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A guest blog post by Dr. Karen Herbst, M.D., Ph.D. This article starts with a basic review of lipedema, then explores how patients can treat the condition at home during a pandemic. It is a 7-minute read.
Approximately 11% of the female population has some degree of lipedema. There are three stages of lipedema and the first stage can be hard to detect. However, even if a woman is very athletic and has significant muscle mass, she will have small nodules of fat under the skin in Stage 1.
Most women who have lipedema are at Stage 2, displaying pearl-like to apple-like fatty masses with irregular overlying skin. These women often display the “mattress phenomenon,” with an almost fluffy look to the skin’s surface due to the underlying fat nodules.
By Stage 3, the woman is developing fibrosis around her fat cells and fat lobules. Lipedema is not just fat; it’s also fibrosis and fluid, which is why it is highly resistant to dieting, exercise, and bariatric surgery. In Stage 3, a woman’s body has changed shape significantly and she may have a loss of mobility. She is at high risk of developing lymphedema at this stage.
Lipedema Treatment During a Pandemic
If a patient has too much fluid in the interstitial space due to lipedema, she’ll need ongoing treatment for the condition. Consistent treatment is quite effective, but it is, of course, difficult to arrange during the shutdown of the COVID-19 pandemic.
What can a patient do to manage lipedema from home during a quarantine period? I’d like to share some at-home treatment options that can help someone with lipedema self-manage their condition.
As I mentioned earlier, diets and weight-loss plans rarely make a significant impact for lipedema patients due to the trio of fat, fibrosis, and fluid. However, it’s beneficial for a patient to reduce the salt intake in their diet.
Sodium causes enhanced capillary filtration, creates more interstitial fluid flow, and stimulates interstitial matrix production. This can worsen lipedema. Of course, some women have other conditions for which sodium restriction is not advised. Each person should follow their own doctor’s advice in terms of limiting their salt intake.
Hormones, Food, and Supplements
Unless absolutely necessary, avoid the use of corticosteroids (mimics the hormone cortisol in the body). Also, encourage stress management techniques such as breathing methods to reduce stress because stress keeps cortisol in the body chronically high.
Fresh, anti-inflammatory foods should be a priority for lipedema management during a quarantine period.1 Avoid processed foods, which are typically high in sodium and preservatives.2
Anti-inflammatory supplements may be helpful, as long as the patient responds well to them.3 These include Diosmin and Vitamin C.4
Body movement is essential to creating much-needed negative interstitial fluid pressure for lipedema patients. As the body remains immobilized, the pressure creeps up toward zero. Movement restores the desired negative pressure.
Another route to creating the right pressure is found in the application of external forces. This includes activities like stretching and swimming, plus the use of compression garments and pumps.
Manual therapy from a professional is very effective but may be difficult to impossible to access during a pandemic. For this reason, a sequential pneumatic compression pump may be the best option for someone who is homebound during a quarantine period.
Why does this work? There is evidence that mechanical stretching prevents pre-adipocytes from becoming fat cells. Under external forces, cells spend more time healing than on triglyceride storage.
Pumps improve fluid flux into the capillary, reduce inflammation, and promote the health of the interstitial space. Ensure that in using the pump, the patient is treating these essential areas where fluid is at risk of accumulating:
- Medial knee
- Medial elbow
- Inner thigh
A pump must be used properly in order to get the best results and avoid fluid movement that is counterproductive. For example, don’t focus only on the lower legs, because this will simply move fluid into other undesirable areas like the inner thigh and abdomen.
Maximizing the Effects of Pumping
For patients who use sequential pneumatic compression pumps, there are things they can do to get the most benefit from the device. I have seen positive results from combining the following activities with pump use:
- Exercise, including walking
- Elevating the legs
- Using compression garments
- Whole-body vibration
- Deep-tissue treatment with the hands
- Gua sha tools
- Bouncing up and down while standing or on a trampoline
- Squeeze-and-release action on the tissue, including yoga
- The dead cat shake, lying on your back or standing and shaking your arms and legs
During the COVID-19 period, I urge anyone with lipedema to continue with the protocols that positively impact their condition. Take action now to prevent the condition from worsening and transitioning to a more severe stage of lipedema or even lymphedema.
Eat anti-inflammatory, enzyme-rich foods. Get exercise of any kind, even if it’s just the dead cat shake. Use compression garments and sequential pneumatic compression pumps regularly.
Thank you so much for your time. Please remember that it is up to all of us in the medical community to support women with lipedema, especially as they struggle to maintain their treatment regimens during this pandemic.
About Dr. Herbst
Dr. Karen Herbst, M.D., Ph.D. is board-certified in endocrinology and has held faculty positions at Martin Luther King Drew Medical Center/UCLA, VA San Diego Health Care System/UCSD, and the University of Arizona. She won the Lifetime Achievement Award from Tucson Business and was named one of America’s top physicians. You may recognize her as the research physician on Mystery Diagnosis, featuring a man with Dercum's Disease (The Man with 1000 Lumps). Now retired, Dr. Herbst is currently pursuing a career in private practice and research.
1. Chuck Ehrlich, Emily Iker, MD, Karen Louise Herbst, Ph.D., M.D., Linda-Anne Kahn, CMT, CLT-LANA, Dorothy D. Sears, Ph.D., Mandy Kenyon, MS, RD, CSSD, and Elizabeth McMahon, Ph.D., Lymphedema and Lipedema Nutrition Guide, LymphNotes.com, accessed June 1, 2020, http://www.lymphnotes.com/nutrition.php.
2 Deanna M. Minich, A Review of the Science of Colorful, Plant-Based Food and Practical Strategies for “Eating the Rainbow”, Hindawi Journal of Nutrition and Metabolism, Hindawi.com, accessed June 1, 2020, https://www.hindawi.com/journals/jnme/2019/2125070/.
3. Tanaka H, Lund T, Wiig H, Reed RK, Yukioka T, Matsuda H et al. High dose vitamin C counteracts the negative interstitial fluid hydrostatic pressure and early edema generation in thermally injured rats. Burns 1999;25:569–574.
4. McGregor GP, Biesalski HK. Rationale and impact of vitamin C in clinical nutrition. Curr Opin Clin Nutr Metab Care 2006; 9: 697-703. doi: 610.1097/1001.mco.0000247478.0000279779.0000247478f.