Lipedema is a chronic disorder characterized by the excessive accumulation of subcutaneous body fat, primarily in the lower extremities, accompanied by pain, increased capillary fragility, and easy bruising. It predominantly affects women and is often misdiagnosed as obesity or lymphedema. This article explores the potential of the ketogenic diet as a therapeutic intervention for managing lipedema, drawing upon recent research and expert opinions.
Understanding Lipedema
Lipedema, a condition almost exclusively found in women, is estimated to affect approximately 11% of women worldwide. Typical clinical signs include disproportionate lower body adipose tissue deposition excluding feet, pain in the extremities, and easy bruising. Adipose tissue soreness occurs in a significant majority of patients with lipedema. The onset of the disease usually occurs during periods of significant hormonal changes in the female body, such as during puberty, after pregnancy, or during menopause.
Clinical Presentation
The clinical presentation of lipedema includes:
- Bilateral and symmetrical accumulation of fat deposits, mainly in the lower extremities, excluding the feet.
- Pain (spontaneous or with palpation).
- Increased capillary fragility with bruising.
- Disfiguration and reduced mobility.
Misdiagnosis and Comorbidities
Lipedema is often misdiagnosed as obesity, although they frequently co-occur. Untreated lipedema and concomitant obesity may lead to secondary lymphedema. Other frequent comorbidities include cardiac disease (such as hypertension), thyroid disorders (as hypothyroidism), fibromyalgia, and type 2 diabetes mellitus.
Staging and Types of Lipedema
Lipedema has a highly variable progression over time through four stages, leading to disability for several decades if not treated. Staging is based on structural skin changes and skin palpation:
Read also: Easy Low-Carb Cheese Crackers
- Stage I: Skin appears smooth, but the thickened subcutaneous tissue contains small nodules.
- Stage II: Skin has an irregular texture, subcutaneous nodules occur that vary from the size of a walnut to that of an apple in size.
- Stage III: Deformed lobular fat deposits form, especially around thighs and knees, and may cause considerable distortion of limb profile.
- Stage IV: Lipedema acts in synergy with lymphedema with large protruding portions of fat tissue on the legs and arms.
With regard to the localization of the changes, lipedema has five types:
- Type 1: Fat tissue accumulation around the hips and buttocks.
- Type 2: Hips to knees.
- Type 3: Hip to ankle.
- Type 4: Arms are also involved (in more than 80% of the cases).
- Type 5: Lipedema is limited to arms exclusively or calves exclusively (very rarely).
The Role of Diet in Managing Lipedema
Proper nutritional management and moderate physical activity are key components of lipedema therapy. Dietary recommendations generally include a diet low in refined carbohydrates, especially added sugars (particularly fructose) and refined grain products, as well as salty and animal-based products. The diet should primarily include unprocessed products, mainly plant-based, different colored vegetables, fruits (excluding juices) and fermented products, as well as use herbs for seasoning.
Dietary Strategies
Patients with lipedema typically follow restrictive, low-energy diets that often prove ineffective and result in increased hunger. An appropriate dietary strategy can break the vicious cycle of successive restrictive diets and simultaneous weight gain. Diet may slow the progression of the disease by inflammation and pain reduction, decrease tissue fluid content and improve quality of life. Nutritional management should include body weight and body fat reduction through a tailored and caloric restriction diet.
The Rare Adipose Disorder (RAD) Diet
The Rare Adipose Disorder (RAD) Diet is one option that focuses on reducing swelling and inflammation, maintaining low insulin levels, and adhering to a low glycemic index. It is a modification to a standard Mediterranean diet that helps you maintain a low glycemic index to limit the number of occurrences and levels your blood sugar spikes through the day. In order to do this, it is recommended that you avoid any refined or processed starches and sugars. These are usually found in pasta, rice, bread, corn, and potatoes.
Reducing Dietary Inflammation Triggers
It is also recommended that individuals with lipedema may want to reduce dietary inflammation triggers. The dietary triggers of inflammation vary from individual to individual and need to be investigated through systematic trial and error. Some lipedema patients may have gluten or dairy sensitivities. Gluten is typically found in wheat, rye, and barley. If you have a gluten sensitivity, instead of gluten, make sure your lipedema diet focuses on foods high in omega-3 fatty acids and are also high in fiber to assist your body in burning fat and fighting inflammation.
Read also: Keto Calorie Counting: A Detailed Guide
Ketogenic Diet: A Potential Intervention
A ketogenic diet is very low in carbohydrates and high in healthy fats. When carbohydrate intake is restricted, the body starts using dietary fat, as well as fat stored in adipose tissue, for fuel. A limitation on carbohydrates results in the production of ketones from fat, or ketogenesis. This shifts the body from a sugar-burning machine to a fat-burning machine.
How Keto Works for Lipedema
The onset of lipedema correlates with naturally-occurring times of hyperinsulinemia and insulin resistance, like puberty, pregnancy, menopause. These are natural periods in a woman’s life where she will have a high tendency to increase body fat.
Ketogenic Diet Guidelines
- Very Low Carbohydrate: Limit to 20 grams of carbohydrates per day or fewer.
- Moderate Protein: Moderate protein intake is 1.5-1.75 g per kg of “ideal” body weight.
- High Healthy Fat: Healthy fats include highly stable plant- or animal-sourced saturated and monounsaturated fats (olive oil, avocado oil, coconut oil, lard and butter) and omega-3 polyunsaturated fats from marine sources.
- Avoid Partially Hydrogenated Seed and Vegetable Oils: Corn, safflower, sunflower, grapeseed, soy, and peanut oils are high in omega-6 polyunsaturated fats.
- Eliminate Artificial Sweeteners and Sugar Substitutes: Artificial sweeteners can result in weight gain or, at the very least, a weight loss stall.
Benefits of Keto Diet for Lipedema
- Swelling/inflammation decrease.
- Pain reduction: There can be a significant reduction in the levels and intensity of pain experienced in lipedema limbs.
- Fat Creates Satiety: The consumption of fat creates a feeling of satiety which lasts for long periods.
- Inflammation is Reduced: Carbohydrates are inflammatory which can create pain and swelling.
- Carbohydrate Addiction: Eating carbohydrates causes an insulin spike, which results in more hunger.
Study on Low-Carbohydrate-High-Fat Diet (LCHF) and Low Glycemic Index Medium-Fat-Medium-Carbohydrate (MFMC)
One group received a low-carbohydrate-high-fat diet (LCHF; n = 46) and the other group a low glycemic index medium-fat-medium-carbohydrate (MFMC; n = 45). Both diets were applied for 16 weeks in each group. A diet with an energy deficit accounting for 15-25% of total energy expenditure depending on the degree of obesity was administered to each study participant. Both diets characterized by high proportion of anti-inflammatory nutrients, such as monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA). The diets were characterized by antioxidants, vitamin C, beta-carotene, and dietary fiber. The diets included foods rich in magnesium, such as cocoa, dark chocolate, nuts and seeds, as well as vitamin E: nuts, oil seeds, and vegetable oils. Additionally, spices such as cloves, garlic, ginger, rosemary, oregano, thyme, pepper and turmeric were added to the diets. Patients were instructed to avoid salty foods to limit dietary sodium intake and to drink a minimum of one green or black tea daily. Pro-inflammatory foods which are sources of saturated fatty acids, such as butter, mayonnaise, and cream were limited.
The LCHF diet was designed to maximally reduce the intake of processed foods and products rich in saturated fatty acids (eg, fatty meat, offal, lard, butter) and to increase the intake of products typical for the Mediterranean diet, such as: vegetables, fruits (berries), nuts and seeds, olive oil and oily marine fish. The diet limited meat consumption to 3-4 portions per week (1 portion was 100-200 g of lean poultry meat, chicken or turkey). It was also recommended that the consumption of lean red meat (eg, beef or veal) should not exceed 1 portion per week (maximum 150 g). The MFMC diet had a low glycemic load and a high proportion of low and medium glycemic index products. Products with a high glycemic index were completely excluded from the diet.
The mean total energy value of two diets was significantly different (1677.0 kcal for LCHF vs 1724.3 kcal for MFMC; p = 0.001) due to individual estimation of energy requirements. The total carbohydrate content of the LCHF diet was 29.8 g/day, which accounted for 6.1% of the energy value, and that of the MFMC diet was 189.4 g/day, which equaled 39.1% of the energy value (p < 0.001). The proportion of fat in the diet was 134.6 g/day (72.3% of energy value) for LCHF and 78.0 g/day (39.1% of energy value) for MFMC; p < 0.001. Both diets did not differ significantly in protein content (p = 0.076). Protein supply in both groups was not less than 0.8-1.0g/kg of body weight.
Read also: Magnesium Supplements for Keto
Scientific Evidence Supporting Keto Diet for Lipedema
Current evidence on the efficacy of VLCKD in the context of lipedema is scarce, with only two studies reporting clinical benefits of a ketogenic diet (KD) in subjects with lipedema.
Sørlie et al. Study
Sørlie et al. studied 9 women with lipedema (aged 46.9 ± 7 years). The low carbohydrate, high fat diet induced a significant weight loss (−4.5 ± 2.4%, p < 0.001) and reduction in pain (−2.3 ± 0.4 cm, p = 0.020). Weight loss was maintained between week 7 and 13, but pain returned to baseline levels at week 13.
Cannataro et al. Study
In subjects with lipedema, circumference measurement is a rapid, inexpensive, and repeatable method to monitor the course of treatments. Studies on women with lipedema who underwent KD protocols reported significant reductions in upper limb, lower limb, waist, and hip circumferences.
A Study Published in Obesity
A study published in Obesity evaluated the effects of a low-carbohydrate diet (LCD) on pain and quality of life in women with lipedema. The randomized controlled trial involved 70 female patients and compared LCD with a standard control diet over eight weeks. Results showed that the LCD group experienced greater weight loss and reduced pain, though there was no direct link between pain reduction and weight loss.
Metabolic Improvements
A low-carbohydrate, high-fat ketogenic diet appears to be an effective approach for promoting weight and fat mass reduction in women with lipedema. Observed metabolic improvements include reductions in baseline insulin levels, decreases in the HOMA-IR, and diminished levels of inflammation and oxidative stress. Such dietary interventions have been associated with significant decreases in body weight, BMI, and pain sensitivity.
Mechanisms of Formation of Lipedema and Pathways
Hormonal Effects
Lipedema is strongly associated with periods of hormonal fluctuation in women, notably during puberty, pregnancy, and menopause, thereby suggesting a critical role for hormonal influences.
Genetic Predisposition
Genetic factors are thought to play a role in lipedema, with potential gene mutations affecting leukocyte clones, mitochondrial activity, and localized disorders of subcutaneous adipose tissue.
Macrophage Accumulation
Lipedema may be associated with macrophage accumulation and changes in macrophage polarization, influencing adipose tissue differentiation and metabolic processes.
Microvascular Dysfunction
Microvascular dysfunction in the blood capillaries and the lymphatic system may lead to endothelial dysfunction and increased angiogenesis due to hypoxic stimuli resulting from excessive expansion of adipose tissue.
Mast Cell Activation
Mast cells, immune cells that secrete histamine and other inflammatory molecules, may mediate hypersensitivity and allergic reactions in lipedema, contributing to tissue inflammation and pain.
Additional Conservative Treatments
The ketogenic diet can give great results for people with lipedema, but other conservative treatments are required for truly remarkable results. Work with a trained therapist well-versed in lipedema to develop your personal protocol for management. Your protocol may include: compression therapy with a pneumatic compression pump and/or compression stockings, manual lymph drainage, skin care, and exercise.
Diagnostic Challenges and Differentiation
Distinguishing lipedema from obesity can pose diagnostic challenges. According to the World Health Organization (WHO) guidelines, a body mass index (BMI) exceeding 30 kg/m2 is indicative of obesity. However, it is interesting to note that lipedema can coexist with a state of obesity, which in turn can promote a state of chronic low-grade inflammation. This state of chronic low-grade inflammation in turn can impair lymphatic function, exacerbating adipose tissue accumulation.
Differential Diagnosis
It is important to differentiate the term lipedema from lymphedema, obesity, and lipohypertrophy since it is a distinct clinical entity, even though the pathogenesis is not yet fully understood. Lipedema is always bilateral, with non-pitting edema unlike lymphedema, and a proper diagnostic algorithm can help rule out similar disorders such as lipodermatosclerosis, chronic venous insufficiency, obesity, and lymphedema.