Lighter legs. Same fat.
The Daily Mail ran the story of a reader with lipoedema (lipedema, here) whose legs felt better on a citrus supplement. Marti Stelling asked me why. My answer, as I sent it:
“Diosmin and hesperidin are plant flavonoids, mostly from citrus peel. The best-studied form is a purified blend that is about 90 percent diosmin and 10 percent hesperidin, which has been used for decades for vein problems such as leg heaviness, aching and swelling from chronic venous disease.”
“It appears to work by tightening the tone of the veins, making small blood vessels less leaky, and calming some of the inflammation in the vessel wall. Since lipoedema legs also feel heavy, swell and bruise easily, it makes sense that people would try it.”
Where It Stops
“The honest answer is that the lipoedema evidence is still thin. The strong data come from vein disease, not lipoedema, and the lipoedema work so far is small and early.”
“A supplement like this may ease some of the swelling and heaviness for some patients, but there is no good evidence that it shrinks the abnormal fat itself, which is the heart of the condition. That is the gap readers need to understand.”
How I Say It in Clinic
“Diosmin and hesperidin are flavonoids which mainly help with venous insufficiency. Although they have been studied in small trials for lipedema, there’s really not enough evidence to support it. If a patient wants to take them, I wouldn’t stop them from doing it, but I wouldn’t get their hopes up either.”
The Fat Nobody Believes
“Lipedema usually doesn’t respond to diet and exercise. The patient can lose weight and they’ll lose it around the waistline, but the areas affected by lipedema do not respond. The usual patient has dealt with this problem for many years and has always been told to lose weight, but that in essence does not help.”
“Diet and weight-loss drugs can help the overall weight, but lipoedema fat tends to resist them.”
Stubborn fat after real weight loss comes up in men after weight loss too.
What Comes First
“The conservative treatment for lipedema is compression garments, increased mobility, maintenance of weight or even weight loss, lymphatic massages, and an anti-inflammatory diet.”
More on the massage in lymphatic massage after lipo.
What Treats the Fat
“When the fat itself is the problem, lymph-sparing liposuction is the one treatment shown in long-term follow-up studies to remove the diseased fat and reduce pain and swelling for years.”
“Once patients have tried this and they continue with pain, bruising, and limited mobility, then surgery can be considered. This consists of liposuction to remove the diseased fat, but the conservative measures will need to continue even after surgery.”
“All stages of lipedema can be treated surgically, but conservative measures should be adopted as maintenance both before and after surgical treatment.”
The operation is on the liposuction page. Clinical version, with a table: agulloplasticsurgery.com.
If You Try It Anyway
“Buy a product that states the dose and diosmin content clearly, since supplement quality varies. And give it a fair, limited trial, a couple of months, rather than taking it forever on hope.”
And ask your doctor first if you are on a blood thinner.
Why She Asked Me
“Body contouring is a large part of my practice, so I see women with lipoedema in consultation, often after years of being told they simply need to diet harder.”
Mayo Clinic fellowship. Texas Tech faculty.
Ready to Talk?
Call (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
Clinical read: Agullo Plastic Surgery. Compression and massage: Southwest Plastic Surgery.