Lipedema is a common but not well recognized subcutaneous fat storage disorder. Some of the reasons it is poorly recognized are that lipedema can present in many forms and it is not very well known among medical professionals. It is often confused with Obesity and Lymphedema, which are more common and becoming even more so. The exact cause or causes of lipedema are not known. However, there appears to be a pattern of inheritance in 60% of women.
While lipedema is likely inherited, the pathologic physiologic mechanism responsible for lipedema is not fully known. Medical research so far has given students and experts of the disease much to think about and consider. There are over a dozen of well-designed studies that are currently trying to better diagnose, understand, and treat lipedema. The author of this page participates currently in five studies to better understand the disease, its pathologic mechanism, and how to better treat it. In a recent article titled ” Pathophysiological dilemmas of lipedema.” Dr. Szel discusses the three most compelling hypotheses for the cause of lipedema. The goal of this page is to use the current medical literature to share some educated thoughts about what is likely causing lipedema.
Hormones have often been suspected as a cause of lipedema because lipedema almost exclusively occurs in women. Although it Has been seen in some men who have hormone imbalances. Estrogen plays a role in fat metabolism estrogen receptors differences in adipose tissue can lead to differences in the lipolysis activity of the adipose tissue, for example, a decrease in alpha estrogen receptors in an increase in beta receptors leads to decrease lipolysis and increased fat deposition. Lipedema could be a result of differences in the number of estrogen receptors in the subcutaneous fat on buttocks arms and legs. Or just possible that there is a decreased signal in the estrogen receptors. While this is not proven yet, it could explain the development of lipedema during puberty and worsening during hormonal events such as childbirth.
Impaired Vascular Function
Another possible explanation for lipedema is impaired vascular function or vasculopathy. Microangiopathy is seen even in histologic studies of the early stages of lipedema. Tissue expansion by increased fat deposition requires increased vascularity. This tissue expansion causes tissue hypoxia and the tissue hypoxia of adipocytes leads to increased inflammatory markers like Tumor Necrosis Factor, TNF-alpha and, Interleukin 6, IL-6. It also can lead to increase secretion of VEGF.
Lipedema could also be caused by a lymphatic circulation problem. Lymphatic fluid promotes the collection of fat cells grown in the presence of length in chylomicrons have increased growth and differentiation. Or lipedema could be caused by an obstruction of lymphatic capillaries. There have been studies that are showing poor uptake lymph in the pre lymphatic spaces and lymphatic capillaries in lipedema.
Finally, lipedema could be caused by neuropathy. A decrease in sympathetic nerve function could cause impaired lipolysis and increased fat accumulation. Dr. Karen Herbst has noticed cutaneous hypothermia in lipedema. Hines noticed that there is an increase in vascular congestion peripherally in lipedema with reddened feet.
New Research on Lipedema Genes
In recent years the number of medical research studies about the causes of lipedema has been increasing. There is also growing interested by experts in the vascular, lymphatic, and fat storage fields to try to more completely understand lipedema. With the ongoing scientific research and increased interest, we may not be far from having a clear understanding of the cause or causes of lipedema.
Aldo-Keto Reductase 1C1 (AKR1C1) has been marked as the First Mutated Gene in a Family with Nonsyndromic Primary Lipedema. This gene codes for an enzyme that breaks down progesterone and aldosterone. As a result, this gene mutation would result in a slower and less efficient reduction of progesterone to hydroxyprogesterone, and an increased subcutaneous fat deposition in variant carriers.ijms-21-06264-v2 (1)
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E. Szél Pathophysiological dilemmas of lipedema. Medical Hypotheses 83 (2014) 599–606.. https://www.ncbi.nlm.nih.gov/pubmed/25200646.