Do you have to be keto for lipedema?
Jul 22, 2026
Do you have to be keto for lipedema?
This is one of my most commonly asked questions, and today I want to tell you why I never start my people there, what the research actually says when you read beyond the headline, and my favorite carbs for lipedema support along with the reasoning behind each one.
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And before we start: This is not medical advice nor is it prescriptive for you. This is for informational purposes only. Please run therapeutic dietary changes by your practitioner.
The trial everyone points to:
The strongest evidence we have here is a randomized controlled trial published in Obesity in 2024, where Lundanes and colleagues randomized women with lipedema to either a low-carbohydrate diet or a low-fat control diet, matched for calories and for protein, over eight weeks.
The finding held up. The low-carbohydrate arm reduced pain more than the control diet did, and the piece I find most compelling is that the pain relief happened independent of weight loss, so this wasn't simply a case of women getting smaller and their legs hurting less as a result.
So far the keto argument looks solid. But then look at what the low-carbohydrate arm actually ate.
75 grams of carbohydrate a day.
Both arms were matched at 60 grams of protein. The low-carb arm was 75 grams of carbohydrate alongside 73 grams of fat, and the control was 180 grams of carbohydrate with 27 grams of fat.
Seventy-five grams. The researchers themselves noted that the fat to protein-plus-carbohydrate ratio meant this didn't technically qualify as a ketogenic diet, and reviewers have since classified it as a low-carbohydrate model rather than a ketogenic one, since ketogenic diets are generally defined as sitting under 20-50 grams a day.
The same research group published imaging data from the trial as well, showing significant reduction in calf subcutaneous adipose tissue area, calf circumference, and pain in the low-carbohydrate group only, though it's worth knowing that arm had five participants.
To be fair, other trials did go ketogenic, and they helped also
I have no interest in arguing against something that's working for people, and there is a body of research using genuinely ketogenic approaches that also shows benefit.
The most useful one to look at is Jeziorek and colleagues, who ran a seven-month intervention in 113 women, 56 of whom had lipedema and 57 of whom had overweight or obesity without it. The lipedema group lost around 10.8 kg, most of it body fat, saw greater reduction in ankle circumference than the comparison group, and had significantly reduced pain scores on the visual analog scale, dropping from 4.6 to 3.0.
The LIPODIET pilot study found pain reduction as well, again with no correlation between the amount of weight lost and the change in pain.
There's a systematic review and meta-analysis now too.
And worth knowing, the 2024 German S2 guideline gives the Mediterranean diet a strong consensus recommendation for lipedema management and gives the ketogenic diet a consensus, which tells you there's no settled agreement on a single best dietary approach.
So if you want to try keto, try it. It's a legitimate option and for some women it turns out to be the right one - but I strongly recommend that you work with someone while you do this & don't make diet your ONLY approach (click here for my article on how light impacts cellulite and lipedema)
The comparison of the studies & drawbacks
Here's where it gets interesting: When you put the two strongest studies side by side, they sit at completely opposite ends of the carbohydrate spectrum, and both of them reduced pain.
| Lundanes 2024 (RCT) | Jeziorek 2023 | |
|---|---|---|
| Carbohydrate | 75 g (25% of calories) | 30 g (6% of calories) |
| Protein | 60 g (20% of calories) | 88 g (21% of calories) |
| Fat | 73 g (55% of calories) | 133 g (72% of calories) |
| Energy | 1200 kcal | ~1680 kcal |
| Fiber | not reported | 8.6 g |
| Duration | 8 weeks | 7 months |
| Design | randomized controlled trial | prospective, no control group |
| Pain outcome | reduced, independent of weight loss | reduced (VAS 4.6 → 3.0) |
Seventy-five grams reduced pain. Thirty grams reduced pain. Which tells you the benefit isn't a simple matter of going as low as you possibly can, and that's the assumption most lipedema advice online is built on.
Now here's the part of the Jeziorek paper that almost nobody quotes, and it's in the researchers' own data.
Their diets came out deficient in fiber, with median intake sitting at just 34.4 percent of Polish recommendations for adults. And they were also deficient in iron, magnesium, potassium, iodine, manganese, thiamine, calcium, folate, and vitamin D.
Read that list again with lipedema in mind. Magnesium and potassium are two of the most important minerals for fluid handling and lymphatic tone, and fiber is the entire mechanism by which conjugated estrogen actually leaves your body rather than getting reabsorbed. The authors of a keto-for-lipedema paper documented that their own protocol left women short on all three.
One more detail from that same study that's worth knowing: total body water did not change significantly in the lipedema group across seven months, even with roughly 11 kilograms of weight loss, while it did drop in the comparison group. Fat came off. The fluid stayed.
Why I don't start with keto or even low carb (75g) for my lipedema clients:
My reasoning comes down to thinking carefully about what you might be giving up on the way down.
The thyroid cost:
There's a study from 1976 that I think about constantly, where researchers put subjects on 800-calorie diets and varied nothing except the carbohydrate content.
Total fasting reduced T3 by 53 percent, with a 58 percent rise in reverse T3. The zero-carbohydrate diet, at those same calories, reduced T3 by 47 percent, which is very nearly what total starvation produced. And the same subjects at the same calorie level, eating just 50 grams of carbohydrate, showed no significant change in T3 or reverse T3 at all.
A dose-response follow-up found the T3 decline only appeared once carbohydrate fell below roughly 120 grams a day, and that it happened regardless of total calories, whether subjects were eating 360, 645, or 1200.
Study: Serog P, et al. J Endocrinol Invest.
The calorie deficit wasn't what drove the thyroid response - the carbohydrate restriction was.
T3 is your active thyroid hormone, and when it falls your metabolic rate slows down and your body handles fluid less well than it did before.
Now hold that next to what lipedema already involves, which is impaired lymphatic and vascular function, fibrosis, inflammation, and fluid retention. Adipose tissue analysis in women with lipedema shows decreased expression of genes related to lymphatic and vascular function alongside increased expression of genes related to fibrosis and inflammation in thigh compared with abdominal fat.
I'd rather not lower inflammation on one side of the equation while slowing metabolism and fluid clearance on the other, because that starts to look like trading one problem for a different one.
I want to be clear about what's established here and what isn't. The T3 drop on very low carbohydrate is well documented across decades. Whether that specifically worsens lipedema outcomes has never been trialed, so what I'm describing is mechanism and clinical reasoning rather than proof.
The estrogen piece
Lipedema is estrogen sensitive, which means I want to protect the pathways that clear estrogen rather than compromise them.
Here's how that machinery works. Your liver conjugates estrogen and excretes it into bile, that bile enters your intestine, and gut bacteria carrying beta-glucuronidase activity, collectively known as the estrobolome, can deconjugate that estrogen and free it to be reabsorbed back into circulation. How much of it actually leaves your body comes down to fiber and transit time.
High-fiber diets are associated with increased fecal estrogen excretion and lower serum estrogen, and a very-low-fat, high-fiber diet reduced serum estrone and estradiol in premenopausal women across both the follicular and luteal phases.
This is exactly why that 8.6 grams of fiber in the Jeziorek study matters so much to me. At 30 grams of carbohydrate a day, getting meaningful fiber in becomes very difficult, and the researchers documented that themselves.
My favorite carbs for lipedema support
Raw carrot, shredded. The fiber supports moving conjugated estrogen out of the body rather than letting it get deconjugated and reabsorbed along the way. It needs to be raw, since cooking changes the fiber structure that does the work. One human study found that raw carrots eaten at breakfast produced a 50 percent increase in fecal bile acid and fat excretion.
A caveat on this one: the whole-diet fiber and estrogen evidence is solid, but carrot-specific human trials measuring estrogen outcomes don't exist. This is mechanism and it's low risk, rather than something proven.
Cooked white button mushrooms. These contain compounds that inhibit aromatase, the enzyme that converts androgens into estrogen. White button mushroom suppressed aromatase activity dose-dependently in a human placental microsome assay, and the active compound appears to be conjugated linoleic acid and its derivatives.
There's a human dose-finding trial in postmenopausal breast cancer survivors as well, though it's worth knowing the doses used were concentrated freeze-dried extract rather than a dinner portion. Cook them, both because they're better that way and because cooking reduces the agaritine content.
Cooked and cooled potato or white rice. Cooling a cooked starch converts part of it into resistant starch through retrogradation, which then reaches the colon intact and feeds the gut bacteria that regulate the estrobolome. Reheating gently doesn't undo it, so you aren't stuck eating cold potatoes forever (you can grab the full resitstant starch protocol in my CARBS ebook - use code SUMMER50 for 50% off)
Berries and cooked apples. Fiber, transit time, and microbiome support, and cooked apples in particular tend to be gentle on people who are just adding carbohydrate back in.
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Where this leaves you
Low carbohydrate has actual evidence behind it for reducing lipedema pain, and the fact that the relief appears independent of weight loss makes it worth taking seriously rather than dismissing.
But look again at those two studies sitting side by side. Seventy-five grams worked. Thirty grams worked. The version at 30 grams came with documented deficiencies in fiber, magnesium, potassium, iron, iodine, calcium, and folate which are not small things to be short on when you're trying to support lymphatic tone, fluid handling, and estrogen clearance.
Clinically: I actually have several cases where we were closer to 100-150g and the client got tremendous relief - (as part of a whole lifestyle approach that includes light - grounding 0 hydration & a few other tools - not just food) - that's where I'd rather have people consider starting (remember - this is for informational purposes only - not prescriptive - always work with a practitioner when implementing any therapeutic nutritional protocols).
And if you've been doing strict keto for your lipedema and you're colder than you used to be, more tired, finding hair in the shower, and your legs still haven't responded, cutting harder may not be the answer. You may be sitting below the threshold where your thyroid starts paying the bill.
Lastly: Remember that diet is only 1/3 of the equation. Light exposure - circadian rhythms, nervous system, & lifestyle are the other forgotten parts. (read more on light and cellulite HERE)
Click here to get on my waitlist for our next round of coaching if you want my help!
And one more clinical note: If you are a client or student of mine reading this - there is always a reason why I recommend a specific nutritional approach after looking at your comprehensive intake - including your entire stress load - latitude - job - responsibilities - hormone landscape & age/stage of life.
Hope this was helpful!
Sarah
Lipedema can only be diagnosed by a qualified medical professional, usually an endocrinologist, vascular specialist, or trained dermatologist. This article is educational and is not medical advice. Please work with your own providers on your care.
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