Lipedema – A Fat Disorder

“Lipedema is not rare, but the diagnosis of lipedema is rarely made.”

  • Beninson and Edelglass, 1984

Family butt? Thunder thighs? Everyone thinks you eat too much. But why is it distributed this way? It seems impossible to lose. It seems different from other people’s weight problems. That’s because it is different. It’s called lipedema (Lip – fat; edema- swelling caused by excess fluid). It almost exclusively occurs in women.

For details of the characteristics, you can go to:

https://consultqd.clevelandclinic.org/making-a-definitive-diagnosis-of-lipedema/

or

https://lipedemaproject.org/lipedema-differential-diagnosis/

 

but that’s pretty technical.

Simply:

  • Fat distribution is usually from the waist down, equal on both sides. Sometimes it’s in the arms, but generally people find they take a smaller size in tops and a significantly larger size in pants or skirts.
  • Often tender to the touch.
  • Bruises easily.
  • The fat can be lumpy or granular.
  • The fat does not extend into the feet. There may be a clear line, like a cuff, at the bottom of the calves. (Over time, the feet can become swollen but that means that lymphedema has become an additional problem.)
  • Onset usually during times of hormonal changes: puberty, pregnancy, or menopause.
  • Hereditary; about 90% of the time, it goes through the maternal line.

And – more later on these:

  • Often accompanied by low metabolism/hypothyroidism
  • Calorie restriction does not reduce lipedema fat.

 

So why is it so rarely diagnosed? Because most health care providers don’t even know it exists. Boy, that does make it hard to diagnose! Over a year ago, I went to an Obesity Medicine Association conference, and Karen Herbst, MD, educated us about this condition. I think most of us had never heard of it. But if you speak to the experts, you’ll find that it isn’t taught in medical schools. No wonder we hadn’t heard about it. So I started learning about it, talked to my pal Leslyn Keith, doctor of occupational therapy. Then she got me involved with a group called the Lipedema Project, headed by Catherine Seo, PhD, and Mark Smith, MD.

 

Leslyn and Catherine have found that ketogenic diets (or “Way of Eating”) are effective for helping people lose lipedema weight. Providers and scientists who study people using keto way of eating find that metabolism does not dip in most people. But some of them do plateau while still maintaining the same behaviors. They also may have other symptoms of low thyroid. As you may already know from listening to me, traditional testing for hypothyroidism (TSH only or TSH and FT4) is insufficient and inappropriate for finding famine response hypothyroidism. We have only looked at a couple of people who plateaued on keto; they were found to have famine response hypothyroidism. When treated appropriately, weight loss resumes. So we’re very early in the process of working on this connection.

So if you now know what it is, you can appreciate that there are reasons why it’s been so hard for you to lose the weight. Find the Lipedema Project online and you will see resources including

https://lipedemaproject.org

If you have lipedema, you’ll be interested to see Catherine Seo’s documentary: “The Disease They Call Fat,” available on Amazon Prime.


San Luis Obispo weight loss expert opens new office locations

–Carol N Rowsemitt PhD, RN, FNP-C, owner of Comprehensive Weight Management, A Nursing Corporation, which specializes in unique and effective weight loss management, recently announced the opening of two new office locations in San Luis Obispo County.

To better serve clients across the county, the company opened offices both above the grade and below the grade, in Templeton and Grover Beach. Dr. Steven McAllen is her new supervisory physician. Her Templeton office is located in Dr. McAllen’s off at 295 Posada Lane, along with Diabetes and Nutrition Education Center. The Grover Beach office is located on 815 West Grand Avenue.

Carol Rowsemitt’s methodology for weight loss management applies a deep understanding of the physiological human response to hunger. Her technique differs from many weight loss San Luis Obispo practitioners. Carol specializes in treating thyroid disorders and helping patients understand that their battle with weight loss is more than a matter of will power. Her practice and treatment regimen accounts for the biological changes in brain chemistry that are a determining factor in the effectiveness of a person’s weight loss. Patients of Carol Rowsemitt have a better understanding of the primitive “famine response” and the changes in brain chemistry that occur when a person begins dieting. Her individualized treatment plans take into consideration the changes in a patient’s brain chemistry, genetic disposition, and overall health history to determine the best treatment method.

Carol N. Rowsemitt received her B.A. in Chemistry from Boston University and her PhD in Biology from the University of Utah, with an emphasis in ecological physiology. This background gave her an understanding of how humans, like animals, adapt and respond to seasonal environmental changes. She later received a second Bachelor’s and Masters Degree in Nursing, with an emphasis in Diabetes Care, from the University of Utah and founded the Diabetes Wellness Center in South County, California with colleague Kris Dilworth, RN, NP-C, CDE.

Carol worked under supervising physician Dr. Thomas Najarian, an innovative pioneer in the field of non-surgical weight loss and appetite suppression medicine, for many years before opening her own private practice in 2015.

An initial one-hour assessment visit costs $190 and the recommended half-hour follow-up appointments cost $95. Patients have seen the best results when regularly attend review and maintenance sessions every 6 to 8 weeks.

For more information about Comprehensive Weight Management, A Nursing Corporation, or to book an appointment with Carol N. Rowsemitt, PhD, RN, FNP-C, call (805) 748-0954 or visit http://www.carolrosey.com.

Press release by San Luis Obispo SEO company Access Publishing, 806 9th Street, #2D, Paso Robles, CA 93446 (805) 226-9890.


Why choose Carol Rowsemitt, PhD, RN, FNP, weight-loss specialist?

If you are looking for a San Luis Obispo dietician, instead consider weight-loss specialist Carol Rowsemitt. She may offer the weight loss solution you are looking for.

Do you ever go through a search engine or look through the old reliable phone book looking for a dietician in San Luis Obispo? Yes, there can be several to choose from but do you really want to go that route since all you are trying to do is lose weight and be healthier? Many people already know what they should eat; the problem is sticking to a healthy eating plan. Carol Rowsemitt, a weight loss expert, could have a solution for you. As a nurse practitioner, she can prescribe medications to help suppress your appetite and keep your metabolism normal. If you know very little about calories, carbs, fats, and proteins, seeing a dietician may be helpful.

Don’t get it wrong, a San Luis Obispo dietician is a great source, but if you desire something more than just the knowledge of what and how much to eat, try this weight loss program instead.

With Carol Rowsemitt, you will not just receive a weight-loss plan; you will be educated on how your brain and body respond to food as well.

For instance, your brain chemistry and hormones play a big part in how your mind knows whether it is full or not. When you diet, these pathways push you to be more interested in eating as well as having to eat more to feel full. FDA approved medications can help you stick to your eating plan.

Another thing that Carol believes is important to focus on is thyroid function. Many providers, including various San Luis Obispo dieticians, pay more attention to thyroid stimulating hormone (TSH) than to any other factor when evaluating the thyroid. Carol will assess a variety of lab values as well as listening to your report of symptoms to determine how to evaluate and treat thyroid problems.

Some doctors will order thyroid blood tests, but do not include all thyroid hormone evaluations such as free T3, free T4 or reverse T3. These thyroid hormones need to be evaluated and thyroid treatment may be needed to return metabolism to normal.

Learning what your body needs and how it works will assist you in your weight loss goal. With Carol’s expert weight loss solutions, she will get you where you want to be, and help you maintain that weight.

Call San Luis Obispo weight-loss expert Carol Rowsemitt, PhD, RN, FNP, today at (805) 748-0954.


Pill Poppers vs. Weight Watchers?

Now that two appetite-suppressing medications have obtained FDA approval, you’ll be hearing lots of discussions posing an either/or view. Should you use medications to lose weight and rely on a magic pill, or should you watch your diet and get more exercise? Weight Watchers or Pill Poppers? Which is the best approach? I believe this is a ridiculous view of the problem. We know that the human body is designed to want food whenever it’s available. We know that the pathways in the brain that cause strong desire for food are the same pathways involved in addiction to narcotic drugs. So this is a major battle. Or should I say “war” because this is a long term process with no end in sight?

You bring all of the tools you have available to fight a war. You wouldn’t go to war using just the Army, while leaving the Navy and Air Force behind, would you? Would you say “Oh, we’ll bring them in later if we need them.) Use all of the resources at your disposal.

Sure, there are some people in our society who can lose weight and keep it off without help from medications. There are some people who can quit any kind of addiction by going cold turkey. My father quit smoking cold turkey at age 32 and remained tobacco-free for the rest of his 92 years. But does that mean everyone can do these things? Why did we turn these addictions into moral questions? Before we had an understanding of the biological mechanisms of addiction, we felt these were moral issues. Alcoholics, drug addicts, smokers, all of these people were considered to be of weak moral character. The more we have learned about the biology of addiction, the more we understand that there are many biological differences between individuals. Sure we all know that people have different hair and eye color, and different likelihoods of reaching a specific height. Those are things you can clearly see. Do you think I am a failure because the NBA never even considered me for a job in pro basketball? (I’m not much over 5 feet.) Of course not. So let’s start accepting the fact that there are differences in people’s brain chemistry, stomach hormones, insulin levels, etc. that make it harder for some people to avoid the most appealing foods. And don’t forget that the most successful people in primitive times were the ones who managed to get the most food so they could live long enough and have many children who survived to reproduce. We are the product of those success stories.

Bottom line here: Let’s use every tool we can to achieve weight loss. You certainly have to consume fewer calories, one way or another. (Lots of ways to do that. We’ll discuss that at a later date.) But why not help people eat fewer calories using medications that can decrease interest in food and make you feel full sooner. In our society, we are stimulated by the sight of food almost constantly – every place from the bank to the office supply store, to the gas station – put food in front of your face, to say nothing of the ads on TV. This is way more challenging than it was even 40 or 50 years ago when food was sold at grocery stores only and fast food restaurants had not yet appeared.

I often hear people say, “I like to take as few medications as possible” or “I don’t believe people should take medications to lose weight.” (There’s that moral issue again.) But when you consider that losing weight can reverse or prevent many problems, it starts to become a different question. Many people have all three of these diseases: Type 2 diabetes, high blood pressure, and heart disease. Often, one person will be on a total of nine or more medications just for these three problems. What possible reason could there be to avoid using medications that can help with all three of these problems? It’s certainly well known that most people will see improvement of each of these conditions if they can achieve and maintain weight loss.

So how come there are people who remain skinny and aren’t so interested in food? Some of these differences are genetic and some are environmental. Some environmental effects occur in the womb, based on how much food your mother had while she was pregnant with you. So we are all different for lots of reasons. Many of those reasons are not your fault. Get past the blame business here. Now look forward and see what you can do about it.

In future posts, we’ll talk about some of the other tools (or weapons or branches of the military) you should be thinking about using in this fight against the waistline.


Why do I always regain the weight I lost?

Something very important happened last week. I’m sorry I haven’t gotten this note out sooner:

The New England Journal of Medicine published an article (10/25/11) on an excellent piece of research.  The study was designed to look at hormones and other factors involved in metabolism, sensations of hunger, and fullness in people who lost 10% of their body weight.  They gathered data before dieting, after the loss, and after 1 year of maintaining the weight loss.

(more…)


A Confession: A donut in my House

In office visits, we’re often discussing what’s known as the obesogenic (obesity-creating) environment around us. We can’t control it all. When you drive by a billboard with appealing food,please don’t close your eyes.

But we can control some of it. A couple of months ago, some young friends showed up at my house with one of those lovely pink cardboard boxes. My brain quickly said,

“DONUT ALERT: Highly appealing food with warm emotional history has invaded inner sanctum.”

My response was classic. With distain and dismay, I mustered an accusing tone of voice. I yelped,

“WHAT? You brought donuts?”

Then I responded with a practiced approach. I looked at the person sitting next to me, smiled graciously and said,

“Do you want to split one?”

He said yes and we split a donut. I was pretty proud of myself for not eating a whole one.

However, a few minutes later, I stood up, walked the three steps across the room to that pretty, pink box, tore a donut in half and consumed another half of a donut. So much for not giving in to the siren song of the sugar/fat combo that is my downfall.

“Oops,” I thought, “There you go again. And you do this for a living – trying to help people stay away from food that is appealing and unhealthy.”

My young friends didn’t seem to believe me at first when I commanded,

“When you leave, you will take the donuts with you.”

They argued a bit; then louder and more firmly.

“When you leave this house, you will take the donuts with you.”

They looked downright startled. Then I said,

“A donut in my house is a donut in my mouth.”

We visited for a while during which time I must have sat on my hands because I can proudly say that I did not eat another one. But that’s because they did take them with them.

So that’s my confession. Many of the challenges of trying to control weight are like this: It sounds simple, but it isn’t easy to say no to the foods we love. These are foods full of calories that our bodies crave because it was important in primitive times when food could be scarce.

So here’s one of the things you can control:
1. Get the junk out of the house.
2. Don’t bring the junk into the house.
3. Listen to yourself: You say you buy it for your___________(fill in the blank grandchildren, children, spouse). Say that in front of the mirror. Is it really true?

No one needs this stuff. It isn’t good for any of us. Sure, some people can “get away” with eating it in terms of their weight. But what is it doing to their arteries?. . .their mood swings? Is it helping them focus on a healthy lifestyle? And do you need it out of the house? Aren’t your needs important?

Think about it.


Articles in Thyroid Science

Some of you have known that, for several years, Dr. Thomas Najarian and I were working on some issues that we planned to publish. Now, you can find our two papers in the online journal Thyroid Science.

In these works, we:
1. Review the evidence that mild thyroid abnormalities often occur during weight loss attempts
2. Show why we think these abnormalities are important to treat
3. Explain why that treatment is usually misunderstood by conventional evaluation of lab values
4. Present the details of how we treat patients.