Lipedema is a complex, chronic condition characterized by the abnormal buildup of fat in specific areas of the body, often leading to disproportionate swelling, tenderness, and mobility challenges. Misunderstanding surrounding the condition can lead to frustration and delayed care as it's frequently mistaken for obesity or other medical concerns. Managing its symptoms requires a comprehensive approach that addresses the root contributors to discomfort, such as inflammation, poor circulation, and fluid retention. While there's no cure, proper diet and lifestyle changes can significantly improve symptoms and quality of life for those affected. This guide explores effective strategies for managing lipedema through nutrition and exercise, with a focus on the RAD (Rare Adipose Disorder) diet and other dietary approaches.
Understanding Lipedema and Inflammation
Lipedema is not simply obesity or the result of poor lifestyle choices. It's a distinct condition where the body accumulates fat in an abnormal way, often resistant to traditional weight loss methods. The primary goal of conservative treatment, including diet and exercise, is not necessarily to reduce fat tissue but to alleviate symptoms caused by inflammation. The treatment of lipedema does not have weight loss as its sole objective, as the inflammation of adipose tissue characteristic of lipedema does not respond solely to weight loss. This understanding is crucial as we explore various management strategies. Our focus will be on reducing inflammation, improving lymphatic function, and enhancing overall well-being.
Inflammation plays a significant role in lipedema symptoms. An anti-inflammatory diet can help reduce pain, swelling, and discomfort associated with the condition. The common thread of nonsurgical management of lipedema should be to limit possible inflammatory states.
The Anti-Inflammatory Lipedema Diet Approach
An anti-inflammatory diet can help reduce pain, swelling, and discomfort associated with lipedema. Let's explore the key components of such a diet:
- Fruits and vegetables: Rich in antioxidants and phytonutrients, these should form the foundation of your diet. Aim for a variety of colors to ensure a wide range of nutrients. Vegetables with bright colors and flavors such as dark green leafy vegetables, colorful beets, corn, squash, peppers, and flavorful onions, garlic, mushrooms, and herbs.
- Omega-3 fatty acids: Found in fatty fish (like salmon and sardines), flaxseeds, chia seeds, and walnuts. These healthy fats have potent anti-inflammatory properties.
- Whole grains: Provide fiber and nutrients. Choose options like quinoa, brown rice, and oats. Grains (whole grains not containing gluten): amaranth, brown rice, buckwheat, millet, oats, quinoa, sorghum, teff, and wild rice.
- Lean proteins: Support muscle health and tissue repair. Good sources include poultry, fish, legumes, and tofu.
- Herbs and spices: Many have anti-inflammatory properties. Turmeric, ginger, garlic, and cinnamon are particularly beneficial. Use herbs and spices to provide your favorite flavors.
- Berries (fresh or frozen): blackberries, blueberries, cranberries, raspberries, strawberries, etc.
- Citrus fruits: grapefruit, orange, etc.
- Fruits: apples, apricots, bananas, cherries, grapes, kiwi fruit, mangoes, melons, papaya, peaches, pears, pineapple, plums, etc.
- Potatoes: smaller waxy potatoes such as new, red, purple, etc. Not starchy Russet or Idaho potatoes.
- Sweet potatoes or yams.
- Fermented foods: kefir and yogurt with active cultures, sauerkraut, dill or sour pickles (subject to salt limits), kimchi, etc.
- Soy that is minimally processed or fermented: soybeans/edamame), tofu, miso, natto, tempeh.
- Milks (unsweetened non-dairy milk drinks): almond milk, coconut milk, or hemp milk.
- Coffee, tea (black, green, herbal, red, white), unsweetened cocoa or cacao.
Foods to Avoid
Just as important as knowing what to eat is understanding what to avoid. Certain foods can exacerbate inflammation and lipedema symptoms:
Read also: The Hoxsey Diet
- Processed foods: Often high in unhealthy fats, sugars, and additives. These can promote inflammation in the body.
- Refined carbohydrates: Can spike blood sugar and promote inflammation. This includes white bread, pasta, and sugary snacks. It's better to avoid white bread, pasta, and other foods made with refined flours. Also, try to avoid sweets and drinks with a lot of sugar.
- Excessive sodium: May increase fluid retention and swelling. Be mindful of added salt in prepared foods.
- Alcohol: Can worsen inflammation and interfere with lymphatic function. If you choose to drink, do so in moderation.
- Trans fats: Found in many processed and fried foods. These are particularly harmful and should be avoided.
- Dairy products containing A1 beta-casein: May cause increased inflammation in some individuals. Avoiding dairy (other than kefir and yogurt) appears to help with lipedema.
Foods are grouped by recommended frequency:
- Eat Primarily: have a variety of different foods from this list every day in reasonable serving sizes. Include at least a half-cup of beans, a half-cup of whole grains (such as oats) or starchy vegetables, and one cup of fruit (preferably citrus and banana) each day.
- Eat in Limited Quantities: foods best enjoyed in smaller amounts and only a few times a week, including no more than 6-8 servings of animal products each week.
- Brazil nuts: limit to 1 ounce or 6 nuts purchased shelled, or 3 nuts purchased unshelled per day, OR take a selenium supplement, not both.
- Chocolate: dark chocolate with 70% or more cacao.
- Dairy (preferably organic, not recommended for lipedema): butter or ghee, cheeses (not processed cheeses or cheese spreads), goat’s milk cheese goat cheese), sheep’s milk cheese, milk.
- Eggs including yolks: preferably organic, pastured or free-range
- Fish: tuna, wild salmon, mackerel, herring, sardines, anchovies, and other seafood high in omega-3 unsaturated fats.
- Meats: preferably organic grass-fed beef, buffalo, lamb, pork, wild game.
- Poultry: preferably organic chicken (without skin), turkey, duck including dark meat.
- Nuts and seeds (raw and unsalted): almonds, cashews, hazelnuts, macadamia nuts, pecans, pistachios, pumpkin seeds, sesame seeds, sunflower seeds, walnuts.
- Oils: extra-virgin olive, avocado, walnut, coconut, cocoa butter, flaxseed, macadamia, sesame oil.
- Salad dressing products containing healthy fats and modest amounts of sodium or sweeteners.
- Sugar and real maple syrup.
- Condiments: chili, hot sauce, or pepper sauce, horseradish, mustard, salsa, tamari soy sauce, tapenade, vinegar (white, red wine, apple cider, balsamic), Worcestershire sauce, etc.
- Dried fruits: cranberries (low sugar), currants, dates, figs, prunes, raisins.
- Wine: preferably red, no more than 3 servings (5 ounces or 150 ml)/week.
- Eat Rarely or Never: save these for special occasions, if you still want them.
- Grain products containing gluten (wheat, barley or rye): breads, breakfast cereals, bulgur, cakes, cookies, couscous, crackers, cupcakes, kamut, noodles, pancakes, pasta, pies, pita, pizza, triticale, waffles, etc.
- Gluten-free food substitutes: breads, pasta, pizza, baked goods, etc. made with cornstarch, potato starch, rice starch, tapioca starch, etc.
- Fried foods and food products such as chips, crisps, fries, etc.
- Meat processed or preserved using nitrates, nitrites, or salt (such as hot dogs or lunch meats), cooked at high temperatures, or over a flame.
- Meat substitutes made from gluten, seitan, or highly processed soy.
- Soy-based processed foods: infant formula, soymilk, etc.
- Sugary snacks: candies, energy bars, fruit roll-ups, ice cream, sherbet, etc.
- Sugary sweeteners: agave syrup or nectar, high-fructose corn syrup, honey, and artificial sweeteners.
- Sweet condiments: chutney, jams, jellies, preserves, sauces, syrups, etc.
- Sweet drinks, sugar sweetened and diet (artificially sweetened): sodas, soft drinks, teas and tea-based beverages, coffee and coffee-based beverages, energy drinks, fruit drinks (especially 100% fruit drinks), etc.
- Unhealthy fats: hydrogenated oils (palm, palm kernel), polyunsaturated oils (corn, cottonseed, grape seed, safflower, soybean, sunflower), trans-fats, and chemically modified fats.
The Role of Exercise in Lipedema Management
Exercise is fundamental in treating lipedema, as it improves symptoms and increases quality of life. Preferred activities for this condition include low-impact exercises that promote moderate limb mobilization. Exercise frequency is important for lipedema management and should be done three to 5 times a week for one hour a day. Remember to start slowly and gradually increase intensity. Always consult with your healthcare provider before beginning a new exercise regimen.
Benefits of regular exercise for lipedema patients include:
- Improved circulation and lymphatic drainage
- Reduced inflammation and pain
- Maintenance of a healthy weight
- Strengthened muscles and improved mobility
Recommended exercises for lipedema management:
- Swimming and water aerobics: The water's buoyancy reduces stress on joints while providing resistance for muscle strengthening.
- Cycling: Whether on a stationary bike or outdoors, cycling is an excellent low-impact cardio option.
- Yoga and stretching: Improves flexibility, reduces stiffness, and can help with stress management.
- Nordic walking: Engages multiple muscle groups while being gentle on joints. The use of poles can also aid balance.
- Strength training: Builds muscle and supports metabolism. Start with light weights and focus on proper form.
Lipedema-Specific Dietary Approaches
While a general anti-inflammatory diet can be beneficial, some specific dietary approaches have shown promise in managing lipedema symptoms.
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RAD (Rare Adipose Disorders) Diet
The RAD diet is an anti-inflammatory approach with Mediterranean roots, designed specifically for lipedema and similar conditions. The Rare Adipose Disorder (RAD) Diet is one option that targets these issues. Plastic Surgery Institute of Atlanta (PSI), led by plastic surgeon Dr. Wright recommends following a Rare Adipose Disorder (RAD) diet, 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.
Key aspects include:
- Prioritizing legumes, tubers, cereals, vegetables, and fruits
- Including foods rich in Omega-3 and antioxidants
- Focusing on high-quality, minimally processed proteins
- Limiting animal fats and pasteurized dairy
- Reducing intake of preservatives and artificial additives
This diet aims to reduce inflammation and alleviate the heaviness and swelling experienced by lipedema patients.
You would need to avoid processed or refined sugars and starches. For instance, you should not have rice, pasta, bread, potatoes, and corn. You should also avoid processed food, in particular, processed carbohydrates. Lipedema experts report that patients cannot prevent symptom flare-ups by avoiding only starch. They also recommend reducing gluten intake. Gluten is largely found in rye, barley, and wheat. Instead, the diet should contain high amounts of food rich in omega-3 fatty acids and fiber.
Need some recipe inspiration for how to follow the RAD diet plan and still enjoy whole, nutritious food? It’s easier than you think!
Read also: Weight Loss with Low-FODMAP
- Breakfast: Add something different to a slice of toasted, whole-wheat bread each day, so you’re following the plan but mixing it up enough that it doesn’t get boring!
- Lunch: Try keeping lunch to different versions of a salad. Dried Fruits: The more colorful, the better!
Ketogenic Diet for Lipedema
Some studies suggest a ketogenic diet may benefit lipedema patients. The ketogenic diet (KD) seems to have the right conditions to be effective. The main features of the KD applied for lipedema could be the anti-inflammatory and the regulatory actions in the management of free radicals. The aim was to confirm our hypothesis on the effectiveness and safeness of the KD in this pathophysiological condition, even when kept for long time. KD had positive effects on neuroinflammation and antioxidant status in obese subjects. The KD is a nutritional program that provides for a minimal daily intake of carbohydrates (<30 g or <10% of the total calories).
This diet is designed to minimize carbohydrate intake and increase consumption of healthy fats. Keto diet for lipedema involves limiting carbohydrates while eating a lot of healthy fats. The body will shift to a fat-burning machine from being a sugar-burning one. Keto diet for patients with lipedema involves a low-carb diet. You would be eating approximately 20 grams or less of carbs each day. The primary focus in this diet is to consume eggs, meats and vegetables that are non-starchy. Carbohydrates and natural sugars from fruits are also restricted.
Potential benefits for lipedema include:
- Reduced inflammation through antioxidant components
- Potential weight loss in non-lipedemic fat
- Possible alleviation of pain and improved mobility
However, it's crucial to note that the ketogenic diet should always be supervised by a nutritionist or specialist. In some patients, especially those with insulin resistance or diabetes, it may induce the release of inflammatory substances and increase lipedema symptoms.
Moderate Carb Restriction Benefits
Research suggests that even moderate carbohydrate restriction (typically 75g-150g daily) may help lipedema patients by:
- Stabilizing Blood Sugar: Preventing glucose and insulin spikes that can trigger inflammation and fluid retention.
- Supporting Healthy Weight Management: While not directly reducing lipedema fat, maintaining a healthy weight in non-affected areas can improve mobility and reduce strain on joints.
- Improving Metabolic Health: Addressing related conditions like metabolic syndrome that may exacerbate lipedema symptoms.
- Reducing Cravings and Hunger: Many patients report more stable energy and reduced food cravings when following a moderate low-carb approach.
Consider these approaches when incorporating a moderate low-carb diet:
- Carb Quality Matters: Focus on complex carbohydrates from vegetables, limited fruits, and occasional legumes while minimizing refined carbs and sugars.
- Carb Timing: Some patients benefit from consuming most carbohydrates around exercise or earlier in the day.
- Carb Cycling: Alternating between lower and slightly higher carb days may help maintain metabolic flexibility while supporting exercise performance.
- Personalized Carb Threshold: Each person has a unique carbohydrate tolerance. Working with a nutritionist can help identify your optimal range for symptom management.
Additional Tools for Lipedema Management
Besides following a RAD diet, patients should also have a robust and regular vitamin supplement.
- Vitamin D3: Lipedema patients are typically deficient in Vitamin D, an essential supplement that plays a critical role in your immune system. It also helps your bone, muscle, and nervous system health.
- Selenium: A supplement that can aid with your daily metabolism is Selenium. It has been known to help reduce lipedema swelling that is often painful and continuous. Selenium in the treatment of acute and chronic lymphedema. Treatment of secondary lymphedema of the arm with physical decongestive therapy and sodium selenite: a review.
- Diosmin: Perhaps the most effective supplement to take is Diosmin, a bioflavonoid that is commonly found in citrus fruits. Diosmin also improved leg edema or swelling and decreased leg circumference. Other studies have shown Diosmin improved venous ulcer healing, hemorrhoids, and lymphedema.
Lifestyle Tips for Lipedema Symptom Management
In addition to diet and exercise, consider these lifestyle strategies to manage lipedema symptoms:
- Wear compression garments: These support circulation and can help reduce swelling.
- Practice stress-reduction techniques: Stress can exacerbate inflammation.
- Stay hydrated: Aim for at least 8 glasses of water per day.
- Get adequate sleep: Quality sleep promotes overall health and can help reduce inflammation. Aim for 7-9 hours per night.
- Consider manual lymphatic drainage: This specialized massage technique can help improve lymph flow and reduce swelling.
- Reduce Discomfort with Compression Garments!
Case Study: Ketogenic Diet for Lipedema Management
A 32-year-old woman diagnosed with lipedema type IV and V, stage II-III; she complained of widespread pain, particularly in the lower limbs; heaviness; and difficulty in making various movements. She refused any type of treatment if it was not nutritional.
We choose to operate a caloric deficit of 200-250 Kcal compared to the 14-day food diary reported, as we did in a previous work to better design the nutritional program; the carbohydrate intake was set at no more than 25 g per day. The ratio between proteins and fats was between 1:1 and 1:2; the choice of having a considerable protein intake was to preserve the muscle mass as much as possible, which was already in suboptimal conditions, probably also due to lipedema. No kind of food was excluded; therefore, milk and milk derivatives, red meat, and even gluten were included (the latter in any case in small quantities, as it is related to carbohydrates). We immediately inserted nutritional supplements: omega3 fish oil (3 g per day of product, about 1.8 g of DHA + EPA), vitamin C (1 g per day divided into 2 doses), and vitamin D (2000 iu per day); all supplements were from 4+ Nutrition, Padua-Italy. The program provided on average an intake of 1300 Kcal, divided into 30% from proteins, 66% from fats, and 4% from carbohydrates. The recommended sources of protein were mainly meats (veal, pork, chicken, turkey) and fish (of any type with even more fat, such as salmon, anchovies, or mackerel) or seafood, eggs and dairy products. Vegetables, preferring those in season and limited to those with a non-negligible carbohydrate content, such as eggplant, peppers and tomatoes, were included. Obviously, we completely prohibited tubers, squash, legumes, and any type of cereal or pseudocereal (unless they fell within the small amount of carbohydrates allowed; for example, 30 g of rye bread in the morning). The sources of fat were mainly extra virgin olive oil (butter or mayonnaise was granted as a substitute, but these choices were unwelcome, therefore little used) and nuts or seeds. The patient also was given indications and suggestions on how to cook food, also with few limitations in this case; for example, even fried food was allowed in moderation. After the sixth month, we included a fortnightly free meal, which included a quantity of carbohydrates ranging from 60 to 120 g; then after the twelfth month, the free meal was offered every week, and this did not affect the progress of the program itself. We must say that during this long period, there were some moments in which the program was not followed in an optimal way; for example, during the Christmas period, we could not monitor the changes except to report a flare-up of the pain reported that then subsided as soon as the program was reinstated.
The results in ponderal terms were striking: the subject lost 41 kg, with a change of about 20 Bf%, and maintained a healthy condition, as evidenced by the phase angle. Any side effect was recorded, and only a difficulty in focusing at day 3 that returned to normal at day 5. Vitamin D increased and insulin decreased.
The WOMAC score had a decrease of 53%, and SQS 48%. Taken together, these represented a great improvement in the overall quality of life.
The most significant result, in our opinion, was the strong compliance, which allowed the subject to continue the program even during the first, unexpected lockdown due to the COVID-19 pandemic. This also was thanks to a variety in food choices, as no food category was excluded, confirming that there was no food that directly influenced lipedema unless specific intolerances or allergies were manifested.