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131 , pii: jcs214593 (2018)

This creates an ecological vacuum in the microbiome, allowing opportunistic pathogens and pro-inflammatory Gram-negative bacteria, such as Streptococcus and certain Clostridium species, to proliferate unchecked

Longer trials tend to accumulate more weight loss over time

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This can help manage how quickly glucose goes into the blood

The cornerstone of management is decongestive lymphatic therapy (DLT) , which comprises four main components: Manual lymphatic drainage (MLD) : A specialised massage technique that stimulates lymphatic flow and redirects fluid to functioning lymphatic pathways Compression therapy : Multi-layer bandaging during intensive treatment phases, followed by compression garments for long-term maintenance Skin care : Meticulous hygiene, emollient use, and prompt treatment of skin breaks to prevent cellulitis Exercise : Tailored physical activity programmes that promote lymphatic drainage through muscle pump action whilst wearing compression Patients should be educated about self-management strategies , including daily skin inspection, appropriate exercise, limb elevation when resting, and recognition of cellulitis symptoms (increased warmth, redness, pain, or systemic features such as fever)