Lipedema: Understanding a Chronic Fat Disorder

Lipedema is a chronic disorder characterized by the abnormal accumulation of water-absorbing fat cells, accompanied by a large amount of fluid. 

This condition leads to disproportionate body size and shape, particularly affecting the lower extremities, buttocks, and sometimes the arms. Even with a healthy diet and regular exercise, fat cells in individuals with lipedema do not respond as expected.

Moreover, it is commonly seen in women, and if genetically present in the family, men can be carriers. The etiology includes genetic factors, hormonal influences—particularly the impact of estrogen on fat metabolism—and vascular disorders contributing to the development of lipedema.

Types of Lipedema

• Genetic lipedema
• Hormonal lipedema: Estrogen directly affects fat metabolism in white adipose tissue.
• Vascular disorders: Increased permeability in the vascular wall.
• Adipose tissue disorders

Common symptoms

This includes edema, weight and tightness in affected areas, limited mobility, recurrent infections, and skin changes such as thickening and hardening. 

Top 5 Symptoms of Lipedema:

• Edema in the hands and feet, including the legs or hands
• Weight and tightness in the legs or hands
• Limited mobility in the arms or legs
• Recurrent infections in the arms or legs
• Thickening and hardening of the skin in the arms or legs

Diagnosis involves considering the patient’s medical history, including disproportionate fat storage, limited response to weight loss efforts, pain or bruising in the legs, and other associated symptoms.

Also Patient’s Medical History:

• Disproportionate fat storage in the body
• Limited or no effect of weight loss on fat distribution
• Pain or bruising in the legs
• Feeling of fatigue or sensitivity to touch in the legs
• Non-pitting edema
• No reduction in pain or discomfort in the legs when elevating them 

Lipedema can be classified into various categories based on its etiology and progression. The condition progresses through stages, from the initial increase in subcutaneous fat tissue to the formation of large fat masses causing deformities and wrinkles.

 

Stages

To clarify, the stages include:

• Stage 1: Normal and soft skin with increased subcutaneous fat tissue, maintaining skin elasticity. Lower extremities appear uneven, creating a pear-shaped appearance.
• Stage 2: Rough skin with palpable fat nodules, resembling cellulite but distinct from it. Lipedema stockings and corsets may be used for management.
• Stage 3: Large fat masses causing wrinkles and deformities, with sensitivity in areas of fat accumulation. Edema is often present in the skin and joints.
• Stage 4: Lymphedema may develop, leading to significant tissue sagging and reduced quality of life. Movement limitations and health problems can arise if untreated.

Several management strategies aim to alleviate symptoms and improve the quality of life for individuals with lipedema, including exercise, diet and healthy eating, psychological support, and physiotherapist-administered programs.

Treatment

• Exercise: Recommended to reduce body weight, strengthen muscles, and increase blood and lymph flow. Low-intensity exercise types such as walking, lymphatic yoga, cycling, and Pilates may be preferred.
• Diet and Healthy Eating
• Psychological Support
• Orthopedic Support
• Manual Lymphatic Drainage
• Complex Decongestive Therapy: A program administered by a physiotherapist to reduce swelling and complaints related to edema in the legs. The personalized treatment program includes manual lymphatic drainage, intermittent pneumatic compression, personalized bandaging, compression garments, and therapeutic exercises.
• Breath Exercises: Activate the diaphragm and support lymphatic flow.
• Food Supplements: Cocaine and selenium supplements can reduce symptoms in lipedema patients.

Nutrition Therapy

1. Low carbohydrate, moderate protein, high-fat intake
2. Limit salty foods.
3. Ketogenic diet can be applied.
4. Dairy products can be consumed in limited quantities.
5. Anti-inflammatory nutrition therapy
6. Consume low glycemic index foods.
7. Consume prebiotics and resistant starches (inulin, dandelion, pectin, etc.). Include probiotics and fermented products in your diet.
8. Make an effort to reduce your toxin load. Avoid endocrine disruptors such as BPA, phthalates, etc.
9. Reduce your stress level. You can do vagus breath exercises and triflow exercises.
10. Perform joint-appropriate exercises with the guidance of an expert.
11. Support the liver with methods: maybe castor oil packs.
12. If there is a constipation problem, it should be prevented. For example; Vitamin C, magnesium, cold-pressed olive oil, and kiwi can be beneficial.

The Importance of the Ketogenic Diet in Lipedema

Furthermore, The ketogenic diet has emerged as a valuable component in the management of lipedema. Emphasizing low carbohydrate, moderate protein, and high-fat intake, the ketogenic diet is thought to promote metabolic adaptations that can be beneficial for individuals with lipedema.

For example, in one article, highlights the remarkable success of a ketogenic diet (KD) as a sole nutritional intervention in a lipedema patient, showcasing a significant weight loss of 41 kg, notable reduction in body circumferences, and improved pain, suggesting the potential for a tailored KD protocol in the management of lipedema.

Reduction of Inflammation

Although, The ketogenic diet is known for its anti-inflammatory effects. By reducing carbohydrate intake, particularly refined sugars and processed foods, inflammation in the body may be mitigated. In lipedema, where inflammation plays a role in symptomatology, the ketogenic diet could offer relief.

Stabilizing Blood Sugar Levels

The diet’s emphasis on low carbohydrate intake helps stabilize blood sugar levels, potentially reducing insulin fluctuations. This may also have positive effects on fat metabolism and storage, addressing one of the challenges seen in lipedema.

Promoting Fat Utilization

The ketogenic diet encourages the body to shift from relying on carbohydrates for energy to using fats. This metabolic shift may be advantageous in lipedema by addressing the abnormal fat accumulation seen in affected individuals.

Weight Management

While lipedema is not solely an issue of excess weight, the ketogenic diet’s potential for weight management can be a supportive factor. Maintaining a healthy weight is essential for overall well-being and may contribute to improved mobility and reduced strain on affected limbs.

It’s important to note that nutritional strategies, including the ketogenic diet, should be personalized and monitored under the guidance of healthcare professionals. The combination of a ketogenic diet with other therapeutic approaches, such as exercise, psychological support, and physiotherapist-administered programs, can contribute to a comprehensive and individualized management plan for individuals with lipedema. 

To sum up, ongoing research is essential to further explore the benefits and potential variations of dietary interventions in the context of lipedema.

Important notes to take home with you

• First, long-term use of diuretics should be avoided.
• Metformin should be considered in individuals with lipedema and metabolic complications.
• Thyroid functions should be evaluated in individuals with lipedema.
• Meal plans for lipedema individuals should minimize fullness, insulin, and glucose fluctuations and be sustainable in the long term.
• Vitamin D levels in lipedema individuals should be monitored and normalized.
• Also, sex hormones can affect fluid retention, and low-dose sex hormones for birth control or hormone replacement may be considered when necessary.
• Additionally, lipedema can occur when estrogen decreases in menopause, as well as when estrogen increases during puberty. Estrogens partly increase insulin secretion and the sensitivity of target tissues, possibly by partially inhibiting fatty acid oxidation, promoting fuel storage. Insulin, in addition to its other complex effects on the body, promotes the storage of metabolic fuels and inhibits the breakdown of stored triglycerides. The perception of an energy deficit can lead to increased hunger and food intake. In this way, the high insulin effect can lead to weight gain.

References

• Herbst KL, Kahn LA, Iker E, et al. Standard of care for lipedema in the United States. Phlebology. 2021;36(10):779-796. doi:10.1177/02683555211015887
• Sørlie, V., De Soysa, A. K., Hyldmo, A. A., Retterstøl, K., Martins, C., & Nymo, S. (2022). Effect of a ketogenic diet on pain and quality of life in patients with lipedema: The LIPODIET pilot study. Obesity Science & Practice, 8(4), 483-493.
• Cannataro, R., Michelini, S., Ricolfi, L., Caroleo, M. C., Gallelli, L., De Sarro, G., … & Cione, E. (2021). Management of lipedema with ketogenic diet: 22-month follow-up. Life, 11(12), 1402.
• Keith, C.A. Seo, C. Rowsemitt, M. Pfeffer, M. Wahi, M. Staggs, J. Dudek, B. Gower, M. Carmody, Ketogenic diet as a potential intervention for lipedema,Medical Hypotheses, Volume 146, 2021,110435, ISSN 0306-9877, https://doi.org/10.1016/j.mehy.2020.110435.