Today I’d like to feature two papers that detailed a case study of a woman with lipedema using carbohydrate restriction. The first paper is by a group of nutritionists in Poland. One of the authors, Magdalena Jerzak, will be working with Lipedema Simplified as a Keto coach. This paper is entitled Low-carbohydrate (non-ketogenic diet) – also an effective possible intervention in lipoedema. A case report of the patient. It was published in the journal Drugs in Poland in October 2021.
The second case study paper is out of Italy, led by Dr. Roberto Cannataro. The paper is called Management of Lipedema with Ketogenic Diet: 22-Month Follow-up. Dr. Cannataro has written several papers about using a ketogenic diet for various conditions. As you might have guessed, both case studies showed significant results even though the diets used were a little different from each other.
Let’s explore each case study.
Polish Case Study
In the Polish case study, the woman was 28 years old and had just been diagnosed with lipedema two years prior. The onset of lipedema was at puberty, with disproportionate weight gain in her lower body. She reported a family history of lipedema as both her mother and grandmother had a body shape. She also reported a history of not eating meals on any kind of regularity and often snacking on sweets.
When she first met with the dietitian as part of this case study report, she stated that she suffered from an eating disorder. She also had a history of negative experiences related to weight-reducing diets and working with dietitians and personal trainers. She suffered from depression, poor body image, pain in her legs, painful menstruation, and premenstrual syndrome. The baseline measurements included blood work for insulin levels, lipid profile, kidney function, and liver function, as well as body measurements. Because she had become obsessed with weight, she was not weighed initially. After about four months, her weight was measured at 77.5 kg or 170 lbs.
Her Eating Plan
Because of her eating disorder, the nutritionists in this study decided to use a low carbohydrate diet instead of the lower carb levels used in a ketogenic diet, so her eating plan was composed of fresh vegetables, low-carbohydrate fruits (such as berries), healthy sources of fats (such as olive oil, nuts, seeds, and avocados), fish, and various types of cheeses and legumes.
Other activities
During the case study period, this patient also began using other self-management techniques as she began to feel better, such as lymphatic drainage, brushing, anti-swelling creams, and compression therapy.
Results of this case study
After approximately seven months of gradually decreasing her carbohydrate intake and increasing her protein and fat intake, she was able to achieve the following results:
- Weight decreased by 5 kg or 11 lbs (from her weight taken at the midpoint of the intervention)
- Body measurements showed that all parts of the body decreased evenly, without any visible disproportion
- There was a significant improvement in well-being. Symptoms of PMS subsided and the pain with menstruation and in her legs reduced.
- Blood work showed that she had been insulin resistant, but this was resolved. The values for her lipid profile, liver tests, and kidney function were now all in the normal range.
This case study also presented the patient’s perspective. She reported that she had tried and failed many diets as well as used what she called “murderous workouts,” all unsuccessfully. She reports that things began to improve for her when she got a diagnosis of lipedema and realized that it wasn’t her fault. After achieving success with a low-carb diet in this study, she “learned to accept my body and take care of it the best I can. Lipoedema ceased to appear as a problem that can’t be solved.”
Italian Case Study
The Italian case study was about a 32-year-old woman diagnosed with lipedema in her lower body and upper arms. She complained of widespread pain, particularly in her legs, heaviness, and difficulty moving. Baseline measurements included pain, quality of life, sleep quality, body composition, and phase angle (which is a measure of cell membrane quality.) Blood work included ketone and glucose levels, insulin, HbA1c, Vitamin D, CRP, and others. Please see the article for the entire list of blood tests performed.
Her Eating Plan
The eating plan they chose to use was ketogenic with carbohydrates restricted to 25 grams per day. Additionally, they chose to emphasize protein to ensure that weight loss was not from losing muscle.
This eating plan was divided into 4 percent of calories from carbohydrates, 30 percent from proteins, and 66 percent from fats. Foods included meats (such as veal, pork, chicken, turkey), and fish (especially those of a fattier variety, such as salmon, anchovies, or mackerel), any kind of seafood, eggs, and dairy products. She was encouraged to eat in-season vegetables that had lower carbohydrate content (such as eggplant, peppers, and tomatoes). Any kind of tubers, squash, legumes, as well as any type of cereal, were excluded due to their high carbohydrate content. The sources of fat were mainly extra virgin olive oil and nuts or seeds.
Interestingly, she did not always follow her diet precisely, especially during holidays, and she reports a flare-up of pain during these times that resolved when she got back on plan. This case study also used supplementation which included omega3 fish oil, vitamin C, and vitamin D.
Other activities
Like the first case study, this patient also engaged in other activities to manage her lipedema, including 1 ½ to 2 hours of brisk walking per week and 1 to 2 times per week of 30-minute low-intensity weight lifting sessions.
Results of this case study
Here are some of her results at the 18-month follow-up:
- Weight loss was 41 kg or 90 lbs
- Percent body fat decreased by almost 20 percent
- Blood work improved: insulin resistance and CRP were significantly reduced and vitamin D levels increased
- Phase angle improved indicating improved cell membrane health
- Body measurements decreased everywhere on her body, but also significantly in the areas affected by lipedema
- Questionnaires showed improvement in quality of life, activities of daily living, and sleep quality. She reported an improved perception of her health and felt like her lipedema was more manageable.
Takeaways
These papers are important for women with lipedema for several reasons. First, it is wonderful to see not only an interest in diet and nutrition interventions for lipedema but also in carbohydrate restriction specifically. It was great to see how the investigators in both studies sought to individualize an eating plan that encouraged carbohydrate restriction but suited each patient’s needs.
Both of these papers, incidentally, referenced our paper published at the beginning of 2021, Ketogenic Diet as a Potential Intervention for Lipedema. In general, though, the number of papers published exploring the causes and treatment of lipedema continues to expand, especially in the last several years, which is exciting!
~ Leslyn Keith, OTD, CLT-LANA
Board President, Director of Research | The Lipedema Project