritime pine trees that grow in southwest France are used to make pycnogenol, the trademarked name for a specific maritime pine bark extract. Pycnogenol is an antioxidant and a bioflavonoid. Its antioxidant properties protect against damage caused by free radicals, while its bioflavonoid properties reduce capillary leakage, perivascular inflammation, and subcutaneous swelling, helping to reduce leg pain and heaviness in those with chronic venous insufficiency. It is also used to decrease symptoms of asthma and to improve some symptoms of knee osteoarthritis.
“The complex diosmin + hesperidin (90% diosmin and 10% other flavonoids expressed as hesperidin) has also been widely studied; it appears to be less powerful and effective than Venoruton and Pycnogenol in patients with chronic venous insufficiency; it is definitely less potent than Pycnogenol alone and needs a dosage some 10 times higher than Pycnogenol.”
From the research paper Management of varicose veins and chronic venous insufficiency in a comparative registry with nine venoactive products in comparison with stockings.
Pine bark is considered safe when used in recommended amounts. Some may have sensitivities to pine bark, including older adults, pregnant and breastfeeding women, and those who are immunosuppressed; the use of pine bark extract should be avoided in these groups. Medications for blood clotting, diabetes, and immunosuppressants may interact with pine bark.
Recommended by Dr. Karen Herbst at 50-360 mg daily, taken all at once or in divided doses.
Belcaro, G., Dugall, M., Luzzi, R., Corsi, M., Ledda, A., Ricci, A. … & Feragalli, B. (2017). Management of varicose veins and chronic venous insufficiency in a comparative registry with nine venoactive products in comparison with stockings. The International Journal of Angiology. 26(3), 170–178. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552898/
Editorial team. (2015, Mar 21). Pycnogenol: 12 benefits according to studies. Doctors Health Press. https://www.doctorshealthpress.com/pycnogenol-benefits/
National Library of Medicine. (2021, Jan 29). Maritime pine. Medline Plus. https://medlineplus.gov/druginfo/natural/1019.html#Safety
Snyder, C. (2021, Feb 11). Pine bark extract: uses, benefits, and side effects. Healthline. https://www.healthline.com/nutrition/pine-bark-extract
Quercetin
Quercetin is a flavonoid that supports cardiovascular health, helps regulate blood pressure, and protects against stress by suppressing the release of cortisol in the body.
Quercetin is naturally present in many foods and herbs, including: apples, berries, black tea, broccoli, buckwheat tea, grapes, Ginkgo biloba, green tea, peppers, red onions and red wine. However, taking a quercetin supplement would work better for treatment of allergies because these foods contain significantly lower levels of the flavonoid.
Quercetin is generally safe for most people. It may cause headaches and tingling in the arms and legs of some people. Very high doses, especially when taken long-term, may cause kidney damage. Contraindicated in those with kidney stones.
Recommended by Dr. Karen Herbst at 500 mg twice daily.
https://www.verywellhealth.com/natural-antihistamine-5224433
Leonard, J. (2023, Apr 5). Top 5 Natural Antihistamines For Allergies. Medical News Today. https://www.medicalnewstoday.com/articles/323276#quercetin
For mast cell disorder.
Rhodiola
Trace mineral supports healthy functioning of the adrenal glands.
Rutosides
Selenium
Selenium is a helpful supplement for lipo-lymphedema patients because of its ability to reduce swelling. It can also reduce the risk of certain kinds of bacterial skin infections.
Recommended by Dr. Karen Herbst.
Selenium. (2019, Dec 10). National Institutes of Health. https://ods.od.nih.gov/factsheets/Selenium-Consumer/
Learn More About Selenium
Selenium Fact Sheet for Consumers | National Institutes Of Health
Selenium Fact Sheet For Health Professionals | National Institutes Of Health
Serrapeptase
Serrapeptase should be taken 2 hours after a meal.
Recommended by Dr. Karen Herbst at 30 mg once daily or 10 mg three times daily.
Hills, J. (n.d.). Ginger should be avoided when taking certain medications or having certain health conditions. Healthy and Natural World. https://www.healthyandnaturalworld.com/ginger-should-be-avoided-by-these-people/
Serrapeptase. (2020, Jun 22). Drugs.com. https://www.drugs.com/npp/serrapeptase.html
https://enzymetherapies.com/30/serrapeptase/can-you-use-serrapeptase-and-nattokinase-together
https://nattokinasehearthealth.com/nattokinase/side-effects-and-dangers
https://pulmonaryfibrosisnow.org/2019/10/04/serrapeptase-nattokinase-what-you-need-to-know
Spirulina
Spirulina is a type of blue-green algae that contains a number of nutrients, including B vitamins, beta-carotene, vitamin E, copper, iron, magnesium, selenium, and zinc. Spirulina contains antioxidants, minerals, and chlorophyll. It also contains a plant-based protein called phycocyanin – the a plant pigment that gives spirulina its blue-green color – which has been found to not only reduce inflammation in the body but also block tumor growth and kill cancer cells. Spirulina also contains zeaxanthin, a plant pigment that may reduce the risk of cataracts and age-related vision loss.
Spirulina has been used in a number of health conditions, including fatigue, high cholesterol, high triglycerides, and viral infections. Purported spirulina benefits also include weight loss, increased energy, and stimulation of the immune system. Animal and test tube studies suggest that spirulina may protect against allergic reactions by stopping the release of histamines.
Although few adverse effects are associated with the use of spirulina, consuming spirulina may cause headaches, allergic reactions, fatigue, dizziness, stomach upset, increased gas, muscle pain, sweating, swelling, and insomnia. People with allergies to seafood, seaweed, and other sea vegetables should avoid spirulina. Spirulina may not be appropriate in thyroid conditions, autoimmune disorders, gout, kidney stones, or phenylketonuria (PKU, decreased metabolism of the amino acid phenylalanine).
Spirulina harvested in the wild may be contaminated with heavy metals and bacteria, as it can also absorb heavy metals from the water where it is grown. In high amounts, some of these toxins may cause liver damage. Spirulina is available in pill or powder form, or as flakes or juices. Most of the spirulina consumed in the United States is grown in a laboratory. There are many different spirulina species, only some of which are identified on labels of commercially-available products. Spirulina maxima (cultivated in Mexico) and Spirulina platensis (cultivated in California) are the most popular. Spirulina has a bitter taste, and it’s often mixed with yogurts, juices, and smoothies to improve its flavor.
Because spirulina can help reduce blood clotting, it may increase the risk of bruising and bleeding in people with certain bleeding conditions. Spirulina might also affect blood sugar levels. The B12 content in spirulina is not well-absorbed by the human body; if you have a B12 deficiency (common in people with plant-based diets), you should make sure you’re supplementing from another source. Spirulina might interfere with drugs given to suppress the immune system, including: adalimumab (Humira), azathioprine (Imuran), cyclosporine (Neoral), etanercept (Enbrel), infliximab (Remicade), leflunomide (Arava), methotrexate, or mycophenolate (CellCept).
Leech, J. (2018, Oct 5). 10 Health Benefits of Spirulina. Healthline. https://www.healthline.com/nutrition/10-proven-benefits-of-spirulina
Spirulina. (2021, Jul 7). Drugs.com. https://www.drugs.com/npc/spirulina.html
Spirulina. (n.d.). Mount Sinai Health Library. https://www.mountsinai.org/health-library/supplement/spirulina
Spirulina: are there health benefits? (n.d.). Web MD. https://www.webmd.com/diet/spirulina-health-benefits
Wong, C. (2021, Oct 15). What Is Spirulina? Very Well Health. https://www.verywellhealth.com/the-benefits-of-spirulina-89079
Statins
Recommended by Dr. Karen Herbst.
National Library of Medicine. (2020, Sep 28). Statins. Medline Plus. https://medlineplus.gov/statins.html
Terbutaline
Coming soon!
Recommended by Dr. Karen Herbst at 5 mg four times daily.
National Library of Medicine. (2021, Jan 22). Terbutaline. Medline Plus. https://medlineplus.gov/druginfo/meds/a682144.html
Thiazolidnediones
Recommended by Dr. Karen Herbst.
Actos (pioglitazone), Avandia (rosiglitazone)
Thiazolidinediones (also called glitazones) are a class of medicines that may be used for the treatment of type 2 diabetes. They are a type of oral hypoglycemic (a medicine that lowers blood glucose levels). They bind to a receptor called the peroxisome proliferator activated receptor-gamma in adipocytes (fat cells) and promote maturation of fat cells and deposition of fat into peripheral tissues. Thiazolidnediones increase subcutaneous adipose tissue and should be avoided in people with lipedema.
Kajita, K, Mori, I, Hanamoto, T, et al. () Pioglitazone enhances small-sized adipocyte proliferation in subcutaneous adipose tissue. Endocr J 2012; 59: 1107–1114.
Thiazolidinediones. (n.d.). Drugs.com. https://www.drugs.com/drug-class/thiazolidinediones.html
Thyroid Hormone
Recommended by Dr. Karen Herbst.
Thyroid hormone treatment. (n.d.). American Thyroid Association. https://www.thyroid.org/thyroid-hormone-treatment/
Turmeric – see Curcumin
Turmeric is an antioxidant with a wide range of antiinflammatory properties.
https://www.healthline.com/nutrition/top-10-evidence-based-health-benefits-of-turmeric#TOC_TITLE_HDR_3
Learn More About Tumeric
Tumeric | National Center For Complementary And Integrative Health
Ubiquinol – see Coenzyme Q10
Gallbladder disease
Vasculera
Vasculera (diosmiplex)
Recommended by Dr. Karen Herbst.
Save on Vasculera. $132 for 3 months’ supply.
Primus Care Direct is a hassle-free, mail-order pharmacy service where patients can get their Vasculera prescription for $49 for a 30-day supply or $132 for a 90-day supply ($44 per month), Medicare patients included. This is the lowest possible price available and includes free home delivery. If you have insurance coverage for prescription medical foods, you may pay even less. Vasculera Prescribing Information
Blink Pharmacy Plus also offers a discount on Vasculera.
Vitalyzyme
Systemic enzyme which reduces fibrotic tissue and swelling in the body.
Wobenzyme
Systemic enzyme which reduces fibrotic tissue and swelling in the body.