“Although dietary interventions were once considered ineffective for managing lipedema, emerging evidence increasingly supports the therapeutic potential of CHO reduction in alleviating lipedema symptoms.” (Reedy et al., 2025)
Lipedema, a disorder of fat accumulation, has limited treatment options. Evidence suggests that dietary carbohydrate restriction – a ketogenic diet, specifically – may be effective for targeting stubborn lipedema fat, as well as for decreasing pain and inflammation and improving quality of life even in the absence of significant weight loss. However, a strict ketogenic diet can be difficult to adhere to consistently, and, like any dietary or lifestyle change, successful implementation requires attention to comorbidities, cultural issues, mental health, capacity for change, and other factors.
A paper in Recent Progress in Nutrition provides a comprehensive framework for tailoring a low-carb nutritional strategy to patient needs and preferences specifically in the context of lipedema. This patient-centered, holistic approach starts by acknowledging that therapeutic carbohydrate restriction (TCR) encompasses a wide range of carbohydrate intake, and that benefits can be experienced even when carbs are not reduced to a ketogenic level (typically < 50 g/day, and often < 20-30 g/day).
Insulin sensitivity and carbohydrate tolerance vary widely among individuals, and a more generous carbohydrate intake of up to 130 g/day allows flexibility for those who prefer a vegetarian approach, whereas staying at the very low end of carb intake facilitates a larger intake of animal foods. It is noted, however, that some of the therapeutic benefits of carbohydrate restriction may not be realized unless someone does limit carbs to the point of generating ketones.
The paper covers common comorbidities with lipedema, such as hypothyroidism, sleep disorders, chronic venous disease, and others, and the role of TCR in improving these, with mention of specific nutrients that may be beneficial for addressing these, and those that may exacerbate them.
Beyond the “nuts and bolts” of TCR for lipedema, the authors also address critical psychological aspects of dietary change, particularly related to a condition that can so dramatically reduce quality of life. The patient-centered holistic approach presented includes guidance on addressing depression and anxiety, socioeconomic status, the importance of community, cultural and ethnic influences, and more. All of these can affect capacity for change and capacity to adhere to any dietary or lifestyle change, not just reducing carbohydrates.