Lipedema with Dr. Ben Bikman

the metabolic classroom I am Professor Ben bman a biomedical scientist and professor of Cell Biology thank you for joining me today this is a topic that has been a long time coming especially for a fat scientist like me uh to say that again a scientist that studies fat tissue and adapost tissue um which is lipidemia that's the topic of the day lipidemia this is one that I have been probably more than any other singular topic over the past few years been asked to discuss and it took a little time for me to learn enough to

really speak about it hopefully that's going to be helpful information today's episode is sponsored by health code complete meal you've heard me talk about insulin resistance of course for years it is the focus of my career and you need to address insulin resistance by addressing your diet the problem is we of course get very busy we get stressed we're tired we have the best of intentions to eat well but those fly out the window health code complete meal shake is an ideal convenient way to make sure you're getting optimal nutrition without spiking your blood glucose

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want to it's it really is essential for you to have a better understanding of fat tissue so let's take a little time to give to go over a little primer on adapost tissue when you think about adapost tissue very commonly and indeed the only thing you've really heard me talk about is the fat cell itself but the actual adapost tissue is composed of a lot of other things so I want to first start out as we uh basically cover the more foundational information of fat tissue by talking about atpy structure so each fat cell each

atopos site atopos tissue made up of little atopos sites or fat tissue made up of little fat cells primarily consists of a large cell a fat cell that is basically one big lipid droplet or one big fatty bubble and then any other parts of the cell like the nucleus or the mitochondria are there's so little of it but it's all just kind of pushed up to the edge I mean literally pushed up against the edge of the cell so when you look at the fat cell under a mic microscope like we're doing all the time

in my lab you just see this big like Blank Space it looks just like a big bubble now fat cells are you would despite me saying bubble although that's not a bad analogy for reasons I'll get on to in a moment when you think of a bubble you think of about just just this big spherical round ball like shape but in reality if you were to take Bubbles and start stacking them together you would see that they then begin to form some angles so fat cells are referred to as having a polyhedral shape formation so

it when fat cells start to Aggregate and come together like they do in fat tissue they're packed together in a in a structure in this polyhedral or angular shape lots of little straight edges um arises because the cells deform slightly they get pressed in a little bit as they're packed in together kind of like a honeycomb Arrangement although they're not in neat little hexagrams but it is that sort of View and now again let's go back to the idea of the bubble if we're packing bubbles together where the bubbles meet the sphere doesn't continue to

go around it becomes a straight line where they're packed in so imagine a bubble that has a bunch of other bubbles around it now as you're looking at it down from the top you would say it has a polyhedral shape um so that's the overall shape of it now how does it get organized in part how does it maintain that structure the polyhedral atopos site are embedded or are are shoved within this network of collagen fibers now collagen is going to be a very important part of this story as we get into lipidemia so collagen

in fact we'll we'll Define and discuss collagen more in just a moment but collagen fibers are wrapping around the fat cells to give them structure um and it also is supported the atopos structure by blood vessels um that are feed ing the tissue and pulling away waste but also they're fed by lymph tissue and that's another important part of lipidemia the lymph flow now I hadn't planned on doing this but now that I mention it I think maybe I ought to briefly what is lymph lymph is the fluid that is surrounding cells there's water and

stuff or fluid outside of cells and it's slowly getting pulled away there's it's always slowly getting pulled away and it that is what will then come into a lymph vessel so lymph is the fluid that's coming away from tissues separate from blood flow now I'd mentioned how that collagen is helping create this framework or structure around all each individual fat cell of course that's a lot when you think about fat tissue how many fat cells there are there's collagen weaving around all of those fat cells where does the collagen come from the fat cells aren't

making it the collagen is being produced from fibro blasts so fibroblasts are a different cell type entirely although they actually share An Origin with the fat cells you know there's they they share a common ancestor and So within the fat tissue we have a lot of fat cells but we also have a fair amount of fibroblasts and fibro blasts in adapost tissue play a crucial role in producing and organizing what's called The extracellular Matrix now I'm dropping on you guys a lot of words The extracellular Matrix is basically just the term for all of the

framework around cells including collagen collagen indeed is the main part of the extracellular Matrix in adapost tissue fiber blasts contribute to the tissue's ability to expand and contract which is of course essential for fat storage and mobilization but it also the fiber blasts also play a very critical part in healing and remodeling um within the tissue so if someone's gaining weight you need to remodel some things if they're losing weight you need to remodel some things if there has been damage some impact some trauma you need to remodel and recover you need to build the

the structure back you need to repair the blood vessels Etc so that is all the role of the fibroblasts this other cell type that lives within the neighborhood of the atopos tissue whereas the primary residence are the fat cells atopos sites there is the secondary in fact there are many many more cell types too fiberblast is a very important one particularly in this story of lipedema all right so that is all the primer um with regards to um fat storage and fat tissue some aspects you probably didn't know but what I want you to take

away from it is that fat cells are all surrounded by collagen which are being produced which is being produced by fibroblasts which are just resident little cells tucked within you know randomly throughout all of the fat cells all right so let's move on to it now now that we've laid down the groundwork for understanding how fat tissue Works let's now move into um the subtopics or or lipedema but then I want to cover lipedema by going through an order of a series of questions first one being um how is collagen affected in lipidemia so now

that you understand that collagen is an essential part of the structure of fat tissue how is it affected in lipidemia so firstly one thing to establish is that there's too much collagen in fact let me just take a a step out of this for just a second and confess to you that when I first heard of lipedema I thought that it was just a fat cell problem you know lipidemia is this distort this this altered storage of fat tissue where an individual overwhelmingly a female although we're going to get more into the specifics of of

lipidemia in a moment they're storing fat in in a way that is really painful it's a very uncomfortable and very hard rigid type of fat whereas normally particularly in women who have more subcutaneous fat something we've discussed previously but fat stored just beneath the skin usually it's very squishy you can pinch it and jiggle it this is fat that is also stored beneath the skin but it gets very rigid and hard and it's very painful for the person all right um but my point only in bringing all of this up I used to consider lipidemia

to be a problem of fat cells I don't anymore uh particularly doing my homework in preparation for this discussion I've concluded uh that and I don't mind if anyone disagrees with me that lipidemia is a problem of connective tissue like collagen all right now so let's get back into lipidemia how is collagen affected or altered in lipedema first and foremost there's too much in lipedema there is often an overproduction of collagen by the fibr blasts this incre this increase can lead to in to excessive collagen deposition in the atopos tissue so what should be a

very thin little malleable wall of collagen around a fat cell becomes thicker and harder and this is something that can be evidenced with fat biopsies in people with lipidemia if they do a fat biopsy even in the same person in an area where they have lip EMA and then do another Fat biopsy in an area where they don't so maybe they do a biopsy in the thigh of the woman and then they do a biopsy in her triceps or upper arm they will and the lower limbs having lipidemia but the upper arms not um they

will detect that there's a much thicker layer of the extracellular Matrix which as you'll recall is primarily collagen so it gets really really thick and so again what should have been a very malleable pliable um surrounding or sack of collagen becomes this thick kind of brick wall which starts to physically press on the fat cell now independent of the amount there's changes in the collagen structure the collagen and lipedema can become more fibrotic which just means it's kind of redundant a little bit to what I just said which it becomes thicker and more rigid so

independent of the overall amount the nature of the collagen starts to change and this is a known phenomenon within collagen the human body and all animals have very types of collagen but it essentially is now behaving like a different type of collagen a more rigid type just by way of Interest subcutaneous fat normally has a type of collagen that is softer whereas visceral fat typically has a type of collagen that is more rigid and this almost appears as if the subcutaneous fat is taking on the characteristics of the collagen within the visceral fat a more

rigid stronger less pliable type of collagen and adding to that where it's getting thicker and thicker and that just compounds the issue of course now all of this of course still speaking about collagen and how it's changed in lipedema can change the functionality of the atopos tissue the altered collagen structure can lead to reduced tissue elasticity and increased rigidity so the loss of elasticity simp as the name suggests just means it's not quite does bouncy it's less elastic and less compliant those are kind of terms of physics so it can't stretch out as well and

it can't rebound as well but this makes the adapost tissue ultimately as I've said just much more rigid which um Can very much contribute to the pain and tenderness um and then leading to compromised lymph drainage and fluid retention so that's where the kind of Edema part comes from edema is another term of biology and it refers to too much fluid outside the cell like accumulating in a in a space usually a limb but as a result of that they're swelling all right now I've kind of segued into this a little bit already having gotten

a little bit ahead of myself in these subtopics but let's go to another question which is why is the collagen a problem um so I've we've now made it clear what collagen is we've now hopefully made it clear how collagen is misbehaving in lipidemia that there's too much of it and it's too hard but why is that a problem let's go through a few reasons here um again answering the question why is the collagen a problem so here's how fibrosis which is when there's more production of the of the collagen um can affect the function

within the adapost tissue in the limbs usually again usually lower limbs but it can also happen in the upper arms so first of all and I've mentioned this somewhat but the first is increased tissue stiffness as collagen accumulates and becomes more fibrotic or rigid and thicker the atopos tissue becomes stiffer and less flexible and this um increased rigidity can exert some pressure on the fat cells and importantly nearby nerves and nerves is something we're going to revisit more in a moment but as the nerve can become well we'll come back to that in a second

but we've introduced nerves for the first time but that can of course lead to discomfort and pain uh remember all pain is going to be sensed centrally in the brain by nerves so whatever the problem is it has to somehow be conducted the signal that there's a problem to the brain and then the brain senses this as pain or discomfort all right number two in answering the question of why is this collagen a problem so what if we have more um but number two is impaired blood flow and lymphatic flow now again just by way

of reminder the lymph circulation system is kind of a parallel system to the blood vessels and whereas the blood vessels are a pretty closed group you know what is in the blood the fluid is generally staying in the blood and it's just circulating lymph is very different where lymph is constantly just pulling any excess fluid around cells and bringing it back in ultimately depositing it back into the bloodstream but but through its own vessels um but if you have compromised lymph flow you will have lymph reten or water retention or lymph retention and lymph itself

is just a watery mix of of stuff mostly water some proteins some cells but again mostly water and so if you can't if your lymph circulation is compromised then you're getting the lymph or the fluid hanging out and this is just it happens more readily in limbs like legs especially and arms where gravity wants to pull all that water down making it even harder for it to return so anyway back to fat tissue and lipedema the rigidity within this collagen Matrix around fat cells can compress the blood vessels and the lymph channels or the lymph

vessels which can impair circulation the reduced blood flow can lead to esea which is basically a the cells start to suffocate they are not getting enough oxygen um which itself can cause pain but also the impaired lymph drainage can cause lymphadema which is just a classic word for just you have fluid in your limbs you know your limbs are swollen and and that will lead to swelling of course and inflammation which as we'll get to in a moment when we talk more explicitly about the pain um but that will lead to pain inflammation can enhances

the sensitivity to pain signals now I'd mentioned the nerve compression a moment ago and let's just revisit it that now the fibrotic and stiffened fat tissue can compress and even entrap nerves within the adapost tissue and that nerve compression literally a nerve coming through it used to be a very squishy pliable space now it's rigid so if there's a movement it can start to pinch off but that can result in pain which can very readily become chronic and significantly affect quality of life another part about why the collagen is a problem is the inflammatory responses

the altered tissue environment within this um fibrotic uh tissue with impaired dynamics of of the fluid with blood or circulation in the blood system and in the lymph system it can foster inflammatory responses and chronic inflammation can be a source of pain not only because some of the inflammatory mediators directly stimulate pain on nerve endings but also as I mentioned it enhances the sensitivity to pain signals and so this is very much playing into how um why the the often the woman or the individual experiencing lipedema why it hurts so much and why it does

affect their quality of life so much and then lastly why is the collagen a problem as you have started to wall off a cell and compromise blood flow and lymph drainage um and also just created this rigid structure the mechanical stress exerted on on the atpa site by surrounding by by the surrounding rigid toughened collagen can lead to not only cell dysfunction but also outright death and so it's not uncommon for there to be a much higher level of fat cell apoptosis um occurring within lipidemia fat tissue all right now throughout this discussion I've been

mentioning women more than men let's talk about that for just a moment uh well for a few moments actually um why do women suffer so the next question then as we move through the topics ISS why do women suffer from lipedema so much more often than men do um there are some estimates just by way of Statistics that um lipidemia affects as almost a little over 10% of all women and in men the number is unknown to the point of of negligible it is so uncommon um and this is so lipidemia is nearly exclusively reported

in women and can begin or worsen this is very important and we're going to move on to this as the next topic it can begin or worsen at times of substantial hormonal change three in particular puberty pregnancy and then lesser than those ones menopause mostly it's puberty and pregnancy menopause sometimes but it's much less common there there's also of course a genetic or familial component to it I should say familial to be clearer the genetic component is based on sex and then the familial component is just a natural variation that we see across individuals which

is some people tend to have things that happen within a familial line without a clear genetics to explain it all right now let's having said all of this it's easy then to conclude that there must be some difference within the sex hormones that is a rational conclusion and indeed the likely one why is it that women experience lipedema so much more than men likely because of the vastly higher levels of estrogens remember there is no individual hormone called estrogen there are the estrogens the prototypical female sex hormones now men have estrogens but much much lower

levels than females all right so let's move on what is the relevance of estrogen in lipedema well let's really get specific because I've been sort of framing this up through the lens of fibro blasts making too much bad collagen which starts to choke off the fat cells and the fat cells themselves are just innocent bystanders lipedema is not a disorder of the fat it is a disorder of the connective tissue so this is interesting um there within the family of fibro blast there is something called a myofibroblast which is basically this they are they're they're

specialized cells that are derived from fibroblasts so fibroblasts can turn into myofibroblasts and the difference among a few other things is that they are much more aggressive in their production of collagen and thus really contribute to a tissue that becomes fibrotic or or sometimes we would say scarred so where there's a lot more fibrosis occurring this much heavier production and thicker collagen um usually myofiber blasts are responsible for that well wouldn't you know it estrogen can influence and increase the differentiation or the activation of converting fiber blasts into myofibroblasts and so in those who have

this familial predisposition when the young woman starts to go through puberty and she has this substantial increase in estrogens it's no surprise that now things start to happen basically then the estrogens are stimulating this conversion of benign and content fiber blasts producing a benign and normal amount of collagen into much more in this case I I mean aggressive but in this case more Sinister myofiber blasts producing a much more aggressive in this case Sinister form of collagen and amount of collagen and this this conversion from happy fiberblast to aggressive myofiber blast with the change in

collagen production is generally thought to be mediated through this particular pathway that estrogen's activated namely TGF beta tissue growth factor beta and this is a potential area of therapy then um although TGF beta is involved in a lot of processes but there are some trials exploring the regulation of TGF beta as a therapy for lip idema so again uh just to wrap that thought up estrogens induce the activation or the conversion from fiber blasts into myofiber blasts um also just a little on that estrogen's the effect on fibroblasts and myofibroblast activity can really vary depending

on the tissue um but this explains some of why this can happen um at all but for example in reproductive tissues like the uterus estrogen's effects are very pronounced in regulating fiberblast function it's just um including like stimulating the growth of fibroids which is a lot of collagen too much extracellular Matrix um so that's where the estrogens are playing its part well um normally you know stimulating fiberblast activity in a tissue like the uterus but there is an influence in non-reproductive tissues like skin and lungs estrogens also play a role there but and again in

the case of the fat tissue in lipo in lipedema it's simply something that's gone too far now to complicate things even a little more and to introduce a bit why men can experience this despite having fantastically lower levels of estrogens it is now a problem potentially within the fat cell itself uh so we have discussed before how fat cells Express an enzyme called aromatase and aromatase is responsible for the conversion of androgens like testosterone into estrogens like the ones we've been talking about and so in this instance um where a woman if you measure her

circulating levels of estrogens they may be normal but if you were to look and and you know drill down or that's a kind of gruesome way of saying it take a biopsy of her lipedema fat tissue it could be that her fat cells have a much much higher level of aromatase so as androgens like testosterone are flowing through the fat cells pull it in and release it as estrogens but it's only having a local effect this is is something within the realm of Endocrinology called a paracrine effect so if you have a woman who has

more fat tissue that is overexpressing or expressing an an unusually high amount of aromatase it could be that her fat tissues making too much estrogens which don't get into General circulation but are sufficient to activate the fiber blast which is right next door that's where the paracrine phenomenon comes into play so you have one fat cell making a lot of estrogens and it's releasing the estrogens and it just goes next door and stimulates the fiber blast converting it into a myofiber blast and telling it just to continue to pump out thicker collagen contributing ultimately of

course to lipedema so I believe that's a relevant part of this that disconnect blood estrogen levels from lipidemia um but increases but still keeps the focus on estrogens but now right at the only at the level of the fat tissue where the fat tissue itself is making a lot of estrogens but it's kind of staying within the neighborhood and it's stimulating other cells within the neighborhood namely in this case the fibroblasts now independent of estrogen levels it could be a difference in in expression of estrogen receptors so this is another potential area it is an

area of research in lipedema and even a potential area of therapy um where uh it's it's thought that rather than the actual amount of estrogens there is just too much sensitivity to it so maybe the fibroblasts have too much of the estrogen receptors which is a small hormone of sorry a small class of receptors so it's one thing for the hormone to come to a cell but if the cell doesn't have a receptor for that hormone it's there's no door for the hormone to knock on if you will so the cell ignores it in this

case however the cell is expressing estrogen receptors and in the case of lipedema the fiber blasts may be expressing too much estrogen receptor so they're too sensitive to the estrogens and reacting too strongly to the estrogens ultimately contributing to a fiberblast that is simply too active becoming a myofibroblast and aggressively producing a thicker collagen all right now to kind of wrap some of these thoughts up before we move on to the next couple subtopics before we wrap up this helps you I hope understand why lipedema is sometimes referred to as an atpo facial disorder atpo

facial that is this combination of words for you of course atopos meaning fat tissue and then fascia fascia just referring to connective tissue so the research does suggest that fiber blasts which are cells responsible for producing and Main maintaining connective tissue particularly through the production of lipedema uh through sorry through the production of collagen may play a role in the the pathophysiology or the origins of lipedema all right now let's move on to the next final two topics with this next one being why does it hurt so much now this is not something I I

speak about this with almost some reverence because it's just based on reports that I've heard from people with lipidemia uh that they will note that it is just so painful whereas someone else storing an equal amount of fat without lipedema it doesn't hurt them it might be difficult to move around just based on the amount of fat they have but it doesn't hurt with lipidemia it is a painful thing and this is generally both a mechanical and a biochemical phenomenon that there is this mechanical restriction that is that is literally aggravating the nerves then there's

this biochemical effect where there's signals that are activating the nerves which are then sending the signal to the brain that hey we're sensing pain right now so there can be a couple there's two things I wanted to mention here the first one is just the simple physics of it which is the pressure and the tension the fibrosis and the excess and the fat kind of pushing against its restraints can create a physical pressure on the tissue near in that area including nerves that are innovating we have nerves everywhere of course the nerves are kind of

kind of caught between these two hard rocks if you will and the pressure can directly stimulate the nerve fibers this should be this um pressure induced stimulus that's one of the ways to activate a nerve and that will be sensed that will be relayed back to the brain as a pain sensation so again that is the tension and the pressure because it's like we are continuing to try to blow air into the bubble but now the bubble is reaching its constraints and so it's pressing against this brick wall of colge and then the next point

the last one here just with regards to pain is the inflammation and I've alluded to this already but lipidemia is associated with chronic inflammation um this is largely coming from the fat cells themselves and other nearby cells like fibro blasts like macrofagos which is another cell type in the fat tissue that I've not invoked at all but inflammatory cells inflammatory cells within the kind of constrained tense fat tissue is releas they're releasing cyto and other chemical mediators one like for example called substance p and prostacyclin and these not only can directly stimulate the sensation of

pain but it also enhances the sensitivity to the signal so it's one thing to say hey here's a pain signal it's a pain signal that should be sensed at a five but then there are other signals that amplify that up and then it turns what should have been a five pain signal up to an eight or nine out of 10 so th those are some of the main reasons again um to just I like to look at that as a mechanical sources of pain with the pressure and attention and biochemical Pathways activating pain through the

inflammation and similar mediators all right now the last part of this is what can you do about it this is of course where what anyone with lipidemia wants to know I I really hope that my Paradigm has been helpful to sh shift The View away from a fat Centric Paradigm which is not I'm not happy doing so I like to just talk about fat tissue or fat cells but we don't have to leave the fat tissue to understand lipedema but it's rather connected tissue and collagen and a different cell type entirely namely fibroblasts so the

kind of conventional therapies are and anyone with lipidemia you know would be laughing at me for discussing these so readily um because they know how maybe shortlived the the alleviation of pain is but the first one is compression therapy this is basically just a way to try to do anything you can to help help the fluid get out of the limb um as the lymph drainage and circulation becomes compromised as the collagen becomes ever more rigid and fibrotic um if you can keep it compressed you just make it easier for the fluid to return so

this would be the same thing like these compression socks um these sleeves down the leg that you would use with just normal edema you know the accumulation of fluid um a next another intervention is manual lymphatic drainage this is basically just massage um but of course that can be really painful just the physical touching of the limb can be very very painful so I don't State this lightly but it is a therapy where it is this massage with an elevated limb just trying to get the lymph to return and reduce some of the swelling in

that are area um and then and physical therapy just to improve mobility and to open up flow with drainage and blood flow vibration therapy is one that has been used before um it's thought to so this would be this could be something as benign as like standing on a vibration plate um but vibration is thought to stimulate um the muscle to to contract and relax of course and that helps activate this this process of helping remove fluid from a limb particularly the legs of course ultrasound therapy particularly loow intensity pulse ultrasound lipus that's a type

of ultrasound therapy that uses AC acoustic waves so a vibration and this is thought to possibly help with lipidemia by softening up the tissue um what is a hard rigid wall of collagen this fibrotic sack around the fat cells the ultrasound is thought to loosen it up a bit which can which can improve not only the physical sensation and restriction on nerves but also improve the return flow from blood and lymph now this one's a little controversial controversial and indeed the results are conflicted namely lipos suction you've heard me talk about liposuction before and I

generally talk about it in negative terms because if someone's doing it for vanity reasons the fat tissue will simply just grow back on the body somewhere else in the case of lipedema well you could make a stronger case that lip liposuction has been shown to Be an Effective method for reducing limb volume and alleviating pain associated with lipidemia one of the and improving quality of life at least temporarily one of the concerns that I have um about uh liposuction is that you can damage lymph vessels and lymph nodes these kind of we stations for lymph

return and that of course would exacerbate or make worse edema and so there's a there's a trade-off there there are different types of or different interventions with liposuction that are um designed to spare lymph a little better than others and so that would just be of course a strong strong consideration um again just to really make sure that you can leave the lymph structures the lymph vessels intact now what I haven't mentioned is weight loss of course um anyone with lipid I'm ready for you to roll your eyes at me because you would be so

tired of hearing that right um but I want to of course show my own view on that naturally if there's something you can do to shrink the fat cells you are easing up the pressure at least somewhat but of course weight loss is not easy and the fat cells in lipedema appear to be a little more stubborn than normal fat cells and that could be a result of the altered blood flow frankly they're just not getting as much of the signal to break down um so here when it comes to the dietary interventions classically of

course everyone would just say eat less exercise more that's purely thermodynamics and just cut your calories well yes calorie cutting can work um or to say that another way long-term starvation can work but it's always short-lived which is why I never Advocate that style but just to show you that not all calories are created equal I I want to share with you a paper that was just published a few weeks ago as we record this in March is that right no April April of 2024 a paper was just published the name of this the title

of it is effect of a low carbohydrate diet on pain and quality of life in female patients with lipidemia a randomized controlled trial that's very important this is the last name of the first author is lundanes l u n d a NES in the journal obesity in 2024 so they took 70 women with confirmed lipedema average age was 47 years old average BMI 37 so hide so these were very overweight women and they put them both on low calorie diets but one was very low carb and the other one was higher carb lower fat interesting

so if all calories were equal there should be no difference between them right and that was not the case the low carb diet had almost three times more fat loss over the eight weeks of this study over three times greater loss and they had an almost four times greater reduction in pain um as measured through a host of surveys and they did a bunch of quality of life surveys and in every instance the low fat version underperformed compared to the low carb diet with all of the other quality of life surveys that they did including

just overt sensation of pain now interestingly they found that it was not just a consequence of the fat loss or the weight loss that the reduction in pain actually didn't perfectly track it but it was still four times stronger so there was some other effect due to the low the low carb diet which of course is going to be increasing ketones and this is where I can speculate a little because the authors of this paper did not but there is some work being done um uh sponsored by this company called American Ketone that has finding

that just even exogenous ketones are helpful in women with um lipedema and I would encourage anyone to look up the work of Siobhan Huggins she's really been pioneering this but it could be a result of the anti-inflammatory effect of ketones ketones are known to have an anti-inflammatory signal and in so far as inflammation is not only initiating the sensation of pain but also heightening the sensitivity to the signal if you can block that inflammation it stands to reason that you are mitigating pain a little better but even still there was three times greater fat loss

um here um which is pretty significant um so that's one study another paper was published in 2024 um sorry 2023 this is the uh the first author last name is goric that's a quite the name j z i o r e k jezior we'll say 2023 um but they found that uh once again a low carb diet significantly reduced body fat fat mass and leg volume um in women with lipedema and also also notably um with a notable reduction in pain levels so I would say this is a ray of Hope um here that as

much as a person with ladema has been trying diet in the past I would strongly based on these reports and more suggest that perhaps not all calories need to be cut that there's going to be a bigger bang for the buck a bigger benefit um when it comes to selectively reducing carbohydrates over say fat all right I hope this has been helpful once again just reminding you of my own Paradigm Shift here looking at lipedema not as fat cell problem but as a collagen fibr blast problem and the relevance of estrogens in increasing the activity

of the fiber blasts resulting in a phenetic production and a hyperactive production of collagen which begins to choke off not only the fat cells but also nerves resulting in substantial pain choking off the lymph vessel return resulting in swelling which is further contributing to the pain this mechanical and biochemical the the mechanical and biochemical cont contributions to this discomfort hopefully this has been helpful if it has been please share it with a friend and if you're watching this live thank you so much for being a member of the insulin IQ Community I look forward to

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