Today’s study was done by a group of researchers in Russia. The title of the paper is Influence of Ketogenic Diet and Nutraceutical Correction in the Complex Treatment of Lower Limbs Lipedema, and it was published in The Bulletin of Rehabilitation Medicine in October 2021.
What was the aim of the study?
The authors report the goal of their study as follows: “To study the effect of the keto diet, accompanied by the correction of changes in the intestinal microbiome and hepatoprotection, on the reduction of body fat in lipedema and the dynamics of changes in lipid and carbohydrate metabolism.”
What is Nutraceutical Correction?
I want to point out that the authors reported that they believed it was necessary to use what they termed a “nutraceutical correction” (supplements) due to a possible misunderstanding about the likelihood of a ketogenic diet causing gut dysbiosis and fatty liver disease.
The authors cite one review article (Paoli et al., 2019) that examined the risk of gut dysbiosis with a ketogenic diet. Nine studies were reviewed. Three of the 9 studies were animal studies and provided data and conclusions that may not be very applicable to humans. Another 3 of the studies reviewed were on children with epilepsy. It is well known that the ketogenic diet used historically for this population was not very well-formulated and, although it managed seizures very well, had other adverse side effects. That left 3 studies to draw their conclusions from. The human population studies in these remaining studies included: Glucose Transporter 1 Deficiency Syndrome, Autoimmune Multiple Sclerosis, and elite race walkers, all very obscure groups with limited generalizability. Further, the sample size in each of these 3 studies was very small, ranging from 6 to 29 participants. The intervention length of one study was only 3 weeks, while the other two were 3 months and 6 months. In my opinion, this seems like very flimsy evidence to base a fear of gut dysbiosis.
Additionally, the causal link between the consumption of saturated fat and fatty liver disease seemed to be based on one animal study. There are multiple studies using human subjects that show a ketogenic diet can actually reverse fatty liver disease (Watanabe et al., 2020).
Who were the participants?
60 patients with lipedema representing stages 1-3 (using a 3-stage model of the disease) were included in this study. The average age of the participants was 55 years and the average length of time they had lipedema was 10 years.
What were the methods used?
The participants were randomly divided into 2 groups for a 4-week intervention. Group 1 (n=30) used a low-calorie, low-fat diet, consuming 1300 calories a day with 25% of calories in fats. This diet was very low in protein at only 15% of calories and high in carbohydrates at 60%. They also did gym exercises for 30 minutes a day, 5 days per week, as well as daily walking of up to 3-5 km a day.
Group 2 (n=30) used a ketogenic diet composed of 55% of calories in protein, 30% in fats, and 15% in carbohydrates. This group also received special probiotic supplements and participated in the same gym exercises and daily walking as used by Group 1.
Here are the assessments/measurements utilized:
- Height and weight, with BMI calculated
- Body measurements of legs, waist, and hips
- Bioimpedance to measure body composition (percent body fat and edema)
- Blood panel including total cholesterol, LDL, HDL, triglycerides, glucose, ACT, AST, ALT, leptin, and insulin
What were the results?
Group 1 (Low Fat): weight decreased by 2.3%, BMI decreased by 3.1%, decrease in muscle mass by 4.1%, and decrease in the extracellular fluid by 4.18%. There was a statistically significant decrease in total cholesterol and HDL and an increase in triglycerides. Changes in insulin levels were not significant and leptin decreased by 12.73%.
Group 2 (Keto): weight decreased by 3.74%, fat mass decreased by 6.49%, lean mass by 4.56%, and decrease in total fluid and extracellular fluid by 5.93% and 6.32%. Decreased levels of total cholesterol and triglycerides, decreased leptin expression by 32.02%, and decrease in blood insulin levels by 9.87%.
| Group 1 (Low Fat) | Group 2 (Keto) | |
| Weight | decreased 4.7 lbs. | decreased 7.6 lbs. |
| Fat Mass | decreased 4 lbs. | decreased 5.69 lbs. |
| Lean Mass | decreased 10.2 lbs. | decreased 5.6 lbs. |
| Total Body Water | decreased 4 lbs. | decreased 5.25 lbs. |
| Extracellular Water | decreased 1.5 lbs. | decreased 2.65 lbs. |
| Total Cholesterol | decreased .57 mmol | decreased .55 mmol |
| HDL | decreased .25 mmol | decreased .35 mmol |
| LDL | decreased .4 mmol | decreased .09 mmol |
| Tg | increased 17 | decreased 30 |
| Leptin | decreased by 12.73% | decreased by 32% |
| Insulin | No change | decreased by 9.87% |
While both groups lost weight, it was only in the keto group that this was correlated with greater limb volume reduction, fluid loss, and fat mass decrease. The keto group also showed greater leptin and insulin decreases and a corresponding triglyceride decrease.
What were the conclusions?
The keto group outperformed the low-fat group in every measure in this study. The authors conclude that a ketogenic diet with appropriate supplementation and exercise can be an effective treatment for lipedema.
Takeaways
While it is unfortunate that the outcomes are somewhat clouded by the use of supplementation in this study, overall this research has made a nice contribution to the concept of managing lipedema symptoms with nutrition. Because the biggest difference between the two diets in this study was the amount of carb restriction and protein allowance, the results suggest that restricting carbs may reduce the intake of potentially inflammatory foods, which has a favorable impact on symptoms of lipedema.
For more updates on the latest research regarding lipedema, check out Lipedema Simplified’s Flash Briefings. It’s our daily mini-podcast where we share tips, tools, and research pertaining to Lipedema.
~ Leslyn Keith, OTD, CLT-LANA
Board President, Director of Research | The Lipedema Project
References:
Paoli, A., Mancin, L., Bianco, A., Thomas, E., Mota, J. F., & Piccini, F. (2019). Ketogenic diet and microbiota: friends or enemies?. Genes, 10(7), 534. https://pubmed.ncbi.nlm.nih.gov/31311141/
Watanabe, M., Tozzi, R., Risi, R., Tuccinardi, D., Mariani, S., Basciani, S., … & Gnessi, L. (2020). Beneficial effects of the ketogenic diet on nonalcoholic fatty liver disease: A comprehensive review of the literature. Obesity Reviews, 21(8), e13024. https://pubmed.ncbi.nlm.nih.gov/32207237/