Very-low-calorie ketogenic diet (VLCKD) is emerging as a targeted adjunct for lipedema, a painful adipofascial disorder that resists standard hypocaloric approaches. This narrative review collates pre-clinical signals and early clinical data indicating that nutritional ketosis down-regulates adipose and systemic inflammation, stabilizes leaky micro-vessels, and boosts β-oxidation—processes central to the lipedema cascade. Uncontrolled cohorts show 7–10 % reductions in limb girth and pain within 8–12 weeks, outperforming isocaloric Mediterranean or intermittent-fasting plans. The authors emphasise vigilant monitoring: brisk weight loss can transiently raise sodium and uric-acid loads, and endocrine shifts warrant step-wise re-feeding. A three-phase strategy is proposed—brief VLCKD induction, graded carbohydrate re-introduction paired with compression and resistance exercise, and biomarker-guided maintenance—aimed at interrupting the inflammation-edema-adipogenesis loop. For vascular surgeons and rehabilitation teams, these insights justify integrating VLCKD into multidisciplinary algorithms; for patients and dietitians, they supply an evidence-framed rationale when weighing ketogenic options. (pubmed.ncbi.nlm.nih.gov)
Ludovica Verde – Department of Public Health, University of Naples Federico II, Naples, Italy
Elisabetta Camajani – Department of Human Sciences & Promotion of Quality of Life, San Raffaele Roma Open University, Rome, Italy
Giuseppe Annunziata – Department of Experimental Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
Antoanstefan Sojat – Clinic for Endocrinology, University Clinical Centre of Serbia, Belgrade, Serbia
Ljiljana V. Marina – Clinic for Endocrinology, University Clinical Centre of Serbia, Belgrade, Serbia
Annamaria Colao – Centro Italiano per la cura e il Benessere del Paziente con Obesità, Naples, Italy
Massimiliano Caprio – Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
Giovanna Muscogiuri – Dipartimento di Medicina Clinica e Chirurgia, University Federico II, Naples, Italy
Luigi Barrea – Università Telematica Pegaso, Naples, Italy
Tags: Anti-Inflammatory Agents; Diet, Ketogenic; Humans; Lipedema – complications; Lipedema – diagnosis; Lipedema – therapy; Obesity – complications; Treatment Outcome
