Glasser Massage & Lymphedema Services, LLC

  Therapeutic Massage & Lymphedema Treatment Center

By Diana Brady, MA, CNC, in conjunction with Peter Glasser, LMBT.

Ultimate Health Center, Inc, Asheville, N. C.

The use of plants and food as natural medicine dates back many thousands of years ago to the early cultures of China, Egypt and South Africa (Murray, 1992, 1-Philo-2). Hippocrates, hailed as the first medical doctor, used plants and foods to heal his patients. Conventional or allopathic medicine came to the U.S. in the late 19^th century through discovery of the germ theory of disease, and natural healing took a backseat  (Murray, 1992, I:Histnm6).

Since that time, the accomplishments of allopathic medicine have been remarkable.  However, allopathic medicine has failed in the areas of disease prevention and management of the many new and chronic illnesses (Chopra, 1994,3).  As a result, there has been resurgence back to the original medicine, plant and food based remedies.  Natural remedies have been especially effective in the areas of disease prevention and treatment of chronic illness.  Combining the two approaches, and using them each judiciously provides the individual with the best of both worlds.

Peter Glasser, LMBT, has been using natural remedies to enhance lymphedema treatments and compliment CDT, since opening our own treatment center in 1995.  Prior experience at another center, without natural remedies, and with our own patients who choose not to take supplements, provided us with records to compare results.  Typically there is an overall decrease in initial treatment time, in maintenance treatments and in symptoms. Patients following our supplement protocol consistently report less pain, less edema, a reduced or eliminated need for compression bandaging/garments and an increased quality of life.

Although there are too many variables between patients to provide for an exact comparison test, even a general comparison clearly shows better results with supplementation than without.  We compared our clinical results based upon affected limbs and stages of lymphedema.  All treatments were performed by the same therapist, Peter Glasser.

Secondary LE 1 Leg

We have developed a basic supplementation regime that is a starting point for most of our patients.  There is a more advanced supplement program containing fish oils, dandelion leaf and root, burdock/red root, butchers broom, garlic, etc. However, that program is tailored to the individual’s condition and needs.  The basic program is a good starting point. Adaptations of the basic program depend upon the particular circumstances of the individual and their response to the supplements.

Before recommending any supplements, a complete understanding of the patient’s medical history, physical condition, current medication and current supplement regime is essential.

Basic Supplementation Regime:

Horse Chestnut:

According to the Physician’s Desk Reference (PDR) for Herbal Medicines,  “Horse Chestnut … has an anti-exudative, vascular tightening effect, and reduction of vascular permeability which result in an antiedemic effect.  The vein-toning properties of the Horse Chestnut extract also demonstrated improvement of venous return flow…The edema reduction effect and reduction of leg volume with edema provocation of the Horse Chestnut extract were both statistically significant.

Drug Interactions:  Horse Chestnut ….has a coumarin component and may interact with warfarin, salicylates and other drugs with anti-coagulant properties” (Jaenicke, C, et al, 2000, 403-405).

Contraindications: Horse Chestnut is not recommended in combination with blood thinning medications, high blood pressure medication, pace makers, serious heart conditions and during pregnancy.

Side Effects: Approximately 4% of our patients reported side effects including gastro intestinal upset and mild heart palpitations.  When taken with food, the gastro intestinal upset was eliminated.

Therapeutic Benefits:

In clinical trials for chronic venous insufficiency, “Significant edema reductions were achieved with Horse Chestnut and compression compared to placebo, and the two therapies were shown to be equivalent” (Diehm C, 1996).

After initial CDT treatments, edema reduction can be sustained in a majority of patients.  Some patients have even been able to eliminate compression bandages and/or garments, while others have been able to reduce maintenance treatments.  If results are not seen within one to two months, increase dosage to 2 capsules after breakfast and 2 capsules after dinner.

Mild cases of lymphedema usually respond within one to two months.  More severe cases may take between six months to one year to achieve the desired results.  Continued long-term usage is recommended, however, after achieving results for a period of months, dosages may be reduced and results still maintained.

Products used at our center:

Nature’s Herbs - Veno-Care with 257 mg of Horse Chestnut extract, 100 mg of butchers broom, 73 mg of ginger root and 50mg of rutin.  Take one capsule after breakfast and one after dinner.

- or-

Enzymatic Therapy – Horse Chestnut Extract, 250mg.Take one capsule after breakfast and one capsule after dinner.-
         

Life Extension Foundation Venotone Horse Chestnut Extract, 250mg.  Take one capsule after breakfast and one capsule after dinner.

Topical Application:

            Topical application of Horse Chestnut gel will act synergistically with oral supplementation.  However, even without oral supplementation, noticeable benefits will be derived from topical application alone.

Products used at our center:

            Venenkraft Bein-Gel -Horse Chestnut, 100 ml.

Rutin:  Bioflavonoids are biologically active compounds found in fruits, vegetables, nuts, seeds, leaves, flowers and barks (Murray 1992 V:Querc-1). Rutin is a bioflavonoid, derived from eucalyptus, and known for its potent antioxidant, anti-inflammatory and capillary strengthening properties (Hudson 1999 152).

Contraindications:  None noticed to date.

Side Effects:  Extremely high doses may cause diarrhea.

Therapeutic Benefit:  Rutin has been shown in clinical trials to enhance the effect of Horse Chestnut in the treatment of venous stasis (Quarterly Review of Natural Medicine 1996;169-171).  “Oxerutins (rutin) belong to a group of edema protective agents and possess anti-exudative and membrane protective activity”, (Unkauf, M, et al 1996).

Products used at our center:

Thompson (or Solgar) rutin with 500 mg of rutin.  Take one tablet after breakfast and one tablet after dinner together with Horse Chestnut.

Note:  If the dosage of Horse Chestnut is increased, increase the dosage of rutin accordingly.

Grape Seed Extract – PCO – or Pycnogenol:

In clinical studies, pycnogenol and procyanidins (PCO) were found to be effective by “either stabilizing the collagenous subendothelial basal membrane or scavenging the free radicals, or by a combination of these activities.  Clinically, capillary leakage, perivascular inflammation and subcutaneous edema were all reduced.  The safety of use of pycnogenol is demonstrated by the lack of side effects or changes in blood biochemistry and hematologic parameters” (Petrassi, C, 2000).

Contraindications:  None noticed to date.

Side Effects: Headaches have been noted when the dosage is too high.

Therapeutic Benefits:  In clinical trials for venous insufficiency, “pycnogenol significantly reduced the circumference of the lower limbs and significantly improved subjective symptoms” (Koch, R 2002).

Products used at our center:

Enzymatic Therapy – 50 mg.  Take two capsules per day, one mid day and one in the evening.

Multi-Vitamin:  In June of 2002, the AMA announced that based on the results of long-term clinical studies, it now recommends that everyone take a multivitamin supplement every day.

Products used at our center:

Amni Basic Preventive 5 (capsules).  Take three capsules with each meal.

 Additions to Basic Regime:

Digestive Enzymes:

According to Michael Murray, ND, digestive enzymes are “important in preventing tissue damage during inflammation and the formation of fibrin clots.  Proteases cause an increase in the breakdown of fibrin, a process known as fibrinolysis.  Pancreatic enzymes and protease enzyme preparations have been shown to be useful in the treatment of many acute and chronic inflammatory conditions” (Murray, 1993).

Contraindications:  None to date.

Side Effects:  None to date.

Therapeutic Benefits:  Clinical trials of enzymes for inflammation and injuries date back to the 1960’s (Deitrick RE. Oral proteolytic enzymes in the treatment of athletic injuries: a double-blind study. Pennsylvania Med J 1965;Oct:35-7).  Digestive enzymes taken on an empty stomach reduce the accumulation of protein and fats in the lymphatic system and connective tissue.  Edema is reduced and fibrotic tissue softened, making this a beneficial treatment for lipedema as well as lymphedema. Results may take between 2 to 3 months to be noticeable, but are worth pursuing.  Digestive enzymes are recommended for use before, during and after treatments, until the limb or affected area is close to normal size.  At that point the inflammation and proteins, fats, causing it will be under control.

Products used at our center:

American Biologics Infla-Zyme Forte with pancreatin, bromelain, papain, trypsin, chymotrypsin, rutin, zinc, superoxide dismutase, catalase and l-cysteine.  Take 3 tablets one hour before breakfast, and 3 tablets one hour before dinner.  Must be taken on an empty stomach.

 Infections:

Colloidal Silver:

            Dr. Harry Margraf, a biochemist and pioneering silver researcher, of Washington’s University Dept of Surgery stated in the 1970’s, “Silver is the best all-around germ fighter we have.”  According to Natural Health, “colloidal silver works by disabling the oxygen metabolism enzyme of a bacteria or virus, thereby suffocating and killing it.  Since its mechanism of action is directed at the microorganism itself, no tissue cell enzymes are destroyed.  Silver does not form toxic compounds or react with anything other than a germ’s oxygen metabolizing enzyme, thereby making it a safe, natural remedy.  Resistant strains fail to develop and the body does not develop a tolerance.

Product Quality:  Many brands of colloidal silver are inferior, and some may not even be safe.  The highest grade is produced by the electro-colloidal/non-chemical method where the silver particles and water have been colloided, i.e., dispersed within and bound to each other by an electric current.  The super fine silver particles are suspended indefinitely in demineralized water.  The ideal color of colloidal silver is a golden yellow.  Darker colors indicate larger silver particles that are not true colloids.  If a product contains a stabilizer or lists trace elements other than silver, or if it needs to be shaken, it is inferior.  If a product requires refrigeration, some other ingredient is present that could spoil. The container and dropper must be glass.  Some brands with high concentrations of silver may actually not be completely safe.  Safe ranges are from 3 to 10 parts per million” (Natural Health 2002).

Contraindications:  None to date.

Side Effect:  None to date.

Products used at our center:

Source Naturals Ultra Colloidal Silver – 10 PPM (parts per million). One tablespoon, twice daily, between meals for 10 days at a time.  Can be taken repeatedly, and for extended periods of time.

Topical Application:

Topical application of colloidal silver is used on wounds, skin abrasions, red and scaly skin and other skin abnormalities. Source Naturals makes a colloidal silver spray product that works well for topical use.

Liquid Selenium:

            Low levels of the trace mineral selenium have long been associated with infections, and decreased immune response, demonstrated repeatedly in clinical trials (Werbach 1996 371).

Contraindications: None to date.

Side Effect.  None to date.

Products used at our center:

            Allergy Research, liquid selenium – 100 mcg.  One half teaspoon, twice a day, on an empty stomach for 10 days at a time.  Can be taken repeatedly, and for extended periods of time.

Topical Castor Oil Packs:

In a double blind, placebo study, castor oil packs were shown to increase lymphocyte production and the level of activity of T-cell lymphocytes that identify and kill viruses, fungi and bacteria.  Castor oil packs improve lymphatic circulation and draw acids and infection out of the body (Grady H, Castor Oil Packs: Scientific tests verify therapeutic value. A.R.E. magazine, 1998, pp 12-15).

Application: Trim a disposable diaper to remove the elastic edging.  Put castor oil on the inside of the disposable diaper.  Make sure the castor oil soaks into the absorbable part of the diaper, but not to the point that it is running.  Apply this pack to the infected area, and wrap in place.  Leave the application on the infected area for 8 to 12 hours before changing the application.  After 8 to 12 hours, remove the application, wash the area with hydrogen peroxide and reapply a new castor oil pack.  If the infection is severe, add activated charcoal powder to the castor oil, making a paste like peanut butter before putting the paste onto the diaper. Within one to three days, there should be a noticeable effect, such as reduced redness, reduced warmth and decreased pain.  Once the infection is resolved, stop the packs.

Products used at our center: Heritage, Castor Oil – cold pressed.

Wound Care/Leg Ulcers:

Honey:

According to a recent review in the Journal of Wound Ostomy, “Many studies have demonstrated that honey has antibacterial activity in vitro, and a small number of clinical case studies have shown that application of honey to severely infected cutaneous wounds is capable of clearing infection from the wound and improving tissue healing” (Lusby PE 2002).  The PDR mentions slippery elm with its mucilaginous characteristics for wound care (Jaenicke, C, et al, 2000, 697).

Application:  Add slippery elm to honey until it is a paste, the consistency of peanut butter.  Spread this paste on a sterile bandage and apply directly to wounds.  Then apply a gauze wrap and tape to keep the dressing in place.  On a daily basis, spray the bandage with hydrogen peroxide or water, to soak the bandage for easy removal.  Gently remove the bandage, taking care to leave any herbal mixture that is adhering to the wound in place.  Reapply herbal mixture on top of herbs remaining on wound, and put new sterile bandage and wrap.  After one week of daily applications, clean wound entirely with hydrogen peroxide, removing all of the herbal mixture.  Let the wound air dry for 15 or 30 minutes, and apply new herbal mixture and bandage.  Repeat the latter process daily until the wound is healed.

Skin Care:

Before bandaging, spray hydrogen peroxide on the skin to keep bacteria levels down.  Areas of high bacterial content will produce white foam.  Gently wipe dry.  Then apply Horse Chestnut gel and/or natural low PH moisturizer to protect and lubricate the skin.  Apply compression wraps or bandaging, if needed.

Dietary Suggestions:

 A health promoting diet, defined by Michael Murray ND, includes:

1.            Eating a plant based, predominantly vegetarian diet.

2.            Reducing the intake of fat.

3.            Eliminating the intake of refined sugar.

4.            Keeping salt intake low and potassium high.

5.            Reducing exposure to pesticides and herbicides.

6.            Eliminating the intake of food additives and coloring agents.

7.            Drinking 32 to 48 ounces of water daily.

8.            Identifying and addressing food allergies.

9.            Determining caloric needs to achieve or maintain ideal body weight (Murray 1998 48-69).

 We concur and advise a diet:

* high in complex carbohydrates and plant fiber; but low in calories, sodium, fat, sugar, caffeine, alcohol, preservatives, protein and cholesterol.

* high fiber legumes (vegetables and beans) should be a major component of your daily diet.  These include beans, kale, broccoli, artichoke, mustard greens, escarole, cabbage, Brussels sprouts, cauliflower, squash, onions and potato.

* increasing potassium intake will help reduce fluid retention as well as limiting sodium.  Foods high in potassium include: bananas, oranges, tomatoes, dandelion, fresh fruit, wheat germ, lettuce, broccoli, potatoes, celery, nuts, dried apricots, cantaloupes, flounder, chicken and haddock.

* garlic, onions and unsaturated olive, canola oils have anti-inflammatory  properties and should be added to your diet in abundance.

* anti-inflammatory spices include turmeric and curcumin.

* ginger and cayenne aid circulation.

* natural diuretics include celery seed, parsley, dandelion and corn silk (Jaenicke, C, et al, 2000, 245, 565,172).

* burdock root relieves congestion of the lymphatic system.  It also cleanses the blood by eliminating uric acid and excess waste materials (Jaenicke, C, et al, 2000, 128).

Product Quality:

The safety, purity and potency of vitamin, mineral and herbal supplements vary dramatically.  It is best to purchase products from companies that have a long-standing reputation for quality.  The better companies, like Enzymatic Therapy, conform to the same standards as pharmaceutical manufacturing.  Their products are scientifically tested and validated for efficacy and purity.  Active ingredients are standardized to deliver the same quantity on a consistent basis.  Better product labels may say: hypoallergenic, or contains no sugar, salt, yeast, wheat, gluten, corn, soy, dairy products, artificial flavoring or preservatives.

Some companies, like American Biologics, actually have their own research center and perform clinical research on their own products.

Suppliers:

American Biologics, Chula Vista, CA – Consumers 800-227-4473.

Health Care Professionals 800-227-4473 ext 3321.

Enzymatic Therapy, Source Naturals, Thompson, Solgar, Nature’s Herbs can be purchased at a good health food store, or online at www.vitacost.com or at www.vitaminshoppe.com.

Phyto Pharmica is the Enzymatic Therapy brand for professionals, and can be purchased by professionals at 800-553-2370.

Venenkraft Horse Chestnut gel can be purchased online at www.nakaherbs.com or by phone at  800-668-0519.

Amni products 800-356-4791.

Life Extension Foundation products 800-544-4440.

Heritage products 800-862-2923.

Allergy Research can be found at www.nutricology.com.

Bibliography

Clinical trials of Horse Chestnut, procyanidins (pco), alpha tocopherol (vitamin E), melilotus (clover), centella asiatica (gotu kola), pycnogenol, oxerutin (rutin) and Butcher’s broom for venous insufficiency.  Available through the National Library of Medicine (NLM).

Vanscheidt W, Jost  V, Wolna P, Lucker PW, Muller A, Theurer C, Pat B, Grutzner KI.). Efficacy and safety of a Butcher’s broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency. Arzneimittelforschung; 2002;52(4):243-50.

Koch, R.. Comparative study of Venostasis and Pycnogenol in chronic venous insufficiency. Phytother Res 2002 Mar;16 Suppl 1:S1-5.

Petruzzellis V, Troccoli T, Candiani C, Guarisco R, Lospalouti M, Belcar G, Dugall M. Oxerutins (Venoruton): efficacy in chronic venous insufficiency – a double-blind, randomized, controlled study.  Angiology 2002 May-Jun;53(3):257-63.

Rehn d, Unkauf M, Klein P, Jost V, Lucker PW. Comparative clinical efficacy and tolerability of oxerutins and Horse Chestnut extract in patients with chronic venous insufficiency.  Arzneimittelforschung 1996 May;46(5):483-7.

Unkauf M, Rehn d, dlinger J, de la Motte S, Grossmann K.  Investigation of the efficacy of oxerutins compared to placebo in patients with chronic venous insufficiency treatment with compression stockings. Arzneimittelforschung 1996 May;46(5):478-82.

Petrassi C, Mastromarino A, Spartera C. Pycnogenol in chronic venous insufficiency. Phytomedicine 2000 Oct;7(5):383-8.

Diehm C, Trampisch HJ, Lange S, Schmidt C. Comparison of leg compression stocking and oral Horse Chestnut seed extract therapy in patients with chronic venous insufficiency. Lancet 1996 Feb 3;347(8997):292-4.

Cataldi A, Gasbarro V, Viaggi R, Soverini R, Gresta E, Mascoli F.  Effectiveness of the combination of alpha tocopherol (vitamin E), rutin, melilotus (clover), and centella asiatica (gotu kola) in the treatment of patients with chronic venous insufficiency. Minerva Cardioangiol 2001 Apr;49(2)159-63.

Costantini A, De Bernardi T, Gotti A. Clinical and capillaroscopic evaluation of chronic uncomplicated venous insufficiency with procyanidins (PCO) extracted from vitis vinifera (grape). Minerva Cardioangiol. 1999 Jan-Feb;47(1-2);39-46.

Diehm C, Vollbrecht D, Amendt K, Comberg HU. Medical edema protection – clinical benefit in patients with chronic deep vein incompetence.  A placebo controlled double blind study. Vasa 1992;21(2):188-92.

Clinical review of honey for wound care.  Available through the NLM.

Molan, PC. Potential of honey in the treatment of wounds and burns. Am J Clin Dermatol 2001;2(1):13-9.

Topham J. Why do some cavity wounds treated with honey or sugar paste heal without scarring? J Wound Care 2002 Feb;11(2):53-5.

Lusby PE, Coombes A, Wilkinson JM. Honey: a potent agent for wound healing? J Wound Ostomy Continence Nurs 2002 Nov;29(6):295-300.

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Pizzorno, J, & Murray, M (1992). A textbook of natural healing volume I. Washington: Bastyr University Publications.

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Blumenthal, Busse, Goldberg, Gruenwalk, Hall, Klein, Riggins, Rister.  The Complete German Commission E Monographs – Therapeutic Guide to Herbal Medicines, American Botanical Counsel, Austin, Texas 1998.

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Fletcher, R MD, Fairfield, K MD, Vitamins for Chronic Disease Preventions in Adults, JAMA. 2002;287:3116-3129.

Murray, M. Pancreatic enzymes serve many important purposes including assisting digestion and relieving inflammation.  Health Counselor Vol.5, No. 4, Oct/Nov 1993;41-43.

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