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lipedema and the relationship to both fascia and inflammation

“Despite its description in 1940 by Allen and Hines, little is understood about the disorder.  Lipedema (Adiposis Dolorosa or “painful fat”) is a common adipose tissue disorder that is believed to affect nearly 11% of adult women worldwide. It is characterized most commonly by disproportionate adipocyte hypertrophy of the lower extremities, significant tenderness to palpation, and a failure to respond to extreme weight loss modalities. With an incidence that may affect nearly 1 in 9 adult women, it is important to generate appropriate awareness, conduct additional research, and identify better diagnostic and treatment modalities for lipedema so these women can obtain the care that they need and deserve.” Cherry-picked from the abstract of the September 2016 issue of Plastic Reconstructive Surgery Global Open (Lipedema: A Relatively Common Disease with Extremely Common Misconceptions)

Although the December 2011 issue of the medical journal Annals of Rehabilitative Medicine stated via the title of a published study (Lipidema, A Rare Disease) that this disease is, well, “rare,” this may not be the case at all.  Just five years after this study was published in Annals, the person who is arguably the world’s foremost authority on Lipidema, Dr Karen Herbst (MD / Ph.D), showed us otherwise through the title of her scientific article, which I quoted at the top of the page.  If Dr. Herbst is correct, it means that 17 million American women suffer from this problem.   What does she have to say about Lipedema?  For starters, it’s not simply a cosmetic issue — it’s both highly painful and extremely prone to bruising.  What causes this?  As nearly as I can tell, the lypmpatics begin to leak fluid (lymph — the colorless fluid that bathes tissues, eventually draining into the bloodstream) into the superficial fatty tissues due to microscopic aneurysms.  As to why this happens, many experts believe it to be yet another of the numerous AUTOIMMUNE ISSUES we are collectively being plagued with.  Here is what Dr. Herbst says about Lipedema on her site.

“In lipedema, on examination of tissue samples, they found dilation of subdermal blood capillaries, fibrosis of arterioles, fibrosis and dilation of venules, hypertrophy and hyperplasia of adipocytes… this means that the capillaries just under the surface of your skin are wide and can be seen as little red marks on your skin if you look closely enough, that the walls of small vessels have increased connective tissue (fibrosis).  According to German, Italian and Swedish literature, lipedema starts as a microangiopathy.  This means that there is damage to blood vessels and they leak their contents into fat. This is why you bruise easily – your blood vessels, at least in your fat and skin are not normal. Something is wrong we just don’t know what!”

Lipids are fats and Edema is swelling, thus Lipedema is a disease characterized by swelling of superficial fatty tissues.  To see the perfect example of a very thin person with Lipedema, click THIS LINK.  The point with today’s post is not to try and create somethng that is somehow going to solve Lipidema (I’m an not any sort of expert) — the only known “cure” (word used loosely here) is a special kind of liposuction; a procedure that does not come without it’s own unique set of risks (HERE). My hope is that because a huge number of women struggle with this issue, yet seemingly so few doctors aware of or talking about it, I might be able to educate my readers so that you might be able to spot this in your family members or close friends and help educate them.

What has helped make this problem increasingly difficult to diagnose?  Because overweight and obesity have become the new norm in the United States, this makes it tougher to know who might be struggling with Lipidema.  According to a study called Rare Adipose Disorders Masquerading as Obesity from a 2012 issue of Acta Pharmacologica Sinica, “Lifestyle-induced obesity in children and adults has reached epidemic proportions worldwide. In the United States (US), a third of adults aged 20 years and over are overweight, a third are obese, and over five percent are extremely obese.”  While this is a problem in and of itself simply because OBESITY is one of the MANY HEALTH ISSUES considered to be “inflammatory,” and because inflammation is an EPIGENETIC risk factor in every single health issue you can name (as well as those you can’t), it means that many more people are at risk than otherwise would be due to simple genetics.  Unfortunately, unlike MOST OTHER AUTOIMMUNE OR INFLAMMATORY ISSUES, this problem, once off and rolling, cannot simply be solved via DIET & EXERCISE (“caloric limitation and increased energy expenditure alone“).

“…….have not only helped us to improve our understanding of different lymphatic-related pathologic conditions and their relationship with inflammation, autoimmunity, and cancer, but also to re-evaluate the functional roles of the lymphatic vascular network. For example, lymphatic vascular defects were identified as leading causes of late-onset obesity….”  From the October 2010 issue of Genes Development (Current Views on the Function of the Lymphatic Vasculature in Health and Disease).

Although inflammation and autoimmunity are big deals, when we talk about swelling of the limbs associated with CANCER, we immediately think of Lympedema as it is so common.  What is the difference between Lipedema and Lymphedema and what are the challenges in diagnosing that makes this problem so ridiculously underdiagnosed?  According to last August’s issue of the International Journal of Women’s Health (Lipedema: Diagnostic and Management Challenges)…….

“Lymphedema is the development of localized swelling due to lymphatic dysfunction. Lymphedema can be either primary or secondary. Secondary lymphedema typically occurs as a result of malignancy or its treatment…… In the typical presentation for lower extremity lymphedema, patients report a history of prior lymph node biopsy or dissection and/or radiation of the lymph node basins. Patients may also describe a history of cellulitis or other superficial infections in the affected extremity. Swelling is typically unilateral and often extends from the groin down the foot into the toes, with a positive Stemmer sign as described earlier. In the early stages, the swelling is typically soft and pitting (through deposition of adipose tissue) and can progress to fibrosis as the disease progresses. Patients with long-standing lipedema may develop secondary lymphedema as a result of progressive mechanical strain on the lymphatic system from the fatty hypertrophy. Long-standing lipedema in combination with morbid obesity can lead to edema due to immobility and subsequent decreased activation of the muscle pump. Further, the weight of the excess adipose tissue might decrease the lymphatic transport capacity as well increase the lymphatic load.”

There are numerous sources, including the one mentioned above, that have some great pictures, as well as discussing what tests and examinations are needed to definitively make s diagnosis. These include a detailed history and physical examination (doctors are looking for bruising, pain on touch, and “column legs” with “step-off sign” — calves the size of the thighs, with normal feet — in my estimation the number one best/easiest thing to look for, even in women who have “thin” legs), blood work, MRI, and a test called lymphoscintigraphy, as well as the fact that Lipedematic skin is often colder than normal skin.  Also, women with Lipedema will always have it in both legs, while many / most cases of Lymphedema will be unilateral (it is very possible, however, to have both issues simultaneously).

And while treating the problem as you would treat obesity is not going to solve it, it may prove beneficial on some level, if for no other reason than to diminish SYSTEMIC INFLAMMATION. “Early detection with concurrent weight and dietary changes through nutrition and exercise may be helpful in reducing nonlipedemic fat and reducing inflammation, which can also potentially reduce the debilitating effect of the condition. This approach may possibly prevent the lower body from enlarging as much as it would if the patient were to become obese.”  This is why it’s critical to bring your kids up eating and understand the value of a healthy diet.  In lieu of a healthy diet, it’s easy for things to start sliding south as seen in these conclusions cherry-picked from a 2011 issue of the Annals of the New York Academy of Sciences (Lymphatic System Acts as a Vital Link Between Metabolic Syndrome and Inflammation).

“The lymphatic vasculature is essential for the adsorption of lipids from the intestine. Lipid-rich intestinal content is packaged by the absorptive cells of the small intestine into water-soluble particles named chylomicrons.  The fact that, for example, lymph nodes are normally surrounded by adipose tissue and subcutaneous adipose tissue lies in close proximity to the dermal lymphatic vasculature suggested a relationship between lymphatic vessels and adipose metabolism. Additionally, ectopic adipose tissue growth is observed in patients suffering from chronic lymphedema, and lymph or chyle (i.e., a mixture of lymph and chylomicrons with a milky appearance) promotes the differentiation of rabbit preadipocytes. Chronic inflammation of the peripheral lymph nodes increases the number of adipocytes surrounding the nodes.  In the case of human pathologies, lipedema is a chronic syndome that arises almost exclusively in post-pubertal females and causes characteristic swelling of the bilateral and symmetric lower extremities as a consequence of excess subcutaneous fat deposition, although the feet remain normal. Defective lymphatic vasculature should not be ruled out as a leading cause of this disease.” 

Lipedema is definitely inflammatory (see how many times I previously highlighted the word), and probably AUTOIMMUNE, but how in the heck is it related to Fascia?  To understand that, you’ll probably need to read my posts called FASCIA AS ANOTHER ENDOCRINE SYSTEM as well as ADIPOSE TISSUE AS ANOTHER ENDOCRINE SYSTEM, since Lipedema deals with cutaneous (superficial) adipose tissue.  As for the questions I invariably know I’ll be asked and have been asked in the past…..  What about using DIY treatments for Lipidema that people might use for cellulite or other lymphatic issues — CUPPING, INVERSION, REBOUNDING (trampolining — Case Reports in Dermatology asked the question via a study title, Is Lymphostasis an Aggravant of Lipedema?, concluding that, “stimulation of the lymphatic system can be used to reduce leg volumes in patients with lipedema, thus suggesting the regional involvement of cutaneous lymphostasis in this disease“), or devices like ASHLEY BLACK GURU’S “FASCIABLASTER” since studies like THIS ONE show that CELLULITE can be a contributing factor?  I have no idea.  Will they make things better?  Will they make it worse?  Will they not really do much of anything at all?  I’m not sure.  If you have suggestions, simply leave them as comments.  One thing I would probably do if I had this problem and could afford it would be to purchase a CLASS IV LASER, as I doubt a Cold Laser would penetrate deeply enough in most cases.

One last thing; because the word “FIBROSIS” was mentioned repeatedly in the studies I looked at (I highlighted it for you several times), we know that inflammation is involved.  How so?  Simply because inflammation always leads to the scar tissue that the medical community refers to as fibrosis (HERE). Because there are a number of ways to control inflammation without drugs, I would think that knowing and adhering to some basic principles might have the potential stop, or at least slow down the progression of this disease — especially if, as we saw earlier, it’s caught earlier rather than later.  What does “PREVENTION” of a disease like this really look like?  To the degree that it’s even possible, THIS would provide a starting point.


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