Lipedema - Dr. Reid's Corner

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Lipedema - Dr. Reid's Corner

Postby patoco » Mon Oct 23, 2006 8:55 pm

Lipedema - Dr. Reid's Corner

I have received many questions about the relationship between excess weight and lymphedema and the response to last months survey was amazing. It is clear that many people are concerned about the relationship between weight and lymphedema. Another issue that comes up frequently. How to distinguish lymphedema from lipedema. A very good article was published in the April edition of Consultant (2001) 41, 613. The figure demonstrating lipedema is from that article.

Lymphedema and lipedema are often confused. Lymphedema is due to increased lymphatic pressure with accumulation of edema in the subcutaneous tissue. Over time this results in firming or hardness of the tissues that is characterized by fibrosis. In contrast, lipedema results from the deposition of excess fat in the subcutaneous tissues but does not involve lymphatic hypertension or abnormal lymphatic vessels. The excess fat is normal in appearance under the microscope and there is generally no abnormalities of the lymphatic channels. In addition, there is no abnormal accumulation of excess edema or fibrosis in lipedema.

There are several features about lipedema that distinguish it from lymphedema. One of the most notable differences is the fact that the feet are generally not involved in lipedema. The excess accumulation of subcutaneous fat can involve the entire leg but will generally stop at the ankle, leaving a characteristic ring at the base of the ankle where the lipedema stops. Another difference is the fact that the excess fat is generally symmetric so that both legs are involved equally. In many patients, only the lower extremities and the buttocks are involved, with no excess accumulation of fat in the arms, chest or abdomen. Chronic venous insufficiency can cause a similar appearance; however, chronic venous insufficiency results in swelling of the feet and the accumulation of subcutaneous fluid. The pitting edema seen in lymphedema and in edema due to congestive heart failure is generally not seen in lipedema. This is why leg elevation can be helpful to many patients with venous stasis and to some patients with lymphedema, but is rarely helpful for patients with lipedema. The excess fluid seen in venous insufficiency and lymphedema causes darkening and fibrosis of the skin over time. These skin changes are not seen in lipedema. Congestive heart failure can cause swelling in the legs; however, lipedema is characteristically seen in women and generally starts during adolescence. These patients do not have heart failure. Ulcers and recurrent infections are commonly observed in venous stasis and lymphedema respectively, but are rare in lipedema.

Lipedema generally starts slowly during adolescence and progressively worsens over time, especially in patients who gain significant amounts of excess weight. Dieting can result in a normal appearance in the upper body but persistently enlarged legs. Diet control can be helpful in the management of lipedema since it appears that excess fat preferentially accumulates in the lower extremities. Patients with lipedema often have a history family members with disproportionately large legs.

The treatment for lipedema is generally diet control. Excess weight will preferentially accumulate in the lower extremities. However, even strict dietary measures may not result full resolution of the lower extremity accumulation of lipid. Elevation and compression have modest impact since there is no vascular compromise and no interstitial fluid that needs to be removed. Some efforts have been made to treat lipedema with surgical removal of the excess fat. It is too early to determine the long-term effects of these surgical treatments.

Tony Reid MD Ph.D

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Postby silkie » Thu Oct 26, 2006 10:37 pm

As a person with both Primary lymph and lip
this is very confusing as the symtoms overlap

And i would like to question Dr Reids actual idea that lipedema can be helped by diet when from actual experience dieting does not help

Unless you aiming to lose body fats elsewhere

With lipoedema to lose weight from the infected limbs is near impossible

especially when very few sufferers are even diagnosed till later on in life

When the problems is so out of contol because of non recognition of lip

even mis diagnosis many people with lipedema are told they have lymphedema.

If you have both lymph and lip diet is doubly confusing
one condition alls for high protein diet the other low protien the experts advice us

Also lymphedema is helped enormously by compression garments
success with reducing lymph can cause garment to cause breakage of the skin around the ankle as the overhang from lip causes garments to dig in around the crease of the ankle
As you are all aware a break in the skin can cause infections where the MLD has to stop or you cannot wrap or wear garments because of very painful skin and wounds This causes the swelling from the lymph to return very quickly

Dor reid states diet can help i am afraid if they do its the upper part of the body

Also lip can be in the upper part of the body too
Very little help and research with lip is going on

I can only desribe the problems having both primary LE and Lip bring
from over 40 years of trying to deal with it and only six years of doctors recognising that i had the condition in the first place

over 40 years of accumilation of fluid from lymph and fat cells not being
broken down into my body by lip 40 years of my very obvious condition not being recognised Spending nearly 30 years on diets these by nutritionist hospitals etc without success

I think the diet has to be specifically for the needs of lipos normal dieting does not help

the condition causes pain huge limbs so excercise becomes more and more difficult. depression gathers momentum in many that do not have
any condition but obesityaccording to the doctors they have saught help from

you become larger and larger till your self esteem is buried under the condition called lipedema

and one of the worse pressures on sufferers of lipedema is the assumption by medical proffesionals and society is you are just another

overeating wont help yourself lazy woman who lies about an eating problem

Normal dieting does not help lipdema

I am sorry but this is my opinion from over 40 years of dealing
with lipedema without any help or recognition of the condition
by Doctos

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