WHAT IS LIPEDEMA
Lipedema: Adipose Tissue Disorder
Lipedema is a chronic condition caused by an abnormal proliferation and deposition of adipose/fatty tissue. It is not obesity. This condition is present in approximately 11% of the female population. (Foldi et al, 2005)
Lipedema was first recognized by The Mayo Clinic in 1940.
What are the underlying triggers?
Lipedema may be inherited and often arises in relationship to hormonal changes such as at puberty, during pregnancy or peri-menopause.
Lymph fluid accumulates around the proliferating fatty tissue, which compromises the integrity of the lymphatic system causing the body tissue and limbs to appear engorged and swollen. Blood vessels, capillaries, nerves & lymph vessels in the regions of the fatty tissue deposits are contorted or squeezed by the presence of the enlarged fat cells. The blood capillaries being fragile will become leaky, putting more fluid into the tissues which often respond to light pressure with bruising. Squeezed nerves in the affected region are much more sensitive to touch.
Eventually, with the presence of extra fluid and the enlarged fatty deposits, the lymph vessels which are already contorted and overwhelmed are unable to remove the excess fluid. This can then add lymphatic dysfunction to the fatty tissue disorder. This is known as a Lipo-lymphedema.
-Bilateral, symmetrical fatty deposits in the legs and arms of women. It is rare in males.
- Typically affects legs (upper and/or lower), buttocks, hips, arms (upper only or upper and lower)
- Usually the trunk, feet and hands are unaffected, unless there is a lymphedema component.
- Often, a “bracelet” of fatty tissue can be palpated, just above the wrists and ankles.
- Skin is typically silky smooth, with indentations from the nodules of fat (similar to a cushion with a button sewn into it).
-Not uncommon to have spider veins, skin infections, large fat gains & reduction in mobility.
-Due to poor recognition of this condition, it is not uncommon for depression & anxiety to be present.
How can you manage Lipedema?
The following “conservative measures” will aid in pain reduction & hypersensitivity:
1. Compression garments - knee high, thigh high, leggings, arm compression sleeves (while highly recommended, are often not tolerated in the beginning)
2. CDT - Complete Decongestive Therapy (particularly recommended if there is a lymphedema component, such as lipo-lymphedema)
3. MLD - Manual Lymphatic Drainage massage (especially useful to improve circulation, decrease sensitivity/pain and improve tolerance of compression)
4. Dry Brushing (if tolerated)
5. Dietary measures to reduce inflammation & weight loss: - Most women with lipedema will have been told (especially at onset) to diet or restrict caloric intake.
Lipedema fat itself does not respond to dieting. However, Jean LaMantia, Nutritionist could provide useful information on general dietary principles*.
6. Exercising is highly recommended for optimal health and pain management. Aquatic exercise is especially effective, when the body if vertical in the water the hydrostatic pressure of the water creates compression.
7. Pain needs to be managed, & social support is necessary to overcome emotional issues.
8. Therapists do not prescribe, but supplements such as Dr. Karen Herbst’s Supplement Protocol, may be helpful.
9. Surgical measures: Lymph sparing Liposuction
In BC, patients need prior approval from the Medical Services Plan (MSP) for surgery to be covered. There an only a few surgeons qualified to perform this surgery on patients with Lipedema
The VGH Lymphedema program started performing de-bulking liposuction in 2021.
However due to the number of lymphedema patients on the wait list they are not taking lipedema patients at this time.
For further information refer to: CLF website https://canadalymph.ca
Lymphedema Guru blog Lipedema
* Jean LaMantia www.jeanLaMantia.com