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A study published just a few weeks ago gives us something I did not expect to find in 2026: a completely new way of looking at lipedema, quite literally. Not at the whole tissue, not at inflammatory markers in the blood, not at lymphatic architecture or connective tissue changes — but at something much smaller and, in some ways, much more fundamental. The researchers looked inside the fat cells themselves. And what they found there, under very high magnification, is something that raises questions about lipedema biology that I do not think anyone has properly asked before.

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Why? Because this is where you’ll find lipedema research explained in language you can actually understand, and it is also a place where you can ask questions.

I have worked in the lab for years, with cells, peptides, DNA, and inflammation markers such as cytokines. I have also published scientific articles in peer-reviewed journals related to food science.

The paper I am talking about is “Adipocytes from lipedema adipose tissue show lipoma-associated nuclear atypia”, published on May 1st, 2026, in Frontiers in Cell and Developmental Biology by Steiner, Rinnerthaler, Mueller, Russe, Lipp and Bauer from the University of Salzburg, Austria. The Salzburg group has been doing serious, technically demanding work on lipedema tissue for several years now, and this study is perhaps their most morphologically striking contribution yet.

Let me tell you what they did and what they found — carefully, because the terminology can sound alarming if pulled out of context, and this is not an alarming finding. It is a fascinating one.

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Looking inside lipedema fat cells — at the nucleus

The researchers used two forms of microscopy: light microscopy and transmission electron microscopy, the latter being an extraordinarily high-resolution technique that can visualize structures at the nanometer scale — far below what conventional clinical microscopy can reach. They analyzed approximately 3,000 adipocyte cross-sections from subcutaneous adipose tissue samples: nine from women with lipedema and five from non-lipedema controls. All donors were non-obese. Tissue was collected from the extremities — upper arms and lateral thighs — specifically from the deeper subcutaneous layer, during liposuction procedures.

What they were looking for — and what they found — is a structural feature of adipocyte nuclei called a Lochkern.

The word is German, and it means something close to “nucleus with a hole.” It describes a fat cell nucleus that has been deformed — indented, pushed inward, distorted in shape — so that in cross-section it appears to contain a hole or a notch or a ring-like space. Different morphological forms have been described in the older histological literature under names like Ringkerne (ring nuclei) and Kerbenkerne (notch nuclei), but the researchers use Lochkerne here as a single umbrella term for all varieties of nuclear indentation.

Before you read the result, you need to know one thing about these nuclear structures: they are not normally found in ordinary adipose tissue in meaningful numbers. They are associated primarily with lipomas — the benign fatty growths that occur in various lipomatous conditions. Finding them in normal fat is unusual. Finding them frequently is even more so.

In the lipedema samples, 24% of identifiable adipocyte nuclei showed Lochkerne. In the control samples, that number was 3%. The difference was statistically significant at p = 0.001. And when the researchers checked whether this difference could simply be explained by the slightly different average BMI or age between the groups, they found no such relationship — Lochkern frequency did not correlate with either variable in their dataset.

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What Lochkerne actually are — and how they form

This is where I want to slow down, because the electron microscopy images in this paper are genuinely unlike anything I have seen in lipedema research before. They do not just document the presence of Lochkerne — they show their formation in real tissue, step by step.

In paraffin histology — the standard technique used in most clinical settings — lipids are dissolved away during tissue processing. This is why Lochkerne have historically looked like empty holes: the lipid that created the indentation is simply gone by the time you look at the slide. With transmission electron microscopy and epoxy resin embedding, lipids are chemically fixed and preserved by osmium tetroxide. This means you can see them exactly where they were in the living tissue. And what this reveals changes the picture entirely.

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The researchers describe — and document through a beautifully constructed sequence of images — the involvement of what they call satellite droplets: small lipid droplets that form in the narrow cytoplasmic space between the nucleus and the plasma membrane of the fat cell, arising from the endoplasmic reticulum. In the Salzburg images, you can follow what appears to be a progression: a satellite droplet approaches the nucleus, makes contact with the nuclear membrane, begins to press into it. The nucleus deforms visibly around the droplet — it bulges, it contorts. The droplet then appears to move through the nuclear region, with the nuclear membrane opening around it, until it exits on the other side and fuses with the large central lipid droplet that occupies most of the mature fat cell.

This sequence — approach, indentation, transmigration, fusion — is what creates the Lochkern appearance. The paper includes a figure that pairs microscopy images with schematic drawings of each stage, and the result is unusually clear for a study of this technical complexity. The electron micrographs show the contact zone between the satellite droplet and the nuclear membrane, the deformation of the lamina, and what appears to be the dissolution of the lipid droplet’s phospholipid membrane as it merges with the main central lipid mass.

This is genuinely new in the context of lipedema. The researchers state explicitly that this is the first demonstration of this phenomenon in lipedema adipose tissue.

The lipomatosis argument

The deeper interpretive claim the paper makes is that the elevated frequency of Lochkerne — a feature associated with lipogenic tumors — supports classifying lipedema as a form of lipomatosis from a morphological perspective.

The word lipomatosis can sound either alarming or technical depending on your background, so let me be precise. Lipomatosis broadly refers to conditions characterized by abnormal, non-encapsulated overgrowth of adipose tissue — not simply obesity, but tissue-level structural abnormality in how fat accumulates and organizes. Madelung’s disease, familial multiple lipomatosis, and diffuse infiltrating lipomatosis are examples. Some researchers have already proposed placing lipedema within this spectrum, based on clinical and epidemiological reasoning, but concrete histological evidence has been limited. This paper is arguing that the cellular-level morphology now provides a more direct basis for that classification.

Critically, the researchers are not suggesting that lipedema is malignant. They found no lipoblasts — the cells that distinguish benign lipoma-like tissue from liposarcoma — in either lipedema or control samples. The nuclear atypia observed here refers to unusual shape and indentation, not features of malignant transformation. This distinction matters enormously, and the authors are careful to make it.

What matters is that lipedema adipocytes carry a structural signature that is, in the language of histology, more similar to lipogenic lesions than to normal fat tissue. That is a meaningful difference.

A convergence with genetics

One of the things I find most intellectually compelling about this paper is that it does not sit in isolation. It connects — indirectly, but suggestively — with a 2022 genome-wide association study by Grigoriadis and colleagues, which identified genomic variants near the LHFPL6 gene as being suggestively associated with lipedema, particularly familial forms. LHFPL6 is a member of the lipoma HMGIC fusion partner gene family — a gene family implicated in translocation-associated lipoma formation. The Salzburg researchers mention this explicitly: the cellular morphology they are observing, and the genomic signals pointing toward lipoma-related biology, are converging on the same territory.

This is not proof of mechanism. Two suggestive findings pointing in the same direction are not confirmation of a causal pathway. But as a researcher who has spent time working with genomic data, there is something worth sitting with here. When morphological evidence and genetic association evidence both point independently toward lipoma biology in lipedema, that is not easily dismissed. It invites serious follow-up.

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What this does not tell us — and why that matters

I want to be honest about the limitations of this study, because I think intellectual honesty is what makes science trustworthy. The sample size is the most important constraint: nine lipedema patients and five controls is small. The statistical result is striking, but effect size estimates from small samples can shift considerably in larger cohorts. The finding needs replication, ideally in much larger groups with better-matched controls and richer clinical data.

The patient information available is also limited. We know the mean BMI (26.1 for lipedema, 22.8 for controls), mean age (33.8 and 44.4 years respectively), that none showed pronounced fibrosis, and that all were undergoing their first or second liposuction. But lipedema stage, disease duration, hormonal status, symptom severity, pain levels, nodule characteristics, family history, and genetic background are not reported. Lipedema is a heterogeneous disease, and a study of nine patients cannot tell us whether Lochkern frequency differs between early and late-stage disease, between women with and without family history, between different hormonal contexts, or between tissue from different body regions.

The tissue was also sampled from one specific anatomical location — the deeper subcutaneous layer of the extremities — and we cannot extrapolate from this to other layers or regions without further investigation.

Most fundamentally: this is a morphological study. It shows structure. It does not demonstrate function. The connections to lipogenesis, chromatin biology, gene expression, and lipoma genetics are intellectually motivated and scientifically plausible — but they are not yet demonstrated in lipedema tissue. The authors are proposing directions for future work, not reporting mechanistic conclusions.

The question of what nuclear deformation might actually do

The part of this paper that has stayed with me most is a short section in the discussion where the authors raise the possibility that the physical deformation of the adipocyte nucleus might have consequences for gene expression.

This is speculative — the paper does not contain transcriptomic data, epigenetic profiling, or any functional molecular measurements. But the reasoning is grounded in real cell biology. We know that the nucleus is not simply a passive container for DNA. Its three-dimensional shape, its mechanical environment, and the organization of chromatin inside it are all connected to how genes are regulated. A 2023 paper by Ivanovska and colleagues (cited by the Salzburg group) showed in adipogenically induced cells that small lipid droplets are physically rigid enough to indent the nucleus, dilate the nuclear lamina, and in some cases cause nuclear rupture — with associated DNA damage and disruption of repair mechanisms. The Salzburg team did not observe nuclear rupture in lipedema samples, but they raise the reasonable question of whether the degree of deformation they did observe might be sufficient to reorganize chromatin and alter transcriptional patterns.

Again: this is a hypothesis, not a finding. But it points toward a genuinely fascinating direction. If future studies can combine ultrastructural microscopy with single-cell transcriptomics in lipedema tissue, it may become possible to ask whether adipocytes carrying Lochkerne express different genes than those that do not — and whether those differences intersect with what we already know about inflammation, lipid metabolism, adipogenesis, extracellular matrix biology, or estrogen signaling in lipedema tissue.

What this means for those of us living with lipedema

I want to end with something that is neither hype nor dismissal, because I think both would be wrong here.

This study does not give us a new treatment. It does not tell us what causes lipedema. It does not tell us how to manage our symptoms differently. In clinical practice right now, Lochkerne are not a diagnostic criterion and could not be assessed in routine care.

What it does is contribute something genuinely important to the longer project of establishing that lipedema is a biologically serious disease with measurable structural differences at the cellular level. Differences that are independent of BMI. Differences that show up inside the fat cells themselves — inside the nucleus of the fat cell — and that resemble features previously associated with lipoma biology rather than ordinary adipose tissue.

For those of us who have spent years being told that our tissue is “just fat,” that sentence is not nothing. Diseases become harder to dismiss when their abnormalities can be seen under a microscope, quantified, and published. We are moving, incrementally but genuinely, toward a biology of lipedema that matches the lived experience of the disease.

The researchers — Steiner, Rinnerthaler, Mueller, Russe, Lipp and Bauer — deserve credit for approaching lipedema tissue with the technical seriousness it warrants, for being transparent about limitations, and for not overclaiming what their data show. That is the kind of research the lipedema community needs: careful, methodologically rigorous, and deeply curious about what is actually there when you look closely enough.

What they found, when they looked closely enough, was something strange and unexpected and worth following.

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Thank you for being here and for supporting this work. LipedemaScience exists because I believe that every woman living with lipedema deserves access to the real science — not simplified away, not hidden behind paywalls she cannot afford, not filtered through voices that do not understand what it feels like to live in this body. Making complex research readable, honest and human is my passion, and it is something I pour myself into with every single piece I write. Your support is what makes it possible for me to keep doing this — not just for you, but for the woman who was just diagnosed last week, for the teenager who does not yet have words for what is happening to her, and for everyone who has ever been told that this is just fat. It is not just fat. And together, we are going to keep proving that.

1. Adipocytes from lipedema adipose tissue show lipoma-associated nuclear atypia (DOI: 10.3389/fcell.2026.1804040)

Her days are full. Her husband works away, which means much of the daily rhythm at home falls on her. She looks after two young children, manages the house, works, trains, and continues to build an online space where women with lipedema can feel less alone.

But Taylor’s relationship with her body began long before she had a name for what was happening.

Growing up, she was always active. Sport was part of her life from as early as she can remember, and she joined her first gym while still in high school. Movement became familiar, consistent, and important to her. But even with that consistency, something about her body never seemed to respond the way she expected.

She was a size 8 on top and a size 12 in her legs. People commented on her shape. Some framed it as a compliment, especially during the era when curvier bodies were becoming more visible in popular culture. But Taylor did not experience those comments as compliments. To her, her legs felt different, disproportionate, and confusing.

She also bruised extremely easily. For years, she saw doctors and specialists, trying to understand why. Her blood tests, scans, and investigations kept coming back normal. Instead of answers, she was left feeling as though she might be overreacting.

So she stopped talking about the pain.

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She assumed maybe everyone’s legs hurt like that. Maybe her legs were sore because she trained hard. Maybe this was just what her body was like.

For many women with lipedema, this is where the story becomes painfully familiar. The symptoms are real, but the explanations are missing. The body keeps sending signals, but the medical system often does not yet know how to read them.

Taylor’s fitness journey deepened after the birth of her first child, when she started F45 HIIT training and fell in love with it. That experience eventually led her to study personal training alongside nursing. During that period, she also gave birth to her second child and had hip reconstruction surgery, something she now wonders may have been connected to her lipedema.

That surgery changed the way she understood movement. It taught her about rehabilitation, injury, and how to exercise in a way that supports rather than punishes the body. It opened up a new side of personal training that she became deeply passionate about.

Still, her own body remained difficult to understand.

Taylor became a personal trainer partly because she wanted answers for herself. She wanted to know how to train properly. She wanted to understand the body well enough to finally change her own. Her clients were getting strong results, but her own legs still did not respond in the same way.

That was emotionally difficult.

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She had spent years pushing herself in the gym, yet her cellulite always seemed worse than other people’s. Her legs remained disproportionate. Her confidence suffered deeply. She avoided the beach for years. She stayed away from social situations involving pools. Even taking her children to swimming lessons became mentally hard.

Over time, this developed into a painful relationship with food, over exercising, and binge eating.

After her second child and hip surgery, Taylor’s legs felt worse than ever. She did not want to leave the house. She did not want to wear shorts. She felt low in a way that affected her life, her family, and her children.

Then, in 2024, she came across an Instagram page run by a personal trainer who had just been diagnosed with lipedema.

For the first time, Taylor heard someone describe symptoms that sounded like hers.

She began researching. The more she learned, the more convinced she became that lipedema explained what she had lived with for years. But no one around her had heard of it. Even as a registered nurse working closely with doctors, she found that many people in healthcare did not know about the condition.

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That lack of awareness made her hesitate.

She worried about paying to see a specialist only to be told again that she was fine.

So she made a deal with herself. She would commit fully to training and nutrition for four months. If her body still did not change, she would seek help.

Four months passed. Her body had not changed much. Other people doing similar challenges were seeing impressive results, but Taylor’s legs remained stubbornly the same.

She booked an appointment with her GP. Her doctor admitted she did not know much about lipedema, but she was willing to help Taylor find someone who did.

At the time, they could only find two people in Perth who could diagnose the condition. The first doctor responded by suggesting Taylor was probably just obese and should keep trying before spending money at the clinic.

Then Taylor found a physiotherapist who specialised in lipedema and lymphedema.

She waited four months for the appointment.
The physiotherapist diagnosed her within the first three minutes.
Taylor remembers feeling relieved. Heard. Validated. For the first time, it was not all in her head.

The first month after diagnosis was emotional. But it also became the beginning of something much bigger. Taylor shared one post about her diagnosis on social media, and that single post went viral. Messages poured in. Magazines reached out. Women saw themselves in her story.

That was when Taylor decided that raising awareness about lipedema had become part of her purpose.

After diagnosis, everything changed.

She started adjusting her lifestyle. She changed the way she trained. She changed her diet. She learned about lymphatic drainage. She stopped treating her body like something that needed to be forced into submission and began learning how to support it.

About four weeks later, she noticed a shift.

Her legs felt different. The pain she had assumed was normal was suddenly reduced. Her weight was dropping. Her energy improved. For Taylor, it was a moment of shock and clarity.

Progress no longer meant chasing a goal weight.

Today, she measures progress through pain levels, muscle growth, energy, confidence, and self love.

Taylor still trains, but not the way she used to. Before diagnosis, she would strength train six times per week, often for two hours per session. She did CrossFit and F45 HIIT for years, which she now believes may have worsened her symptoms.

Now, her approach is different.

She focuses on low impact strength training around three times per week, with a fourth day only if her body feels ready. She swims when she can. She walks daily. She uses cycling, rebounding, vibration, and recovery strategies to support her lymphatic system and manage symptoms.

For Taylor, strength training is still important. But the intensity, frequency, and recovery have changed.

Her advice to women with lipedema who are afraid to train because of pain or swelling is simple. Start small. One session per week is enough. Even 20 minutes is enough. The goal is not to overwhelm the body. The goal is to build gradually without increasing inflammation.

Taylor also uses supportive tools, including a vibration plate, a trampoline for rebounding, and a stationary bike. She discovered many of these through research and social media. When she uses her vibration plate consistently, she notices less aching and pain. If she stops for several days, she can feel the difference.

Rebounding has also become part of her routine. She usually follows YouTube videos and hopes to learn more, eventually creating her own rebounding exercise series.

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Her stationary bike is another regular tool. She often cycles 5 to 10 kilometres before a strength session or as her cardio for the day.

Still, she is honest that learning the balance has been difficult. There is a fine line between movement that reduces swelling and movement that triggers it.

Flare ups are part of her life too. She notices that high carbohydrate meals can sometimes worsen pain in her feet and legs. On those days, she focuses on simple supportive strategies. She elevates her legs against the wall several times per day, eats anti inflammatory foods, uses vibration morning and night, and wears compression for as long as she can.

A realistic good week for Taylor includes three strength sessions, one abdominal session, one swim, two rebounding sessions, daily vibration, and at least 8,000 steps per day.

But the hardest part has been learning how to balance discipline with listening to her body.

The gym has always been her escape. As a FIFO wife and mostly solo parent, training is her time to herself. Cutting back has been mentally difficult. She is still learning new ways to look after herself without relying on constant intensity.

Her relationship with her body has changed, too.

The validation of diagnosis and the support of her online community have helped her confidence grow. She now wears shorts most days and feels almost a responsibility to do so, because she wants other women to feel that they can too.

She still has bad days. But now she accepts them as normal. On those days, she dresses in a way that makes her feel comfortable and moves through it with more compassion.

If she could speak to the younger version of herself, the one who was frustrated and confused about her legs, she would tell her not to give up.

There is light at the end of the tunnel.

Taylor wants more people to understand that fitness with lipedema is not only about aesthetics. It is about preventing progression, supporting mobility, reducing symptoms, and protecting quality of life.

Her mission now is twofold.

First, she wants women to understand lipedema and feel more confident in their own bodies. Second, she wants to raise awareness so that the condition becomes known and recognised across healthcare.

She hopes women take confidence, self love, and practical education from her journey. She wants them to know that simple changes can make a meaningful difference, even without surgery.

And for the future, Taylor’s hope is clear.

• She wants lipedema to be taught in medical school.

• She wants healthcare professionals to recognise it.

• And she wants health insurance companies to help cover the cost of treatment.

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Taylor’s story is not only about transformation. It is about recognition. It is about what happens when a woman who has spent years blaming herself finally receives an explanation that makes sense.

And perhaps most importantly, it is about learning that the body does not always need to be pushed harder.

Sometimes, it needs to be understood.

Want to read more stories from women with lipedema?

Check out these stories, or go to the front page, then the top bar, and click Stories to read them all.

Chia seeds, flax seeds, extra virgin olive oil, Brazil nuts, unsalted walnuts and avocado are ingredients I almost always buy when they are available in good quality.

They are all good sources of healthy fats and different nutrients, and for me they are part of building meals that support my body in a steady, realistic way.

Healthy fats matter. Female hormones such as estrogen and progesterone are closely connected to fat metabolism, and the body needs enough dietary fat to support hormone production, brain function, cell membranes and overall metabolic health. Very low fat diets can, for some women, contribute to hormonal imbalance, irregular cycles, low mood and reduced wellbeing.

That is why I do not try to remove fat from my diet.
I try to choose better sources of fat.

For me, that often means avocado, extra virgin olive oil, walnuts, Brazil nuts, chia seeds and flax seeds. Simple ingredients, but very powerful ones.

Mercury in canned tuna

The house we are staying in here in Portugal has beautiful light in the kitchen, which makes it much easier to document what I eat. But my eating habits also depend a lot on where I am. In Spain, for example, I ate canned tuna almost every day, usually with 85 percent dark chocolate after dinner.

But tuna is an apex predator, high up in the food chain, and because of that it can accumulate higher levels of heavy metals such as mercury. Mercury binds to the protein in the fish muscle, which is why I do not want tuna to become an everyday food for too long.

It also depends on what kind of kitchen equipment I have available. In this new place, the kitchen is much better equipped, so I can make homemade hummus, baked vegetables and more proper meals again. So now I am shifting a little, and eating more colourful, more like I do when I am at home.

Today, my first meal was around 14:00 after the gym. It was simple, but very good. Scrambled eggs without butter or cream, cottage cheese, cherry tomatoes, spinach, avocado, kefir water without too much sugar, and extra virgin olive oil.

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And how do I use olive oil?

Raw, not heated.

Extra virgin olive oil is one of my favourite staples because it contains oleic acid, a heat stable monounsaturated fat, together with fat soluble vitamins like vitamin E and vitamin K. But a lot of its benefits come from the polyphenols, such as oleocanthal, hydroxytyrosol and oleuropein. These are plant compounds with antioxidant and anti inflammatory properties, and they are also what give a good olive oil that bitter, peppery taste.

For dinner, which I had with my partner around 18:00, I made a dressing by blending olive oil, avocado, cottage cheese and lemon. It was actually quite similar to my first meal, because that was what we had in the fridge. Spinach, cherry tomatoes, hard cheese, and chicken cooked in butter.

My eating window was between 14:00 and 18:00, which means I fasted for around 20 hours

I know fasting can be a sensitive topic, especially when we talk about women’s health, hormones and lipedema, so I want to be very clear about how I think about it. For me, fasting is not about punishment, restriction or trying to force my body into fat loss. It is something I use carefully, in certain periods, when my body feels calm enough to handle it.

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When we fast, the body gradually shifts into a different metabolic state. One of the processes often discussed in relation to fasting is autophagy, which literally means “self eating.” It is the body’s own cellular recycling and housekeeping system, where damaged cell components, misfolded proteins and cellular waste can be broken down and reused as new building blocks or energy. Autophagy is not something that only happens during fasting. It is happening in the body all the time, but fasting, exercise and certain metabolic states may increase this process.

This is one of the reasons fasting is so interesting from a biological perspective. As liver glycogen gradually becomes lower and insulin levels drop, the body may begin to rely more on stored fat and ketones for energy. This can support metabolic flexibility, insulin sensitivity and cellular repair processes. But I think it is very important not to oversimplify this, especially when we talk about lipedema.

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We do not yet have strong science showing exactly how intermittent fasting affects lipedema tissue specifically. And I also think women with lipedema may respond very differently depending on their hormones, stress levels, sleep, inflammation, pain, lymphatic function and general life situation. Lipedema fat does not behave like ordinary fat tissue. It is often resistant to diet and exercise, and it is connected to inflammation, fluid retention, pain, connective tissue changes and hormonal factors. So I do not fast because I believe it will “melt away” lipedema fat. That is not how I see it.

For me, fasting is more about supporting insulin regulation, digestion, metabolic flexibility and how my body feels overall. But it only works for me when the rest of my life is relatively calm. Right now, I feel like my body is under very little stress. I sleep well, I move my body, I lift weights, I run, I eat nutrient dense food, and the stress I expose myself to is mostly controlled stress. Training is stress. Fasting is also stress. But in the right context, and in the right amount, it can be a useful signal to the body.

In periods where I am under a lot of emotional pressure, work stress, poor sleep, travel stress or general life stress, I do not fast this long. Then my body needs something else from me. It needs more regular meals, enough protein, enough healthy fats, stable blood sugar and less pressure. I have learned that fasting should never be separated from the life situation a person is in.

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That is why I think fasting with lipedema has to be approached carefully. Shorter and more consistent fasting windows, like 14 or 16 hours, may feel supportive for some people. But extreme fasting, especially when the body is already stressed, can easily backfire. For some women, it may increase cravings, worsen sleep, raise stress hormones, increase fluid retention or make the body feel more inflamed and unsafe.

So my approach is flexible. Some days I fast longer. Some days I do not fast at all. I am not trying to live inside a rigid system. I am trying to understand what my body can handle in different seasons of life.

And that is really the core of my 80 percent. It is not about perfection. It is not about restriction. It is about creating structure that supports my body, while still respecting the fact that my body is not the same every day.

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This is just the beginning of me showing more of my 80 percent

The day before, when we arrived at the house here in Portugal, our Airbnb host had left us a fruit basket. And honestly, it made us so happy. There is something very sweet about arriving in a new place and being welcomed with fresh fruit on the kitchen table.

I usually do not eat grapes as part of my 80 percent, because they contain more sugar than apples and oranges. Apples and oranges are generally better daily choices for me because they give more fullness for the amount of sugar and calories they contain.

Grapes consist of roughly 15 percent sugar, while apples and oranges are usually closer to 7 to 10 percent. That means you can eat a larger volume of apple or orange for the same amount of sugar found in a smaller portion of grapes.

And this matters, at least for me. Grapes are small, sweet and very easy to overeat. You can suddenly eat a whole bunch without really noticing it, and it can become a quick intake of fast carbohydrates without making you feel especially full.

Apples and oranges are different. They contain more water and fiber, they take longer to eat, and they give a stronger sense of fullness. Oranges also provide a lot of vitamin C, which supports the immune system and collagen production, while apples contain pectin fiber and antioxidants that support digestion and cholesterol balance.

But still, I ate the grapes.

Because this is also part of my 80 percent. It is not about being perfect. It is about having a structure that supports my body most of the time, while still being able to enjoy a beautiful fruit basket from a kind Airbnb host in Portugal.

For lunch yesterday, I kept it very simple.

I had plain scrambled eggs with spinach and extra virgin olive oil, and then a bowl of natural Greek yoghurt with chia seeds, flax seeds, Brazil nuts, walnuts, apple, orange and a few grapes from the fruit basket we got when we arrived.

Brazil nuts and walnuts are two small ingredients that bring a lot of nutritional value. Brazil nuts are especially known for their selenium content, which is important for thyroid function, metabolism and antioxidant protection. Because they are so rich in selenium, I usually think of them as something to eat in small amounts. One or two Brazil nuts a day is more than enough for most people.

Walnuts are different, but equally interesting. They are one of the best plant sources of alpha linolenic acid, also known as ALA, which is a plant based omega 3 fatty acid. Together with their antioxidants and polyphenols, walnuts can support heart health, brain health and help lower inflammation in the body.

So even though this was a very simple lunch, it was still full of good building blocks. Protein from the eggs and yoghurt, fibre from the chia seeds, flax seeds and fruit, healthy fats from the nuts and olive oil, and colour from the spinach, apple, orange and grapes.

A very typical 80 percent meal for me. Simple, anti inflammatory, colourful and easy to make in a temporary kitchen in Portugal.

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Normal. Within range. Nothing to worry about.

And you leave the appointment carrying both the test result and your body’s testimony, trying to reconcile two things that seem to be describing completely different realities.

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That contradiction is not in your head. It is not anxiety about getting older, or a failure to accept change, or something that will resolve with the right mindset. It has a biological explanation — one that standard hormone panels were simply never designed to find. And understanding it, really understanding it, changes the entire way you see what is happening inside you.

The conversation your blood test cannot have

When a doctor measures your hormone levels, they are measuring what is circulating in your bloodstream at a given moment. That information is real and it matters. But it tells you almost nothing about what is happening inside lipedema adipose tissue specifically — because lipedema fat is not passive. It is a biologically active environment with its own local hormonal economy, its own enzyme systems, and increasingly, its own estrogen production. The blood and the tissue are having two completely separate conversations.

Since so many people are asking similar questions about lipedema and menopause, I would really recommend leaving your question in the comments. That way, every subscriber can see the answer, and we can build a shared discussion that helps more people understand this topic better.

This is the central insight from a 2025 narrative review published in the International Journal of Molecular Sciences. The paper — titled “Menopause as a Critical Turning Point in Lipedema: The Estrogen Receptor Imbalance, Intracrine Estrogen, and Adipose Tissue Dysfunction Model” — is one of the most detailed attempts yet to map the molecular landscape of why menopause so often acts as an accelerant in lipedema. It is a hypothesis-driven review, not a clinical trial, and I want to be precise about that. But it draws on converging lines of evidence from earlier studies and constructs a model that is difficult to dismiss — and that, in my view, every woman with lipedema navigating perimenopause deserves to know about.

Two receptors, one imbalance

To understand the model, you need to know a little about how estrogen actually works inside fat tissue. Estrogen does not simply arrive and act uniformly. It binds to specific receptor proteins inside cells, and different receptors drive very different outcomes. The two main ones in adipose tissue are called estrogen receptor alpha (ERα) and estrogen receptor beta (ERβ), and they are not interchangeable.

In healthy adipose tissue, ERα is broadly considered the metabolically protective receptor. When it is active and functioning well, it supports healthy fat metabolism, helps regulate lipid oxidation, supports mitochondrial function, and generally keeps the tissue behaving in an orderly, responsive way. ERβ, by contrast, appears to promote a different type of cellular environment — one more associated with fat accumulation, increased inflammation, reduced lipolysis, and tissue fibrosis when it becomes dominant.

For some years now, researchers studying lipedema have noticed that this receptor balance is already disrupted in lipedema tissue. Earlier work, including an influential 2021 review in the International Journal of Molecular Sciences, proposed that dysregulation of estrogen receptor distribution — specifically a shift in the ERα/ERβ ratio — might drive the altered fat metabolism seen in lipedema. According to that model, reduced ERα activity could increase the activation of PPARγ (a transcription factor that promotes fat cell differentiation and fat storage), drive free fatty acids into adipocytes, suppress lipolysis, impair mitochondrial biogenesis, and stimulate angiogenesis — collectively creating the biological conditions for disproportionate fat accumulation.

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That hypothesis gained further molecular grounding from a 2024 cell study published in Obesity, who examined estrogen receptor gene expression in adipose-derived stem cells (ASCs) and three-dimensional spheroid cultures from women with lipedema compared to BMI- and age-matched healthy controls. Their findings were striking: ERβ gene expression was significantly elevated in hormone-depleted lipedema ASCs and spheroids compared to healthy cells. ERα and GPER — a third estrogen receptor — were significantly decreased in estrogen-treated lipedema spheroids. Lipedema cells, in other words, were already wired differently at the receptor level. The study also found altered expression of CYP19A1, the gene that encodes the enzyme aromatase — something I want to come back to, because it becomes central to the menopause story.

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This was a cell study, so the findings reflect what happens in isolated adipose-derived cells in laboratory conditions rather than in living tissue in a complex human body. Cell studies are important starting points, not endpoints. But the pattern they revealed aligned closely with what other researchers had been proposing on theoretical grounds.

What menopause actually does to this already-disrupted system

Here is where the 2025 review adds the most important layer. If lipedema tissue already has an ERα/ERβ imbalance, what happens when menopause arrives and systemic estrogen begins to fall?

The intuitive answer might be: less estrogen, less problem. But the biology goes in a more complicated and, frankly, more difficult direction.

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According to the proposed model, the decline in circulating estrogen that comes with menopause does not calm the tissue down. Instead, it amplifies the existing imbalance. ERα signaling — already relatively weak in lipedema — becomes further suppressed. ERβ activity is further enhanced. The protective receptor retreats and the receptor more closely associated with fat accumulation, inflammation, and fibrosis becomes more dominant. Mitochondrial function worsens. Insulin sensitivity in the tissue declines. The capacity to oxidize fat decreases. And all of this unfolds in tissue that was already struggling to maintain metabolic balance.

But there is a second mechanism at work here, and it is the one that I think is most important for understanding why the blood test and the body’s reality can be so completely at odds.

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The tissue keeps making its own estrogen

Adipose tissue does not just respond to estrogen arriving from the circulation. It also produces estrogen locally, through a system of enzymes that can convert precursor hormones directly within the tissue cells. This is called intracrine signaling — and it is one of the most consequential concepts for understanding lipedema around menopause.

The key enzyme here is aromatase, encoded by the CYP19A1 gene. Aromatase converts androgens into estrogens locally, inside the fat tissue itself. The 2025 review proposes that in lipedema adipose tissue, aromatase activity is upregulated — meaning the tissue is producing more local estrogen even as circulating estrogen falls. This was supported by findings from an earlier early-stage lipedema tissue study published in Biomedicines in 2022, which found altered aromatase gene expression in lipedema stromal vascular fraction cells even at early disease stages, alongside evidence of endothelial barrier disruption — suggesting that the hormonal alterations are present early and are embedded in the tissue’s cellular architecture.

The 2025 review describes a further enzymatic imbalance: 17β-hydroxysteroid dehydrogenase type 1 (17β-HSD1), which converts weaker estrogens into the more potent estradiol, is reportedly upregulated in this model. Meanwhile, 17β-HSD2, the enzyme that performs the reverse conversion — inactivating estradiol back into a weaker form — is suppressed. The net result, according to this proposed mechanism, is a sustained excess of local estradiol inside the tissue, even after blood estrogen has fallen to postmenopausal levels.

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The fire, in other words, does not go out when the systemic supply drops. It shifts inward, sustains itself through local enzyme activity, and continues driving the inflammatory, fibrotic, and metabolically disruptive processes that characterize advanced lipedema. Your blood test measures the flame it can see. It has no way to see what is burning underground.

A molecular signature that is beginning to look familiar

One of the most scientifically interesting aspects of the review is a comparison that has been quietly building in the lipedema literature for a few years. The authors note that the molecular signature observed in lipedema — local estrogen excess, ERα suppression, ERβ dominance, intracrine estrogen production through aromatase overactivity, and downstream inflammation and fibrosis — closely mirrors the biology seen in other estrogen-driven gynecological conditions, including endometriosis, adenomyosis, and uterine fibroids.

This is not a coincidence, and it is not something the authors mention casually. It is part of a broader argument they are making: that lipedema may need to be reframed not simply as an adipose tissue disorder or a lymphatic disorder, but as an estrogen-receptor-driven gynecological disorder — one that shares fundamental molecular mechanisms with conditions that have long been taken more seriously in clinical medicine, because they affect reproductive organs rather than fat tissue.

A 2025 review in Archives of Plastic Surgery, which specifically examined hormonal links between lipedema and gynecological disorders and explored the potential therapeutic roles of gestrinone and drospirenone, reinforces this framing. It describes a common pathway involving estrogen receptor imbalance that links lipedema’s biology to these other conditions — not identically, but through recognizable molecular themes. The authors discuss how certain hormonal treatments already used for estrogen-driven gynecological conditions might theoretically be relevant to lipedema, though they are careful to note this is preliminary and requires clinical evaluation.

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For me, as someone who has lived with lipedema since diagnosis in 2012 and who spent years in laboratory settings studying inflammation at the cellular level, this reframing matters enormously. It is not just academically interesting. It changes the legitimacy framework around lipedema. It suggests the tissue is not poorly behaved fat. It is tissue caught in a hormonal signaling loop that, under the right molecular conditions, cannot easily regulate itself.

What this model still does not answer

Scientific honesty requires that I say this clearly: the 2025 paper is a narrative review — a synthesis of existing research into a proposed model. It is not a randomized trial. It is not a clinical outcome study. The mechanisms it describes — the receptor imbalance, the intracrine estrogen loop, the enzymatic shifts — are proposed based on converging evidence from cell studies, earlier mechanistic reviews, and molecular parallels with related conditions. They have not yet been confirmed through large-scale human tissue studies specifically designed to test these pathways in lipedema patients at different menopausal stages.

A 2026 systematic review on hormonal influences in lipedema, which screened 64 papers and ultimately included 15 for analysis, concluded that lipedema appears to be a multifactorial condition driven primarily by hormonal dysregulation — especially involving estrogen — alongside metabolic and possibly genetic components. It identified four main pathophysiological hypotheses in the literature, including changes in estrogen metabolism and receptor function, but also general hormonal imbalance, growth hormone changes, and metabolic imbalance involving adipokines and PPARγ. The review concluded that further research into diagnostic biomarkers and targeted therapies is urgently needed. Fifteen included papers is not a large evidence base, and the heterogeneity across studies remains significant.

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So what we have is a biologically plausible, increasingly well-articulated model — supported by cell studies, gene expression data, mechanistic reviews, and molecular parallels with better-studied conditions — that has not yet completed the full translational journey from proposed mechanism to confirmed clinical protocol. That matters when you are trying to decide what to do with this information. It does not mean the model is wrong. It means it is not yet proven in the way that clinical medicine requires before it shapes treatment guidelines.

There is also important heterogeneity in lipedema itself that is easy to overlook in mechanistic reviews. Not all women with lipedema experience the same progression around menopause. Not all women with lipedema have the same disease stage, the same genetic background, the same metabolic profile, or the same hormonal history. A model constructed from averaged findings and proposed mechanisms may capture something real about the biology without capturing every woman’s individual experience. Research in this area remains in relatively early stages, and the lipedema field still lacks the large, prospective, well-controlled clinical studies needed to confirm or refine these mechanistic proposals.

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What it means to understand this

I think there are two different ways this knowledge can land, and I want to name both of them.

The first is the purely intellectual one: this is a scientifically sophisticated explanation for why something real is happening, and it deserves to be taken seriously by clinicians and researchers. It gives lipedema a legitimate hormonal biology, not a mystery or a lifestyle failure or an inevitability to simply manage. If the proposed mechanisms hold under further study, they open genuine questions about whether hormonal modulation strategies developed for related conditions might eventually be evaluated in lipedema — and about what metabolic interventions might support the tissue environment in meaningful ways.

The second way this knowledge lands is more personal, and I think it matters equally. If you have been told your hormones are fine while your body tells you something very different, this research offers a biological framework for why both of those things can be simultaneously true. The blood test is not lying. But it is looking at the wrong place. The lipedema tissue has its own hormonal activity, its own enzymatic environment, its own internal dynamics — and a standard panel cannot see inside it.

That is not a small thing. It is the difference between being told there is no explanation and being told the explanation requires more sophisticated tools to find. One of those is dismissal dressed as reassurance. The other is the beginning of a real conversation.

Menopause may be a turning point for lipedema. But understanding the mechanism is itself a form of power — not because it offers a quick answer or a guaranteed treatment, but because it means you are no longer navigating in the dark.

You are seeing the terrain.

Since so many people are asking similar questions about lipedema and menopause, I would really recommend leaving your question in the comments. That way, every subscriber can see the answer, and we can build a shared discussion that helps more people understand this topic better.

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1. Menopause as a Critical Turning Point in Lipedema: The Estrogen Receptor Imbalance, Intracrine Estrogen, and Adipose Tissue Dysfunction Model (DOI: 10.3390/ijms26157074)

2. Lipedema and the Potential Role of Estrogen in Excessive Adipose Tissue Accumulation (DOI: 10.3390/ijms222111720)

3. The Expression of Adipogenic Marker Is Significantly Increased in Estrogen-Treated Lipedema Adipocytes Differentiated from Adipose Stem Cells In Vitro (DOI: 10.3390/biomedicines12051042)

4. Multi-Level Analysis of Adipose Tissue Reveals the Relevance of Perivascular Subpopulations and an Increased Endothelial Permeability in Early-Stage Lipedema (DOI: 10.3390/biomedicines10051163)

5. Lipedema and adipose tissue: current understanding, controversies, and future directions (DOI: 10.3389/fcell.2025.1691161)

6. Impact of hormones on lipedema development: a systematic literature review (DOI: 10.1007/s00404-026-08318-1)

7. Hormonal Links between Lipedema and Gynecological Disorders: Therapeutic Roles of Gestrinone and Drospirenone (DOI: 10.9734/jammr/2025/v37i25731)

Since I published my last post about life in Spain, I had really settled into some great fitness routines. The gym was ridiculously expensive, so naturally I had no choice but to go every single day for two weeks. Financial discipline, but make it wellness. And honestly, I think it worked. I can finally see that my arms and shoulders are coming back a little. Or maybe I am imagining it. Either way, I feel very good about myself at the moment, and sometimes that is the whole point.

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It might also be because I am not as pale as I can be. During my surgery period, I could not expose my scars to the sun at all for one and a half years, and I honestly felt like my legs looked like chicken legs. Not cute Mediterranean chicken either. More like confused Norwegian supermarket chicken.

It is so interesting how we can walk around in this world with so many positive thoughts about the body we live in, and then at other times feel completely disconnected from it. Right now, I feel like I can show off my cellulite and lipedema unevenness without caring too much whether people notice it or not. It is not always like that. So when this feeling appears, I try to pay attention to it. I try to understand what builds this kind of confidence, because I really want to protect it and foster more of it.

Because so much of body image, self esteem and self love is about feelings. It is about what you tell yourself when you look in the mirror.

Those of you who have followed my articles for a while know that earlier this year, I was in a very different place. I was desperate for a change. I needed something dramatic, even though I knew it probably was not ideal for my physical health after everything my body had gone through. I had two egg retrievals in January and February, and my body was still very affected by all the hormones. I lost so much hair, and a lot of my hair turned grey. It was honestly wild to watch all those changes happen so quickly.

As a food scientist and nutritionist who has lived with a lipedema diagnosis for many years, I know that sustainability is the key. I know this deeply. But at that moment, my mental health needed a shift. And as soon as I started feeling like myself again, I stopped the dramatic changes.

So being in the place I am now feels a little strange, because it was not that long ago that everything felt like the complete opposite. At the same time, I know I will probably need a couple more egg retrievals, so I am aware that more waves may come in the future.

So yes, I have been running almost every day for nearly a month to the store to buy water, and then walking uphill with ten liters of water like some kind of lipedema pilgrim. Conveniently, the gym was right next to the grocery store, so for two of those weeks I also added proper workout sessions. Now I feel highly motivated to keep these routines going here in Portugal.

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I usually take photos of my twenty percent. The joy, the food, the culture, the small beautiful moments, the life part of life. But the place I am staying in now in Portugal has much better light, so I will try to take more photos of the eighty percent too. What that looks like for me. Because you have probably already seen that I enjoy life and that I do not let lipedema take everything away from me. But you have not yet seen everything I do for my lipedema.

Before we close the Spain chapter, let us have a little throwback since my last post from Spain.

I had five golf lessons with an amazing Scottish trainer who actually helped me improve my skills. After five lessons, I am basically ready for the PGA Tour, as long as nobody asks about my handicap or watches me play under pressure.

My partner and I also had Mexican food every Friday at this little Michelin taco place. In Norway, eating tacos on Fridays is a whole cultural institution, so doing that for several Fridays in a row felt strangely like home. Just with better weather, better tacos and alcohol free Corona beer.

We only left the resort once in almost four weeks, which is slightly insane when I say it out loud. But that one trip was to Cartagena, a beautiful Spanish town that gave us some fresh impressions, a proper change of scenery and some really good freshly roasted coffee beans.

Enjoy the photos.

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Portugal already feels easy to move around in. Since we have a car, it feels like we can go almost anywhere. One small town, one beach, one café, one supermarket, one restaurant at a time. The driving culture also seems much calmer than what I experienced in southern Italy. Sorry to my Italian readers, but that was honestly a little scary.

Our plan while we are here is simple. Work a lot. Go to the gym. Eat healthy most of the time. Enjoy good restaurants. Explore small Portuguese towns. Find a rhythm that supports both life and health, without turning everything into a strict health project.

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And while I am here, I also want to continue building this community. I can already see that LipedemaScience is having an impact in the lipedema world, not only among readers, but also through conversations with doctors, researchers, and people working in this field. That means a lot to me.

My hope is that, in the future, lipedema treatment becomes more focused on the actual drivers of the condition, not only on symptom management. Surgery can be important. For some of us, it can be life-changing. But surgery is not a root cause treatment. It is a treatment of symptoms and diseased tissue. And those are two very different things.

But that is not really what this article is about..

This article is about how I managed to travel, live, recover, and still feel like myself between my lipedema surgeries. It is about what I actually did when I travelled during that period, what advice I received, what worked for me, what was difficult, and why I am still so glad I chose to keep living my life while I was going through it.

During this period, I had four lipedema surgeries. My first surgery was in September 2021, the second in November 2021, the third in February 2022, and the fourth in October 2022. Between those surgeries, I was healing, wearing compression, dealing with swelling, managing complications, and slowly learning how to live in a body that was constantly recovering. And still, in the middle of that process, I travelled.

Want to see photos from my surgeries and recovery process? You can find them in this article..

Barcelona (Spain)

November 2021

I remember going to Barcelona because my partner had to travel there for work. This was two months after my leg surgery in September, and it was also my first trip after the COVID lockdowns. During the day, I wore double compression garments, and at night I slept with one layer of compression. It was the first time I really understood that travelling affected my whole body, not only my legs. My face was bloated and full of water too.

Flying can make swelling worse because of low cabin pressure, prolonged sitting, reduced movement, and dehydration, which may slow lymphatic flow and allow fluid to pool in the tissues. For many people, this is most noticeable in the legs, ankles, and feet, but for me it felt more systemic. I am not always perfect at wearing compression now, several years after surgery, but I still try to always wear it when I fly. Yesterday, when I flew from Spain to Portugal, I had my compression on. Back then, I remember trying hard to find a hotel with a pool, because I wanted to be in water after the flight and support lymphatic drainage, but I didn’t manage to find one. I was a little scared during that whole trip, because my body still felt fragile and unfamiliar after surgery, but I also really needed that journey. So I tried my best to enjoy Barcelona anyway.

You can see it in the photos too. My body was bloated, and even my face looked full of water. It was one of the first times I truly understood how much travelling and flying could affect my whole system after surgery, not just my legs. When I came back to Norway, it was straight back to the lymphatic press machine, trying to help my body move the fluid again and calm everything down.

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Reykjavík (Iceland)

January 2022

Then came Iceland. This was a little more than four months after my first leg surgery, two months after my thigh surgery, and one month before my third surgery. We went there to celebrate my partner turning 30, and I remember feeling much less afraid than I had felt in Barcelona.

By this point, I was no longer wearing double compression in the same way. I used one layer of medical compression, and then compression tights from 2XU or something similar on top. We stayed in four different hotels and Airbnbs during the trip, both in Reykjavík and in other places, and explored the island by car. It felt freeing to move around like that again, even though my body was still very much recovering.

We also spent a couple of days at a lagoon hotel close to the Blue Lagoon, which meant I got to spend time in warm water several times during the trip. We swam both in the Blue Lagoon and in other lagoons, and the warm geothermal water felt amazing for my body, my lymphatic system, my recovery process, and honestly, for my inner peace as well. The Blue Lagoon is known for having warm water temperatures around 37 to 40 degrees Celsius, which is about 98 to 104 degrees Fahrenheit. That warmth felt deeply calming for my body, my lymphatic system, my recovery process, and honestly, for my inner peace as well.

Interestingly, I did not feel as bloated on this trip as I had in Barcelona, even though the flight from Oslo to Iceland was longer than the flight to Barcelona. I cannot say for sure why. Maybe the swimming helped. Maybe my body had simply recovered a little more. Maybe it was the combination of movement, warm water, less fear, and being in a place that felt peaceful. It is difficult to know.

At this point, I was also dealing with a huge seroma on my right thigh after my November surgery. So even though Iceland felt easier than Barcelona in many ways, it was not because my body was fully healed. It was because I was learning how to travel with a body that was still healing.

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Prague (Czechia)

April 2022

At the end of February, I had my upper arm surgery. This is the surgery where you will see some fluffy, bloated lobster hands in the photos. Around the same time, I had also started wearing class two compression garments on my legs, the kind that looked more like thin nylon pantyhose than the heavier garments I used earlier in the process. Some of the photos of my hands will probably never make their way to the internet, because they are still hard for me to look at. So the photos from this Easter trip are a little limited. This was in April, about one and a half months after my upper arm surgery, five months after my thigh surgery, and seven months after my first leg surgery. The trip started in Prague in Czechia, then we took the train to Vienna in Austria, and from there we continued by bus to Budapest in Hungary.

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Vienna (Austria)

April 2022

There is a reason I studied both nutrition and food science. Food genuinely fascinates me, not only because it is cultural, social, and beautiful, but because it can play such an important role in healing the body. And when you are going through a surgical pathway, healing becomes a top priority.

To be completely honest, I think we sometimes underestimate how much the body goes through during liposuction. Even when surgery is necessary and carefully performed, it is still invasive. I sometimes think of it almost like a war inside the tissue. Cannulas have moved back and forth through the fat tissue, removing tissue and leaving the body with a lot of internal repair work. And someone has to rebuild that. That someone is your immune system.

Your body is not just resting after surgery. It is actively repairing tissue, clearing fluid, resolving inflammation, and trying to restore order. That requires energy, protein, micronutrients, hydration, sleep, patience, and the right kind of support. This is also why surgeons emphasize compression garments. They help the tissue heal more evenly, support fluid movement, reduce fluid buildup, and may help prevent contour irregularities. Nutrition matters for the same reason. Your body needs building blocks to repair what has been disrupted.

And then there is patience. The visible bruising and swelling may improve within the first weeks, but the deeper healing takes much longer. Residual swelling can last for months, and for some people it can take up to a year before the final result is visible. That is important to understand before going into a surgical pathway.

Because of this, I do think many people may need to be more careful during surgery periods. Maybe the usual 80 20 approach becomes more like 90 10 for a while. More nutrition, more sleep, less alcohol, fewer inflammatory triggers. But there is also another side to this.

The mental burden can be huge. At least it was for me. Surgery, compression, swelling, pain, waiting, uncertainty, and constantly observing your own body can become exhausting. So giving myself space to breathe, travel, enjoy, and still feel like a person was also important.

I am a cultural seeker, an explorer, and a foodie. So when I went to Vienna for the first time, I knew I had to use some of my 10 or 20 percent joy there. I often talk about the 80 20 rule, but I don’t think it has to look the same for everyone. For one person, it may happen within a day. For someone else, across a week. For others, across a month, a travel period, or even a year. What matters is that it fits your real life.

Today, I have learned much more about how to eat well while traveling. But during this surgery period, I drank more alcohol, ate more sugar, had more fried food, and did not have the same balance I have now. That balance is something I have built gradually, together with my partner, through many reflections on what kind of travel lifestyle we actually want.

I bring this up when writing about Vienna because Vienna is one of those places where food is part of the experience. The city is known for its coffeehouses, cakes, pastries, and layered tortes. Viennese confectionery is part of Austria’s cultural heritage, and sitting in a coffeehouse with cake is not only about sugar. It is also about experiencing a place.

And then there is Wiener schnitzel, one of the most famous dishes in Viennese cuisine. A thin, breaded, pan-fried veal cutlet. Simple, crispy, rich, traditional, and everywhere. Would I do that trip differently today? Yes, probably.

If I went back now, I would still enjoy the cake and the schnitzel, because that is part of the experience for me. But I would also add more vegetables, more nutrient-dense food, more protein, and more balance throughout the day. I did not really do that back then. Back then, I used up a lot of my “enjoy life” credits on that trip.

But when I came back to Norway, I returned to my routines. The gym. My anti-inflammatory, vegetable-rich diet. My gut health routines. My compression. My recovery habits.

And I think that is part of the point. You don’t have to live perfectly to support your body. But you do need to understand what your body is going through, especially after surgery. You need to give it what it needs most of the time. And sometimes, when life gives you Vienna, you also allow yourself to sit down, taste the cake, and remember that healing is not only about controlling the body. Sometimes it is also about letting yourself live inside it.

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Budapest (Hungary)

April 2022

And then, on the bus ride to Budapest, the shit hit the fan. I started to feel nauseous during the journey, and that night, a heavy food poisoning hit me. My partner stayed completely healthy, and I still don’t know what caused it. Since I studied food science, I had spent a lot of time learning about the microorganisms that cause foodborne illness, including in the laboratory. My first job after my master’s degree was also as a food safety responsible in the food industry, so I knew very well that it can be difficult to know exactly what caused a food poisoning episode. But whatever it was, my body was not happy.

I lost so much fluid, and my body made it very clear that it did not want any more food or liquid. We only had one day to explore Budapest, so it felt really sad to be in such bad shape in such a beautiful city. I felt terrible the whole day. I remember going to this really nice restaurant, and I could tell that the food was delicious, but my body completely refused to accept anything. I had to leave with a full plate of amazing food in front of me, which honestly felt tragic for the foodie in me.

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Stavanger (Norway)

May 2022

And then spring finally arrived in Norway, and I went on an amazing girls’ trip to Stavanger.

At that point, it had been about three months since my upper arm surgery, six months since my thigh surgery, and eight months since my first leg surgery. I still had five months left before my fourth and final surgery, so I was very much still in the middle of the whole surgical pathway.

I was still wearing regular compression on my arms, and when I worked out, I wore a full compression tights suit, as you can see in the photos. That meant I had two layers on my arms during training, which felt necessary since my upper arm surgery was still quite recent. I was also still wearing compression pantyhose for my legs. I am not completely sure if I slept with compression at that point, but I probably still used it on my arms at night.

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Kløfta (Norway)

May 2022

Later in May, my brother got married, and at the party that evening, my legs had their first real hours without compression after surgery. I took so many mirror selfies that day because I felt amazing. I wanted to document my new legs. I felt light, proud, and honestly a little fascinated by seeing my body look that way. But I also want to be honest. My legs did not look exactly like that after they settled.

I am not completely sure why, or what the full biological process behind it is, but I think it makes sense. When you wear compression continuously after surgery, the tissue is being mechanically supported and shaped for a long time. When that support is removed, the body has to find its own balance again. The remaining fat tissue, fluid, connective tissue, fibrosis, swelling, hormones, and lymphatic function all play a role in how the legs eventually look and feel.

For me, I think several things may have contributed. I am not always consistent with compression now, and I am not always the best at supporting my lymphatic system. I really want to work on that, but I am also trying to figure out how to manage it in a way that does not take over my whole life. Because honestly, lipedema management already takes up a lot of space.

After lipedema surgery, some people experience that the legs look very slim at first, especially while wearing compression regularly, and then later feel fuller again once the tissue settles. This can be incredibly frustrating. It does not necessarily mean that everything has “come back.” It may be related to fluid, fibrosis, tissue remodeling, surviving fat cells returning to their natural shape, hormonal changes, weight changes, or a combination of all of these things.

I have also been on a lot of hormones during the past year, and I do feel that I have seen changes in my body after that. But I do not want to go too deeply into that here. I mainly wanted to explain why I think my legs looked different on this day. This was basically day zero of not wearing leg compression every day after lipedema surgery. And for that moment, I just felt happy in my body.

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Santorini (Greece)

July 2022

Then came Greece in July 2022. By that point, it had been about ten months since my first surgery, eight months since my thigh surgery, and five months since my upper arm surgery. I still had three months left before my fourth and final surgery, so I was still in the middle of the process, but I also felt more experienced in how to live with the recovery.

During this trip, I stopped wearing compression on my legs because it had been more than eight months since those surgeries. But I still needed compression on my arms, since my upper arm surgery had only been five months earlier. My surgeon had also told me to cover my scars and keep them out of the sun for one year, to help them heal as pale and neat as possible. So I did exactly that.

At this point, I had not yet had surgery on the lower part of my arms, so I found a bikini top that covered my upper arms. I used that when I was in the water. I wore SPF 50+ all the time, covered up carefully, and avoided direct sun exposure that whole summer. I stayed pale and happy, and I still enjoyed life.

Because I was still wearing compression on my arms, I also bought several long-sleeved dresses for this trip. We were in Greece for about three weeks in total, so I needed clothes that made it possible to feel comfortable, protected, and still like myself.

Santorini is very known for its wine, and at that point, my partner and I had not yet started limiting our alcohol consumption the way we do now. We were genuinely interested in wine and went to several wine tastings that year. Back then, we often bought a bottle of wine to share at home, like Chianti from Tuscany, Chardonnay from Burgundy, or Pinot Noir from California.

That is something we have stopped doing now. Today, we may have a glass or two at a nice restaurant, but we no longer drink wine at home. Part of me feels a little sad about closing that chapter, because it was something we explored together and enjoyed for a while. But I am also grateful that we had that period, and I am equally grateful that we have changed our habits as our lifestyle and health priorities have changed.

And Santorini really is a place where wine is part of the landscape and culture. The wines are known for their vibrant acidity, volcanic minerality, and dry profile. The island’s volcanic soil, intense heat, limited rainfall, and strong Aegean winds create a very specific wine tradition that feels deeply connected to the place itself.

But Santorini is not only wine. It also has beautiful seafood, vegetables, and ingredients shaped by the same mineral-rich environment. So even there, it was possible to find some balance. Enjoyment did not have to mean giving up completely on taking care of myself. It was more about learning how to protect my scars, respect my recovery, experience the place, and still live.

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Island Hopping in Greece by Sailboat

July 2022

Then we met our friends in Athens, where we started our sailboat island hopping trip to more remote places, including Hydra. Hydra was especially interesting because the island has no cars, and from what I understood, they use mules to transport things around. It gave the whole place a very different rhythm.

Food-wise, this part of the trip felt much more aligned with what my body usually likes. Mediterranean food is basically perfect for my lipedema lifestyle. Greek salad every day, lots of seafood, simple ingredients, olive oil, vegetables, and meals that felt fresh rather than heavy. After some of the richer food earlier in the year, this felt like a much better balance.

During the sailing trip, I wore compression garments on my arms almost 24 hours a day. When they got wet, I basically let them dry on my body in the wind. I also tried to stay covered as much as possible so my scars did not get direct sun exposure, and honestly, it worked quite well.

There is also something about being on a sailboat that almost forces your nervous system to slow down. The sea, the movement, the silence between places, the wind, the lack of rush. You start to feel that calm, grounded, zen feeling quite quickly. And for a body that is still healing after surgery, I think that kind of environment can matter too. Not as a medical treatment, of course, but as part of the whole recovery picture. A calmer body, a calmer mind, simple food, water, movement, and rest. For me, that trip felt like healing in a very human way.

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Copenhagen (Denmark)

July 2022

Then came Copenhagen, where I celebrated my birthday together with my partner. Denmark has a very distinct food and drinking culture, and Copenhagen is a lovely place to experience that. It is a beer drinking country, and it is also known for its open-faced sandwiches, or smørrebrød, with all kinds of beautiful toppings. Fish, eggs, shrimp, meat, herbs, sauces, pickled vegetables, and rye bread. Simple, but still very rich in culture and tradition.

At this point, I was still wearing compression garments on my arms, so even though I was celebrating, travelling, eating out, and trying to enjoy the city, recovery was still part of the background. That is often how this period felt. Life was happening, but compression, scars, swelling, and healing were always there too.

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Berlin, Germany

September 2022

My partner studied in Berlin, so this city feels a little like home to him. He still has friends there, and because of that, visiting Berlin never feels like just another city trip. It feels more personal.

Berlin is also one of those cities where history is everywhere. You feel it in the streets, the buildings, the memorials, the contrasts, and the atmosphere. It is a fascinating city to visit because it carries so many layers at once. Heavy history, creativity, nightlife, food culture, street markets, and a kind of rawness that makes the city feel very alive.

And of course, Germany is good at beer, currywurst, street food, and markets. So this was another trip where food and culture were a big part of the experience.

September became a month where we travelled a lot. It was also the month before my fourth and final surgery, so in the background of everything, I knew I was getting close to the last part of the surgical pathway. I was enjoying life, seeing places, eating, walking, meeting people, and at the same time mentally preparing myself for one more round of surgery, compression, swelling, and recovery.

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Paris (France)

September 2022

September was a month where I travelled a lot, and honestly, I feel a little shocked when I look back at the dates and see how much we actually did. What a dream month, right before my very last surgery. It is quite a long time ago now, so I do not remember every detail clearly, but looking through old photos brings so much of it back.

We had one full day in Paris on our way to Mauritius, before taking a night flight later that evening. Paris was short, but still Paris. One of those places where even a few hours can feel like something. Then we continued to Mauritius, which was a completely different kind of experience. Warm, tropical, slower, and far away from Norway, but still surprisingly practical because the time difference from Oslo was only two hours. I remember that made it possible for me to keep working from there, which was important at the time. So even though it felt like a big journey, I could still stay connected to my everyday responsibilities while being somewhere that felt almost unreal.

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Mauritius

September 2022

Mauritius was a place that truly gave me peace. I loved it. It is located in the Indian Ocean, off the coast of Africa, and it felt like such a warm, calm, and welcoming place to be. The people I met there seemed happy, open, and kind, and the island itself has this beautiful multicultural atmosphere.

The food culture in Mauritius is also amazing. It is shaped by African, Indian, Chinese, French, and Creole influences, which makes the cuisine incredibly rich and interesting. You can taste French techniques, bold Creole flavors, spicy Indian curries, and Sino-Mauritian dishes all in the same food culture. For someone like me, who loves food and culture, Mauritius was a dream. You cannot really be there without taking part in the food, the people, and the atmosphere of the island.

At this point, my legs and arms were mostly free from compression, but I still tried to cover my scars as much as I could. It had been one year since my first surgery on my legs, so I allowed my legs to be free during this trip. My lower arm surgery had not been done yet. That surgery came in October the same year. But I still covered my upper arms carefully, using the same long-sleeved dresses I had bought earlier that summer. So even though I felt freer in my body, recovery was still part of how I dressed, moved, and planned my days.

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Venice, Sirmione and Milan (Italy)

October 2022

Then in October, I went on an amazing girls’ trip to Italy. In Norwegian, we call this type of trip a “blåtur”, which directly translates to “blue trip”, but the meaning is more like a mystery trip. One or two people plan everything, and the rest of the group does not know where they are going or what will happen. I love that concept, because it makes the whole trip feel like a surprise from start to finish.

We ended up visiting several beautiful places in Italy, including Venice, Sirmione, and Milan. It was one of those trips filled with beautiful scenery, good conversations, nice wine, and really good food. Italy is almost impossible not to enjoy if you love food, culture, architecture, and atmosphere. Everything feels like an experience, from sitting down for a simple meal to walking through old streets and suddenly finding yourself surrounded by history.

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Sweden

October 2022

The very last trip I had before my fourth surgery was to Sweden for a concert with my parents-in-law, where we celebrated my father-in-law’s birthday. This was only a few days before surgery, so I was very aware that I was about to enter the final round of the whole process.

At that point, it had been about 13 months since my first surgery on my legs, 11 months since my second surgery on my thighs, and 8 months since my third surgery on my upper arms. My fourth and final surgery was on my lower arms, but my surgeon also did a little more work on both my legs and thighs. So even though I had already been through a lot, I knew my body was about to go through one more major healing phase.

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Kraków (Poland)

December 2022

And then, guys, I was done. I was done with all of my surgeries, and I felt completely done with going into surgery. Yes, I travelled a lot during this period, and in all of these photos, I am probably at my happiest. But to be completely honest with you, what I do not show here is all the hard work behind it.

I do not show all the struggles. All the hours spent in the lymphatic press machine. All the appointments with my physiotherapist for manual lymphatic drainage. I do not show the fear, or how scared I was of the outcome, the healing process, and whether everything would actually turn out okay. I do not show how tired I was. I do not show the mental struggle I had with my body during this period of my life.

I was focusing on my body all the time, to the point where I sometimes struggled to actually live in it. I did not always see the positive changes. I did not always see the things that were still good about my body. The surgery process took up so much space in my emotional life, and when I look back now, I feel deeply grateful that I am in a very different place today.

It was worth it. But it was hard.

Looking at these photos now, I can see that travel became my escape during that period. I escaped into new places, food, culture, beautiful views, restaurants, hotels, cities, islands, and memories with my partner, friends, and family. I found joy where I could. And I think that matters.

Because this brings me back to what I am trying to foster in this stage of my life. Life should be about more than lipedema management. Life should be about happiness, connection, curiosity, culture, food, movement, love, and collecting memories with people who matter to you.

And my first trip after my very last surgery brings me back to exactly that.

During that last surgery, both my lower arms, legs, and thighs were affected. Basically more than half of my body had gone through trauma at the same time. Seriously, when I think about it now, I almost cannot believe it. Imagine all the immune cells in my body working like crazy, trying to recruit more immune cells, clean up the internal mess, move fluid, repair tissue, and calm everything down again.

On that trip, I felt like a big fluid balloon. I can really see it in my face and hands in the photos. My body was still very much in recovery, and I still had many months of healing ahead of me.

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But I think we will end this story here for now.

Thank you for reading and for being here. I hope you enjoyed this article. And if you have ever been through something similar, where you are trying to find a balance between living your life and carrying something difficult at the same time, I would really love to read your story in the comments.

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You can see glimpses of the struggle I had during this year in this article here.

For those of you who are new here, my name is Carina. I’m a food scientist with a master’s degree in food science and a bachelor’s degree in nutrition from Norway. I’ve lived with lipedema since I was 15 years old, when a birth control pill called Loette 28 changed my body in ways I couldn’t understand or explain at the time. Within just two months, my lower body felt completely different. Heavy. Tight. Painful in a way that made no sense to me as a teenager. And although I didn’t receive my diagnosis until I was 20, at Aker Hospital in Oslo, the condition had already been shaping my life for years before I had a name for it.

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That meant five years of pain, confusion, frustration, and not understanding what was happening inside my own body. Five years of trying to explain symptoms that nobody around me seemed to fully understand. I know what that silence feels like. I know what it feels like to massage your legs at night just to be able to sleep, because the pain in the fat tissue is so intense and relentless that it follows you even into the dark. I know what it feels like to question yourself when your body keeps telling you something is wrong, while the outside world struggles to see it.

And I want to add something else that most people don’t know about my story.

Before lipedema was diagnosed, before I even had the language for it, I had already learned what it meant to be seriously ill. When I was 18 and on my first girls’ trip to Greece — just three days after turning 18 — I developed sepsis caused by a bacterium called Fusobacterium necrophorum. What started as a strep throat infection escalated into something that put me in hospital for several weeks. My recovery took nearly a full year. I couldn’t attend school for the first six months, and then had to compress almost an entire year’s curriculum into just a few months to graduate with my class. My school was incredible. A specialist came every Tuesday to help me rebuild my memory and cognitive function. A teacher stayed after school every single day.

That experience taught me something early: that the body can be pushed to its limits and still find a way back. Not without scars. Not without lasting effects. But back, nonetheless.

Science has always been a huge part of my identity. I’ve spent years working in laboratories — culturing human intestinal cells during my master’s thesis (which I was doing alone, during the COVID lockdowns, traveling to the lab to feed my cells while the entire world had stopped), researching how pea peptides influence inflammation, performing whole genome sequencing of pathogenic bacteria, and co-authoring a published scientific paper on food poisoning pathogens. I’ve also worked as a laboratory manager. Research is not just something I casually read online. It is something I have spent years working with professionally. Today I work in IT — as a project manager in software development, a completely different world — but my scientific foundation never really leaves me. It’s the lens I see everything through.

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Before LipedemaScience came to Substack, I had already spent years building a lipedema knowledge community for Norwegian women — trying to create something that didn’t exist when I was first diagnosed and felt utterly alone with my questions. In November 2025, I brought that work to Substack as LipedemaScience, because I felt there was a much larger gap to bridge — between scientific research and the lived reality of people with lipedema all over the world. Research papers are often difficult to read, difficult to access, and difficult to translate into practical understanding. I wanted to build something different. A place where science, lived experience, reflection, and honesty could exist together. And I’ll be honest — my own surgeon played a role in that. After my surgeries, she encouraged me to use my academic background to help others, because she saw how many of her patients were hungry for guidance around food, nutrition, and science. That stayed with me.

Today, LipedemaScience has readers from 44 countries. That still feels surreal to me. But this article is not really about research. It is about life.

Because the older I get, the more I reflect on how fragile and precious life actually is. And how important it is to live it now — not someday in the future when everything is finally perfect, calm, healed, organized, painless, or emotionally easy.

I have also spent a long time thinking about the relationship between how we speak to ourselves and how we actually live. People often describe me as having a positive attitude — and that’s mostly true — but it didn’t come from nothing. I’ve had to consciously learn to speak to myself the way I would speak to my best friend. To draw a line between honest acknowledgment and outright self-attack. Saying my legs are painful today is honest. Saying my body is a disaster is something else entirely. That distinction matters when you live with a chronic condition, because management depends on consistency, and consistency is nearly impossible when you are at war with yourself.

One of the things I am most grateful for is that I never allowed my surgeries to completely stop me from traveling.

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Traveling has always been a huge part of who I am. It gives me energy. Perspective. Creativity. Freedom. It makes me feel alive. It’s also deeply connected to one of my greatest loves — food. Not just eating, but the experience of it. Sitting somewhere you’ve never been before, ordering something unfamiliar, sharing plates, letting a meal become a memory. I am, honestly, a true foodie. My absolute favorite dish in the world is biff tartar — raw beef, egg yolk, onions, capers. I could eat it every day. And even during periods where my body felt difficult, painful, swollen, or unpredictable, there was still a part of me that deeply needed to experience the world, to sit at a table somewhere new, and feel like a person rather than just a patient.

And to be honest, it was not always glamorous.

I remember traveling with double compression garments. I remember feeling swollen and inflamed after flights. I remember my face looking like it was filled with water from fluid retention and stress. I remember physical exhaustion. Anxiety. Recovery. Uncertainty. And still choosing to go.

My first lipedema surgery was in September 2021.

The second was in November 2021.

The third was in February 2022.

The fourth was in October 2022.

Some of these surgeries were far more difficult than I expected.

After the surgery in November 2021, I developed a large seroma in my right thigh. Massive. Honestly, it looked almost like a large squash attached to my leg. I struggled with it physically and mentally for a long time, and it took years before I truly felt that the tissue started changing and healing properly. There are still nerves that haven’t fully healed — I sometimes lose sensation along the sides of my palms. That’s something I carry quietly.

At the exact same time I had the surgery in February 2022, I got COVID for the first time. My partner unknowingly caught it from friends while I was still at the hospital. We were staying only a couple of minutes away from the clinic, and while I was in surgery, he met some friends nearby. While he was sitting in the car waiting to pick me up after the operation, he got the message that one of them had tested positive. And shortly after, so did we.

Then came the surgery in October 2022. After that surgery, I developed internal bleeding in both of my hands. It was honestly a pretty brutal period.

But even in the middle of all of this, I kept traveling. Not because everything was easy. Not because my body was magically healed. Not because I always felt confident. But because I did not want lipedema to become the thing that completely stopped me from living.

So during these years — between surgeries, recovery, swelling, complications, compression garments, uncertainty, and exhaustion — I still experienced the world.

Barcelona in November 2021.

Iceland in January 2022.

Budapest, Vienna, and Prague in April 2022.

Santorini in July 2022. Island hopping in Greece on a sailboat that same summer. Copenhagen. Berlin. Paris. Mauritius. Italy — Venice, Sirmione, Milan. Sweden.

Kraków in December 2022 — where I remember my body still holding so much fluid, everything feeling heavy and sensitive, just weeks after my fourth surgery. I went anyway. Years later, I went back to Kraków again, and it was completely different. Same city, different body, different chapter.

Here is a separate post where I share photos from all the travels I had during my surgery process, what I actually did when I travelled, the advice I received from my physiotherapist and others, and the practical tips I followed myself.

When I look back at that period now, I honestly feel proud of myself.

Not because I managed to look perfect while doing it. Not because I was symptom-free. Not because everything went smoothly. But because I continued showing up for my own life anyway. Because I built what I now think of as my 80-20 approach to living — doing the work, following the structure, making the choices that support my body most of the time, while still allowing myself to sit down at a beautiful restaurant somewhere in the world and simply be a person who loves being alive.

I know many of you reading this are currently preparing for lipedema surgery. Some of you are terrified. Some of you are exhausted already before the process even begins. Some of you are afraid of the recovery, the pain, the uncertainty, the financial burden, or whether it will even help. And I completely understand that. There was a moment during my third surgery — the one on my upper arms in February 2022, when I caught COVID the day after being discharged — where the only emotion I distinctly remember feeling was relief. Relief that the surgery had happened before COVID hit me. Relief that I had managed to get through it. Even in exhaustion, even while sick, my body found something to hold onto.

That’s the kind of resilience I want to talk about. Not the kind that looks pretty. The quiet, stubborn, showing-up-anyway kind.

I want this article to give you something important. Hope.

Not unrealistic hope. Not social media perfection. Not the kind of inspiration where people pretend healing is linear and beautiful all the time. Real hope. The kind that says your life does not necessarily end because things become difficult. Your body may change. Your priorities may change. Your relationship with yourself may change. But you are still allowed to live. You are still allowed to travel, laugh, create memories, fall in love with places, have difficult days, have beautiful days, and continue building a life that feels meaningful to you.

Lipedema can take a lot from people. But I hope it never takes your entire future.

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That is why studies on diet and lipedema need to be read with nuance. The central question is not simply whether a diet causes weight loss. The more interesting question is whether a dietary intervention can influence some of the biological processes that appear to be involved in lipedema itself.

A 2025 study published in Nutrients explored exactly that question.
The researchers investigated whether a Mediterranean-style ketogenic diet could reduce the inflammatory potential of the diet and lower systemic inflammatory markers in women with lipedema.

Not all ketogenic diets are the same, and I’ll explain the difference in the article.

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My own eating lifestyle is mostly built around high-quality, nutrient-dense foods that may also have anti-inflammatory effects. In practice, it is closest to a Mediterranean-style diet, combined with an 80/20 approach, because that is what feels sustainable for me over time. I do not personally follow a ketogenic diet, and it is not the dietary pattern that fits best with my own lifestyle. But I know many of you are interested in keto, and there is now a growing body of research looking specifically at ketogenic diets and lipedema. For that reason, I think it is useful to share some knowledge on this topic, while still being clear that keto is one possible approach, not the only one.

A Mediterranean-style ketogenic diet is not just “keto with olive oil.” It is a low-carbohydrate, high-fat dietary pattern built around food quality. The goal is to keep carbohydrates low enough to support nutritional ketosis, while choosing foods that also provide unsaturated fats, omega-3 fatty acids, fiber from low-carb vegetables, polyphenols, antioxidants, minerals and anti-inflammatory plant compounds. This means that some foods can be eaten more freely, while others need more careful portion control.

I want you to keep something in mind while reading this article.

You and I may both have lipedema, but our bodies are not the same. We may react differently. We may have different food preferences, different access to ingredients, different cultures, different routines, and very different lives.

You may also have things going on in your life that need to come before trying to manage lipedema through diet. And that matters too.

I have readers from 44 countries, and I am writing this while travelling. Right now I am in Spain. In two days I leave for Portugal. Then Norway. Then Italy. So many different cultures, foods, habits, and ways of living. And my lipedema simply comes with me.

I try my best, every day. Sometimes that feels easy. Sometimes it feels hard.

When you read my articles, my hope is that you find knowledge, reflection, support, and inspiration. Not pressure. Not judgement. Not another voice telling you that you are doing something wrong.

I will never judge you, your body, your choices, your lifestyle, or your journey.

I am cheering for you, and I am truly happy you are here.

Enjoy the article.

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The foods that usually fit best are fatty fish such as salmon, sardines, mackerel and trout, because they provide protein and omega-3 fatty acids without adding carbohydrates. Olive oil, avocado, nuts, seeds and flaxseed oil also fit well because they provide mostly unsaturated fats and help the diet feel Mediterranean rather than heavy and animal-fat dominated. Eggs, lean poultry and moderate amounts of lean meat can also fit, especially when they are combined with vegetables, herbs and healthy fats.

Non-starchy vegetables are central. Leafy greens, broccoli, cauliflower, zucchini, cucumber, asparagus, mushrooms, cabbage, peppers, tomatoes, herbs and spices add volume, flavor, micronutrients and plant compounds while keeping carbohydrate intake relatively low. These are the foods that make the diet feel nourishing rather than restrictive.

Berries can often be included in small amounts, especially raspberries, strawberries and blackberries. They contain more carbohydrates than leafy greens, but they also provide polyphenols and antioxidants. Blueberries can also fit for some people, but usually in smaller portions because they are slightly higher in carbohydrates.

The foods to be more careful with are the ones that can quickly push carbohydrate intake too high. This includes bread, pasta, rice, oats, grains, potatoes, sweet potatoes, most legumes, large amounts of carrots, bananas, apples, grapes, oranges, dried fruit, fruit juice, honey, sugar and desserts. These foods are not “bad,” but they usually do not fit easily into a ketogenic diet because ketosis depends on carbohydrate restriction.

There is also another category to be careful with: foods that are technically low-carb but not necessarily anti-inflammatory or Mediterranean in spirit. A ketogenic diet can easily become built around butter, cream, cheese, bacon, sausages, processed meats and very large amounts of saturated animal fat. These foods may keep carbohydrates low, but they do not automatically support the anti-inflammatory quality of the diet. This is why “keto” is not one diet. A plate built from salmon, olive oil, avocado, herbs and vegetables is very different from a plate built from bacon, cheese and cream, even if both are low in carbohydrates.

Why might keto improve lipedema symptoms for some people?

Some people with lipedema report improvement on ketogenic or very low-carbohydrate diets. This does not mean keto cures lipedema, and it does not mean it works for everyone. But there are several possible reasons why symptoms may improve in some individuals.

One reason is that carbohydrate restriction can reduce insulin levels and improve metabolic flexibility. Insulin is involved in fat storage, fluid balance and inflammation-related pathways, so lowering insulin exposure may help some people experience less swelling, heaviness or fluctuation in symptoms.

Another possible reason is reduced water retention. When carbohydrate intake drops, glycogen stores decrease, and glycogen binds water. This can lead to a noticeable reduction in fluid-related heaviness for some people. In lipedema, where many patients describe pressure, swelling sensations and painful tissue tension, even modest changes in fluid balance may feel meaningful.

A third reason may be inflammation. A well-designed ketogenic diet that emphasizes fish, olive oil, nuts, seeds, vegetables, herbs, spices and small amounts of berries may reduce the inflammatory potential of the diet. This is different from simply eating high fat. The quality of the fat, the presence of plant compounds and the overall nutrient pattern matter.

Weight loss may also play a role, especially reduction in visceral fat and overall inflammatory load. But in lipedema, the story cannot be reduced to weight loss alone. Many people with lipedema know that their affected fat tissue does not behave like ordinary fat. That is why it is more useful to ask whether a dietary pattern improves pain, swelling, energy, inflammation, metabolic health and quality of life, not only whether it changes the number on the scale.

The most important part: it has to fit your life

A ketogenic diet is not a casual short-term experiment for everyone. To stay in nutritional ketosis, carbohydrate intake usually has to remain consistently low. That requires planning, repetition, food awareness and long-term commitment. For some people, this structure feels calming and helpful. For others, it becomes stressful, socially difficult, emotionally restrictive or simply unrealistic. That matters.

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A diet that improves biomarkers but damages your relationship with food, your social life or your mental health is not necessarily the right diet for you. And if a ketogenic diet does not fit your body, your medical history, your digestion, your family life, your culture, your budget or your personality, that does not mean you have failed. It may simply mean that another dietary pattern is a better match.

For some people, a broader Mediterranean lifestyle may be more sustainable. For others, a generally anti-inflammatory diet may be enough: more fish, olive oil, vegetables, berries, nuts, seeds, herbs, legumes if tolerated, fewer ultra-processed foods, less added sugar and a steadier blood sugar pattern. Some people do better with moderate carbohydrates. Some need to consider IBS, histamine intolerance, food allergies, thyroid disease, diabetes medication, eating disorder history, pregnancy plans, kidney or liver conditions, or other personal factors.

This is why diet in lipedema should never be reduced to one universal rule.

The best dietary pattern is not the one that sounds most impressive on paper. It is the one that supports your symptoms, your health, your biology and your real life over time. For some people with lipedema, that may be a Mediterranean-style ketogenic diet. For others, it may be a Mediterranean anti-inflammatory diet without ketosis. And for many, the answer may be found somewhere in between.

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There is a particular kind of loneliness that comes from living in a body that medicine has decided doesn’t exist.

You’ve felt it. Maybe you felt it the first time a doctor told you to just lose weight, while you sat there knowing — with the kind of bone-deep certainty that comes from years of trying — that what was happening in your body was something else entirely. Maybe you felt it when you searched for answers and found nothing credible, nothing that named what you were experiencing, nothing written by someone who took it seriously. Or maybe you felt it the way I did: standing in a hospital in Oslo in 2012, finally hearing the word lipedema for the first time, and experiencing simultaneously the relief of a diagnosis and the dawning realization that almost no one in the scientific world had been paying attention.

That second feeling — that the science had barely begun — was correct.

But here’s what I want you to understand, because it matters enormously: the story of lipedema science is not a story of permanent neglect. It is a story of a slow, difficult, and increasingly accelerating awakening. And if you follow that story from its very beginning to where we stand today, in May 2026, what you find is not a tale of hopelessness. What you find is a field that spent decades asleep, then stirred restlessly, then began to run — and is now, finally, asking the right questions with the right tools.

This is that story. All of it.

A Name Without a Body of Evidence (1940–1999)

The Mayo Clinic, 1940

The year is 1940. Two American physicians, Edgar Van Nuys Allen and Edgar Alphonso Hines Jr., are working at the Mayo Clinic in Rochester, Minnesota. They publish a brief report in the Preliminary Staff Meetings of the Mayo Clinic describing an unusual pattern they have observed in a small group of women: a symmetrical, bilateral accumulation of subcutaneous fat in the legs that is painful, doesn’t respond to dieting, and is clearly distinct from ordinary obesity. The hands and feet are spared. The condition is tender to pressure. It runs in families.

They call it lipedema.

They describe it carefully. They distinguish it from lymphedema. They note the striking hormonal pattern — it appears almost exclusively in women, often emerging or worsening at puberty, pregnancy, or menopause. They use words like “bilateral” and “symmetrical” and “painful” that, eighty-five years later, remain the clinical hallmarks.

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And then, for the most part, the world moves on.

There is no explosion of follow-up research. No dedicated funding stream. No clinical guidelines. No awareness campaigns. No medical school curricula. The condition sits in the medical literature like a message in a bottle, occasionally retrieved by a curious clinician in Germany or Austria or the Netherlands, occasionally cited in a lymphology textbook, but never truly examined with scientific rigor. For the next six decades, lipedema exists as an orphan entity — named, observed, and almost entirely unstudied.

Why the silence?

This is worth asking, because the silence was not accidental. It reflects something systematic about which bodies medicine has historically chosen to investigate — and which bodies it has chosen to explain away.

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Lipedema affects women almost exclusively. It involves fat tissue, a category that medical culture has long viewed through a moral rather than a biological lens. Its primary symptoms — disproportionate fat distribution, pain, swelling, easy bruising, heaviness — are things women have been told to expect, to endure, to lose weight to fix. When you combine female biology, adipose tissue, and chronic pain in one condition, you get something medicine has historically been very comfortable ignoring.

The word “obesity” did enormous damage here. Because lipedema can coexist with obesity, and because it causes visible fat accumulation in the lower body, clinicians who encountered it often stopped at “she needs to lose weight” and never looked further. The specific, structural, biological distinctiveness of lipedema tissue — its abnormal cellularity, its vascular dysfunction, its inflammatory signature, its resistance to caloric restriction — remained hidden beneath a layer of assumption that was, in retrospect, both medically incorrect and deeply unkind.

It took the molecular revolution in biology to finally crack this open.

The Literature Begins to Wake Up (1990s–2009)

In the 1990s, a small but meaningful body of European literature begins to accumulate, primarily from German-speaking countries — Germany, Austria, Switzerland — where a tradition of phlebology and lymphology had kept lipedema at least minimally alive as a clinical concept.

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I’m opening a new Q&A about lipedema and science

I’ve built LipedemaScience by combining my own lived experience with my scientific background, and that’s exactly the lens I bring into everything I create.

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I was diagnosed with lipedema in January 2012 at a Norwegian hospital at 20 years old, after years of severe leg pain that was eventually linked to a birth control pill containing synthetic estrogen. Before that, at 18, I survived sepsis caused by Fusobacterium necrophorum — an experience that completely changed how I viewed the body, health, and resilience. Between 2021 and 2022, I went through four lipedema reduction surgeries.

My academic background is in science and nutrition. I hold an MSc in Food Science and a BSc in Human Nutrition. I’ve worked with human intestinal cell cultures, pea peptides and inflammation, whole genome sequencing of pathogenic bacteria, laboratory management, and scientific research, including co-authoring a published study. Today, I also work within IT and AI project management while building LipedemaScience as my passion project — where my science brain meets my lived experience with lipedema.

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I’m the founder of LipedemaScience on Substack, which now reaches readers in 44 countries around the world. My own lipedema is strongly influenced by hormones and sugar, and I’m deeply fascinated by the biology behind the condition. I’m also a huge foodie who loves traveling and experiencing culture through food, and I personally believe in a balanced 80/20 approach to eating.

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For many women with lipedema, one of the hardest parts is being told that their body is simply a matter of weight, willpower or lifestyle. But when researchers look at lipedema tissue under the microscope, a different picture begins to appear. This study gives us one of those important glimpses. It suggests that lipedema affected tissue is not only larger. It may also be structurally different, more fibrotic, and immunologically active in ways that do not look exactly like ordinary obesity. That does not answer every question about lipedema, but it does help move the conversation away from blame and toward biology.

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For many women with lipedema, the relationship with body fat becomes psychologically and biologically complicated long before they understand the condition itself. Puberty changes the body rapidly. Fat accumulates disproportionately around the legs, hips or arms. Pain, heaviness and swelling appear gradually. Some women notice dramatic worsening during pregnancy, hormonal contraception, fertility treatment or menopause. Others spend years trapped in cycles of restrictive dieting, overtraining and guilt around food, often without understanding why their body seems to respond differently than expected.

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At the same time, modern nutrition culture sends deeply conflicting messages to women. For decades, dietary fat was framed as something dangerous that should be minimized. Grocery stores filled with low-fat yogurts, low-fat desserts, “light” products and heavily processed diet foods marketed as healthy choices for women. Simultaneously, another narrative emerged online saying that women “need fat for hormones,” often presented in an oversimplified and equally misleading way.

Women with lipedema frequently find themselves caught between these extremes. Many have spent years trying to lose fat aggressively while simultaneously noticing that hormonal changes seem to influence their symptoms profoundly. Some develop fear around eating fat altogether. Others begin to believe that eating more fat will somehow “fix hormones.” Neither explanation captures the complexity of female endocrinology.

What modern research actually shows is far more nuanced and far more interesting.

Female Hormones Are Not Controlled by One Single Factor

The female reproductive system is not controlled by a single nutrient, a single hormone or a single body composition measurement. Instead, it operates through a highly integrated network involving the brain, ovaries, adipose tissue, stress systems, metabolic signaling pathways and energy availability. Body fat itself is not merely passive storage. Adipose tissue functions as an active endocrine organ that continuously communicates with the hypothalamus, pituitary gland, immune system and reproductive axis. This becomes especially relevant in lipedema because lipedema exists within a hormonally sensitive, inflammatory and metabolically dynamic environment.

One of the most repeated statements in women’s health is that female hormones are “made from fat.” Biochemically, this is only partially true. The primary ovarian sex hormones such as estradiol and progesterone are steroid hormones synthesized from cholesterol. Steroid-producing cells obtain cholesterol through multiple pathways, including uptake from circulating lipoproteins, intracellular cholesterol stores and de novo synthesis. In other words, the body is not literally melting body fat into estrogen in a simplistic mechanical way.

The more clinically relevant point is that reproductive function is highly sensitive to energy status and adipose-derived signaling. Research over the past several decades suggests that many cases of hormonal dysfunction associated with restrictive eating, excessive exercise or significant weight loss are driven less by “running out of hormonal raw materials” and more by neuroendocrine adaptation. The brain continuously evaluates whether the body perceives the environment as metabolically safe enough to support reproduction.

This distinction matters enormously.

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Energy Availability Matters More Than Most Women Realize

A woman can have relatively low body fat and still maintain normal reproductive function if energy availability, stress regulation and neuroendocrine signaling remain stable. Conversely, another woman may develop menstrual dysfunction despite not appearing extremely lean. In modern endocrinology, this is one reason why researchers increasingly focus on energy availability rather than body weight alone.

Some of the strongest experimental evidence comes from work by Anne Loucks and colleagues, who demonstrated that relatively short-term reductions in energy availability could disrupt luteinizing hormone pulsatility in healthy menstruating women. This research later became foundational for concepts such as Relative Energy Deficiency in Sport, often abbreviated RED-S. However, one of the most misunderstood aspects of this literature is the tendency to treat numerical thresholds as universal biological laws. The frequently cited value of approximately 30 kcal per kilogram fat-free mass per day originated from relatively small experimental studies and should not be interpreted as a rigid cutoff that applies identically to every woman. Later research and recent consensus statements emphasize considerable individual variation, methodological limitations in measuring energy availability and the importance of context.

This is particularly important in lipedema communities, where many women have histories of repeated restrictive dieting, chronic caloric deficits, appetite suppression, aggressive exercise or significant psychological stress around body image and food. The body does not respond solely to fat mass itself. It also responds to perceived energy sufficiency.

Leptin, Scarcity Signals and the Female Brain

Leptin illustrates this principle particularly well. Leptin is often described superficially as a satiety hormone, but its role is much broader. It functions as an endocrine signal communicating information about energy status to the brain. Women with functional hypothalamic amenorrhea frequently show lower leptin levels than eumenorrheic controls, even when researchers adjust for body composition. This suggests that the reproductive axis responds not simply to absolute fat mass, but to the body’s interpretation of energetic sufficiency.

This becomes deeply relevant when discussing women who appear “healthy” externally yet experience disrupted cycles, infertility or hormonal suppression after prolonged periods of underfueling, psychological stress or overtraining. The female reproductive system is remarkably sensitive to signals suggesting scarcity or physiological threat.

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Importantly, leptin is not the entire explanation. Modern research points toward a complex interaction involving kisspeptin neurons, GnRH signaling, cortisol regulation, thyroid function, inflammatory mediators and psychological stress pathways. While small interventional studies using recombinant leptin demonstrated partial restoration of reproductive function in some women with hypothalamic amenorrhea, this should not be misunderstood as established routine clinical treatment. Current guidelines from Endocrine Society still emphasize restoration of adequate nutrition, reduction of physiological and psychological stressors and normalization of energy balance as the primary intervention.

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Stress Is Also a Hormonal Signal

Stress itself remains profoundly underappreciated in discussions about female hormones. Functional hypothalamic amenorrhea is not simply a disorder of thinness or calorie restriction. Many women with FHA also demonstrate elevated cortisol levels, increased anxiety, disturbed sleep, perfectionistic traits or disordered eating patterns. Psychological stress and metabolic stress interact continuously within the neuroendocrine system.

For women with lipedema, this perspective may feel unexpectedly validating. Living with chronic pain, swelling, body image distress, repeated medical dismissal and constant pressure to lose weight creates a significant physiological burden. The body does not separate emotional stress from biological stress as neatly as wellness culture often implies. Chronic stress signaling can influence inflammation, appetite regulation, sleep quality, insulin sensitivity and reproductive hormone signaling simultaneously.

When Excess Adiposity Also Becomes a Hormonal Stressor

At the other end of the spectrum, excessive adiposity can also disrupt reproductive physiology, particularly when visceral or central adiposity becomes metabolically dominant. Research summarized by American Society for Reproductive Medicine demonstrates associations between obesity, ovulatory dysfunction, menstrual irregularities and subfertility. Yet even here, simplistic explanations fail. The issue is rarely “too much estrogen” alone. Instead, researchers increasingly focus on the interaction between insulin resistance, chronic low-grade inflammation, altered adipokine signaling, hyperandrogenism, reduced SHBG production and ovarian dysfunction.

This is another reason why body composition alone cannot fully explain hormonal health.

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Two women with similar BMI values may have profoundly different endocrine profiles depending on fat distribution, inflammatory state, insulin sensitivity, stress burden, sleep quality, genetics and overall metabolic function. Visceral fat appears metabolically more disruptive than subcutaneous gluteofemoral fat in many contexts, and adipose tissue itself behaves differently depending on anatomical location. This complexity becomes highly relevant in lipedema because lipedema adipose tissue appears biologically distinct from ordinary obesity in several important ways, including inflammatory signaling, vascular alterations and pain mechanisms.

The Problem With Simplistic Diet Culture

The discussion around dietary fat also deserves far more nuance than most women were taught growing up. The scientific literature does not support the idea that eating dietary fat automatically improves hormones in a simplistic way, nor does it support decades of extreme low-fat ideology. What matters far more is the broader physiological environment in which the body operates. A woman consuming low-fat products while chronically underfueling, sleeping poorly, overtraining and experiencing persistent stress may place the reproductive axis under substantially greater strain than someone eating a balanced diet with adequate energy availability and metabolic stability.

Similarly, high-fat diets themselves are not magical hormonal cures. Modern guidelines for conditions such as PCOS increasingly emphasize overall dietary quality, sustainability, insulin sensitivity and lifestyle patterns rather than rigid macronutrient dogma. The body responds to integrated signals, not isolated nutrition slogans.

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Hormones Do Not Simply “Float Around in Fat”

Another commonly misunderstood aspect involves hormone transport. Sex hormones do not circulate primarily through “fat in the blood.” Instead, hormones such as estradiol and testosterone are largely transported bound to proteins such as sex hormone-binding globulin and albumin. SHBG itself is highly sensitive to metabolic status. Insulin resistance and obesity often suppress SHBG production, increasing free androgen exposure and altering hormonal balance. This is one reason why metabolic dysfunction can influence reproductive physiology even when absolute hormone concentrations do not appear dramatically abnormal.

What Women With Lipedema Deserve to Understand

For women with lipedema, the most important takeaway may not be a specific diet rule or hormone theory, but a different conceptual understanding of the female body itself.

Female endocrinology is deeply energy-sensitive, stress-sensitive and metabolically interconnected. Adipose tissue is biologically active. Hormonal health cannot be reduced to simplistic statements about calories, fat grams or body weight alone. The body continuously interprets information about safety, nourishment, inflammation, recovery and energetic sufficiency.

And perhaps this explains why so many women with lipedema feel misunderstood by conventional health narratives. Many were taught to view their bodies through an overly simplistic framework where body fat was treated merely as stored excess to be eliminated. But modern research increasingly shows that adipose tissue participates in endocrine signaling, immune regulation and metabolic communication in ways far more sophisticated than older models suggested.

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Understanding this complexity does not mean abandoning metabolic health or pretending nutrition no longer matters. It means moving beyond reductionist explanations that fail to capture the biology women are actually living inside.

If this article challenged something you previously believed about hormones, fat tissue or lipedema, I would genuinely like to hear your thoughts.

What is one thing about female metabolism or hormonal health that nobody ever properly explained to you before?

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1. Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline (DOI: 10.1210/jc.2017-00131)

2. Current understanding of hypothalamic amenorrhoea (DOI: 10.1177/2042018820945854)

3. Where Have the Periods Gone? The Evaluation and Management of Functional Hypothalamic Amenorrhea (DOI: 10.4274/jcrpe.galenos.2019.2019.S0178)

4. Functional hypothalamic amenorrhea: Impact on bone and neuropsychiatric outcomes (DOI: 10.3389/fendo.2022.953180)

5. Low energy availability, not exercise stress, suppresses the diurnal rhythm of leptin in healthy young women (DOI: 10.1152/ajpendo.2000.278.1.E43)

6. Energy availability discriminates clinical menstrual status in exercising women (DOI: 10.1186/s12970-015-0072-0)

7. Energy Availability Is Associated With Luteinizing Hormone Pulse Frequency and Induction of Luteal Phase Defects (DOI: 10.1210/clinem/dgz030)

8. Leptin in human physiology and pathophysiology (DOI: 10.1152/ajpendo.00315.2011)

9. Leptin signaling and circuits in puberty and fertility (DOI: not retrieved)

   Gender differences in the regulation of P450 aromatase expression and activity in human adipose tissue (DOI: 10.1038/0801254)

10. Glucocorticoid regulation of P450 aromatase activity in human adipose tissue: gender and site differences (DOI: 10.1210/jcem.87.3.8288)

11. The Intimate Relationship between Adipose Tissue, Fertility, and Bone (DOI: 10.22540/JFSF-11-080)

12. The Impact of the Endocrine and Immunological Function of Adipose Tissue on Reproduction in Women with Obesity (DOI: 10.3390/ijms25179391)

13. Obesity and risk of female reproductive conditions: A Mendelian randomisation study (DOI: 10.1371/journal.pmed.1003679)

14. Higher waist circumference is associated with increased likelihood of female infertility: NHANES 2017–2020 results (DOI: 10.3389/fendo.2023.1216413)

15. IOC consensus statement on relative energy deficiency in sport (RED‑S): 2018 update (DOI: 10.1136/bjsports-2018-099193)

16. 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs) (DOI: 10.1136/bjsports-2023-106994)

17. Does Relative Energy Deficiency in Sport (REDs) Syndrome Exist? (DOI: 10.1007/s40279-024-02108-y)

18. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome (Hum Reprod) (DOI: 10.1093/humrep/dead156)

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Right now, I am living in La Manga (Spain). I have been here for two weeks, and I will probably stay for another one or two. It is a very particular kind of place. A large resort area filled with apartment complexes, surrounded by golf courses, tennis courts, fitness centers, paddle courts, and restaurants. It feels almost like a self contained world where people come not just for a holiday, but to stay for longer periods of time.

What I did not expect was how dominant the British presence is here. It is almost as if you are standing in Spain geographically, but socially you are placed somewhere between cultures. English is spoken everywhere. I even had a golf lesson with a professional from Scotland who told me he had lived here for ten years without ever really learning Spanish, simply because he never needed to. That says something about how environments shape behavior.

At the same time, the people here are incredibly kind. There is a level of friendliness that you feel in everyday interactions. Small gestures that make daily life softer. We live a bit uphill, without a car, while many others move around in small golf carts. For us, that means a thirty minute walk downhill to the store, and then thirty minutes back up again.

At first, it felt like a practical challenge. Especially because of something as simple as water. The tap water here has a strong chlorine taste, which makes it difficult to drink, especially when you are used to the clean, fresh tap water in Norway. So we have had to buy bottled water, something I normally try to avoid. But when you drink a lot of water, there is not much of a choice.

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This turned into something unexpectedly physical. We started running down to the store, buying large amounts of water, and then carrying it all the way back up. Five liter bottles in each hand, plus a backpack with food. The first day, it was honestly too much. I had to stop several times on the way up. My legs felt heavy, not just from the weight, but in a way that felt very familiar if you live with lipedema.

But over time, something shifted. Not dramatically, but enough to notice. The same hill became slightly easier. The same weight slightly more manageable. My body adapted in its own quiet way. And that is something I find interesting, because it challenges the idea that everything has to be structured, optimized, and perfect to create change.

Sometimes it is just repetition. Real life movement. Imperfect, but consistent.

People here often stop and ask if they can give us a ride when they see us carrying all that water uphill. That kind of kindness stays with you. But we have chosen to continue walking, not because we have to, but because it has become part of our rhythm here. A form of movement that is built into daily life, rather than something scheduled.

Yesterday, I had my first proper gym session since arriving. The membership here is quite expensive, and we have both been working a lot, so it took time before it felt worth prioritizing. Now we have decided to use it intensively for a short period before we move on. Not because it is the perfect plan, but because it fits into the reality we are in.

Soon, we are leaving Spain and heading to Portugal for a few weeks. I am especially looking forward to spending time in Lisbon with some of my friends. We are planning to travel by train, working along the way, experiencing different places without fully stopping.

The weather here has also been unexpected. More cloudy, more rain, almost like a Norwegian spring. In a way, it has made it easier to focus on work, and it has reminded me that expectations and reality rarely match perfectly.

But one of the most interesting reflections for me has been around food.

Coming from Norway, I am used to a very specific food culture. Bread is central. Not just occasionally, but as a foundation of daily meals. Breakfast, lunch, and often an evening meal are built around it. And not just any bread, but dense, whole grain bread with real structure and nutritional value. There is a sense of pride connected to it.

Here, that foundation is completely different.

The bread I have encountered in this area is, to be honest, far from what I am used to. It is mostly white, refined, and lacking the structure I associate with a satisfying meal. Even in restaurants with high ratings, the base of a dish like avocado toast is often a soft white slice of bread with a thin layer of avocado and a poached egg. Nothing is necessarily wrong with it, but it feels incomplete.

At first, I thought it was a coincidence. But after trying several places, I realized it is a pattern. And it made me reflect on how deeply food culture shapes our expectations of what is “good” or “healthy.”

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There is also a clear influence from British food culture here. Dishes like fish and chips are common, and frying seems to play a larger role. It creates a kind of hybrid environment where two food cultures meet, and where the result is something different from both.

For me, this has changed how I choose food while I am here. I find myself gravitating towards salads more often when eating out. Not because salads are universally better, but because they feel more predictable. More aligned with what my body responds well to, especially with lipedema.

And this is where things become more complex.

Because when I talk about food, when I share reflections or knowledge, it is always shaped by the environment I come from. What is available. How food is produced. What quality standards are in place. In Norway, for example, regulations around pesticides and food safety are strict, in some cases stricter than broader European frameworks. Even packaging materials are regulated more tightly.

These factors are often invisible, but they influence the quality of what we eat.

Traveling makes this very clear. It shows that food is not just nutrients. It is culture, geography, regulation, and habit.

I was reminded of this when someone from India with lipedema reached out to me. It made me realize how limited my own reference points can be. Even though I have eaten Indian food many times, it has mostly been within a Norwegian context, often the same adapted dishes repeated. That is very different from understanding the full complexity of food in India itself.

So when we talk about nutrition and lipedema, there is an important layer of humility that needs to be present. There is no single universal answer that fits everyone, everywhere. Your body responds to what you actually eat, in the context you live in. And that context can be very different depending on where you are in the world.

That is why traveling, observing, and staying curious becomes so valuable. Not just for the experience itself, but for the understanding it creates.

And I would genuinely be curious to hear from those of you reading this who are from the UK or Spain. Is this bread experience something you recognize? Is it cultural, or is it specific to places like this?

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Because the more perspectives we share, the closer we get to something that is not just theoretically correct, but actually useful in real life.

If you’ve ever found yourself late at night searching for “vibration plate lipedema” or wondering whether this might be the thing that finally helps your legs feel lighter, you’re not alone.

At some point, most women with lipedema reach a place where the question shifts. It’s no longer just “what helps?” but “what is actually worth my time, energy, and money?”

Because the reality is this:

• You could be doing a lot more than you are doing right now

• And at the same time, you are probably already doing a lot

That tension is where decisions about tools like vibration therapy actually live. The pressure of “doing everything right”.

One of the most difficult parts of living with lipedema is not only the condition itself, but the constant pressure to manage it correctly. There is always something more we could be doing. Compression, manual lymphatic drainage, dry brushing, pneumatic compression, vibration plates, supplements, anti-inflammatory nutrition, strength training, walking, rebounding, stress regulation, hormone support, sleep optimization, surgery, post-surgical maintenance. The list becomes long very quickly, and for many women it can feel as if lipedema management turns into a second job.

This is why studies on treatments like vibration therapy are interesting, but also why they need to be interpreted carefully. When you are the person living in the body, a study is not just an abstract academic question. It may influence whether you spend money on a device, whether you add another routine to your day, or whether you feel guilty for not doing enough.

Before we go deeper, a quick note for those of you who are new here. LipedemaScience is written by someone who was diagnosed with lipedema in 2012, and who has spent years working with cells, DNA and peptides in a laboratory setting. This space is where those two worlds meet — lived experience and science — with the goal of understanding what we actually know, what we don’t know, and how to navigate it in real life.

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The study behind the headlines

In 2018, a study by Rainer Schneider was published in Physiotherapy Theory and Practice. The study was conducted in Germany and looked at whether low-frequency vibrotherapy could improve the effect of manual lymphatic drainage, often abbreviated MLD, in women with lipedema. The title is quite strong: Low-frequency vibrotherapy considerably improves the effectiveness of manual lymphatic drainage in patients with lipedema. At first glance, this sounds very promising. But as always, the real value is in the details.

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This connective framework allows tissues to glide, distribute mechanical forces, and maintain structural integrity. It is also biologically active, containing fibroblasts, immune signaling components, and extracellular matrix molecules that continuously remodel in response to mechanical load, inflammation, and metabolic changes. This is precisely why fascia has become increasingly interesting in lipedema.

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Lipedema is not simply an excess of fat. It is a condition characterized by pain, altered tissue texture, easy bruising, and a very distinct distribution pattern. When patients describe their tissue as “heavy,” “tight,” or “different,” those sensations may not arise from fat alone, but from the entire microenvironment in which fat exists. Fascia sits at the center of that environment.

What the research actually shows

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I cook using real, whole ingredients with short and recognizable ingredient lists. If I make a tomato sauce, it starts with canned 100% tomatoes, then I add garlic, onion, celery, carrots, and good olive oil. If I make lasagna, I prepare a creamy cheese sauce using cream cheese, cream, nutmeg, salt, and pepper. When I want something sweet, I might make chocolate bites from dark chocolate, peanut butter, ground oats, coconut mass, and cocoa powder.

Smoothies are mostly based on berries and vegetables, with very little fruit. I eat a wide variety of vegetables in different colors, unsalted nuts, and I use high-quality cold-pressed olive oil generously. In Norway, I often go for fresh salmon from trusted producers. I also use my air fryer a lot. Roasted chickpeas are a favorite. They can be turned into something sweet with a dark chocolate coating or made savory with spices and salt.

A dressing I come back to again and again is made from sour cream, olive oil, lemon, salt, and pepper. Everything is made from scratch, but I do have a few go-to combinations I naturally return to.

I don’t keep refined sugar, white flour, or ultra-processed foods at home, and I never rely on ready-made meals. Not because it has to be complicated, but because it really isn’t. Cooking healthy food from scratch can be simple once you have a basic understanding and a bit of curiosity. It starts with awareness, then desire, then knowledge. After that, you’re free to explore.

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The pictures show the kind of food I typically make at home in Oslo when I’m working at the office from 8 to 4 and heading to the gym afterwards. It’s simple, nourishing, and built around the same principles I always follow—real ingredients, balanced meals, and something that supports both energy and recovery without overcomplicating things.

LipedemaScience is no longer just a small corner of the internet. It is becoming a global community of people who want to understand, question, and learn what the research actually says about lipedema.

In the last 24 hours alone, 29 new subscribers joined.
Most of them found their way here through Facebook, often through shared posts and discussions in communities where people are actively searching for answers.

That tells me something important:
This is not passive growth. This is people finding this space because they need it.

Where You Are Reading From

I recently looked at the data behind this community, and the reach is wider than I expected.

Right now, LipedemaScience has readers from 44 different countries.

That includes readers across:

• Europe

• North America

• Asia

• Africa

• Oceania

This means that people from completely different healthcare systems, cultures, and backgrounds are all gathering around the same questions:

• What is actually happening in the body?

• Why is lipedema so poorly understood?

• What does the research really show?

Top 5 Countries

While the community is global, a few countries stand out:

1. United States

2. Norway

3. United Kingdom

4. Australia

5. Canada

The United States is clearly the largest group, but what I find just as interesting is how strong the presence is from Norway and the UK, alongside other English-speaking countries.

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Why This Matters

Lipedema is still under-researched, often misunderstood, and many people feel alone in trying to make sense of it.

What we are building here is something different:

• A space grounded in science, not quick fixes

• A place for understanding, not oversimplification

• A community that spans countries, but shares the same experience

And maybe most importantly:

You are not the only one asking these questions.

Thank You

If you are reading this, you are part of this.

Whether you have been here from the beginning or just joined, you are contributing to something that is growing far beyond what I initially imagined.

And if you ever share an article, send it to someone, or engage in a discussion — that is exactly how this community grows.

If you want to help this reach even more people who are searching for answers, you can always share an article or recommend LipedemaScience to someone who might need it. It truly makes a difference.

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Here are a few more articles I think you’ll find interesting, if you haven’t already seen them..

I have a background in nutrition and food science, and I have worked in the food industry. That shapes how I look at food. I still enjoy things like chips, but I rarely eat them. Not because I am restrictive, but because I understand what they represent metabolically. For me, those choices are deliberate. They happen occasionally, often in a social or experiential context, not as a default.

That balance is important. But so is the foundation. And this is where structure becomes more important than willpower.

A Structured Lunch With a Clear Metabolic Direction

This was my lunch:

• 2 tablespoons butter

• 250 ml egg whites

• 70 g tuna

• 1 avocado

• 2 tablespoons olive oil

• 2 tablespoons cod liver oil

• Broccoli and paprika

• Q10 supplement

Energy-wise, this lands around 1,150–1,200 kcal. On paper, that is not far from what you get from a large portion of chips. But metabolically, the difference is substantial.

This meal is high in fat, moderate in protein, and very low in carbohydrates. That combination typically results in a lower postprandial glucose response and a more stable energy profile compared to high-glycemic, ultra-processed foods.

In practical terms, that often means fewer energy fluctuations, better satiety, and less need for constant decision-making around food later in the day.

For many women with lipedema, this matters. Not as a “treatment,” but as part of a broader strategy to support metabolic stability and reduce overall physiological stress.

Nutrient Density vs Energy Density

The key distinction here is not calories, but nutrient density.

This meal delivers:

• Omega-3 fatty acids from cod liver oil

• Monounsaturated fats from olive oil and avocado

• High-quality protein from tuna and egg whites

• Micronutrients from vegetables

• Co-factors like Q10 that support mitochondrial function

In contrast, chips are primarily energy-dense and nutrient-poor. They are typically high in refined fats and starch, low in protein, and contribute minimally to micronutrient intake.

This is not a moral argument about “good” and “bad” food. It is a physiological one. One option supports cellular processes, satiety, and metabolic stability. The other primarily delivers energy and is designed to be easy to overconsume.

Understanding that difference removes a lot of unnecessary self-blame. The response you get from ultra-processed food is often predictable, not personal.

The Lipedema Context

Lipedema is associated with altered adipose tissue, increased sensitivity, and signs of chronic low-grade inflammation. While nutrition is not a cure, it can influence several relevant pathways.

A dietary pattern characterized by lower glycemic load, higher intake of anti-inflammatory fatty acids, and reduced intake of ultra-processed foods may support a more favorable metabolic environment.

That does not mean that one specific meal “reduces inflammation” in a direct or measurable way. The evidence is still developing. But the overall pattern is consistent with what we know about metabolic health.

Why I Rarely Eat Chips

I like chips. That has not changed. What has changed is my threshold for when it is worth it. Because once you understand the difference between energy and function, between fullness and nourishment, it becomes harder to ignore. Chips do not provide what my body needs on a daily basis. They fit occasionally, not structurally.

Lipedema, in a way, reinforces that boundary. It makes prolonged imbalance less sustainable. And over time, that leads to more consistent choices, not through restriction, but through awareness.

A more useful way to think about it is not elimination, but placement.

Chips can fit. But they work best when they are:

• part of a social setting

• part of a defined meal

• a conscious, limited choice

What tends to create problems is when they become unstructured and frequent.

If you are interested in the intersection between lipedema, metabolism, and nutrition grounded in both science and real-life application, you can subscribe to my Substack.

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A More Useful Way to Think About Food

Instead of asking: “How many calories is this?”

A more useful question is: “What does this meal do in my body?”

Does it support satiety?
Does it provide building blocks?
Does it create stability, or fluctuation?

When you start thinking like this, food becomes less about control and more about function. And when meals are structured in a way that supports satiety and stability, you rely less on willpower. The biology is doing more of the work for you.

How to Apply This in Real Life

If you want to make this practical, start simple.

Focus on structuring one meal per day with:

• a stable fat source

• a clear protein source

• low-glycemic vegetables

Keep ultra-processed foods as an intentional part of your diet rather than a default.

You do not need to change everything at once. Consistency in one meal is enough to start shifting the overall pattern.

Closing Perspective

Two meals can contain the same amount of energy and still have completely different effects on the body. One primarily fuels. The other both fuels and supports. For women living with lipedema, that distinction is often felt, not just measured.

Further Reading

If you are following this work, you are already engaging with a topic that still lacks clear answers and practical guidance.

Below you will find a selection of articles within the same area that expand on nutrition, metabolism, and lipedema. These go deeper into the mechanisms, patterns, and practical implications discussed here.

If you are not yet part of LipedemaScience, this might be a good place to start. All support for this work contributes to making research-based knowledge more accessible and applicable for women living with lipedema.

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For years, lipedema pain has been dismissed, misunderstood, or explained away. But new research is starting to show something different. Your pain may not only be real. It may be measurable. And it may be rooted deep inside the structure of your tissue.

Pain is one of the most defining features of lipedema. Not just occasional discomfort, but a persistent, deep, and often unexplained pain that can affect daily life in ways that are difficult to communicate to others. Many women describe the same experience: the body hurts, even when nothing obvious seems wrong on the outside.

A new study published in the International Journal of Obesity in 2026 takes a step closer to understanding this. Instead of focusing on fat alone, the researchers asked a different and more precise question:

What if the pain is connected to how the tissue itself is structured?

Looking beyond fat

For years, lipedema has often been reduced to a question of fat accumulation. But this study shifts the focus away from “how much” tissue there is, and toward “what kind” of tissue it is.

The researchers used a technique called shear-wave elastography, a specialized form of ultrasound that measures how stiff or elastic tissue is. This matters because stiffness can reflect underlying changes such as fibrosis, where the tissue becomes more rigid due to structural remodeling.

At the same time, they measured pain in two ways. One scale captured overall pain intensity, while another specifically assessed nerve-related, or neuropathic, pain. This distinction is important, because many women with lipedema describe pain that feels sharp, burning, or unusually sensitive—features often linked to nerve involvement.

A measurable link between tissue and pain

The findings are not dramatic at first glance, but they are meaningful.

The researchers found that increased tissue stiffness in the thighs was associated with higher levels of pain. This applied both to general pain and to neuropathic pain. The relationship was moderate, not strong, but consistent enough to suggest that something real is happening at the tissue level.

Equally important is what they did not find. Tissue stiffness was not linked to fat measurements, body mass index, or age in the same way. In other words, more fat did not necessarily mean more stiffness, and more stiffness—not more fat—was what related to pain.

This challenges a deeply rooted assumption. Pain in lipedema is often dismissed as a consequence of weight or pressure from fat tissue. This study suggests a different explanation:

It may not be the amount of tissue that matters most, but the condition of that tissue.

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Hey there! You are reading LipedemaScience, founded by Carina W — a nutritionist (BSc), food scientist (MSc), and diagnosed with lipedema since 2012.

She brings a background in cell studies, inflammation, peptides, and DNA from laboratory research, combined with lived experience. Her goal is to use this unique combination to make lipedema science more understandable, relevant, and accessible.

By supporting her work as a member, you are helping make more research on lipedema available for everyone — including yourself.

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Why the thighs

One of the more specific findings in the study is that the relationship between stiffness and pain was most clearly seen in the thighs.

For many women, this will feel familiar. The thighs are often one of the most affected and most painful areas in lipedema. They can feel dense, tender, and resistant in a way that is difficult to describe but very easy to recognize.

This study does not explain why the thighs are particularly affected, but it reinforces the idea that different areas of the body may behave differently at a tissue level.

What is happening inside the tissue

Although this study does not directly examine microscopic changes, its findings align with a growing body of research on lipedema biology.

Several mechanisms are increasingly being discussed:

• The development of fibrosis, where connective tissue becomes thicker and less flexible

• Changes in the extracellular matrix, which alters how cells are supported and interact

• Disruptions in microcirculation, affecting oxygen and nutrient flow

• Irritation or compression of small nerve fibers within the tissue

• Low-grade inflammation that can amplify pain signaling

When tissue becomes stiffer, it does not simply feel different. It may also behave differently. Nerves embedded in that tissue may become more sensitive, more easily triggered, or less able to regulate pain signals effectively.

This could help explain why lipedema pain is often described as disproportionate, unpredictable, or resistant to typical approaches.

A small study with meaningful implications

It is important to be precise about what this study represents.

The study included 35 participants and was observational, meaning it captures a snapshot in time rather than cause and effect. The correlations found were moderate, not strong, and limited primarily to the thigh region.

This means the study does not provide definitive answers. It does not prove that stiffness causes pain, nor does it offer immediate solutions for treatment. What it does offer is something else, and something valuable. It provides measurable evidence that pain in lipedema is linked to physical properties of the tissue itself.

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A shift in how we understand lipedema

Taken together with other recent studies, a more complex picture of lipedema is beginning to emerge.

Lipedema is not simply a condition of fat accumulation. It appears to involve a combination of changes in fat cells, connective tissue, blood vessels, immune signaling, and nerve function.

This study adds an important piece to that puzzle by connecting tissue stiffness and pain. It suggests that the experience many women describe—of painful, dense, resistant tissue—is not just subjective. It may reflect underlying structural changes that can now be measured.

What this means for you

For women living with lipedema, the significance of this kind of research goes beyond statistics and correlations. It speaks to recognition. It supports the idea that the pain is not imagined, not exaggerated, and not simply a result of body weight. It is connected to real, physical changes in the body.

At the same time, it highlights how much we still have to learn. The tools to measure these changes are improving, but they are not yet widely used in clinical practice. Larger studies are needed. Better models are needed. And more attention must be given to how these findings can translate into meaningful care.

Moving forward

This study does not change everything, but it moves the field in a direction that feels more aligned with lived experience.

It shifts the conversation from surface to structure, from quantity to quality, from assumption to measurement..

And perhaps most importantly, it brings us one step closer to understanding why lipedema hurts the way it does.

If this gave you a new way of understanding your body, you are not alone. The more we connect lived experience with research, the closer we get to real answers.

Take a moment to reflect on what resonated with you, and share this with someone who needs to hear that lipedema pain is real and deserves to be taken seriously.

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If you want more science explained in a way that actually makes sense for your life, you are always welcome to follow along.

Before you move on, take a moment to explore some of my other articles on lipedema. I cover a wide range of topics—from biology and hormones to pain, treatment, and lived experience—always grounded in research and explained in a way that makes sense.

If you find value in this work, your support truly makes a difference. By becoming a member of my Substack, you help make lipedema knowledge more accessible, more nuanced, and more rooted in science.

1. Assessment of the elasticity of lipedematous tissue and the examination of the relationship between pain and fibrosis in lipedema (DOI: 10.1038/s41366-026-02049-8)