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There are several conditions which are seen frequently with lipedema, some of which are coexisting and others which result from living with prolonged lipedema.
Ehlers-Danlos syndromes are a group of connective tissue disorders that can be inherited and are varied both in how affect the body and in their genetic causes. They are generally characterized by joint hypermobility (joints that stretch further than normal), skin hyperextensibility (skin that can be stretched further than normal), and tissue fragility. Learn more about Ehlers-Danlos syndromes and their 13 different types.
Why are our joints affected?
Per Dr. Josef Stutz, “The abnormal accumulations of fat on the legs, especially those on the proximal inside of the thighs, cause affected patients to develop a characteristic gait pattern. To avoid chafing of the skin, especially in the warmer months, patients tend to abduct their legs while walking, resulting in their being held in an upside-down V position.” In other words, we tend to walk with our legs spread out to compensate for the fat pads developing on the inside center of our thighs.
“As this fat continues to accumulate, the abduction of the legs becomes wider, and the misaligned joint axes become clinically relevant. The improper stress in abduction causes a valgus deformity in the knee joints and later a “skew-foot” position of the ankle joint and an apparent varus shift of the hip joint.” As the fat pads develop in our thighs and calves, this weight forces our knees together in a knock-kneed position (far right), and we begin to turn our feet outward to compensate for this.
Stutz, J. & Wald, S. (2011). Liposuction of lipedema to prevent later joint complications. Vasomed, 23(3), 2-6.
Part of an evaluation for lipedema may involve completing a Lower Extremity Functioning Scale. Its objective is to measure “patients’ initial function, ongoing progress, and outcome” for a wide range of lower-extremity conditions. It is a self-report questionnaire in regards to twenty different everyday activities. Patient select an answer from the following scale for each activity listed:
Extreme Difficulty or Unable to Perform Activity
Quite a Bit of Difficulty
A Little Bit of Difficulty
The patient’s score is tallied. The maximum possible score is 80 points, indicating very high function. The minimum possible score is 0 points, indicating very low function.
Mast Cell Disorders
Mast cell disorders are caused by the proliferation and accumulation of genetically-altered mast cells and/or the inappropriate release of mast cell mediators, creating symptoms in multiple organ systems. The two major forms of mast cell disorders are mastocytosis and mast cell activation syndromes (MCAS). Mast cell disorders can cause tremendous suffering and disability due to symptomatology from daily mast cell mediator release, and/or symptoms arising from infiltration and accumulation of mast cells in major organ systems. Learn more about MCAS and Mast Cell Disorders in Ehlers-Danlos Syndrome.
Postural orthostatic tachycardia syndrome POTS
Chronic Venous Insufficiency
Mast Cell Issues
Histamine exerts its effects by binding to its 4 receptors: H1R, H2R, H3R, and H4R on target cells in various tissues. Histamine receptors are located all over the body and have many important functions including:
H1 receptors: Smooth muscle and endothelial cells affecting skin; blood vessels (Benadryl and Claritin block activity of these receptors)
H2 receptors: Cells in the intestines control acid secretion, abdominal pain, and nausea; heart rate
H3 receptors: Central nervous system controlling nerves, sleep, appetite and behavior
H4 receptors: Thymus, small intestine, spleen, colon, bone marrow and white blood cells; inflammatory response
Histamine and histamine intolerance Laura Maintz and Natalija Novak
Symptoms of lipedema
excess fat, symmetrically located in buttocks and lower extremities to ankles
fat pad anterior to malleolus
fat pad between achilles tendon and medial malleolus
tenderness of lower extremities
easy bruisability of lower extremities
dependent edema after excess fat has been present for several years
Neurologic- Central Nervous System:
burning or tingling of plantar surface of foot (in some patients)
lipodystrophy is a hallmark of lipedema, edema of the lower limbs less frequent
Localized lipodystrophy can happen to anyone at any age. A small dimple of localized lipodystrophy may look odd, but it probably won’t cause any other trouble.
However, because fat tissue makes the hormone leptin, people with larger areas of acquired lipodystrophy might not have enough of this chemical in their bodies. Leptin tells your body you’ve eaten enough and to make insulin. Fat could also build up in places it shouldn’t, like the blood, heart, liver, and kidneys. Depending on which type of lipodystrophy a person has, it may cause other problems, including diabetes, high cholesterol and triglycerides, liver disease, and kidney failure.
WILSON’S TEMPERATURE SYNDROME
Wilson’s Temperature Syndrome consists of hypothyroid symptoms and low body temperature. WTS is consistent with inadequate thyroid stimulation of the cells, even though the supply of thyroid hormone from the thyroid gland or thyroid medicine is normal (TSH thyroid blood test is normal). It is typically brought on by stress and is often reversible. Learn more about WTS.
Recommended thyroid tests:
Thyroid Peroxidase Antibodies (TPOAb)
Thyroglobulin Antibodies (TgAb)
In most cases of Hashimoto’s thyroiditis, blood tests will reveal one or two types of anti-thyroid antibodies. Thyroid peroxidase antibody (TPOAb) is the most common antibody present (in up to 95% of those with Hashimoto’s), and often antibodies against thyroglobulin (TGAb) are found as well (around 80%). These antibodies may appear decades before a change in TSH is detected. Thus, TPO antibody screening is always crucial in suspected thyroid disease.
Elevated thyroid antibodies have been connected with a feeling of distress, anxiety and depression. Also, the higher the antibodies, it is more likely to experience symptoms of hyperthyroidism when the thyroid cells are broken down, and stored hormone is dumped into the bloodstream, as well as hypothyroidism when there is not enough thyroid hormone.
Cole, W. (2014). Why your lab results could be lying about your thyroid health. Retrived from: https://drwillcole.com/why-your-lab-results-could-be-lying-about-your-thyroid-health/
Myers, A. (2017). What your thyroid lab results really mean. Retrieved from: https://www.amymyersmd.com/2016/10/thyroid-lab-results-really-mean/
Wentz, I. (2015). Hashimoto’s and TPO antibodies. Retrived from: https://thyroidpharmacist.com/articles/hashimotos-and-tpo-antibodies/