A Primal Primer: Lymphatic Health

Inline_Lymphatic Health.jpegI get more questions these days about lymphatic health—particularly lymphedema. Sometimes it’s an issue related to a reader’s cancer recovery or a co-occurring symptom seen with a loved one’s other health concerns. While I might take up specific conditions in future posts (let me know if you have suggestions there), I thought I’d spend today taking apart the basics of lymphatic health. As with many of the body’s core operating functions, the real story often gets camouflaged within vague, consumer-based terms that end up being only medically tangential. Consider today’s post a trip into the weeds and (maybe) the beginning of an ongoing conversation on the topic.

In essence, the lymphatic system is the body’s filtration system, helping to sample incoming substances, filter out waste products from cells, regulate fluid homeostasis, and prime the immune system for action when a threat is located. Central to the entire system is the transportation of lymph, a clear fluid that stores and transports white blood cells, proteins, salts, glucose, bacteria and certain waste products.

Lymphatic vessels perform a similar role to the blood circulatory system, carrying lymph to virtually all areas of the body other than bone marrow.  Unlike the blood system, however, a series of valves force lymph to travel in just one direction, taking it ever-upward towards the neck, whereupon it re-enters the venous circulatory system. New lymph is formed when specialized lymphatic capillaries allow soluble materials and cells to court their way back into the lymphatic vessels.

Lymphatic vessels are connected to lymph organs. These organs are where the lymph is filtered and lymphocyte is created—arguably where most of the exciting action happens.

Red bone marrow and the thymus gland are considered the primary lymphoid organs and act as incubators for maturation of lymphocytes—a type of white blood cell. As these lymphocytes get older, they’re sent into the lymphatic vessels to hunt down and attacking infected or cancerous cells.

Secondary lymphoid organs, which include the lymph nodes, tonsils and spleen, act as traps for incoming pathogens, whereupon foreign bodies are set upon by mature lymphocytes.

Your Lymphatic System In Action

Up until quite recently, the lymphatic system was considered secondary to the blood circulatory systemA series of groundbreaking discoveries in the 90s changed all this, and we’ve been learning since.

For one, the lymphatic system plays a key part in our adaptive immunity. Antigens that make their way into the body or develop within our cells are recognized primarily by the lymphocytes produced by the thymus and bone marrow, or picked up as they pass through the secondary lymphatic organs. Upon detection of the antigen, the lymphatic system initiates a immunological cascade that activates or produces more and more lymphocytes to wipe out the threat. Lymph nodes and other secondary lymphatic organs are strategically located around the body where they are well placed to sample incoming materials and intercept potential threats.

Beyond immunity, there’s the equally important fluid homeostasis role that the lymphatic system plays. Lymphatic vessels act as conduits, allowing surrounding tissues to expel or absorb fluid in order to maintain homeostasis and prevent excess swelling. Recent research has even discovered an element of the lymphatic system devoted to draining interstitial fluid from in and around the brain, thereby exhibiting a critical function in alleviating pressure in the CNS.

Add to that the lymphatic system’s roles in lipid absorption and transportation from the digestive system, and the efficient removal of metabolic wastes from tissue, organs and the central nervous system, and it’s not hard to see why the lymphatic system is so nuanced (not to mention critical).

Lymphatic Dysfunction

It’s all well and good when the lymphatic system is doing what it ought to, but lymphatic disruption can portend unfortunate news for your health: compromised immune function and lymphedema for starters. 

Like any system within the body, factors like chronic inflammation, lifestyle choices, and toxin exposure can all place stress on the lymphatic system. Problems often occur when the flow of lymph is disrupted, whether with systemic inflammation or localized swelling at the nodes and vessels, whereby the entire system can become compromised as it relies on that constant movement of lymph to do its job.

And then there’s the fact that the lymphatic system acts as a sort of microbiological conveyor belt—fundamentally useful when antibodies can be released in a timely and efficient fashion to dispatch any antigens, but highly problematic when the system is overwhelmed or overrun. In these scenarios, the lymphatic system can quickly become a means by which infection can rapidly disseminate throughout the body.

Common diseases associated with the lymphatic system include:

  • Lymphedema—pooling of lymph fluid in the surrounding tissue, typically in the feet or lower legs.
  • Lymphadenitis—inflammation of a lymph node or nodes due to an infection of the tissue, usually in the neck.
  • Lymphoma—a group of cancers that develop in the lymphatic system, involving multiplication of lymphocytes eventually forming a malignant tumor in the lymph nodes and other parts of the body.
  • Non-Hodgkin Lymphoma—another subset of lymphatic cancers that can involve either B cells or T cells.
  • Splenomegaly—more conveniently known as an enlarged spleen. This is caused by several possible factors, including infection or cancer.
  • Tonsillitis—recurrent infection of the lymphoid tissues in the back of the mouth and top of the throat, which together form the tonsils.

There’s plenty more where that came from, but it’s fair to say that if your lymphatic system is ailing, your health in general will be lacking.

Factors That Help or Hinder Lymphatic Health

Inflammation (or Lack Thereof)

While the lymphatic system plays a key role in regulating inflammatory response within the body, it’s also susceptible to inflammation-driven dysfunction. As with every other angle of health, keeping inflammatory foods to a minimum, and anti-inflammatory foods on the regular, is definitely a plus for supporting lymphatic health. 

I’ve periodically shared my thoughts on the most anti-inflammatory foods, so be sure to check out the likes of this post if you’re not already familiar. Foods like wild fish oil/fat, berries, turmeric and pastured animal fat have all been shown to significantly lower chronic inflammation patterns. One interesting case study showed that MCT oil along with fat soluble vitamins helped to improve symptoms of intestinal lymphangiectasia.

Aside from anti-inflammatory foods, there’s the usual lifestyle choices that can make or break an anti-inflammatory way of life: getting plenty of sleep, regular (but not excessive) exercise, and avoiding chronic stress wherever possible.


Whereas the blood circulatory system is propelled by the pump-like workings of the heart, our lymphatic system relies on the contraction and relaxation of a complex series of smaller muscles to keep lymph continually flowing. While lymphatic vessels are equipped with their very own smooth muscle cells, research shows that “outer” forces such as skeletal muscle motion help to maintain healthy lymphatic flow.

Logically-speaking, the more movement you get, the better off your lymphatic system should be—and the literature seems to support this notion. A 2012 literature review concluded that exercise is an effective therapy for the treatment of lymphedema, while a considerable number of other studies indicate that water exercise in particular is a proven, safe way to treat swelling associated with secondary lymphedema.

Rebounding (e.g. jumping up and down on a trampoline), for one, has attained something of akin to cult status, and anecdotal evidence at least suggests there might be something in it. According to its proponents, rebounding helps to stimulate and maintain the flow of lymph by the dual action of weightlessness and “double gravity,” in addition to providing passive lymphatic muscular stimulation throughout many of the major muscle groups.

From a theoretical standpoint, it makes a lot of sense. While there are plenty of enthusiasts, I haven’t been able to dig up direct (confirmed) links between rebounding and lymphatic health. That being said, there’s no doubt that rebounding is good for our general health, so I see no reason not to give it a go.


Stress, as it happens, can exhibit a direct negative effect on the lymphatic system. A study published a couple of years ago, for example, showed that “chronic stress restructures lymphatic networks within and around tumours to provide pathways for tumour cell escape.” Not an ideal scenario…

Consciously pursuing a limited stress lifestyle (and taking advantage of stress reduction strategies) is critical for promoting a robust lymphatic system that’s still capable of fighting infection, regulating fluid, and removing waste. As always, daily meditation is a big step in the right direction, along with regular movement (somehow we keep coming back to that), plenty of social interaction, and getting out into nature as much as possible.

Lymphatic Massage

Lymphatic massage, otherwise known as lymphatic drainage, was developed in Germany specifically for the treatment of lymphedema. While the massage technique varies depending on the location and nature of the lymphedema (lymphatic blockage leading to painful swelling), it generally involves a practitioner gently rubbing, stroking and manipulating the skin in directions that follow the structure of lymphatic pathways. In this way, accumulated lymph fluid is forced to drain from the area of swelling.

And as far as the literature is concerned, lymphatic massage produces tangible results. A 2015 review of six applicable trials found that lymphatic massage was at least moderately effective across the board, particularly when combined with compression bandaging or sleeves. A recent Chinese study also showed that a combination of lymphatic drainage massage and exercise were beneficial in the treatment of axillary web syndrome, a common lymphatic condition in post-op breast cancer patients.

Far-Infrared Saunas

An alternative therapy for lymphatic conditions like lymphedema that shows some promise (although peer-reviewed research is thus far lacking) is far-infrared treatment. 

Disclaimer aside, the premise of infrared sauna treatment is thus: it purportedly stimulates mitochondrial function directly beneath the skin, which just so happens to be where some of the lymphatic system (and action) resides. In theory, more red light means more cellular energy, thereby encouraging more efficient flow of lymph and the possible treatment of conditions like lymphedema. With the cell-repairing, wound-healing, and other probable/confirmed benefits of far-infrared, it’s probably a therapy worth considering if lymph dysfunction is an issue.

Thanks for stopping by. Have you or anyone you know suffered from lymphatic issues? What treatments and/or lifestyle changes have been pivotal? Share your thoughts and questions below, and have a great end to your week, everyone.

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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26 thoughts on “A Primal Primer: Lymphatic Health”

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  1. Thanks for addressing this topic. I suffer from lymphadema after a severe cellulitis infection in my leg many years ago. Doctors could never really agree, was it the infection, or was it hereditary and the infection just brought it out sooner? The state of knowledge is actually pretty poor.

    I did run into an oddity about my lymphadema. An expert herbalist seemed think liver dysfunction was somehow involved with it. I was skeptical. I told my lymphatic specialist and she was intrigued. It seems she had a patient who required a liver transplant for other reasons. After recovering from the transplant, all her lymphatic issues disappeared. It seems there’s a lot we still don’t know.

  2. So what do you think about the discovery of the interstitium? As someone with a critical care background, I’m familiar with the concept of “third-spacing”: vascular collapse and loss of volume to the interstitial spaces. I could never quite figure out how that worked. The interstitium explains it, and would be another facet to consider when looking at fluid compartments and how they interact.

  3. I’ve also heard that dry brushing your body is good for lymphatic health. True or false?

    1. Yes, I was going to ask the same thing…I’ve heard dry brushing can be helpful. I used to do it on a regular basis but kind of got out of the habit.

  4. A topic I’m not well versed on, great overview and much appreciated. Mr. Sisson has a real talent for synthesizing information with enough detail to be useful to the layman.

  5. Thank you for a very well researched post. I have been treating lymphatic disorders for 18 years. I began using a ketogenic diet with my patients 5 years ago when I discovered that 75% of my patients were overweight or obese. I did a small pilot study with 12 patients in 2015, and the results were astounding. Here is a link to the published article: https://journals.sagepub.com/doi/abs/10.1177/1559827617742108
    Currently, I still help my patients with weight management, but as you said in the post, this way of eating is also excellent for helping those patients who are concerned about a recurrence of cancer. Anecdotally, I am also seeing excellent reduction in swelling by dietary change even in the absence of weight loss. Simply put, it seems the lymphatic system runs better on a high fat diet.

    1. Leslyn Keith, thanks so much for sharing your study here. It’s amazing to see how a keto diet supports health on so many fronts. Your patients are clearly in good hands. Grok on! – M

  6. Are you aware of Teresa Tapp and her little cult of lymphatic exercise? She did a seminar in our city in January. Since then I have been doing the T-Tapp exercise routines and dry brushing sequence. Can’t say for sure why, but in my experiment of one, dry brushing FEELS great, and the exercise routine really reduces my tendency to have back and hip pain.

  7. I’ve often wondered what the lifelong consequences are of tonsillectomy…

    1. Me too. I had my tonsils taken out when I was 6. The upside was that I no longer got earaches. If there is a downside, it hasn’t shown up yet.

  8. Fascinating topic. So many health issues related to lymph flow. Really appreciated this info. What about a future post on kidney issues. The kidneys are so integral to all other health issues and seem to be involved in just about every disease process in some way or other, very complex. Would like to know more about them and also how their health or lack thereof affects the lymphatic system.
    Is there much research about how diet affects kidney function?

  9. I saw a physical therapist certified in lymphatic health for a while. A whole lot of her clients did not have it in their legs like I did, but in their arms, a consequence of breast cancer surgeries.

    I did not find the bandaging nor the $300 stockings very helpful, but do find the lymphapress amazing – I’ve been using it for years and rarely have severe swelling anymore and absolutely no cellulitis.

    Mine is exacerbated by bolus insulin, which I could not tolerate before the lymphapress.

  10. As a lymphatic drainage therapist, I am SO thrilled to see this topic getting some air time! Love the points you covered, but would like to add onefactor that is often overlooked, if I may: DEEP BREATHING.

    While most of the ‘rebounders’ will insist there is no pump of the lymphatic system (since it doesn’t have an automatic pump like the heart for the circulatory system), diaphragmatic breathing is the closest thing we have to a lymphatic pump. The contraction of the diaphragm pumps the largest lymph valve in the body (which runs through the diaphragm), pumping more lymph, while also bringing movement into the abdomen (where half of all your lymph nodes are). I swear I would be out of a job if we could all learn to breath deeply and relax..and move more! 🙂

    Ok, done nerding out – I could go on all day. Thanks for this post on such a crucial system!

    1. I wonder if singing would help since if you are doing it correctly you use your diaphragm.

      1. YES! You are right on. In fact, I had a client who had lymphedema, and after I told her about deep breathing, she had an aha moment – her swelling went down by half whenever she joined choir 🙂

  11. I wonder if skipping, boxer skipping, dynamic box jumps and so on have the same effects as the trampoline.

  12. I suffer from mild lymphedema in my right arm and hand as a result of lymph node removal and radiation for breast cancer treatment 12 years ago. In a couple of months, I’m going to have lymph node transfer surgery, where the surgeon will remove nodes that aren’t needed by another area of my body (in my case, the back) and transplant them to my axilla (armpit) where they were removed. That will be combined with lymphovenous bypass, in which lymphatic vessels are channeled into nearby veins, thereby helping to reduce swelling. These surgical methods are not always 100% effective, and it takes a while for the body to recognize that these alternate channels are present and to start using them, but the rate of success is very high and there is little downside to giving this a try. I’m nervous about the surgery, but if it will help alleviate the chronic swelling and heaviness that I feel, it will be well worth it.
    Thanks Mark, for covering this little-known issue.

  13. A friend of mine texted me last night that she was diagnosed with Non-Hodgkins lymphoma last night, so this was a good introduction,

  14. If “like supports like,” then eating Thymus, Spleen and Lymph should be considered here too. Nose to tail dining always conferred benefit beyond explanation.. until now. Thanks to Mark for this highly informative article.

    1. There’s also the thumping of the thymus to stimulate thymic function / immune system… I don’t know if it’s very scientific but I do know that gorillas do it before battle. When I do it, I feel like a warrior.

  15. Such an excellent primer, Mark! I love being able to pass these along. So clear – and so great in covering the impact of food, movement, stress and sleep on our immune system and whole body!

  16. I am also a sufferer of extreme lymphedema. My main issue now is the inner itching. I’ve tried recommended essential oils which has helped a little. Does anyone else have this problem? If so, have you found a way to cure it.

  17. Hey Mark, thanks for sharing such an informational post. It provides brief information on lymphedema or lymphatic health. Some information of this shared post like common diseases associated with lymphatic system, factors that hinder or help lymphatic health inflammation is quite beneficial.