What should I eat for lipoedema and lymphoedema?

Reduce and maintain weight

What should I eat for lipoedema and lymphoedema?

How to support your lipoedema and lymphoedema therapy with a healthy diet

When we eat healthily, we feel fitter, sleep better, and have more energy throughout the day. And also: Lipoedema patients should be particularly careful to maintain or reduce their weight. They can benefit greatly from preventing obesity through a balanced diet.

Studies show that approximately 50 percent of patients with lipoedema also struggle with being overweight. 1 As a result, their symptoms worsen: This often leads to increased water retention and mental stress.

Dieting is not the right approach. Instead strive for a conscious, balanced diet or nutritional change to achieve lasting success.

In addition to the five main pillars of CPD (Complex Physical Decongestion Therapy: Manual Lymph Drainage, Compression Therapy, Exercise, Skin Care, Self-Management), proper nutrition plays a very important role in supporting therapeutic success

I have lipoedema - can I lose weight if I change my diet?

If you change your diet and become physically active, you can avoid or reduce the risk of becoming overweight. But this has little influence on the proliferation of fatty tissue on your extremities caused by the disease. Nevertheless, an adapted diet makes sense, because you can avoid secondary diseases related to being overweight.

One such disease is diabetes (also called diabetes mellitus type II). Lipogenesis (i.e. the storage of fat in depots) is stimulated in diabetes.

Reduce lip- and lymphoedema complaints with a healthy and balanced diet

Patients can reduce their discomfort and pain by up to 80 percent with a long-term dietary change. This was demonstrated by a study at the Centre for Vascular Medicine in Hamburg with obese lipoedema and lymphedema patients. In addition, less therapy was needed.2 2

Healthy indulgence: Tips for a healthy and balanced diet

A healthy and varied diet as well as sufficient liquid intake can support the positive effects of a therapy and counteract possible complications.

  • Fruit and vegetables: Many colourful and fresh fruits and vegetables provide you with all the important substances your body needs. We recommend two portions of fruit and three portions of vegetables per day. More portions of vegetables can be consumed because, unlike fruit, they do not affect blood sugar levels. This means that they keep you feeling fuller for longer. Use the traffic light principle for variety on your plate: treat yourself to green, yellow and red fruits and vegetables.
  • Healthy fats: Fat is not always bad. Linseed oil, seeds, avocados and nuts are very important to the body. You should reduce fats from baked goods, margarine and sunflower oil.
  • Meat, sausage and cheese: Reduce your consumption of meat, sausage and cheese products.
  • Less salt: Do not eat a lot of salt because salt binds water in the tissue.
  • Breaks between meals: In a meal, a lot of energy is consumed that the body does not use immediately. This excess energy is stored in the body in the form of fat or glycogen, which is a carbohydrate. The body draws on this between meals. If there is not enough time between meals, you take in more energy than you need. This is then stored as fat deposits.
  • Blood sugar levels: Avoid foods that raise blood sugar quickly: These include ready meals, jams, fizzy drinks, sweets, white flour foods, such as baguettes, rolls, toast, biscuits, and more.

  • Drink enough: at least two litres of liquids such as water or unsweetened tea. Avoid sugary soft drinks and juices. They contain unnecessary calories. And please refrain from drinking alcohol.

  • Move as well: Exercise also helps you feel good in your own body and reduce stress. Walking in the fresh air is particularly suitable for clearing your mind.

Lose weight with lipoedema thanks to ketogenic protein-optimised nutrition

"Lipodema patients have to take responsibility for their own journeys in life."

The rumour is persistent: Patients with lipoedema can forget about losing weight. Dr Gabriele Faerber proves the opposite and obtains measurable successes in the treatment of lipoedema with her ketogenic protein-optimised nutrition programme. She is head of the department for outpatient weight management and obesity treatment at the Centre for Vascular Medicine in Hamburg (Zentrum für Gefäßmedizin Hamburg). Alongside the right nutrition, she communicates one thing above all to her patients: You are in charge of your own journey in life.  

In an interview with medi, Dr Faerber gives valuable tips about losing weight with lipoedema.

Read the whole interview with Dr Gabriele Faerber here

Dr Faerber, are there also slim lipoedema patients?

“Lipoedema is a fat distribution disorder with a tendency towards disproportion. Lipoedema patients are not always overweight. There are also patients with a dress size of 38 [UK 10] who have thickened fat tissue under the skin. And disproportion is not always an indication of lipoedema. If there are no additional symptoms, this is known as lipohypertrophy: an accumulation of fat tissue at the extremities. The most important criterion for the diagnosis of lipoedema is sensitivity to touch and pressure.”

Does this sensitivity to touch disappear after liposuction or weight loss?

“On a scale from 1 to 10, my patients usually indicate a reduction in pain levels from 6.5 to 2.5. After four years, the value indicated was still 3. Both a change of diet and also liposuction can reduce pain and the feeling of heaviness. The extent of this reduction cannot be predicted in advance.”

Are there women with fat legs who do not have lipoedema?

“Some people have fatter noses, others have fatter legs. If there are no other symptoms then it’s just an anatomical variation. In some cultures, powerful thighs are regarded as attractive but this is not the case here. This is particularly difficult for young girls. Extreme sport and diets don’t work for lipohypertrophy or for lipoedema. This is frustrating and they then say: “My legs are still fat so I might as well eat whatever I want.”

Why is it so important to reduce excess weight?

“Being overweight and the associated metabolic changes make every oedema worse. Lipoedema patients can lose weight too. The legs will still look different to the upper body, even after weight reduction, but the symptoms are reduced.”

Why do lots of people find it difficult to lose weight?

“In my opinion, the biggest risk factor for obesity is the constant availability of food. If we only ate three times a day, without the latte macchiato or biscuits as snacks, obesity would not be much of an issue. Some specialists who recommend eating five meals a day are also responsible for this negative development. Instead of eating five balanced meals, people then predominantly eat bread and sweet things.”

Why does incorrect nutrition make us ill?

“If I keep eating something that keeps driving my blood sugar level up, i.e. mainly carbohydrates, then this will be damaging to my health. In principle, insulin can promote inflammation. That’s why an unhealthy diet can lead to vascular disease or high blood pressure. In the case of lipoedema, this is made worse because insulin activates aromatase: an enzyme that transforms testosterone into estradiol in the fatty tissue. Therefore, if I have a lot of fatty tissue and produce a lot of insulin as a result of my diet, this creates a hormonal imbalance.”

Why is ketogenic protein-optimised nutrition so good for lipoedema patients?

“It lowers insulin production. The balance of vegetables and good proteins has a positive effect on the intestinal flora. Instead of losing important lean body mass, I lose excess fat. The body needs protein for repair and development processes. The lack of protein caused by starving yourself leads to muscle loss, which, in turn, lowers the metabolic rate. If I then eat “normally” afterwards, I start the infamous yoyo effect and put on more weight than I lost by dieting. Nature has cleverly designed it to be like this because this ensures that, after a period of hunger, we can quickly gain weight again. Nowadays, crash diets have the same effect.”

What happens to the body during ketosis?

“Ketosis is a type of metabolic state that we achieve if we our carbohydrate consumption remains below a certain level. When the carbohydrate reserves are used up in the form of glycogen, the body has to manufacture glucose for the brain by itself. During fasting, it uses amino acids from the muscles to do this; on the ketogenic protein-optimised diet, it uses the dietary proteins. This prevents muscle loss from occurring. When the gradual changeover to fatty acid oxidation (known colloquially as fat burning) takes place, ketones or ketone bodies are created. The organs and the brain can use this for energy production. The ketones have a satiating and slightly mood-enhancing effect. The symptoms may subside after just a few days, the legs feel lighter – without feeling hungry.”

Does this mean that your patients avoid fat?

“We need fats so we operate a fat modification method, rather than fat avoidance. Essential fatty acids, omega-3 fatty acids, olive oil, rapeseed oil, linseed or fish oil and also good butter from grass-fed cattle are all allowed. The quantity is critical. If I am aiming for a negative energy balance, I avoid whipped cream. But good oil goes with salad.”

What is a ketogenic menu like?

“Ketosis only occurs when the daily carbohydrate consumption stays below a certain level. On average this is 50 grams per day. Patients should eat two large handfuls of vegetables twice a day. You can also eat fish, meat, eggs and dairy products, such as quark, skyr or cottage cheese. The required amount of protein is around 1.2 grams of protein per kilogram of normal weight. One portion of protein corresponds roughly to the size and thickness of the surface of your hand.”

Is this diet suitable for vegetarians or vegans?

“In theory, yes: Vegetarians simply replace meat and fish with tofu, cheese, quark and eggs. Although pulses contain protein, they also contain a high level of carbohydrates and are therefore not part of a ketogenic diet. This diet is difficult for vegans to follow. They would have to use tofu and other protein-rich replacement products.”

Is fruit allowed?

“Although the sugar contained in fruit is healthier than industrial sugar, it should be avoided when first switching over to the new diet. At a later stage, a daily portion of fruit is allowed again. This should be eaten straight after a meal when the blood sugar increase is not as significant.”

Do your patients stop eating sweet treats forever?

“My patients learn what foods are good for them. If they stick to the diet, then they can also have the odd snack. Of course you’re allowed to have a slice of cake on your birthday – the best kind would be a protein-rich quark cake.” And what can you drink on this diet? “Water, black coffee or unsweetened tea are allowed. We avoid juices and soft drinks. If you want to lose weight, you should avoid alcohol. When everything is going well for my patients, they can have the odd glass of wine.”

Why is it so important for patients to take responsibility for their own journeys?

“Liposuction is an option for women with severe symptoms. But, essentially, lipoedema patients have be responsible for their own journeys: with healthy eating, sport and stress reduction. My message to them: Accept yourself as you are instead of trying to copy unrealistic ideas. And allow yourself to get help when you need it.”

Dr Faerber, thank you very much for the interview.

Sources

S1-Leitlinie Lipödem, AWMF Reg.-Nr. 037-012, Stand Oktober 2015. Online published on: http://www.awmf.org/leitlinien/detail/ll/037-012.html (Last accessed 03.05.2018). 
Faerber, G. Ernährungstherapie bei Lipödem und Adipositas – Ergebnisse eines leitliniengerechtes Therapiekonzepts. vasomed 2016;4:176-177. Online published on: www.der-niedergelassene-arzt.de/fileadmin/user_upload/zeitschriften/vasomed/Artikel_PDF/2017/04-2017/Faerber.pdf (Last accessed 03.05.2018).

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