Lipedema is a common but misdiagnosed condition that is often misinterpreted as obesity. Lipedema affects almost exclusively women, and its painful and life-altering symptoms have long been thought to be resistant to lifestyle interventions such as diet and exercise.
Lipedema presents with a nodular aspect of subcutaneous adipose tissue. It even has its painful aspects and is often associated with obesity, but there are cases of lipedema in young women of normal weight. It is assumed that there is a genetic predisposition to lipedema. More than half of the patients have a first-degree relative affected. Although its incidence is mostly in women, lipodema is also seen in obese men or liver pathologies and there is an unbalanced testosterone/estrogen ratio.
Edema results from fluid imbalance due to lymphatic system dysfunction through fluid overload or impaired fluid transport.
Lipedema has severely altered the tissue, especially in the more advanced stages. Frequent nodular formations are a sign of a strong change in the skin and adipose tissue. Ease of bruising, pain is often noted, more often a feeling of tension is reported in almost all cases.
The immune system is also affected by the condition. In this context, inflammation plays a fundamental role. Inflammation can also be seen as a response to stressful stimuli.
Increased capillary permeability in lipoedema leads to capillary leakage and thus tissue edema. Mechanical irritation from large fat deposits near the joints can soften the skin; Such deposits on the thighs and around the knee joints can also interfere with normal gait and cause secondary arthritis. Other secondary effects include emotional discomfort and decreased self-esteem due to appearance.
Clinical Examination and Treatment
The three stages of the disease are related to the structure of the skin surface (stage I, smooth; stage II, irregular or corrugated; stage 3, markedly thickened and hardened) is characterized by progressive changes:
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Stage I: small nodules, reversible edema
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Stage II: walnut-sized nodules, reversible or irreversible edema
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Stage III: disfiguring fatty deposits, macronodular changes, accompanying lymphedema
The tissue tenderness characteristic of lipoedema can be checked with the pinch test, which is usually felt very uncomfortable in the affected areas but does not cause pain elsewhere. The components are:
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Manual lymph drainage regularly if needed
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Appropriate compression therapy with plain-knit pressure garments
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Physiotherapy and exercise therapy
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Psychosocial therapy
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Diet counseling and weight management
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Patient education on self-management.
Diet Therapy
Prominent items in nutrition recommendations in lipodema; p>
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Hypocaloric, weight loss with a personalized nutrition model,
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Anti-oxidative and anti-inflammatory components
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Ketogenic diet
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Includes edema removal.
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Avoid soy and foods that may contain estrogen
Many patients with lipoedema are known to also suffer from eating disorders. For this reason, diet planning with a dietitian is of great importance.
Lipedema adiposity is resistant to weight loss diets, but may respond to ketosis. Ketogenic diets modulate pain in lipedema independent of weight loss. Ketogenesis positively affects lymph vessel integrity and lymph transport. At the same time, ketone bodies play a key role in modulating inflammation and reducing oxidative stress.
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