Medications & Supplements: A-L

There are several medications and many supplements used in the treatment of lipedema. The more common ones which Dr. Karen Herbst recommends are listed on the site and why they’re helpful for our disease, along with the recommended dosages. The information which has been gathered here is presented for support, especially for those who are new to the disease, and is not intended as a substitute for professional medical advice. ALWAYS CHECK WITH YOUR PHYSICIAN BEFORE BEGINNING ANY OF THESE MEDICATIONS/SUPPLEMENTS TO ENSURE THAT THEY WILL BE HELPFUL FOR YOU. When pregnant, always check with your physician before beginning any new medication or supplement, including herbal teas.

Medications and supplements recommended by Dr. Herbst

Acetylcysteine

Acetylcysteine (also known as N-acetylcysteine or N-acetyl-L-cysteine or NAC) is primarily used as a mucolytic agent and in the management of acetaminophen poisoning. It exerts its mucolytic action by opening disulfide bonds in mucoproteins in bronchial secretions. This, in turn, acts to decrease the hypersecretion and viscosity of mucus secretions of the lungs, thereby thinning mucus, and aids in the removal of these secretions. As with guaifenesin (see below), it is felt to work on the lymphatic system to reduce adhesiveness and surface tension of coagulated proteins in adipose tissue and makes them easier to be transported within and excreted from the lymph system. Its half life is 1.5 hours; therefore, in one and one-half hours, half of its effectiveness is gone, so it’s best to break the daily dose into several doses throughout the day. Jarrow now offers a sustained-release tablet. Dr. Herbst recommends 500-600 mg once or twice daily.*

Acetylcysteine. (2017). DrugBank. Retrieved from https://www.drugbank.ca/drugs/DB06151
Acetylcysteine. (2017). Prescribers Digital Reference online. Retrieved from http://www.pdr.net/drug-summary/Acetylcysteine-acetylcysteine-668#12

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Alpha Lipoic Acid

This section is being added.

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Amphetamines

This section is being added. Amphetamines offer several benefits for lipedema: they improve large (hypertrophic) adipocyte health and improve lymphatic functioning.
dextroamphetamine, Adderall, phentermine, terbutaline an option
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Berberine

Berberine is a bioactive compound that can be extracted from several different plants and belongs to a class of compounds called alkaloids. One of the main actions of berberine is to activate an enzyme inside cells called AMP-activated protein kinase. This enzyme is sometimes referred to as a “metabolic master switch” and plays a major role in regulating metabolism.

High glucose and glycogen levels inhibit AMPK, which leads to many of the long-term consequences of diabetes. Exercise and caloric restriction activate AMPK, and this explains their benefit in treating diabetes. High fat intake also inhibits AMPK. Berberine is very effective at lowering blood sugar and HbA1c and works as well as some pharmaceutical drugs.

Berberine has a half life of several hours, so it is necessary to spread your dosage to several times per day to achieve stable blood levels. Its main side effects are related to digestion, and there are some reports of cramping, diarrhea, flatulence, constipation and stomach pain. A common dosage recommendation is 500 mg, 3 times daily, one-half hour before meals. PLEASE NOTE THAT DR. HERBST HAS NOT GIVEN A DOSAGE FOR THIS SUPPLEMENT.* Berberine may cause digestive side effects for some.

Gunnars, K. (2017). Berberine: a powerful supplement with many benefits. Healthline. Retrieved from https://www.healthline.com/nutrition/berberine-powerful-supplement
Schor, J. (2012). Clinical applications for berberine. Natural Medicine Journal. Retrieved from https://www.naturalmedicinejournal.com/journal/2012-12/clinical-applications-berberine

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Butcher’s Broom

This section is being added. Butcher’s Broom helps improve lymphatic functioning.
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CoQ10 Ubiquinol

CoQ10 Ubiquinol is used to improve large (hypertrophic) adipocyte health and mitochondrial function in lipedema. Coenzyme Q10 is a vitamin-like substance that is made naturally in the body and plays an essential role in the production of energy in all cells. The body requires a sufficient amount of CoQ10 in order to function optimally. As we age, its levels in the body decrease, causing the degeneration of cells. CoQ10 is available in two forms: ubiquinone (USP ubidecarenone), which is the oxidized form of CoQ10, and ubiquinol, which is the reduced form. Ubiquinol is better absorbed than CoQ10.

Because of its structural similarity to vitamin K, it has been suggested that CoQ10 may have procoagulant activity and interfere with warfarin. Do not take CoQ10 without medical advice if you are using blood pressure medicine or warfarin (Coumadin, Jantoven).

Side effects include: upset stomach, nausea, vomiting, loss of appetite, diarrhea, skin rash or low blood pressure.

Coenzyme Q10. (2019). DrugBank. Retrieved from http://www.drugbank.ca/drugs/DB09270
Coenzyme Q10. (2018). Drugs. Retrieved from http://www.drugs.com/coenzyme-q10.html
Ubiquinol. (n.d). Prescribers Digital Reference online. Retrieved from http://www.pdr.net/full-prescribing-information/Ubiquinol–Active-Form-of-CoQl0-CoQ10-24289

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Diosmin

Diosmin is a flavonoid present in a number of plants. It manages venous inflammation and accumulation of white blood cells and platelets as well as edema caused by a deterioration of venous vessel walls. Dr. Herbst recommends 500-600 mg once or twice daily.*

Diosmin-HMC, from Thorne, and DiosVein, from Swanson, which is diosmin and hesperidin, another flavonoid. Both diosmin and hesperidin can increase the strength of veins and capillaries. In addition, hesperidin can reduce histamine release from mast cells by strengthening the cell membrane.

Diosmiplex–or Vasculera–works on the venous system by increasing smooth muscle contractibility and improving contractility and drainage of the lymphatic system. Vasculera is a 630 mg tablet of diosmiplex, which is a combination of diosmin (600 mg) and alka4-complex (30 mg). Alka4-complex works by buffering stomach acid and managing blood pH to affect local acidosis in veins.
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Guaifenesin

Guaifenesin is an expectorant which increases the output of bronchial secretions by reducing adhesiveness and surface tension, therefore loosening and thinning these secretions to ease expectoration. As with acetylcysteine (see above), it is felt to work on the lymphatic system by reducing adhesiveness and surface tension of coagulated proteins in adipose tissue and making it easier to transport these proteins within and excrete them from the lymph system. Dr. Herbst recommends 600 mg twice daily.*

A key aspect of treatment is that salicylates, contained in aspirin and other compounds, completely block the effects of guaifenesin. Moreover, skin readily absorbs salicylates into the body. Salicylates are manufactured by all plants, the choicest parts of which are concentrated to make herbal medications, many cosmetics, and deodorants. Thus, patients being treated with guaifenesin cannot take aspirin or herbal medications, or use any skin creams or topical products which contain herbs, including aloe. Castor oil, Listerine, Ben Gay, and razors with aloe strips are among the many culprits that block the action of guaifenesin. Which products contain salicylates?

Another complicating factor in guaifenesin treatment is hypoglycemia, or “low blood sugar,” better defined as carbohydrate intolerance. Some of the many symptoms of hypoglycemia are tiredness, panic, palpitations, and lightheadedness after eating sugar or starch. Hypoglycemia can be controlled by a strict diet that eliminates sugar, most carbohydrates, and caffeine.

Take guaifenesin with a full glass of water. It can be taken without regard to meals. Its half life is 1 hour; therefore, in one hour, half of its effectiveness is gone, so it’s best to break the daily dose into several doses throughout the day. Extended-release tablets offer somewhat better control. There are many brands of guaifenesin to choose from–make sure you’re taking a product containing guaifenesin only, without other additives. There are many combinations which contain unnecessary ingredients which may cause side effects.

Guaifenesin. (2017). DrugBank. Retrieved from http://www.drugbank.ca/drugs/DB00874
Guaifenesin. (2017). Prescribers Digital Reference online. Retrieved from http://www.pdr.net/drug-summary/Mucinex-guaifenesin-1275.1918
St. Amand, P. (n.d.). Chronic Fatigue Syndrome Treatment. Retrieved from http://cfstreatment.wordpress.com/guaifenesin/
St. Amand, P. (n.d.). The Guaifenesin Protocol. Retrieved from http://www.fibromyalgiatreatment.com/the-guaifenesin-protocol.html

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H1 Blockers

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H2 Blockers

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Horse Chestnut

Horse Chestnut is a plant extract with a group of molecules known as aescins, which are beneficial to circulatory health. Horse chestnut (also known as Aesculus hippocastanum, conker tree, rosskastanie and venostasin) has been effective in treating symptoms of chronic venous insufficiency (decreased blood flow return from the feet and legs back to the heart). These symptoms include leg pain or tenderness, varicose veins, itching or swelling in the legs, and fluid retention. The most commonly reported side-effects associated with horse chestnut consumption were gastrointestinal complaints, dizziness, nausea, headache, and pruritis.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005625.pub3/media/CDSR/CD005625/rel0003/CD005625/CD005625.pdf
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005625.pub4/full

Horse Chestnut. (2019). Drugs. Retrieved from http://www.drugs.com/mtm/horse-chestnut.html
Horse Chestnut. (2018). Examine. Retrieved from http://examine.com/supplements/horse-chestnut/

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Ketoprofen

This section is being added. Ketoprofen helps improve lymphatic functioning and does not create additional swelling as with other NSAIDs.
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L-arginine

This section is being added. L-arginine helps improve leaky cardiovascular and lymphatic capillaries. Choose long-acting forms or as an no-additive powder added to water. Dr. Herbst recommends 3 grams three times daily.*
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Lemon

This section is being added. Lemon polyphenols are used to improve large (hypertrophic) adipocyte health and maintain healthy gut bacteria.
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Lymphomyosot

Lymphomyosot has been shown to act on inflammatory pathways and reduce tissue edema of thrombotic or inflammatory etiology. Its components in other forms and dosages have been shown to regulate inflammation. The mechanism of action and its effectiveness for treating lymphedema specifically are unclear. PLEASE NOTE THAT THIS HOMEOPATHIC MEDICINE IS NOT INCLUDED ON DR. HERBST’S MEDICINES AND SUPPLEMENTS LIST. Suppliers of lymphomyosot drops or tablets.

Keim, A. P., Slis, J. R., Mendez, U., Stroup, E. M., Burmeister, Y., Tsolaki, N., . . . Rubin, L. H. (2013). The multicomponent medication lymphomyosot improves the outcome of experimental lymphedema. Lymphatic Research and Biology, 11(2), 81-92.

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Where to Purchase

Bioinnovations

eVitamins

iHerb

Life Extension

Lucky Vitamin

Natural Healthy Concepts

Pharmaca

Professional Supplement Center

Pure Encapsulations Use Lipedema Support’s fulfillment code for a 20% discount: 230711

Puritan’s Pride

Swanson

Thorne Use Dr. Herbst’s code for a 10% discount: HCP#1012355

Thrive Market

Total Discount Vitamins

Vitacost

Vitamin Shoppe

Wellness Resources
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Prescription Savings

Investigate your state’s Prescription Assistance Program. Residents have access to many statewide programs, which offer pharmacy coupon cards that provide prescription savings of up to 75% at more than 68,000 pharmacies across the country.

These plans may also help:

GoodRx

Needy Meds

Rx Saver

Discount Pharmacies:

Honeybee Health

Go to: Medications & Supplements: M-Z

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