There are no known genes or biomarkers for any of the SAT disorders including Lipedema, Dercum’s Disease, Familial Multiple Lipomatosis or Madelung’s Disease. Symptomatic treatment is therefore the standard of care and does improve the lives of many with SAT disorders.
Current Treatments Include
“Let food be thy medicine and medicine be thy food.”
We all know that food has been important in health for centuries and it is no different for SAT disorders. There are however no diet studies for any of the SAT disorders. Many people with SAT disorders are therefore encouraged to eat low processed carbohydrates to reduce insulin levels, where insulin makes fat grow, to reduce saturated and grain-based fats especially those from animals while increasing healthy fats from nuts and seeds, and to eat a wide variety of colors of vegetables to gain the anti-inflammatory, anti-oxidant and fibrous components that increase the health of tissue and promote a healthy microbiome in the gut. We have found that low carbohydrate diets both ketogenic and anti-inflammatory promote loss of normal weight in people with SAT disorders.
Dr. Herbst has collaborated to write a book with information on lipedema and lymphedema especially what foods to eat on an anti-inflammatory diet. You can find out more about this book here:
Complete Decongestive Therapy (CDT)
Complete decongestive therapy is performed by trained physical, occupational, and massage therapists. This hands on therapy of manual lymph drainage (MLD) helps to move lymph fluid out of the adipose and other tissues, unclogs lymphatic pathways and nodes and encourages normal lymphatic vessel pumping. MLD is known to reduce pain and capillary fragility in lipedema and Dercum’s Disease and has been used to treat Madelung’s Disease and swelling associated with Familial Multiple Lipomatosis. Skin care and a home exercise program (HEP) are part of CDT. CDT however, is not enough to reduce the adipose tissue in SAT disorders. Newer therapies are needed to reduce the adipose tissue structure back to normal.
Manual therapy for SAT in lipedema has been shown to improve the quality of SAT. This means that by using the hands and a special technique called Quadrivas Therapy, that lipedema SAT can be made healthier and less fibrotic.
You can find the paper here:
Other Physical Therapy
Inflammation in SAT results in fibrosis. The fibrotic tissue can contract causing pain, tearing of the tissue and more inflammation with movement. The therapies below are beneficial in many patients with SAT disorders. Examples of these therapies include:
1) Myofascial release
2) Craniosacral therapy
3) Astym Therapy
4) Graston Technique
5) Tui na
Compression garments help keep excess fluid out of the tissue and reduce pain. There are many types of garments and an experienced fitter is important as the wrong garments can cause damage to the tissue. Custom garments are ones for which you need to be measured. Off the shelf compression garments are also available.
Exercise is important in all SAT disorders. Muscle movement helps pump lymphatic fluid. Muscle contraction also oxygenates tissue, reducing low oxygen conditions (hypoxia) thought to be important in the pathophysiology of Lipedema. Exercise in water provides not only compression from the heaviness of the water but harmonic waves are sent through adipose tissue improving lymphatic pumping. Many exercises are good for SAT disorders but long periods of “making it burn” can do some harm to SAT that is unable to expeditiously move out oxidants and lactic acid.
Medications and Supplements
These focus on improving lymphatic pumping, reducing leakage from vessels, reducing inflammation and supporting the immune system. A good start in supplementation includes ensuring that Vitamin D and B levels are within the normal range. Vitamin D protects bone and improves immune functions and Vitamin B protects the nerves and helps mitochondria, the small organ in cells (organelle) that provides power to our cells. Find out more about medications and supplements here.
- Surgical excision of affected SAT, especially painful SAT. The SAT is known to recur in 50% of those with Dercum’s disease.
A. Lymph sparing liposuction especially for Lipedema. Tumescent liposuction and water jet assisted liposuction are the preferred liposuction techniques for SAT disorders. Dedicated studies of these procedures for women with Lipedema are needed to improve insurance coverage for these medically necessary procedures that help to reduce pain and improve mobility.
Dr. Herbst participating in a podcast discussing Lipidema treatment from the Obesity Medicine Association webpage: https://obesitymedicine.org/?powerpress_pinw=3141-podcast