POLSKI
Introduction
Lipedema is a chronic, progressive adipose tissue disorder characterized by a disproportionate accumulation of subcutaneous fat, predominantly in the lower extremities (less often in the upper extremities as well), with sparing hands and feet. Unlike obesity, lipedema fat is typically resistant to caloric restriction and physical activity and is often accompanied by pain, easy bruising, and impaired mobility [1]. Lipedema is estimated to affect up to 11% of women; however, it is frequently underdiagnosed and often misidentified as obesity or lymphedema [2].
Although the pathophysiology of lipedema is not fully understood, increasing evidence points toward hormonal influence, microvascular dysfunction, and chronic low-grade inflammation [1]. These mechanisms may render dietary interventions particularly relevant. Patients frequently report that specific dietary changes—such as anti-inflammatory, low-carbohydrate, or ketogenic diets—lead to symptom relief, improved energy, and reduced swelling or pain [3, 4].
Despite widespread anecdotal support, robust scientific evidence regarding the efficacy of dietary interventions in lipedema remains limited. Most available data derive from patient surveys, case reports, and small-scale studies. There is a growing need to explore and critically evaluate how dietary strategies may modulate the inflammatory state, fluid retention, and adipose tissue behavior in lipedema.
This review aims to summarize the current literature on dietary approaches to managing lipedema, highlight common themes and limitations in existing research, and identify directions for future clinical investigation and nutritional practice.
Pathophysiology and Clinical Presentation of Lipedema
The pathophysiology of lipedema involves a complex interplay of hormonal, inflammatory, and microvascular factors that contribute to abnormal fat deposition and associated symptoms. Hormonal factors are thought to play a significant role, as lipedema often manifests during periods of hormonal change such as puberty, pregnancy, or menopause [5]. It is generally considered to be estrogen-mediated, although the precise role of estrogens is not fully established [5, 6]. Altered estrogen receptor patterns and increased expression of aromatase (an enzyme converting androgens to estrogen) in lipedema adipose tissue have been observed [7, 8]. Progesterone receptors are also present in subcutaneous adipose tissue, and a partial loss-of-function in an enzyme involved in progesterone conversion might contribute to fat accumulation [7]. Testosterone also plays a key role, primarily in relation to its balance with estrogen and its impact on body composition. Reduced testosterone levels have been associated with metabolic dysfunction [9].
The subcutaneous adipose tissue (SAT) in lipedema is pathologically altered, showing adipocyte hypertrophy and/or hyperplasia [6, 7, 8]. A notable characteristic is the resistance of this excessive fat to conventional weight-loss techniques like diet and exercise in the affected areas [6, 9]. Weight loss that does occur tends to be in unaffected areas. Extracellular matrix (ECM) remodeling, including increased fibrosis, collagen deposition, and disturbances in proteoglycans and glycosaminoglycans, is observed [7]. These changes contribute to the formation of palpable fibrotic nodules or fat lobules within the tissue [6]. Lipedemic tissue has a distinct structure and atypical lipid metabolism. Adipose tissue remodeling, including adipocyte death and concurrent regeneration, occurs. Studies suggest increased proliferation of lipedemic adipocytes, linked to increased expression of cell-cycle regulating genes such as BUB1. The expression of certain transcription factors regulating PPARG expression may be decreased. Contradictory results exist regarding the expression of PPARG and Leptin in differentiated adipose-derived stem cells from lipedema patients [5, 7].
A state of chronic inflammation is present in lipedema tissue, similar to obesity, and appears independent of co-existing obesity. Elevated levels of M2 macrophages are found in lipedemic tissue [10]. Inflammation contributes to tissue fibrosis in the extracellular matrix (ECM) and the formation of nodular structures [11].
The pathophysiology involves microangiopathy of blood and lymphatic vessels [12]. Capillary fragility may be present [13]. Dilated blood microvessels and increased microvascular permeability lead to excess interstitial fluid and protein displacement into the extracellular space (a “capillary leak”) [14, 15]. Elevated levels of Vascular Endothelial Growth factor C (VEGf-C) have been reported [16]. Although the lymphatic system may compensate for the increased fluid in early stages, its capacity is overwhelmed in advanced stages [8]. Impaired lymphatic drainage contributes to excess fluid in the extracellular matrix. Studies have shown impaired lymphatic transport in women with lipedema [5]. Lymphatic vessels may exhibit increased permeability and a larger interstitial space [17].
Key clinical features of lipedema include uneven fat distribution, pathological structure of adipose tissue, pain, easy bruising, orthostatic edema, resistance to weight loss, impaired mobility and other associated features such as aberrant lipid metabolism or venous disease [14]. Diagnosis of lipedema is primarily made on clinical grounds, typically through physical examination and history-taking, with diagnostic criteria to help guide the process. Ancillary tests are mainly used to rule out competing diagnoses like lymphedema, obesity, or chronic venous insufficiency [5].
Overview of Current Management Strategies
Despite the relatively high prevalence of lipedema and its impact on the quality of life, knowledge about this condition is limited. Currently, there is no curative treatment for lipedema. Disease management focuses on symptom relief, slowing or halting its progression, and preventing complications. The main goals of treatment are to improve quality of life, reduce the sensation of heaviness and pain, reshape the affected limbs, control body weight, and improve mobility. Treatment should be integrated, multidisciplinary, and individualized [18].
Conservative treatment
Conservative treatment forms the foundation of lipedema management. Complete Decongestive Therapy (CDT) is an intensive program that fundamentally combines four different treatment approaches, including manual lymphatic drainage, compression bandaging, exercise therapy, and skin care [19]. Nowadays CDT also includes psychotherapy, dietary counseling and weight management, patient education and self-care [8].
Manual Lymphatic Drainage (MLD) is a standard component of conservative lipedema management. It is a light skin stretching technique that stimulates the lymphatic system [20]. Appropriate compression therapy usually includes custom-made, flat-knitted compression garments. Multi-layer bandaging is used for pitting edema before applying compression garments. Regular wearing of garments is important to avoid edema recurrence [21]. The main goals are to stimulate lymphatic flow, prevent fluid accumulation and potential progression to lymphatic insufficiency and alleviate symptoms such as pain and swelling.
Exercise therapy is a fundamental part of conservative lipedema care. Tailored exercises (such as swimming/aquatic exercises, elliptical machines, yoga, stationary bikes, whole-body vibration, walking) are aimed at alleviating pain, increasing lymphatic flow, improving muscle strength, mobility, and quality of life. Exercise regimens are considered a necessity [22, 23].
Skin care is considered as an essential component of conservative management for lipedema. The skin of patients with lipedema is usually very sensitive, dry, and itchy due to disturbances of the macro-and microcirculation. That makes the skin more susceptible to inflammation and infection. Impaired healing process, recurring skin injury can lead to severe inflammation, infection or even ulcers. The main target is to retain the skin in healthy condition using proper protective measures and professional dermocosmetics [24].
Patient education and self-care are essential for successful long-term management. Patients require comprehensive information about the chronic nature of lipedema and available treatment options. Providing honest and understandable information is crucial, acknowledging that curing the condition is difficult. Educating patients about self-care plans is vital, as their commitment can significantly improve quality of life [5]. Professional help for emotional coping should be offered due to the limited effectiveness of current treatments and the burden of psychosocial stress. Psychological counseling is listed as a necessity [25, 26].
Surgical Treatment
Surgical treatment is an additional option for selected patients. It is generally considered for those who do not benefit sufficiently from conservative therapy. Surgical reduction (liposuction) of lipedema is described as the only currently available technique for removing the abnormal lipedemic tissue [18]. It can be indicated for esthetic or functional purposes. Surgical intervention combined with conservative treatment may lead to patient satisfaction with the condition of their low extremities and quality of life. It is also considered as the only treatment method that slows the progression of lipedema [27, 28].
Pharmacological interventions
There are currently no known medications that specifically treat lipedema. The use of medications and supplements for lipedema should concentrate on reducing tissue inflammation, fibrosis, swelling, and pain [14]. Pharmacological treatments aiming to reduce edema and inflammatory effects, such as corticosteroids, hormones and their antagonists or modulators, diuretics, flavonoids, and nutraceuticals, are currently under investigation, and their use is not evidence-based [8]. Dietary supplements that reduce adipose tissue, increase lean mass and modify hormonal levels could be an effective strategy for lipedema treatment [29].
Lifestyle modifications
It is important to understand that the specific adipose tissue in lipedema is generally difficult to reduce through diet, exercise, or bariatric surgery [6, 9]. Therefore, lifestyle interventions, as part of conservative management, are primarily aimed at alleviating symptoms, preventing disease progression, and improving quality of life, rather than significantly improving the visual appearance of affected limbs [30]. Weight management is a crucial aspect, particularly if a person with lipedema also has obesity [9]. Obesity can lead to serious health issues and worsen lipedema symptoms. If obesity is present, it should be treated according to standard guidelines [30].
Overview of Dietary Approaches in Lipedema
There is currently no consensus on the most effective nutritional approach for managing lipedema. Although adipose tissue accumulation is resistant to lifestyle interventions such as diet and exercise, these are still mentioned as necessities in management [14].
Anti-Inflammatory Diets
Dietary approaches based on empirical data often aim for inhibition of systemic inflammation with anti-oxidative and anti-inflammatory components [31, 32]. Anti-inflammatory diets have been suggested as a dietary strategy.
A modified Mediterranean diet is considered as a nutrient-rich approach with anti-inflammatory properties [33]. It has been shown to have some potential effects on body composition in lipedema patients, including showing reduced fat mass in one study [34]. The Mediterranean diet offers a supportive, sustainable approach to managing lipedema symptoms, particularly by addressing inflammation, oxidative stress, and overall metabolic health. Though not a cure, it is considered one of the most beneficial diets for improving well-being and reducing disease burden in people with lipedema (Table 1).
Table 1
Benefits of the Mediterranean Diet for Lipedema.
Dietary strategies for individuals with lipedema should focus on minimizing postprandial insulin and glucose fluctuations and must be sustainable long-term. Recent research has increasingly explored low-carbohydrate and low-glycemic diets for their potential benefits in lipedema management (Table 2, Table 3) [6, 14]. A randomized controlled trial indicated that the low-carbohydrate diet (LCD) group reported a significant improvement in symptoms, feelings, and total quality of life. This study also noted that more weight loss occurred in the LCD group despite an isocaloric prescription compared to a control diet, which is considered of clinical relevance. Additionally, ketosis, often achieved through low-carbohydrate diets, has been shown to prevent the increase in appetite typically observed with weight loss [35].
Table 2
Benefits of the Low-glycemic Diet for Lipedema.
Table 3
Benefits of the Low-carbohydrate Diet for Lipedema.
Ketogenic Diet
The Ketogenic Diet (KD) and Very Low-Calorie Ketogenic Diet (VLCKD), characterized by a high-fat intake and drastic carbohydrate restriction (typically 30–50 grams per day), may be an effective treatment for lipedema, particularly when coexisting obesity is present [6]. VLCKD protocols involve a low daily calorie intake of 700–800 kcal/day, with carbohydrates restricted to 30–50 grams/day (approximately 13% of total energy), fats at 30–40 grams/day (approximately 44%), and proteins at about 1.2–1.4 grams/kg of body weight (approximately 43%) [36]. VLCKD has demonstrated a more significant reduction in inflammation compared to other nutritional approaches, such as the Mediterranean diet or intermittent fasting. This anti-inflammatory property is particularly relevant as inflammation is a major contributor to the pathogenesis of lipedema (Table 4) [6].
Table 4
Benefits of the Ketogenic Diet for Lipedema.
One clinical case study described a 32-year-old female with lipedema who achieved significant weight loss after following a 1,300 kcal ketogenic diet consisting of 30% protein, 66% fat and 4% carbohydrates for six months, followed by a low-carbohydrate, low-calorie diet [37].
A pilot study (LIPO DIET) on a low-carbohydrate, high-fat (LCHf) eucaloric diet (70–75% fat, 5–10% carbohydrates, 20% protein) for seven weeks showed significant weight loss (-4.5%), maintained at week 13, along with a significant decrease in waist, hip, and calf circumferences. The study also reported a significant reduction in pain and an improvement in overall quality of life. However, pain levels returned to baseline after participants switched to Nordic nutrition recommendations [38].
Despite these promising observations, the current evidence on the efficacy and safety of KD and VLCKD for lipedema is limited, and more research is necessary to establish its long-term effects [6]. Potential drawbacks include nutrient deficiencies, limited food choices, and a lack of long-term research [39].
Gluten-Free and Elimination Diets
A gluten-free diet may offer benefits for individuals with lipedema, particularly those who exhibit gluten sensitivity or have specific genetic markers associated with celiac disease. Reducing or eliminating gluten, which is found in wheat, rye, and barley, may help alleviate some lipedema symptoms, especially if intestinal inflammation contributes to the condition (Table 5) [40, 41]. Research indicates a higher prevalence of HLA-DQ2 and HLA-DQ8 alleles - genetic markers linked to celiac disease among women with lipedema. A study analyzing 95 women diagnosed with lipedema found that 47.4% were HLADQ2 positive and 22.2% were HLA-DQ8 positive. Overall, 61.1% of individuals carried at least one of these alleles, compared to 54% of individuals in the general population. Notably, 7.4% of individuals had both alleles, which is a significant increase on the 1% observed in the general population [40] .While these findings suggest a potential link between lipedema and gluten-related genetic markers, they do not establish a direct causal relationship. further research is necessary to determine whether gluten elimination can effectively manage lipedema symptoms.
Table 5
Benefits of Gluten-Free and Elimination Diets for Lipedema.
Dr. Herbst and associates are conducting extensive research on a “Rare Adipose Disorders diet”. This diet involves a reduction in pasteurized dairy products, animal fats, simple sugars, carbohydrates, salt, and artificial preservatives, flavors, and sweeteners. While not explicitly termed an “elimination diet” for allergies or sensitivities, this approach to reducing specific food categories aligns with principles seen in elimination diets [42]. The sources, however, do not provide specific reports on symptom relief directly attributable to this diet or discuss its use for patients with coexisting sensitivities, beyond its general composition.
Low-Sodium and Lymph-Friendly Diets
A low-sodium, lymph-friendly diet can be beneficial for individuals managing lipedema, particularly when symptoms overlap with lymphedema or involve significant swelling and fluid retention (Table 6) [43]. Excessive sodium intake can lead to water retention, exacerbating swelling in individuals with lipedema [44]. Reducing sodium consumption may help decrease fluid buildup and associated discomfort. It’s advisable to limit processed foods, canned soups, salty snacks, and cured meats, which are often high in sodium. Instead, focus on fresh, whole foods and use herbs and spices to enhance flavor without added salt. Proper hydration should be an important part of the therapy and become a daily habit. Drinking the right amount of water helps to facilitate lymphatic flow and reduce fluid retention [45].
Table 6
Benefits of Low-Sodium and Lymph-Friendly Diets for Lipedema.
The lymph-friendly diet emphasizes anti-inflammatory and nutrient-rich foods to support lymphatic health. The diet should be based on vegetables and limited intake of fruits (source of antioxidants and fiber), lean proteins (fish, poultry, legumes, and tofu to maintain muscle mass and support tissue repair), whole grains (brown rice, quinoa, and oats to deliver energy and fiber), healthy fats, especially sources of omega-3 fatty acids (flaxseeds, chia seeds, and walnuts to combat inflammation) [46]. Patients should avoid processed foods, refined sugars, and saturated fats. It’s recommended to minimize inflammation and support overall well-being [9].
Nutritional Goals in Lipedema
The primary nutritional goals in lipedema management are to improve quality of life, reduce pain and heaviness, reshape affected limbs, control overall body weight (especially co-existing obesity), and enhance mobility [47].
Weight Management (Weight Stabilization vs. Weight Loss)
Lipedema adipose tissue is resistant to reduction through conventional diet, exercise, or bariatric surgery [14]. Any weight loss typically occurs only in the non-lipedema affected upper body, increasing asymmetry [48]. Despite this resistance, weight control is crucial because excess weight worsens lipedema symptoms. Managing co-existing obesity is vital to prevent metabolic complications such as insulin resistance, type 2 diabetes, high blood pressure and hypercholesterolemia, which can exacerbate lipedema symptoms [49]. for patients with normal BMI, maintaining a healthy weight helps prevent disease progression and supports mobility. Long-term sustainability of dietary plans is essential [8, 50].
Pain Management and Mobility Support
Nutritional strategies, especially those with anti-inflammatory properties, can help reduce pain, prevent fibrosis, and decrease edema [37, 38]. Diets like the ketogenic diet have shown effectiveness in improving pain symptoms and quality of life in lipedema patients, alongside rapid weight loss [6]. Improving body composition by reducing adipose tissue and increasing lean muscle mass can significantly contribute to reduced pain and enhanced mobility [9].
Improving Body Composition
Traditional weight loss methods are ineffective for lipedema adipose tissue, but strategic approaches involving diet and lifestyle modifications can help manage overall body composition and related comorbidities [30]. Body Mass Index (BMI) has limited utility in differentiating lipedema from obesity, as it does not account for variations in fat distribution or distinguish between adipose and lean tissue [51, 52]. Circumference measurements can be useful and inexpensive tools to monitor effects of the treatment [53]. Studies have shown significant reductions in these measurements with certain dietary interventions [37]. Dual-energy X-ray absorptiometry (DXA) is considered a reference method for body composition assessment, capable of estimating body compartments in whole body and single segments (trunk, limbs) and differentiating lipedema from obesity [54]. Bioelectrical Impedance Analysis (BIA), especially Segmental BIA (S-BIA), is a reliable, noninvasive, and low-cost method to estimate fat mass, fat-free mass, and hydration status. S-BIA is particularly useful for monitoring limb-level fat mass changes in lipedema patients [54]. Nutritional goal is to promote healthy body composition by stabilizing blood glucose and insulin levels. favoring low-glycemic carbohydrates like legumes, vegetables, and whole grains (if tolerated) can help reduce fat accumulation and avoid insulin-driven inflammation. Lean proteins and healthy fats further assist in satiety and metabolic regulation [55].
Calming Inflammation
Inflammation is a hallmark of lipedema tissue and a key contributor to pain and fibrosis. Lipedema, obesity, and inflammation can form a “vicious cycle” where inflammation impairs lymphatic function and exacerbates fat accumulation [7, 22]. Dietary interventions aimed at reducing inflammation, mentioned in an earlier paragraph of this paper help manage lipedema by reducing chronic inflammation, supporting lymphatic function, and improving body composition. This approach generally emphasizes unprocessed foods rich in antioxidants, fiber, and healthy fat such as vegetables, berries, fatty fish, olive oil, and nuts, while avoiding refined sugars, processed foods, trans fats, and excess sodium [32]. for some individuals, removing specific inflammatory triggers like gluten or dairy may further reduce symptoms, particularly if there are signs of food allergies or autoimmune responses [40]. Though not required for everyone, elimination diets under supervision may help identify and remove such contributors. finally, combining this nutritional approach with supportive lifestyle strategies like regular low-impact physical activity, stress management, and potentially anti-inflammatory supplements like curcumin, omega-3s, or quercetin can provide a comprehensive foundation for managing lipedema-related inflammation [9, 56].
Psychological support
Psychological support is crucial, as many lipedema patients experience eating disorders or distress about their body image, suggesting that diet modifications should ideally be guided by a psychologist [26].
Conclusion
Lipedema is a chronic adipose tissue disorder with a complex pathophysiology involving inflammation, hormonal imbalance and lymphatic dysfunction. Although there is currently no cure, there is emerging evidence to suggest that dietary strategies can alleviate symptoms and improve quality of life. Anti-inflammatory, low-carbohydrate, ketogenic, gluten-free and low-sodium diets have all demonstrated promise in alleviating pain, reducing fluid retention and improving body composition. Although most of the evidence comes from small-scale studies and patient-reported outcomes, consistent patterns suggest that nutritional interventions are a relevant and accessible addition to lipedema care. While diet alone cannot reverse lipedema, it can substantially improve symptom burden when combined with conservative treatments such as CDT. Nutritional strategies that reduce inflammation and stabilize insulin levels may help to mitigate the metabolic and inflammatory processes that drive disease progression. furthermore, addressing dietary habits can support physical outcomes such as reduced swelling and pain, as well as emotional well-being and long-term adherence to treatment. further research should prioritize randomized controlled trials and large-scale cohort studies to better define the efficacy and mechanisms of dietary interventions in lipedema. What is more, further studies are needed to identify biomarkers of inflammation, lymphatic function and adipose tissue metabolism, with the aim of improving our understanding of pathophysiology, as well as enhancing conservative treatment and the use of innovative interventions. Clinically, practitioners should consider personalized nutrition to be a core component of multidisciplinary care, tailored to the patient’s comorbidities, preferences and lifestyle. Involving dietitians, psychologists and physiotherapists may further enhance adherence and effectiveness. finally, nutritional guidance should prioritize long-term sustainability, symptom relief and psychological support over unrealistic weight-loss expectations.
