June is lipoedema awareness month, and more awareness of this potentially crippling disease affecting up to 10% of women is certainly needed! If you are excessively pear shaped, with lots of lumpy painful fat on the lower half of your body then you need to read this article so you can get help now….
What is lipoedema?
Lipoedema is a genetically inherited disease that can have a sudden and rapidly developing onset in women after a significant hormonal change such as onset of puberty, pregnancy or menopause. The first thing noticed is that you start to lay down a lot of fat on the bottom, hips, thighs, calves or ankles which can be painful to the touch. Fat nodules may be noticed under the skin and the skin may bruise more easily than usual. The body from waist upwards is generally unaffected though some women may also accumulate some fat on the upper arms as well. You may find that other women in your family, going back for generations, also have this same body fat distribution, though it can skip a generation. Unsurprisingly, lipoedema can have profound effects on body image and mental health, often leading to depression.
A doctor’s dilemma in diagnosis
Lipoedema is often confused with the similarly named condition lymphoedema, which also presents with large swollen legs, but this is due to the accumulation of lymph fluid rather than fat and is a different disease entirely, though women with advanced lipoedema may also develop lymphoedema too. Lipoedema can also be mis-diagnosed as obesity, but obesity affects all limbs equally and particularly the abdomen. However, around 80% of women with lipoedema are also obese – adding to the confusion in diagnosis!
How effective is diet in reducing lower body fat accumulation?
Unfortunately, the fat accumulation in lipoedema is resistant to attempts to lose it through severe dieting. Low-calorie, low-fat diets are particularly unhelpful and generally lead to loss of fat from the upper body without losing any fat from the legs and buttocks, making the unbalanced appearance even worse.
A modified Mediterranean diet
A recent study looked at whether a modified version of the Mediterranean diet could help with weight loss in a group of women with lipoedema (1). The diet contained the foods associated with this diet such as fish, low-fat dairy, olive oil, wholegrains, fruits, vegetables, legumes and nuts but reduced the carbohydrate allowance to about 40% of calories per day (a standard Mediterranean diet would have 50-60% of calories from carbohydrates). A high protein intake was also encouraged, and processed meats, sweetened drinks, ready-meals and alcohol were avoided. The diet was high in anti-inflammatory foods (omega-3 from fish) and high in anti-oxidants from the fruits and vegetables. This was actually a high-protein, moderately low carbohydrate real food diet!
After 4 weeks, there was significant weight loss (About 3kg on average) and a reduction is fat mass from the lipoedemic areas of about 2.2kg on average. There was also a significant improvement in perceived quality of life.
Is a ketogenic diet better?
Research into the use of a ketogenic diet is in its early stages but is showing great promise in helping to reduce overall weight, reduce fat-mass in the lipoedemic areas, reduce pain and inflammation, and improve quality of life in women with lipoedema. A ketogenic diet restricts carbohydrates to around 20-50g per day or around 5% of calories. It also involves eating more protein from meat, fish, eggs, cheese, yoghurt or legumes and tofu. Eating healthy fats such as nuts, seeds, olive oil and butter. A full range of above ground vegetables can be eaten and some low sugar fruits such as berries. A ketogenic diet suppresses appetite, helps with weight loss, and improves insulin sensitivity and overall metabolic health.
A small pilot study, the LIPODIET study (2) of nine women with lipoedema who followed a ketogenic diet for 7 weeks, followed by a Nordic Nutrition Recommendations (NNR) diet for a further 6 weeks, lost an average of 4.6 kg of weight whilst on the ketogenic diet part of the study, had significantly reduced pain, and had improved quality of life scores. Interestingly, pain levels increased again during the 6-week NNR diet part of the study, suggesting that the ketogenic diet was better at suppressing inflammation and reducing pain.
A very impressive and thorough case report (3) of a lipoedemic woman following a ketogenic diet who was monitored for 22 months, reported a 41kg weight loss, improved quality of life and reduction in pain. She also experienced a huge improvement in insulin sensitivity and blood glucose control, lost 37cm from her hips, nearly 24cm from her waist as well as significant reductions in the circumference of thighs, knees, calves, ankles and arms.
Finally, a comprehensive review of lipoedema (4), hypothesised that as well as reducing lipoedemic fat mass, reducing pain and improving quality of life, the ketogenic diet also worked on four other symptom areas: improved hormone and metabolic function, reduction of water retention and lymphatic oedema, reduction in inflammation, and fibrosis reduction and retention. This suggests that the ketogenic diet may be effective in the treatment of lipoedema in ways that go beyond just weight and fat loss, though the authors do state that more research is needed.
Get a diagnosis and seek support
If you suspect you have lipoedema, then it is crucial that you get a diagnosis and support. The symptoms of this disease are often confused with obesity and lymphoedema and can be missed by health care professionals. Use this guide to help you identify your symptoms and why not take it your doctors to help them make the correct diagnosis? There are several organisations that help support people with lipoedema:
Lipoedema UK www.lipoedema.co.uk
Talk Lipoedema (UK) https://www.talklipoedema.org/
Lipoedema Online (UK) https://www.lipoedemaonline.com/
Lipoedema Ladies https://www.lipoedemaladies.com/
Lipodema Foundation (US) www.lipedema.org
The Lipodema Project (US) https://lipedemaproject.org/lipedema-support-community/
Conclusion
Lipoedema is an inherited progressive disease in which fat accumulates in the lower part of the body, and generally develops during sudden changes in oestrogen levels, such as puberty, pregnancy or menopause. The accumulated fat is resistant to standard low-calorie, low-fat diets but modified lower-carb Mediterranean or ketogenic diets show great promise at reducing lipoedemic fat mass and reducing pain. The ketogenic diet may also work on other symptoms such as reducing fibrosis, inflammation and improving metabolic health. More research is needed to determine long term effects of the ketogenic diet in women with lipoedema.
If you would like help and support to adopt a low-carb or ketogenic diet then we would be delighted to help you. See our 1:1 Nutritional Therapy page for more information.