Diet for Lipedema

Lipedema is a chronic progressive medical condition that has several treatment strategies, including diet. This blog will focus on lipedema diet, but you should also read about lipedema treatment and lipedema types, stages and diagnosis.

This blog is not meant to diagnose or treat any condition. You can read it from top to bottom or can skip to the section you want to read using this Table of Contents

Lipedema Diet 

What is the best diet for lipedema? In this blog I will disuss anti-inflammatory diet, elimination diet, intermittent fasting, modified Mediterranean diet, Keto diet and RAD diet for lipedema. After my review, keep reading to the end for my bottom line lipedema diet recommendations.

Anti inflammatory Diet for Lipedema

Lipedema is an inflammatory condition (Al-Ghadban, 2019). Let’s look at exactly what researchers think is happening to create lipedema fat.

Fat tissue, also called adipose tissue is one of the largest endocrine organs in the body. An endocrine organ, is an organ that can release hormones into the blood. Another example is the pancreas which makes and secretes insulin. Other endocrine organs are the adrenal glands which produce cortisol (“the stress hormone”), the thyroid which produces thyroxine and the pituitary gland that produces growth hormone, among others.

Fat, being another endocrine organ, can also produce hormones and other chemical messengers. Fat houses immune cells, when there are larger fat stores, then more immune cells are released leading to cellular inflammation, insulin resistance and slow pumping of the lymphatic vessels (Herbst, 2019).

The flow of blood and lymph through this diseased fat is slow resulting in an accumulation of fluid, cell waste material, proteins, cells and other metabolic products that get clogged in the extracellular matrix surrounding the fat cells  resulting in a low oxygen environment (hypoxia).

These oxygen starved fat cells, then send out a signal to recruit more immune cells to the area, this creates more inflammation and tissue breakdown. The body then replaces this broken down tissue with scar tissue (fibrosis).

As this scar tissue accumulates the structure in the extracellular space changes permanently and the flow through this area by blood and lymph is impaired (Herbst, 2019).

This fibrotic fat tissue does not respond to calorie restriction or increased activity, weight loss medications, even bariatric surgery may not reduce it and its painful (Herbst, 2019).

Can an anti-inflammatory diet help reduce some of the inflammation, pain and slow the progression of lipedema? There has not been a diet study to examine this question specifically for lipedema.

But, we know from other research that an anti-inflammatory diet can reduce the level of inflammation in the body and there are several healthy anti-inflammatory dietary patterns such as the traditional Mediterranean diet, the Nordic diet and the traditional Asian diet (Stromsnes, 2021).

I really think you can’t go wrong with an anti-inflammatory diet as there are only benefits and no negative side-effects of this eating plan.

Elimination Diet for Lipedema

Is it possible that the pain and discomfort of lipedema has particular food triggers? From what I have heard from my clients and the students of Lymphedema Nutrition School, I believe the answer to that is YES.

One method to identify food triggers – which is used particularly for people with gastrointestinal issues is an elimination diet.

Many tests to identify food intolerances are unreliable and an elimination diet remains one of the best tools for identifying food culprits. Eliminating multiple foods and substances at one time, then slowly reintroducing each food, one at a time, is the most reliable way to determine which foods are problematic (U of Wisconsin, 2018).

The elimination diet requires strict adherence, record keeping, and label reading and should result in symptom improvement. After five days of being symptom free, then the challenge phase can begin (U of Wisconsin, 2018).

To challenge the body, one new food can be added back to the diet every three days in increasing quantities and pure form (U of Wisconsin, 2018). Once food intolerance(s) are identified, an eating plan that excludes the offending foods/ingredients can be implemented.

Individuals may need to work with a registered dietitian-nutritionist, especially if the number of suspected foods/ingredients is high. It’s important to note that elimination diets are not meant to be used indefinitely, and an individual’s diet ideally should be as liberal as can be tolerated and still get results.

Intermittent Fasting and Lipedema

As well as specializing in cancer, lymphedema and lipedema, I happen to know a lot about intermittent fasting, as I researched and wrote my book Complete Intermittent Fasting.

There are three main benefits of intermittent fasting that can translate well to lipedema. Those are:

1. Weight management
2. Reduced Inflammation
3. Reduced blood sugar and insulin

Weight Management

I know what you’re thinking…you can’t lose lipedema fat with diet (which is debated by some), but, lipedema makes it easy to gain non-lipedema fat too. Stopping further weight gain or losing some non-lippy fat may help with some of the symptoms you are experiencing.

Can intermittent fasting (IF) slow lipedema fat gain? We don’t know the answer to that, as it has not been studied. But several studies of intermittent fasting show that in non-lipedema overweight individuals can lose weight at a rate similar to traditional calorie restriction, and most importantly, that IF is safe (Rynders, 2019).

While most studies show a similar loss of body fat compared to traditional calorie restricted diets (Rynders, 2019) a couple studies showed you lose more fat compared to traditional calorie restriction (Rynders, 2019, Hutchison, 2019).

Blood Sugar and Insulin

There is some speculation that blood sugar and insulin may be involved in the initiation and progression of lipedema.

Intermittent fasting has been shown to help lower blood sugar and insulin levels (Carter, 2018) . Can this translate into a benefit for lipedema? We don’t know the answer to this yet, but intermittent fasting is safe and has shown several health benefits (de Cabo, 2020).

Inflammation

Inflammation can be measured in the blood and if you don’t know your levels of inflammation yet, you can ask your doctor to test your CRP (C-Reactive Protein) level.

In an observational trial, findings suggested that eating more frequently, reducing evening calorie intake and fasting for longer overnight intervals lowered inflammation (Marinac, 2015). Could this translate into a slower progression of lipedema?

Based on the biological process involved in lipedema (described above) I think there is real potential. And…even if it didn’t, reducing inflammation in the body has overall positive health effects, as chronic inflammation is linked to Alzheimer, cancer, diabetes, heart disease and other conditions (de Cabo, 2020).

When it comes to intermittent fasting, I generally suggest people start with 12:12 time restricted feeding. This means, you eat within a 12 hour window and you fast 12 hours. You can gradually increase your fasting time. Ideally, you should pair your eating window with your chronotype.

There are several methods for Intermittent fasting including 5:2, alternate daily fasting and time restricted eating. Image by laurentvalentinjospi0 from Pixabay

Ketogenic Diet for Lipedema

The ketogenic diet is a high fat, low carbohydrate, moderate protein diet. It has been used for years to treat childhood epilepsy and it is now becoming popular as a weight loss diet. It is even being advocated by some for diabetes, cancer and other medical conditions.

There is a right way and a wrong way to do the ketogenic diet. The key to the ketogenic diet is to be in ketosis. This means that the body is using fat as its main fuel and producing ketones (beta-hydroxybutrate, acetoacetate and acetone).

A ketogenic diet should target less than 50 grams of carbohydrate per day and less than 10% of calories from carbohydrate. The blood ketone target should be 0.5 to 3.0 mg/dl (Gershuni, 2018).

Many of the beneficial effects attributed to the ketogenic diet are credited to the ketones and therefore a non-ketogenic low-carb diet may not produce the same effects as a true ketogenic diet (Gershuni, 2018).

As well as limiting carbohydrate, you can’t have too much protein, and ideally, you should measure your ketones via, breath or blood testing. Urine testing can be used in the first two weeks, but after that it is not accurate as the body starts to use ketones for energy.

Another important aspect of the ketogenic diet, is the type of fats you are choosing. While many claim that the ketogenic diet is anti-inflammatory – it isn’t always (Gershuni, 2018).

Some studies suggest ketogenic diets can increase inflammation (Rankin 2007, Rosenbaum 2007) . Be careful with the types of fat you choose.

Lipedema and Keto Diet Case Study

There has been one case study published in Italy featuring a 32 year old woman with lipedema type IV-V, stage 2-3 (Cannataro  2021).

• 200-250 kcal deficit from her usual intake
• 25 grams carbohydrates per day
• Protein:fat ratio 1:1 and 1:2
• Fish oil, vitamins C and D supplements

Ketogenic Diet Results

This young woman’s results included:

• Weight loss of 41 kg (90 lbs)
• Reduced body fat by 20%
• Significant reduction in insulin
• Reduced CRP (C-Reactive Protein- a measure of inflammation)
• Improved quality of life
• Improved quality of sleep

Mediterranean Diet for Lipedema

The Mediterranean diet is a great example of an anti-inflammatory diet. But let me stress, this is based on the traditional Mediterranean diet and not the Greek gyro, and fries diet from your local Greek taverna.

There is a published study of  29 women, 14 of whom had lipedema and 15 control subjects who did a modified Mediterranean diet (Di Renzo, 2021).  At the beginning of the study, there were no significant differences between the lipedema group and the control group for:

• Age
• Height
• Weight
• BMI
• Circumference measurements
• Waist:hip ratio

But, bioelectrical impedance and extracellular water were significantly different, indicating that those with lipedema were holding more water on their bodies. They were all instructed on a low calorie modified Mediterranean diet for 4 weeks. The diet was:

RAD Diet for Lipedema

RAD is rare adipose disease and the RAD diet is the diet that was developed by endocrinologist Dr. Karen Herbst to help her patients with lipedema, Dercum’s disease and other rare adipose diseases.

The RAD diet is described as follows on Dr. Herbst’s website (Herbst, 2012):

Avoid:

• Foods that contain “lots of chemicals” such as artificial preservatives, flavors, “fake sweeteners” like aspartame
• Colors and stabilizers which includes most prepared packaged and fast foods
• Foods with advanced glycated end products (which includes most cooked foods)

Limited intake of:

• Pasteurized dairy products
• Animal proteins
• Animal fats
• Simple sugars and carbohydrates (low glycemic) (Yes, I know this is incorrect, but this is how it is written on her website)
• Wheat or processed flour products
• Salt

Eat more of:

• Organic fruits and vegetables (which have enzymes that “roto-rooter” out stagnant protein)
• Whole grains
• Healthy proteins

In addition the diet recommends that you rest the gut by taking a day off and eating liquid type foods such as soups, stews (without meat or at least with pulled meats), smoothies, protein shakes, apple sauce, juiced vegetables and fruits.

I have a great deal of respect for Dr. Herbst and I have read many of her published studies on lipedema and adipose diseases, but this RAD diet seems to disregard the scientific method and it falls prey to many nutrition myths and fallacies.

Here are my comments and questions on the RAD diet (as it is described on lipomadoc.org):

• Since pasteurized diary products to be limited, are unpasteurized recommended or should all dairy be limited? and Why?
• Because glycated end products should be limited and its pointed out that cooked food have glycated end products, is the RAD diet recommending only raw foods?
• Simple sugars is an outdated term and not used anymore
• Low glycemic foods should be encouraged as they provide a lower insulin response
• Does this diet restrict all wheat? So only non-wheat whole grains are allowed?
• Recommending organic foods demonstrates a lot of privilege and with the high cost of lipedema care, this may isolate someone from following this diet
• If you are still eating soups, stews and smoothies, how does this give the gut a day off? Digestion still needs to take place and the nutrients in the food will still need to be processed. Whether you eat meat, potatoes and green beans or your throw it all into a pot with some water and call it stew…it still uses the gut

While some aspects of this diet – like eating more fruits and vegetables and reducing salt is great…but it seems to me that it would be very difficult to follow this diet, especially as it is described on the website.

I’ve had one client that was prescribed this diet and she were so overwhelmed with what NOT to eat, she was paralyzed and afraid to eat anything. Unless there is more to the RAD diet that what is listed on the website, then this protocol leaves me hungry for more….more detail…more rationale…more evidence….and more food I can actually eat.

I’m not the only one that voices similar concerns about the RAD diet, as researchers in Italy state that “the RAD diet excludes red meat, milk derivatives and sweeteners, but in the current state of things, there is no reason to exclude these or other foods” (Cannataro, 2021).

As a dietitian, I work with a LOT of different diets – diets for diabetes, high blood pressure, cancer risk reduction etc., and what these therapeutic diets have in common – is to only restrict what is necessary to get results.

Adding on restrictions like – only organic food, predominately raw foods and no wheat seems unsustainable. I want my clients to succeed and if I restrict more than is required to get results and more than they can maintain long-term, then the program will fail.

Could I get results with fewer restrictions? I think so, and that is why I will not be recommend the RAD diet protocol as is with my clients and students.

Lipedema Anorexia

Imagine being told by friends, family and the medical community that you “just have to eat less and exercise more”, over and over again. That is often the message that a woman with lipedema receives.

It could definitely lead someone to extreme behaviours, in fact eating disorder is a common comorbidity with lipedema (Herbst, 2021).

In one published case study, a women who had been misdiagnosed since age 12, and had a roux-en-y gastric bypass at age 21 took her disordered eating to an extreme that resulted in protein-energy malnutrition (Wright, 2021).

Thankfully, her lipedema was finally diagnosed at age 41 and she received the proper treatment, including total parenteral nutrition to correct her malnutrition and the lymphedema that it caused. This is an extreme example of why it’s so important to get the proper diagnosis for lipedema and treatment for lipedema.

Bottom Line on Diet for Lipedema

What is the best lipedema treatment diet? Like any diet therapy, I think it needs to be individualized to each person, but some of the common elements could be:

• Anti-inflammatory (even keto can be done in a way that is anti-inflammatory)
• Limited sodium (read more about that in my lymphedema diet blog)
• Intermittent fasting
• Aimed at weight maintenance or loss

In addition, if food triggers are suspected then either an elimination diet or a protocol for recording intake and symptoms to help identify and eliminate food triggers should be included. I also want to emphasize that medical nutrition therapy should be done with a registered dietitian.

Additional Resources for Lipedema Diet

I have several resources to share with you. In addition to this blog, I have two more that focus on lipedema and related topics:

• Treatment for Lipedema
• Cellulite vs Lipedema, Staging of Lipedema and More
• Anti-inflammatory diet
• Intermittent Fasting for Women Over 40

My book, while focused on lymphedema, has a lot of valuable information especially if you have lipo-lymphedema – The Complete Lymphedema Management and Nutrition Guide.

Lymphedema Nutrition School is my program for people with lymphedema and Lipo-lymphedema to help improve their condition with nutrition. It is available in the live class version and self-study.

I also offer virtual 1:1 nutrition counselling.

References for Lipedema Diet

Al-Ghadban S, Cromer W, Allen M, Ussery C, Badowski M, Harris D, Herbst KL. Dilated Blood and Lymphatic Microvessels, Angiogenesis, Increased Macrophages, and Adipocyte Hypertrophy in Lipedema Thigh Skin and Fat Tissue. J Obes. 2019 Mar 3;2019:8747461. doi: 10.1155/2019/8747461. PMID: 30949365; PMCID: PMC6425411.

Cannataro R, Michelini S, Ricolfi L, et al. Management of Lipedema with Ketogenic Diet: 22-Month Follow-Up. Life (Basel). 2021;11(12):1402. Published 2021 Dec 15

Carter S, Clifton PM, Keogh JB. Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Noninferiority Trial. JAMA Netw Open. 2018 Jul 6;1(3):e180756. doi: 10.1001/jamanetworkopen.2018.0756. PMID: 30646030; PMCID: PMC6324303.

de Cabo R, Mattson MP. Effects of Intermittent Fasting on Health, Aging, and Disease. N Engl J Med. 2019 Dec 26;381(26):2541-2551. doi: 10.1056/NEJMra1905136. Erratum in: N Engl J Med. 2020 Jan 16;382(3):298. Erratum in: N Engl J Med. 2020 Mar 5;382(10):978. PMID: 31881139.

Di Renzo L, Cinelli G, Romano L, et al. Potential Effects of a Modified Mediterranean Diet on Body Composition in Lipoedema. Nutrients. 2021;13(2):358. Published 2021 Jan 25. doi:10.3390/nu13020358

Gershuni VM, Yan SL, Medici V. Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Curr Nutr Rep. 2018 Sep;7(3):97-106. doi: 10.1007/s13668-018-0235-0. PMID: 30128963; PMCID: PMC6472268.

Herbst, K. RAD Diet. http://www.lipomadoc.org/blog/rad-diet Last updated. April 18, 2012. Accessed April 1, 2022.

Herbst KL, Kahn LA, Iker E, et al. Standard of care for lipedema in the United States. Phlebology. 2021;36(10):779-796. doi:10.1177/02683555211015887

Hutchison AT, Liu B, Wood RE, Vincent AD, Thompson CH, O’Callaghan NJ, Wittert GA, Heilbronn LK. Effects of Intermittent Versus Continuous Energy Intakes on Insulin Sensitivity and Metabolic Risk in Women with Overweight. Obesity (Silver Spring). 2019 Jan;27(1):50-58. doi: 10.1002/oby.22345. PMID: 30569640.

Marinac CR, Sears DD, Natarajan L, Gallo LC, Breen CI, Patterson RE. Frequency and Circadian Timing of Eating May Influence Biomarkers of Inflammation and Insulin Resistance Associated with Breast Cancer Risk. PLoS One. 2015;10(8):e0136240. Published 2015 Aug 25. doi:10.1371/journal.pone.0136240

Rankin JW, Turpyn AD. Low carbohydrate, high fat diet increases C-reactive protein during weight loss. J Am Coll Nutr. 2007 Apr;26(2):163-9. doi: 10.1080/07315724.2007.10719598. PMID: 17536128.

Rosenbaum M, Hall KD, Guo J, et al. Glucose and Lipid Homeostasis and Inflammation in Humans Following an Isocaloric Ketogenic Diet. Obesity (Silver Spring). 2019;27(6):971-981. doi:10.1002/oby.22468

Rynders CA, Thomas EA, Zaman A, Pan Z, Catenacci VA, Melanson EL. Effectiveness of Intermittent Fasting and Time-Restricted Feeding Compared to Continuous Energy Restriction for Weight Loss. Nutrients. 2019 Oct 14;11(10):2442. doi: 10.3390/nu11102442. PMID: 31614992; PMCID: PMC6836017.

Stromsnes K, Correas AG, Lehmann J, Gambini J, Olaso-Gonzalez G. Anti-Inflammatory Properties of Diet: Role in Healthy Aging. Biomedicines. 2021;9(8):922. Published 2021 Jul 30. doi:10.3390/biomedicines9080922

University of Wisconsin School of Medicine and Public Health. The Elimination Diet. Last updated Nov 2018. Accessed August 4, 2021.

Wright TF, Herbst KL. A 41-Year-Old Woman with Excessive Fat of the Lower Body Since Puberty with Progression to Swollen Ankles and Feet Despite Caloric Restriction, Due to Lipedema and Protein-Calorie Malnutrition: A Case of Stage 3 Lipedema. Am J Case Rep. 2021 May 7;22:e930306. doi: 10.12659/AJCR.930306. PMID: 33958571; PMCID: PMC8112463.