Lipedema is a chronic medical condition affecting the fat tissue. It results in an uneven fat distribution in the body, with the hips, legs and arms most likely to be affected. It afflicts women predominantly and generally begins in puberty. It is chronic and progressive. While it might look like cellulite it is not.
Treatment includes compression garments, manual lymphatic drainage, exercise and skin care. Diet can also play an important role in managing the symptoms of lipedema and this blog post will explore the research on low carb diet for lipedema. This blog does not replace a nutrition assessment from a registered dietitian.
Low Carb Diets and Lipedema, Study Review
This study took place in Norway with 70 of women with lipedema and a BMI between 30 and 45 kg/m2 (A BMI above 30 is classified as obesity) (Lundanes, 2024). The women were divided into groups based on their BMI and randomized to one of two diet groups, either: a low calorie low carbohydrate diet or a low calorie control diet.
The daily diets were matched for calories and both contained 60 grams of protein per day.
The details are as follows:
Low Carb Diet
1200 calories
75 grams of carbohydrate
60 grams of protein
73 grams of fat
The ratio of fat:protein+carb for this diet is 73:135 or 1:1.8, so this is not technically a ketogenic diet, but blood and urine ketones were measured and a target level was set (keep reading for more details on this). I also have a detailed blog on ketogenic diets and lipedema.
This diet was mainly meat, poultry, fish, eggs, nuts and small amounts of low carbohydrate fruits, vegetables and diary. Olive oil was used instead of butter and whole fat dairy foods were minimized.
Control Diet
1200 calories
180 grams of carbohydrate
60 grams of protein
27 grams of fat
The ratio of fat:protein+carb for this diet is 27:240 or 1:9
This diet was mainly whole grains, including bread, pasta, rice, legumes, fruits, vegetables and moderate amounts of eggs, meat, poultry, fish and low fat dairy.
In addition, both groups were encouraged to drink a minimum of 2 litres of calorie-free fluids per day and to take a multivitamin-mineral and continue with physical activity.
During the eight weeks of the study, the participants measured their urinary and blood ketone levels weekly. The goal was for those in the low carb group to be in ketosis, so if the urine showed less that 0.5 mmol/L of acetoacetate or the blood showed less than 0.3mm/L of Beta-hydroxybutyrate then the carbohydrate in the diet was reduced further.
In contrast, if any of the participants in the in the control group had over 0.5 mmol/L of acetoacetate in the urine or more than 0.3mm/L of beta-hydroxybutyrate in the blood, then more carbohydrate was added.
If anyone on the low carb diet were negative for ketones more than twice, or if anyone in the control group were positive for ketones more than twice, then they were excluded from the final analysis.
In addition everyone in the study was required to complete daily food journals.
Results of Low Carb Diet for Lipedema
Pain
The women in the low carb group reported a significant reduction in pain – including several different measures of pain. This was not true for the control group. There was no association between pain and the level of ketones in the blood or urine. The pain was also not correlated with the amount of total body water, intracellular water or extracellular water.
Quality of Life
Quality of Life was measured by three different questionnaires (for details see the reference section of this blog).
After the eight weeks of dieting, both groups of women reported significant improvements in physical functioning, energy levels and general health.
The low carbohydrate group had some additional improvement in their physical health, emotional health and emotional and social functioning. Overall the improvements that the women on the low carb diet reported for energy levels, emotional well-being, and social functioning were larger than the improvements for the control group. In addition, only the low carb group reported improvements in their sex life.
Weight Loss
The women in the low carb group lost more weight compared with the control group, but the amount of weight loss was not associated with the changes in pain. This would lead researchers to conclude that the weight loss was not the reason for the pain reduction.
I want to point out, that low carb diets consistently show more weight loss compared with higher carb diets in the short term. This is because the body stores sugar as glycogen in the muscles along with water. When carbohydrate is restricted, the body releases the glycogen to be used as fuel along with the water.
But, there was more fat loss seen with the low carb group – this is a good outcome. All weight loss is a combination of fat and muscle, but ideally you want to lose more fat and retain as much muscle as possible.
The pain of lipedema is thought to be due to pressure on the nerves, fluid accumulation and inflammation. It would be reasonable to hypothesize that the reduction in fluid could be partly responsible for the pain reduction.
Water Loss
Both groups of women lost body water, both from the intracellular space as well as the extracellular space. There was no link between pain reduction and loss of body water. Surprisingly, the amount of water lost was the same for both groups despite the fact mentioned above the low carb diets result in a loss of glycogen muscles stores along with the water that is contained within.
Summary
In this study that compared a low carb diet to a normal diet diet for women with lipedema, the big winner for pain reduction was the low carb diet…but clarifying the mechanism of that pain reduction proved a mystery.
It wasn’t due to weight loss, the presence of ketones or water loss. It must therefore be due to an unknown variable that wasn’t assessed during the study…perhaps blood sugar or insulin levels? One way to measure your body’s response to blood sugar is to test for insulin resistance with a blood test called a HOMA-IR.
HOMA-IR stands for homeostatic model assessment of insulin resistance, it measures the presence and severity of insulin resistance. It is a way to measure the responsiveness of your body’s insulin to rises in your blood sugar level. When you have insulin resistance, this can make weight loss very difficult and it it persists, can lead to type 2 diabetes.
In a different study of a low carb, high fat diet (ketogenic) on women with lipedema. This diet (although different from the 75 gram carb diet discussed above) did show a reduction in fasting insulin levels (without a change in fasting blood sugars), improved HOMA-IR and insulin levels (Jeziorek, 2023). But, this was not measured in this low carb study, discussed above, so we don’t have proof that this is the reason for the pain reduction seen with the low carb diet.
We will have to wait for more research to understand the mechanism, but it is nice to know that a full ketogenic diet is not necessary, which may be a relief for some who find the very high fat intake and very limited carb to be unsustainable.
Conclusion of Low Carb Diet and Lipedema
According to the study reviewed in this blog, the 75 gram low carb diet with calorie restriction allowed women with lipedema to lose weight and reduce lipedema pain. The exact mechanism beyond the pain reduction is not know, but hopefully future research will help to pinpoint that.
An important tool to help you track your diet and your lipedema symptoms are the lipedema journals, available in three formats: weekly, semi-weekly and daily. These are ideal to helping you to stay on track with your lipedema self-care and diet and to help you evaluate how well these strategies help you to manage your symptoms.
Should I follow a Low Carb Diet for my Lipedema?
I think the 75 gram carbohydrate diet is a reasonable option. Keep in mind, that this study only lasted eight weeks, but working with a dietitian when you do a therapeutic diet can help to ensure that your diet is good for the long term. There have also been studies showing pain reduction in women with lipedema on a ketogenic diet as well as a Mediterranean Diet, so you have options for how you want to manage your lipedema with diet. For detailed help and ongoing support, consider joining Lymphedema Nutrition School.
For more information on lipedema diet, download my free lipedema PDF.
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Low Carb Diet for Lipedema References
Lundanes J, Sandnes F, Gjeilo KH, Hansson P, Salater S, Martins C, Nymo S. Effect of a low-carbohydrate diet on pain and quality of life in female patients with lipedema: a randomized controlled trial. Obesity (Silver Spring). 2024 Jun;32(6):1071-1082. doi: 10.1002/oby.24026. Epub 2024 Apr 16. PMID: 38627016.
Jeziorek M, Szuba A, Sowicz M, Adaszyńska A, Kujawa K, Chachaj A. The Effect of a Low-Carbohydrate High-Fat Diet on Laboratory Parameters in Women with Lipedema in Comparison to Overweight/Obese Women. Nutrients. 2023 Jun 2;15(11):2619. doi: 10.3390/nu15112619. PMID: 37299581; PMCID: PMC10255157.
