Hi, it’s Leslyn Keith here again with another Research Update. As a consultant for Lipedema Simplified, I’m excited to share insights from recent research that can help those affected by lipedema. Today, we will explore findings from a significant study that examines the relationship between endotoxins, inflammation, and lipedema.
Key Study Overview
This pivotal paper is titled “Is the endotoxin–complement cascade the major driver in lipedema?“ by Dr. Kruglikov from Germany and Dr. Scherer from the USA and was published in the peer-reviewed journal Trends in Endocrinology & Metabolism in September 2024. This opinion article discusses a potential pathway for chronic low-grade inflammation in lipedema, which contributes to resistance to fat loss and promotes further adipose tissue expansion.
Hypothesis and Mechanisms
The authors propose that an underlying cause of lipedema may be an accumulation of bacterial lipopolysaccharides (LPS)—also known as endotoxins—in lower body fat. Combined with a malfunctioning immune system, this accumulation can induce low-grade inflammation and uncontrollable fat tissue growth.
Understanding Bacterial Lipopolysaccharides (LPS): These toxins exist inside bacterial cells and are released when bacteria die. The release of endotoxins into surrounding tissue can lead to a condition called metabolic endotoxemia and has been linked to various chronic conditions such as heart disease, autoimmunity, anxiety, insomnia, depression, insulin resistance, diabetes, and weight gain. LPS can cross from the gut into the bloodstream in conditions like leaky gut syndrome, triggering a strong immune response.
The Special Role of the Complement System
A critical component of the immune system is the Complement System, a group of proteins that work with the immune system to protect the body from infections and remove dead cells. These proteins are usually inactive until activated by pathogens or antibodies. However, if this immune response is muted or impaired, it can lead to further complications.
Lipedema and Pregnancy
Pregnancy can trigger lipedema symptoms and mimic characteristics of lipedema itself. During pregnancy, fat on the hips and thighs proliferates and becomes resistant to reduction—similar to what is observed in lipedema. An increased burden of LPS may exacerbate this low-grade inflammation due to higher intestinal permeability linked to elevated estrogen levels present during pregnancy and in women with lipedema.
Inflammation and Changes to Adipose Tissue
This paper highlights research that shows that obesity, lipedema, and lipohypertrophy are characterized by chronic low-grade inflammation. Elevated levels of aromatase, an enzyme that converts androgens into estrogen, have been found in lipedema fat tissue. Excessive aromatase may also contribute to inflammation.
Conditions Associated with Lipedema
The authors note several conditions commonly observed in patients with lipedema that correlate with elevated LPS levels:
- Morbid Obesity: LPS levels are significantly elevated in individuals with morbid obesity. A high prevalence of morbid obesity is associated with later stages of lipedema.
- Hypothyroidism: The incidence of hypothyroidism is estimated at 31% in patients with lipedema compared to 5% in the general population.
- Allergies/Asthma: Increased intestinal permeability is noted in allergic diseases like asthma; asthma prevalence is around 18% in patients with lipedema.
- Polycystic Ovary Syndrome (PCOS): There is an increase in blood LPS concentrations in PCOS patients who also have obesity. PCOS has been noted in some patients with lipedema.
- Lymphedema: Elevated levels of LPS can cause lymphatic cells to release proinflammatory cytokines that increase inflammation. It is fairly common for patients with lipedema to also have lymphedema.
Conclusion
The findings from this study indicate that managing endotoxemia may be crucial for reducing the progression of lipedema and improving symptoms for many patients. This research provides valuable insights into potential interventions for those affected by this condition.
In summary, this paper offers another possible avenue for intervention and management of troubling symptoms associated with lipedema. By focusing on managing endotoxemia, individuals affected by this condition may find relief from their symptoms and improve their quality of life.
Stay tuned for more updates on research related to lipedema as we continue to provide valuable information on managing this condition effectively!
~Leslyn Keith, OTD, CLT-LANA
Board President, Director of Research | The Lipedema Project