Managing Lipoedema
One of the things I found the most time consuming while building my lipoedema management plan was hunting down all the known treatments and lifestyle changes that can be beneficial. So I’ve compiled them here for you, a ‘catalogue’ of key treatments and lifestyle changes that consistently appeared in my research as drivers of improved quality of life and reduction of symptoms.
This isn’t an exhaustive list, nor does it have in-depth descriptions of each – there’s plenty of information online and in my Research Library, no need to repeat it here. This is simply intended as a starting point, to give direction to your own research and planning.
Food and Nutrition
See also: ‘Diet and Nutrition’ section of my Research Library. Diet and nutrition is a fundamental to managing lipoedema, and it was the very first priority on my lipoedema management plan. I had a fairly good diet already – mostly whole foods, minimal sugar and processed foods. But when I started digging into the nutritional requirements that our lipoedema bodies have, I realised there were still plenty of foods that I was eating that were driving inflammation. I was also eating foods high in histamine multiple times a day – spinach, tomatoes, avocados etc.
This diet was the most-mentioned throughout all of my research. It focusses on fresh whole foods, fruits, vegetables that are rich in fiber, healthy fats, and antioxidants while limiting processed foods, sugar and inflammatory substances. It’s well-established for overall health benefits, with some evidence suggesting potential benefits for reducing inflammation associated with lipoedema. Read more.
Book Recommendation:
This book covers a broad range of the nutritional needs of women with lipoedema, including anti-inflammatory eating. It’s authored by an all-star line-up of lipoedema and lymphoedema researchers and clinicians, and you’ll also find an ‘Eating to starve lymphoedema and lipoedema’ medical conference presentation by one of the authors (Chuck Ehrlich) on my Research Library page, in the ‘Nutrition & Diet’ section.
- High in healthy fats, moderate in protein and very low in carbohydrates.
- There’s some research specifically on the effects of the keto diet on lipoedema, but more is needed. It seems to offer some benefits by improving insulin sensitivity, reducing inflammation and driving weight loss. Read more.
Book recommendation:
The Ketogenic Solution for Lymphatic Disorders (Author: Leslyn Keith)
- This eating approach emphasizes protein intake while restricting carbohydrates to help manage blood sugar levels and potentially reduce inflammation.
- Some evidence suggests potential benefits for weight management, which can be beneficial for some lipoedema sufferers.
A Histamine-Restricted Diet eliminates or limits foods high in histamine, to potentially reduce inflammation and improve symptoms.
What the research says: Limited research specifically on lipoedema, but may be beneficial for some individuals with histamine intolerance. I found enough research linking mast cell activation and histamine to lipoedema, to convince me that this diet is worth including.
It was the hallmark of my own dietary approach and I experienced positive results within days. It can be quite restrictive, especially when combined with the high protein/low carb diet as I did, but it was 100% worth it. I did 3 months of low-histamine + low carb/high protein, and was able to reintroduce foods without experiencing the reactions that I’d had before (rashes, headaches, itching, swelling).
It’s worth also reading about DAO – the enzyme that breaks down histamine. Some of us may be low on DAO, which contributes to the excess histamine in our system. I purchased DAO supplements and take one before a meal if I know it contains high histamine foods. You can also eat particular foods like pea sprouts to increase your DAO.
Book recommendation:
Decongestive Therapy
Graduated compression garments that apply varying levels of pressure to the limbs. These come in various ‘strengths’ and generally it’s recommended that patients with lipoedema use Class II medical compression. There’s also a lot of recommendation to use custom ‘flat knit’ compression garments (extremely expensive), but I have done fine with normal round knit. I buy from Amazon for about $30.
What the research says: Well-established for reducing swelling and improving lymphatic drainage.
- Professional MLD: Specialised massage techniques designed to improve lymphatic flow.
- What the research says: Some evidence suggests potential benefits for reducing swelling and improving lymphatic drainage.
- Self-Massage: Techniques individuals can learn to perform themselves to improve lymphatic flow.
- What the research says: Limited research specifically on self-massage for lipoedema, but may offer some benefits when performed correctly.
- Pneumatic Compression Systems: Devices that use air pressure to massage the limbs, aiding in lymphatic drainage. I love pneumatic compression, particularly after leg day in the gym, it’s so relaxing. But I find that it’s effects only last a couple of days so I rarely book a session.
- What the research says: Growing evidence supports their effectiveness in reducing swelling and improving lymphatic flow
A Histamine-Restricted Diet eliminates or limits foods high in histamine, to potentially reduce inflammation and improve symptoms.
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- Research: Limited research specifically on lipoedema, but may be beneficial for some individuals with histamine intolerance. I found enough research linking mast cell activation and histamine issues to lipoedema to convince me that this diet is worth including. It was the hallmark of my own dietary approach and I experienced results within days.
Non-surgical treatments
Extracorporeal Shockwave Therapy and Ultrasound Cavitation therapy are both in their early days of research for lipoedema treatment. The few studies that I’ve found involve only very small cohorts, so hopefully there are larger studies in the pipeline with a more significant cohort size. But both therapies are showing extremely promising (and statistically significant) results in both reduction of limb size, and reduction of pain.
I’m interested in finding out why out why these therapies aren’t more widely used – this 2013 study out of Cairo University’s Faculty of Medicine showed that cavitation was more beneficial than liposuction in terms of thigh circumference reduction, which seems significant. Perhaps it’s a question of long term efficacy – i.e. there doesn’t appear to be any indication of whether the treatments need to be ongoing for life.
Extra Corporeal Shockwave Therapy uses high-energy sound waves to stimulate tissue repair and reduce pain. It can break up soft tissue calcifications, enhance collagen synthesis, release growth factors, and stimulate your body’s healing process to improve pain. It’s only performed by medical professionals – here in Australia it tends to be physiotherapists and podiatrists.
What the research says: There’s a little bit of promising research specifically on shockwave therapy for lipoedema, showing a reduction in limb circumference and reduction in pain. Read more in the ‘Shockwave and Ultrasound Cavitation’ section of our Research Library.
More research is needed, and it’s challenging to find a clinician in Australia who can perform the treatment – most aren’t familiar with lipoedema. I had my shockwave treatment (10 sessions) done in Thailand and it was very successful – significant reduction in pain, significant reduction in feeling of heaviness, small reduction in limb size, activation of slow/weak muscles, improvement in skin condition.
Ultrasound Cavitation uses ultrasound waves to break down fat cells. This treatment can be performed by non-medical professionals such as beauty therapists, or at home.
What the research says: A small amount of promising research on ultrasound cavitation as a treatment for lipoedema, showing promising results in limb size reduction. See the ‘Shockwave and Ultrasound Cavitation’ section of our Research Library for details.
Exercise
Low levels of physical exercise are a risk factor for further deterioration of lipedema, so finding an exercise program that works for you is a crucial part of your lipoedema management program.
Exercise promotes circulation and can aid in lymphatic drainage, helping to reduce swelling associated with lipedema as well as improvements in mitochondrial function, lymphatic drainage, and reduction of inflammation.
Further reading: The Role of Physical Exercise as a Therapeutic Tool to Improve Lipoedema: A Consensus Statement from the Italian Society of Motor and Sports Sciences (2024)
Aquatic exercise (and hydrotherapy) involves the use of water for therapy, rehabilitation, exercise and relaxation. It can decrease pain and swelling, increase function, strength and range of movement and has also been shown to improve mood and sleep in some, fitness and weight loss in others. For lipoedema patients, aquatic exercise / hydrotherapy is recommended as an excellent form of exercise for improving lymphatic flow and improving strength with low impact on joints.
What the research says: Again, there’s little research on the impact of hydrotherapy on lipoedema, but links are made to the benefits of hydrotherapy on lymphoedema (i.e. reduction in limb circumference), as well as reduced burden on joints and increased caloric utilisation.
I find swimming to be a great way to exercise without impact on my joints – I include a short session (either swimming, or walking through the water) after a weights workout and find it prevents muscle soreness.
A Dutch study in 2017 found that lipoedema patients had significantly lower muscle strength in quadriceps than the control group. Maintaining mobility is an important goal in the management of lipoedema, and muscle strength plays a big part in that goal. Strength training builds stronger muscles that can help improve mobility and balance, and can support the joints and reduce the load borne by the limbs – potentially decreasing pain levels. Increased muscle mass also helps boost metabolic rate, which can assist in managing overall body weight. Strengthening stabiliser muscles throughout the body can also help with hypermobility / Ehler’s Danlos.
Weight/strength training doesn’t have to involve complicated equipment or heavy weights – you can start with bodyweight exercises and exercise bands.
What the research says: Little research related to weight / strength training specifically for lipoedema, but recommendations for ideal physical exercise include muscle strengthening in conservative treatment programs to treat the common muscle weakness associated with lipoedema.
A low-impact exercise that can improve lymphatic flow and overall fitness. The movement of the ankle and knee joints and contraction and relaxation of the calf muscles help move lymphatic fluid out of the legs and feet which may in turn reduce swelling in the legs, ankles and feet. You need a small trampoline/rebounder and 10-15 minutes per day.
What the research says: I couldn’t find any formal research indicating that rebounding is effective for reducing the symptoms of lipoedema, but that doesn’t mean that it isn’t!
Lymphatic flow requires muscular contraction from exercise and movement, gravitational pressure, and internal massage to the valves of lymph ducts, and the most common theory is that rebounding stimulates the lymphatic system by activating all three of these conditions, therefore also reducing lipoedema symptoms.
I have no opinion on this one. Jumping up and down without an expensive rebounder (e.g. with a skipping rope) does exactly the same thing, it’s just not as gentle on your joints. Or if you have children and they have a trampoline in the back yard, you could spend 10-15 minutes on it with them rather than buying another expensive piece of equipment. As an ex-gymnast, I prefer a full-sized trampoline to be honest – far more fun! But I can see how buying a rebounder might be a great option if you want to do this exercise while you’re working from home, or watching a movie etc.
Whole-body vibration therapy that may improve circulation and lymphatic drainage.
What the research says: I could find no research specifically on vibration plates for lipoedema treatment, but it seems that links are being made to evidence related to the general benefits of vibration therapy, including increased blood flow to the skin (and indirectly, improvement in lymphatic flow), improved strength, weight loss and improved bone density as summarised nicely here by Dr Wright.
Skin Care
Skin care is a topic that doesn’t have a lot of research specifically in relation to it’s benefits for treating lipoedema. But it’s a topic that has plenty of anecdotal evidence and support particularly from lymphoedema clinicians and therapists. Under the skin is a delicate network of lymphatics, so it makes sense that the health of one impacts the health of the other.
Dry brushing benefits both the skin and the lymph system:
– skin exfoliation, improve surface circulation, improve overall health and appearance of the skin
– improving blood circulation and stimulate your lymph system potentially helping to reduce swelling
What the research says: I couldn’t find any research specifically on dry brushing for lipoedema (it may exist, I just couldn’t find it), but I found plenty of articles by lymphatic clinicians describing the benefits, for example this article by Lymphatic Therapy Services. Considering the number of clinicians that recommend it, and considering a brush is likely to cost less than $10, I saw skin brushing as a beneficial and low risk treatment to add to my lipoedema management plan. I found it particularly effective for exfoliation, which helped to clear and prevent tiny hard bumps that were appearing on the skin of my legs.
Lipoedema skin has a distinctive loss of elasticity, and can can become sensitive and dry due to compression garments and fluid retention. Over time, lipoedema can also cause a thickening and hardening of the skin due to fibrosis. Daily moisturising can help to prevent these issues, and maintain the health and integrity of your skin.
What the research says: Again, I found no formal research regarding the importance of daily moisturiser for women with lipoedema, but plenty of credible advice and information from clinicians (including my own doctors) that moisturising daily is crucial for skin health, particularly if wearing compression daily.
I’ve found it beneficial – my skin is naturally quite dry and thin, but since adding twice-daily body moisturising (once before I put on compression in the morning, and once in the evening) to my routine my skin is hydrated and has no dry/itchy patches or the hard bumps that used to appear on my legs.
Surgery
The two most common surgical options appear to be Tumescent Liposuction and Water Assisted Liposuction (WAL), preferred for their lymph-sparing approach. Traditional ‘dry’ liposuction is not recommended due to potential damage to lymphatics. A third type, Power Assisted Liposuction (PAL) is also discussed but as yet I haven’t found any substantial mentions in research.
One thing I appreciated in surgery research was the number of stage 1 and 2 patients included (often including specific recommendations), which I’ve rarely seen in any conservative therapy information.
Studies show significantly reduced sensitivity to pain and pressure, as well as reduction in the tendency to hematoma, improved mobility leading to an increase in energy turnover, which can contribute to further weight loss and significant improvement in quality of life. I found very little information about the risk of lipoedema developing in other parts of the body after surgery, which is a known potential side effect of surgery.
Lymph-sparing liposuction using local tumescent anesthesia is considered an effective approach for lipoedema, with significant improvement in pain, quality of life and leg size.
‘Tumescent’ anesthesia is a special form of local anesthesia in which large amounts of an anesthetic solution (a physiological solution with local anesthetics and epinephrine) are introduced into the subcutaneous adipose tissue. This local anesthesia swells the adipose cells and constricts vessels, and makes large areas of the skin insensitive to pain – surgical interventions can be carried out without an additional anesthetic procedure.
What the research says:
Tumescent liposuction in particular looks to be an effective method of treatment that produces better results in younger patients with earlier stage disease and a more significant reduction in the need for ongoing decongestive therapy, compared with the results in older patients with more severe disease.
The effectiveness of liposuction using tumescent anesthesia is driven by not only removal of fat, but also the capillaries, including the leaky vessels so common in lipoedema resulting in far less bruising after the liposuction.
See the ‘Surgery’ section of our Research Library for more reading.
Water Assisted Liposuction (WAL) or ‘Body Jet’ has also been shown to offer significant improvement of symptoms, mobility and quality of life. Water Assisted Liposuction uses pressurized tumescent solution to dislodge the fat from surrounding connective tissue and vessels, rather than the blunt micro-cannulas used in tumescent liposuction.
Theoretically, water assisted liposuction should be even gentler than the tumescent liposuction.