June 2020

Nutritional Strategies for Lipedema

Ann DiMenna, PT, CLT, and Jean LaMantia, RD

In recognition of Lipedema Awareness month, we asked the co-authors of “The Complete Lymphedema Management and Nutrition Guide” to provide insight on nutritional strategies for those with lipedema. While changes in diet won’t reduce fat associated with the disease, it can help reduce inflammation and promote energy. Physiotherapist Ann DiMenna is the Clinic Director at Markham Lymphatic Centre, a physiotherapy clinic treating lymphedema patients in the Greater Toronto Area. She also is an active member of the Lymphedema Association of Ontario. Registered Dietitian Jean LaMantia offers diet and nutrition counselling to help people achieve weight goals, reduce lymphedema and reduce cancer risk. The book is available for purchase on Amazon and through Barnes & Noble.

From ketogenic and intermittent fasting – what is the right nutritional strategy for people living with lipedema? For many health care providers working with lipedema patients, we have often heard of a number of fad diets people have tried with little to no success. So, what works?

Very few research studies on humans have been conducted on nutritional strategies for lipedema. Only anecdotal studies exist on the ketogenic diet and lipedema. A ketogenic diet is a very high fat, very low carbohydrate diet and only enough protein is consumed to meet needs protocol. It is designed to change the body from burning glucose as the main fuel to burning fat. There has been one study published of 12 people with lymphedema and ketogenic diet but unfortunately, the diet instructions used in this study were to eat unlimited amounts of protein foods, which is not consistent with a ketogenic diet. In addition, the participants were not required to test their ketone levels and so no conclusions can be drawn about ketogenic diet, ketosis and lymphedema based on this study (Keith, 2017).

Intermittent fasting may be an option to consider. Intermittent fasting focuses on the timing of meals and fasts, with less attention paid to the actual foods consumed. For example, a 16:8 intermittent fast would require someone to fast for 16 hours (water, coffee and tea are permitted) and to eat during an 8-hour “feeding window.” There have been many studies published on both daily and hourly fasting protocols, which show mostly positive results for weight loss and improvement in metabolic changes including lower insulin and glucose levels, lowered insulin resistance, HDL and LDL cholesterol and inflammation (de Cabo, 2019). In the end, more research studies are needed in this area.

Other strategies such as the anti-inflammatory diet and supplementation with selenium-rich foods may also prove to be effective solutions. Selenium is a trace element that plays a role in inflammation and immune function. In a study published in 2020, 47% of people tested with lymphedema and lipedema appear to have a selenium deficiency. The suggested daily intake is 55 mcg (micrograms) per day, which can be found in foods such as brazil nuts, mushrooms, seafoods, beans, meats and poultry.

Lymphedema/lipedema, obesity and inflammation are linked and will continue to promote each other unless you break out of this cycle. As a result, an anti-inflammatory diet is another option to consider. This diet is based on modification of a traditional Mediterranean diet to be lower in fat. To achieve an anti-inflammatory diet, your diet should be:

  • Rich in vegetables, fruits, whole grains, herbs and spices
  • Moderate in omega-3-rich fish
  • Moderate in anti-inflammatory nuts and oils
  • Moderate in legumes
  • Low in meats, sweets and seeds
  • Very low in processed foods, salt, fatty meats, high-fat dairy and other fatty foods
  • Sparse in inflammatory oils
  • Use of MCT oil in place of oils that contain long-chain fatty acids

More details on the anti-inflammatory diet are available in The Complete Lymphedema Management and Nutrition Guide. A number of chapters detail the science behind the diet and helpful recipes and tips you can implement. Follow the Markham Lymphatic Centre on Facebook, Twitter and Instagram for more resources.

References:

  • Keith L, Rowsemitt C and Richards L. Lifestyle Modification Group for Lymphedema and Obesity Results in Significant Health Outcomes. American Journal of Lifestyle Medicine. Nov 2017.
  • de Cabo R, Mattson M. Effects of Intermittent Fasting on Health, Aging and Disease. N Engl J Med. 2019. 381; 2541-2551
  • Pfister C, Dawczynski H, and Schingale FJ. Selenium Deficiency in Lymphedema and Lipedema—A Retrospective Cross-Sectional Study from a Specialized Clinic. Nutrients 2020, 12(5), 1211; https://doi.org/10.3390/nu12051211
  • University Health News - Selenium Foods: Boost Your Intake of This Nutrient. https://universityhealthnews.com/daily/nutrition/top-11-selenium-foods-boost-your-intake-of-this-essential-nutrient/ - retrieved June 14, 2020.
  • LaMantia J, DiMenna A. The Complete Lymphedema Management and Nutrition Guide. Robert Rose Books, 2019. Pages 155-163.

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