Sarah Rice BSc. (Hons), MCOptom (UK), MHP, NNP

Lipoedema is a chronic and progressive disease that tends to be underdiagnosed. Often associated with obesity, lipoedema presents unique pathological features such as an increase in subcutaneous adiposity in the lower limbs along with pain and tenderness. It can also affect the arms. More commonly affecting women, lipoedema can be triggered by hormonal changes (particularly higher oestrogen levels) such as occurring in puberty, during pregnancy, or menopause.

The pathophysiology involves systems such as the hormonal, lymphatic, and vascular systems. Additionally, the connective tissue in the areas of fat distribution exhibits abnormalities. This causes dysfunction of the lymphatic vessels, leading to leakage and fibrotic changes. These changes give rise to the painful symptoms and the generally poor response of the condition to standard approaches such as diet and exercise. 

A genetic component may play a role in disease development through an association of gene mutations driving atypical fat distribution, but mechanisms also point to endotoxins, stress, and trauma as triggers to disease development. Standard treatments such as compression garments and physiotherapy offer limited benefits. The combination of treatment resistance, misdiagnosis, and painful symptoms contributes to reduced quality of life reported by those with the condition (1–4).

While the data are still emerging, recent studies indicate a ketogenic diet can improve disease markers and symptoms.

A systematic review and meta-analysis conducted to examine the effectiveness of ketogenic diets for lipoedema found a significant improvement in body composition and other metrics such as waist circumference, BMI, waist/hip ratio, and pain levels (1).

Compared to a control diet, a randomised study by Lundanes et al. (2024) demonstrated that a low-carbohydrate diet produced greater weight loss and improvements in pain scores compared with the control group. The diets were identical in energy supplied, with the low-carbohydrate arm consuming 75 g of carbohydrates (73 g of fat) and the control diet consuming 180 g of carbohydrates (27 g of fat). Nutritional ketosis was a goal in the low carbohydrate group, with measurements taken and carbohydrate intake adjustments applied to ensure blood ketone levels were ≥ 0.3 mmol/L (2).

Another study from Lundanes et al. (2024) looked at lipoedema in the context of hunger hormones and appetite changes on a low-carbohydrate diet (LCD), where this group  experienced a reduction in postprandial ghrelin and increased fullness. The LCD group also experienced more weight loss despite an energy-matched (and reported) intake (3).

Finally, in a study examining the common metrics measured in lipoedema as a subcutaneous adipose tissue (SAT) disorder (calf adiposity, muscle area, SAT/muscle ratio, calf circumference, and body composition), the LCD arm experienced significantly reduced calf SAT area, calf circumference, and pain levels. Other metrics were similar, with both groups experiencing weight loss (4). 

Pressure on nerves due to fluid buildup, fibrotic changes, and inflammatory responses are believed to cause the painful symptoms of this condition. The metabolic state of nutritional ketosis is thought to improve symptoms by promoting weight loss and reducing excess fluid accumulation and inflammation. Further studies are necessary, but the promising initial results offer hope to those with this debilitating condition. 

Find out more

The metabolic section of the Nutrition Network reference resource has an extensive listing where you can read more about the application of therapeutic carbohydrate restriction (TCR) for lipoedema (under the obesity section). Look at our training options to learn how you can support others using this approach.

References

1. Amato, A.C.M., Amato, J.L.S. and Benitti, D.A. (2024) ‘The Efficacy of Ketogenic Diets (Low Carbohydrate; High Fat) as a Potential Nutritional Intervention for Lipedema: A Systematic Review and Meta-Analysis’, Nutrients, 16(19), p. 3276. Available at: https://doi.org/10.3390/nu16193276.
2. Lundanes, J., Sandnes, F., et al. (2024) ‘Effect of a low-carbohydrate diet on pain and quality of life in female patients with lipedema: a randomized controlled trial’, Obesity, 32(6), pp. 1071–1082. Available at: https://doi.org/10.1002/oby.24026.
3. Lundanes, J., Storliløkken, G.E., et al. (2024) ‘Gastrointestinal hormones and subjective ratings of appetite after low-carbohydrate vs low-fat low-energy diets in females with lipedema – A randomized controlled trial’, Clinical nutrition ESPEN, 65, pp. 16–24. Available at: https://doi.org/10.1016/j.clnesp.2024.11.018.
4. Lundanes, J., Gårseth, M., et al. (2024) ‘The effect of a low-carbohydrate diet on subcutaneous adipose tissue in females with lipedema’, Frontiers in Nutrition, 11. Available at: https://doi.org/10.3389/fnut.2024.1484612.