Why hydration and movement matters? 

In previous articles, I shared some strategies in attempt to better manage our stress, and tips on other modifiable lifestyle factors such as sleep and dietary options to implement to our daily life, especially during this period of challenging time. This article focuses mainly on the lymphatic system, and what can be done actively to yield positive influence on this intricate network of fluids to the benefits of your immune and general health.

The lymphatic system is more than just an extensive drainage network that helps to keep bodily fluid levels in balance, the lymphatic system also defends the body against infections. When the body first encounters with these invaders, it signals the lymphatics to start orchestrate the infection-fighting cells to fight invading microorganisms, serving as a defending system against diseases and prevent illnesses.

More than just fluid clearance

Considering that about 55% (in elderly) and 75% (in infants) of  body weight is water, it is inevitably essential for the cellular homeostasis in the body. [1,2] Relating to the lymphatic system, about 90% of the lymph is water. The system contains vessels that carry lymph, which is largely water escaped from the interstitial tissue spaces. This water/fluid found in the insterstitium is partly due to the semi-permeability of blood capillary walls that allow the aqueous component of blood, along with some proteins to leak out. In total, several litres of water actually escape into the interstitial tissue spaces everyday and must be returned into the venous circulation, ultimately.

The interstitial tissue space is located between the blood and lymph vessels and the cells.

Very often when lymphatic vessels are discussed, the centre of attention is mainly on water and the role of fluid clearance. This is because when the system become malfunctioned, the accumulated water can lead to edema. However, the flow of lymphatic fluid transport through all tissues should not be overlooked as it facilitates efficient supply of nutrients and signaling different molecules. [3,4] Apart from water and protein, the lymphatic flow also plays a role in scavenging particles, viruses and bacteria. This is where the lymphatic system exhibits its integral role in the immune system. In fact, all lymph passes through at least one lymph node, where potentially harmful foreign bodies are sieved and neutralized by immune cells. These specialized immune cells could be the dendritic cells, macrophages and/or the T and B cells of the body’s immune system. [5] As equipped with about 500−600 lymph nodes throughout the body, our immune system should be under constant scrutiny at all times with a well-functioning lymphatic system.


Two simple strategies to promote better lymphatic flow (Self-Care)


Given the effectiveness and influences of the lymph pumping system extend more than just the interstitial fluid balance, active self-care should be taken to promote healthy propulsion of lymph flow, which is also vital for other aspects of overall cellular homeostasis.



When dehydration happens, the above-mentioned physiological functions can be affected and become sub-optimal. The lymphatic flow decreases as water in the body depletes. A stagnant lymph flow may slow down waste removal and build-up of toxins, made worse by sedentary lifestyles and toxin loading. Impaired immune cell trafficking can be another consequence when the dynamic flow in the lymphatic vessels is disturbed. [6] The stagnant fluid in lymphedematous tissue can become a nidus for infection, thus exacerbating the already immuno-compromised state of the affected tissue. [7] It has also been documented that disruption of lymphatic vessels impairs fluid drainage and the body’s ability to activate an immune response to a pathogen, which may lead to persistent infection. [7] Interesting study that look at larger microorganisms, such as mosquito-transmitted filarial parasites, may be trapped and proliferate in lymphatic vessels and subsequently lead to blockage of lymph flow. These examples share common idea about the interconnection between the transport and function of the lymphatic system and the immune response, but to date many of these research are still under-explored. [8,9]


Practical, Actionable steps:
  1. Make sure you take a few sip of water every 30 minutes to ensure proper hydration throughout the day. So, even if it is not for your immune health, getting adequate water intake also prevents you from all other health consequences of dehydration.
  2. Reduce dehydrating foods or drinks. (Common examples are alcohol, tea, coffee, salty food, sugary drinks)
  3. Increase foods with higher water content. (Fruits and Vegetables)


Body Movement
05 - Weight Management (Fat loss) Program

Body Movement

Just like the vascular system, the lymphatic system has extensive network of specialized vessels that carry out the action for the exchange and transport fluids. However, the lymphatic system does not has a “heart” like the blood circulation.[10] Therefore, the flow of lymph through the lymphatic vessel network is mediated by its own unique pumping mechanisms (intrinsic and extrinsic pump). While the intrinsic pump is the principle mechanism by which lymph flow is generated, tissue pressures generated extrinsic to the system also favor forward lymph flow. [11,12] Physical exercise or body movement has been shown to have an effect in changing the lymph flow, which is important to carry out all  vital functions. [13,14] One study has been conducted to analyse the effect dynamic and isometric muscle contractions put on the lymph flow dynamics in human skeletal muscle (using muscles in front of the thigh that extend the knee). The result was that lymph propulsion is most efficient when the muscle is able to shorten close to its minimum length. [15]


Practical, Actionable steps:
  1. Make sure you move away from a stationary position every 45 minutes to engage some body movements.
  2. Schedule around 30 minutes of exercise or 45 minutes of walk whenever possible would be beneficial.
  3. Deep breathing exercises has been studied to improve lymph flow. [16,17]
  4. Most importantly, avoid sedentary lifestyle behaviors.

The lymphatic system isn’t just a network of specialized vessels that exchange and transport fluids throughout the body. The reservoir of fluids collected in the lymphatic system is essentially a sample of filtered plasma that carry out immune system surveillance function for potential threats.


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*Please note: Due to the novelty of COVID-19, there is no absolute research data being published in regards to the effectiveness of dietary or lifestyle interventions for its prevention or treatment. Your individual and unique circumstances during this challenging time are well respected and empathized.The above information /  recommendations are not specific to COVID-19 and are not intended to replace medical consultation with your healthcare provider.

*Reminder: You should always seek medical advice immediately from clinic or hospital if experience signs and/or symptoms related to Covid-19.



  1. Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010;68(8):439–458.
  2. Jequier E, Constant F. Water as an essential nutrient: the physiological basis of hydration. Eur J Clin Nutr. 2010;64:115–123.
  3. Moore JE Jr, Bertram CD. Lymphatic System Flows. Annu Rev Fluid Mech. 2018;50:459–482.
  4. Randolph GJ, Ivanov S, Zinselmeyer BH, Scallan JP. The Lymphatic System: Integral Roles in Immunity. Annu Rev Immunol. 2017;35:31–52.
  5. Moore JE Jr, Bertram CD. Lymphatic System Flows. Annu Rev Fluid Mech. 2018;50:459–482.
  6. Witte CL, Witte MH. Disorders of lymph flow. Acad Radiol. 1995 Apr;2(4):324-34.
  7. Liao S, Padera TP. Lymphatic function and immune regulation in health and disease. Lymphat Res Biol. 2013;11(3):136–143. doi:10.1089/lrb.2013.0012
  8. Szuba A. Rockson SG. Lymphedema: Anatomy, physiology and pathogenesis. Vasc Med. 1997;2:321–326.
  9. Babu S. Nutman TB. Immunopathogenesis of lymphatic filarial disease. Semin Immunopathol. 2012;34:847–861.
  10. Breslin JW, Yang Y, Scallan JP, Sweat RS, Adderley SP, Murfee WL. Lymphatic Vessel Network Structure and Physiology. Compr Physiol. 2018;9(1):207–299.
  11. von der Weid P-Y, Zawieja DC. Lymphatic smooth muscle: the motor unit of lymph drainage. International Journal of Biochemistry & Cell Biology. 2004;36:1147–53
  12. Zawieja DC. Contractile physiology of lymphatics. Lymphat Res Biol. 2009;7(2):87–96.
  13. Hespe GE, Kataru RP, Savetsky IL, et al. Exercise training improves obesity-related lymphatic dysfunction. J Physiol. 2016;594(15):4267–4282.
  14. Lane, K., Worsley, D. & McKenzie, D. Exercise and the Lymphatic System. Sports Med 35, 461–471 (2005).
  15. Havas E, Parviainen T, Vuorela J, Toivanen J, Nikula T, Vihko V. Lymph flow dynamics in exercising human skeletal muscle as detected by scintography. J Physiol. 1997;504 ( Pt 1)(Pt 1):233–239.
  16. Meghan J.O’Melia Amanda W.Lund Susan N.ThomasThe Biophysics of LymphaticTransport: Engineering Toolsand Immunological Consequences IScience Volume 22, 20 December 2019, Pages 28-43
  17. Douglass J, Mableson HE, Martindale S, Kelly-Hope LA. An Enhanced Self-Care Protocol for People Affected by Moderate to Severe Lymphedema. Methods Protoc. 2019;2(3):77.
  18. Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev. 2010;68(8):439–458.

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