Researchers deliver a verdict on supplementation in managing lipedema

Improper use of nutritional supplements has resulted in poor results and sometimes severe side-effects, even from safe supplements, researchers explain in a new research review paper.

Since there is a general lack of specific literature on supplements that support lipedema (a condition that causes excess fat to accumulate in the lower part of the body), they set out to analyse the effectiveness of existing products and formulate recommendations based on “solid scientific rationale​”.

Products were judged based on current knowledge about lipedema and through assessment of scientific studies on diseases with similar pathologies.

Anecdotal evidence​

Recommendations for vitamins D and B12, magnesium, selenium, and Butcher’s Broom (ruscus genus) in managing symptoms are based on anecdotal experience, but there is no scientific foundation, the authors assert.

While evidence supported the beneficial effects of vitamin D and B12, an analysis of the mechanistic activity of magnesium, selenium and Butcher’s Broom revealed no direct impact on disease outcomes.

The authors therefore questioned the logic of current commercial guidance and described their use as “inappropriate​” or “ineffective”​.

Positive action​

A “double positive action​” was considered for vitamin C in lipedema management, given its biochemical antioxidant, anti-inflammatory action, and support for collagen (connective tissue) synthesis.

This activity was observed by the researchers in a case study on lipedema alone, that reported a “particularly favourable outcome​” with 1g per day of 500mg of ascorbic acid.

Similarly, they note the antioxidant activity of polyphenols and curcumin that downregulates pro-inflammatory pathways and stimulates ROS production and may help relieve disease pathology.

As a consequence, researchers “strongly recommended extra virgin olive oil (EVO) as a seasoning fat”​ or oleuropein and its derivatives, where cost is an issue.

Studies demonstrate that diets rich in polyphenols have important mitigating effects on rheumatic diseases, such as osteoarthritis and fibromyalgia, both of which overlap with lipedema, they say.

“Our advice is to strongly suggest a diet rich in polyphenols, recommending a style close to the Mediterranean diet. In any case, we recommend a daily intake of 100–150 mg of polyphenols, coming from multiple sources, as each molecule has a union different genomics or epigenetics and often in synergy with the others.”​

Modulating compounds​

Researchers confirmed the benefits of omega-3 fatty acids ecosapentaenoic (DHA) and docosaheptaenoic (EPA) in promoting healthy adipocytes by reducing activation of macrophages and secretions of pro-inflammatory cytokines.

“It is interesting to note how probably different resolvins modulate the action of different channels (e.g., TRPA1, V1, V4). This could be a very important feature as at least 80% of subjects affected by lipedema manifest a painful component​,” they comment.

Oedema modulating agents serratiopeptidase​ and bromelain ​also have potential applications in lipedema management, given the fibrinolytic action of both proteolytic enzymes, however the authors point out the poor bioavailability of serratiopeptidase​ and suggest further tests to support the use of either compound.

Disease profile​

Lipedema effects mainly women and is defined by an abnormal accumulation of adipose tissue in legs and sometimes the upper arms and abdomen.

Clinicians are still not completely certain about the triggers, but studies suggest intercellular alterations (fibrosis and hypertrophy) and macrophage infiltration are implicated in disease pathology. There may also be a genetic component determining a predisposition to the condition, the authors write.

Patients often exhibit tiredness and pain in the lower limbs, indicative of systemic inflammation, which is compounded by compression of nerve fibres from fluid build-up (oedema).

Liposuction can provide partial relief from symptoms (at a high cost) together with physiotherapy and elastic-compression therapy, but there is no definitive cure and food supplementation may offer a long-term management solution.

“Obviously this does not mean curing the pathology, but mitigating some aspects, in particular the painful manifestations probably due to an inflammatory state,” ​they add.

Source: Nutraceuticals​

Published online, October 2, 2022: http://doi.org/10.3390/nutraceuticals2040020​

‘Nutritional Supplements and Lipedema: Scientific and Rational Use’​

Authors: Roberto Cannataro and Erika Cione