Medical Resources

There are many over-the-counter supplements and several medications available by prescription which have been found to aid in the treatment of lipedema.

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Bad mix: Blood thinners and NSAIDs – Harvard Health Publishing
Caution with these supplements when you have a heavy metal burden – Naturheilpraxis
Dietary Supplement Fact Sheets – National Institutes of Health
Recommended Supplements – Dr. Marcia Byrd
Recommended Supplements and Medications – Dr. Karen Herbst, May 2019
U.S. National Library of Medicine Database – National Institutes of Health

Medications and Supplements to Avoid with Lipedema

Beta blockers are used in the treatment of cardiac health but can cause fluid retention.
Calcium channel blockers are used in the treatment of hypertension but can cause fluid retention.
Clonidine is used in the treatment of hypertension but can cause fluid retention.
Furosemide is used in the treatment of edema but concentrates proteins in interstitial organs, eventually halting fluid flux. Aldactone and hydrochlorothiazide have less adverse effects in women with lipedema.
Gabapentin is used for pain control but can cause fluid retention.
Non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain control but can cause fluid retention.
Oral corticosteroids are used to reduce inflammation but can weaken tissue and cause fluid retention and rebound inflammation. Oral corticosteroids should be used when medically necessary. Nasal or inhaled corticosteroids have less effect on lipedema tissue.
Sex hormones are used for hormone replacement but can cause fluid retention and are implicated to effect the development of lipedema.
Thiazolidinediones are used in the treatment of diabetes but can cause increases in subcutaneous fat tissue and fluid retention.

Herbst, K., (2019, Dec 13). Subcutaneous adipose tissue diseases: Dercum disease lipedema, familial multiple lipomatosis, and Madelung disease. EndoText, 1-46.

Where to Purchase

Beyond Health
Ethical Nutrition
Pure Encapsulations
Woodstock Vitamins


Amino acid that acts as an antioxidant, preventing tissue damage by reducing free radicals.

N-acetylcysteine (NAC) (acetylcysteine) is used to help break up mucus and is used by the body to build antioxidants. NAC is used to treat acetaminophen overdose. NAC is also marketed for its liver-protective properties and to support healthy immune functioning, and there is evidence it can help prevent kidney or neurologic damage caused by some drugs. It has also been studied for several psychiatric disorders with limited success.

NAC can dissolve and loosen mucus caused by some respiratory disorders by reducing protein bonds (disulphide bonds to sulfhydryl bonds) which reduces mucus formation. This mechanism of action is thought to help reduce the thickness (viscosity) of lymph in lipedema patients so that it will move more freely within the body.

NAC also helps facilitate essential biological functions by bonding with two other amino acids–glutamine and glycine–to create glutathione, a powerful antioxidant that plays a key role in regulating numerous cellular activities and helps keep the immune system in check. Glutathione helps neutralize free radicals that damage cells and tissues at the molecular level.

Only minute amounts of NAC are found in food; it is derived from the amino acid L-cysteine. Cysteine is both naturally produced in the body and obtained from animal-based and plant-based foods. These foods are excellent food sources of the amino acid: poultry, eggs, dairy, red peppers, garlic, onions, broccoli, Brussels sprouts, oats, and wheat germ.

Side effects include nausea, vomiting, stomach upset, diarrhea, fatigue, eye irritation, and skin rash. Less common side effects include asthma attack, anaphylactic shock, low blood pressure and headache (due to vasodilation). For those patients with mast cell activation syndrome, it should be noted that NAC is a diamine oxidase inhibitor.

Do not take NAC if you are taking nitroglycerin; NAC can further reduce blood pressure and cause severe headaches. NAC can slow blood clotting and should be avoided in people with bleeding disorders, such as hemophilia or Von Willebrand disease. NAC should be stopped at least two weeks prior to any elective surgery. Caution should be exercised in people with kidney disease; metabolized NAC is excreted via the kidneys and has been known to cause kidney stones in rare cases–even in people without kidney disease. Get emergency medical help if you have signs of an allergic reaction: hives, difficult breathing, or swelling of your face, lips, tongue, or throat.

Recommended by Dr. Karen Herbst, 500 to 600 mg once or twice daily.

Griffin, R. (2020, Mar 3). N-Acetyl Cysteine. WebMD.
N-Acetylcysteine. (2020, Oct 1). Memorial Sloan Kettering Cancer Center.
NAC. (2020, Jan 3).
Wong, C. (2021, Nov 14). What is N-acetylcysteine? Very Well Health.
NAC Contraindications. (n.d.). Glutathione Disease Cure.

NAC – see N-acetylcysteine


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Nattokinase is a natural enzyme extracted from natto, a popular Japanese breakfast dish made from fermented soybeans. Natto has long been used in folk medicine to treat cardiovascular diseases, and nattokinase is believed to possess the same properties.

In alternative medicine, it is believed to benefit people with heart and vascular diseases, in part by breaking down blood clots that can impede circulation. Among the conditions nattokinase is purported to prevent or treat are: angina, atherosclerosis, deep vein thrombosis (DVT), hemorrhoids, high blood pressure, heart attack, peripheral artery disease (PAD), stroke, and varicose veins.

Because nattokinase can influence blood circulation and chemistry, it should be used with caution in certain groups, namely:

People with bleeding disorders, such as hemophilia, in whom nattokinase may make symptoms worse
People who take blood thinners, including warfarin, in whom nattokinase may promote bleeding and easy bruising
People with low blood pressure, also known as hypotension, in whom nattokinase may cause lightheadedness, headaches, dizziness, and fainting
People on antihypertensive drugs, like ACE inhibitors and calcium channel blockers, in whom nattokinase may intensify the drug’s effect, triggering hypotension

Nattokinase should be stopped at least two weeks prior to a scheduled surgery to reduce the risk of excessive bleeding.

Why do people take nattokinase?
There’s some early evidence that nattokinase may have benefits for heart and artery health. One study shows that a nattokinase supplement lowers the risk of blood clots after long plane flights. It may help reduce narrowing of the arteries.

Other studies show that nattokinase may help lower blood pressure. However, we need more research to see if it is effective.

Optimal doses of nattokinase have not been set for any condition. Quality and active ingredients in supplements may vary widely from maker to maker. This makes it very hard to set a standard dose. Ask your doctor for advice.

Researchers first found nattokinase in the Japanese food natto, made with fermented soybeans. It seems that the fermentation process makes nattokinase. You can’t get nattokinase from other soy foods.
Risks. If you have any blood clotting disorders, don’t take nattokinase supplements unless a doctor says it’s safe. You may need to stop taking nattokinase if you’re planning to have surgery.

Given the lack of evidence about its safety, doctors don’t recommend nattokinase for children or for women who are pregnant or breastfeeding.

Interactions. If you take any medications regularly, talk to your doctor before you start using nattokinase supplements. The supplements could interact with blood thinners and other drugs that reduce clotting, like aspirin and ibuprofen. They could cause excess bleeding and bruising.

The U.S. Food and Drug Administration (FDA) does regulate dietary supplements; however, it regulates them under a different set of regulations than foods and drugs. It is up to the manufacturers to assure safety and accurate labeling.

Recommended by Dr. Karen Herbst, 2000 units daily on an empty stomach.

Griffin, R. (2021, Sep 24). Nattokinase. WebMD.
Hills, J. (n.d.). Ginger should be avoided when taking certain medications or having certain health conditions. Healthy and Natural World.
Nattokinase. (2020, Jun 22).
Ratini, M. (2019, Sep 24). WebMD.
Wong, C. (2021, Apr 28). What is nattokinase? Very Well Health.

Nicotinamide riboside

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Recommended by Dr. Karen Herbst.

Bauer, B. (n.d.). Chronic fatigue: Can a natural remedy boost my energy? Mayo Clinic.


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Noni has antiinflammatory and antioxidant properties. It may inhibit the formation of blood vessels that contribute to lipomatosis, a condition in which benign tumors of fat tissue appear throughout the body.


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(also known as fish oil)

Recommended by Dr. Karen Herbst.

Omega-3. (2018, May). National Center for Complementary and Integrative Health.


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For mast cell disorder.

Phentermine – see Amphetamine

Pine bark extract – see Pycnogenol


A WARNING ABOUT POTASSIUM SUPPLEMENTATION: It’s extremely important to ensure that your blood potassium level remains between 3.5 to 5 mmol/L. Unlike sodium and chloride, potassium’s ideal level is in a very small range, and the heart’s function is controlled primarily by potassium. For potassium levels under 3.5 or over 5, dangerous arrhythmias can occur, so please be very cautious when using these supplements.


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Recommended by Dr. Karen Herbst.

National Library of Medicine. (2021, Jan 22). Pregabalin. Medline Plus.


Coming soon!

Recommended by Dr. Karen Herbst.

Probiotics: What you need to know. (2019, Aug). National Center for Complementary and Integrative Health.


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Pycnogenol is an antioxidant and a bioflavonoid. Its antioxidant properties protect against damage caused by free radicals, while its bioflavonoid properties reduce capillary leakage, perivascular inflammation, and subcutaneous swelling.

Recommended by Dr. Karen Herbst, 200 mg daily.

National Library of Medicine. (2021, Jan 29). Maritime pine. Medline Plus.


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Quercetin is a flavonoid that supports cardiovascular health, helps regulate blood pressure, and protects against stress by suppressing the release of cortisol in the body.

Recommended by Dr. Karen Herbst.

For mast cell disorder.


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Trace mineral supports healthy functioning of the adrenal glands.


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Recommended by Dr. Karen Herbst.


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Selenium is a helpful supplement for lipo-lymphedema patients because of its ability to reduce swelling. It can also reduce the risk of certain kinds of bacterial skin infections.

Recommended by Dr. Karen Herbst.

Selenium. (2019, Dec 10). National Institutes of Health.


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Serrapeptase should be taken 2 hours after a meal.

Recommended by Dr. Karen Herbst.

Hills, J. (n.d.). Ginger should be avoided when taking certain medications or having certain health conditions. Healthy and Natural World.
Serrapeptase. (2020, Jun 22).

Can You Use Serrapeptase and Nattokinase Together?

Serrapeptase & Nattokinase: What you need to know


Spirulina is a type of blue-green algae that contains a number of nutrients, including B vitamins, beta-carotene, vitamin E, copper, iron, magnesium, selenium, and zinc. Spirulina contains antioxidants, minerals, and chlorophyll. It also contains a plant-based protein called phycocyanin – the a plant pigment that gives spirulina its blue-green color – which has been found to not only reduce inflammation in the body but also block tumor growth and kill cancer cells. Spirulina also contains zeaxanthin, a plant pigment that may reduce the risk of cataracts and age-related vision loss.

Spirulina has been used in a number of health conditions, including fatigue, high cholesterol, high triglycerides, and viral infections. Purported spirulina benefits also include weight loss, increased energy, and stimulation of the immune system. Animal and test tube studies suggest that spirulina may protect against allergic reactions by stopping the release of histamines.

Although few adverse effects are associated with the use of spirulina, consuming spirulina may cause headaches, allergic reactions, fatigue, dizziness, stomach upset, increased gas, muscle pain, sweating, swelling, and insomnia. People with allergies to seafood, seaweed, and other sea vegetables should avoid spirulina. Spirulina may not be appropriate in thyroid conditions, autoimmune disorders, gout, kidney stones, or phenylketonuria (PKU, decreased metabolism of the amino acid phenylalanine).

Spirulina harvested in the wild may be contaminated with heavy metals and bacteria, as it can also absorb heavy metals from the water where it is grown. In high amounts, some of these toxins may cause liver damage. Spirulina is available in pill or powder form, or as flakes or juices. Most of the spirulina consumed in the United States is grown in a laboratory. There are many different spirulina species, only some of which are identified on labels of commercially-available products. Spirulina maxima (cultivated in Mexico) and Spirulina platensis (cultivated in California) are the most popular. Spirulina has a bitter taste, and it’s often mixed with yogurts, juices, and smoothies to improve its flavor.

Because spirulina can help reduce blood clotting, it may increase the risk of bruising and bleeding in people with certain bleeding conditions. Spirulina might also affect blood sugar levels. The B12 content in spirulina is not well-absorbed by the human body; if you have a B12 deficiency (common in people with plant-based diets), you should make sure you’re supplementing from another source. Spirulina might interfere with drugs given to suppress the immune system, including: adalimumab (Humira), azathioprine (Imuran), cyclosporine (Neoral), etanercept (Enbrel), infliximab (Remicade), leflunomide (Arava), methotrexate, or mycophenolate (CellCept).

Leech, J. (2018, Oct 5). 10 Health Benefits of Spirulina. Healthline.
Spirulina. (2021, Jul 7).
Spirulina. (n.d.). Mount Sinai Health Library.
Spirulina: are there health benefits? (n.d.). WebMD.
Wong, C. (2021, Oct 15). What Is Spirulina? Very Well Health.


Recommended by Dr. Karen Herbst.

National Library of Medicine. (2020, Sep 28). Statins. Medline Plus.


Coming soon!

Recommended by Dr. Karen Herbst.

National Library of Medicine. (2021, Jan 22). Terbutaline. Medline Plus.


Coming soon!

Recommended by Dr. Karen Herbst.

Actos (pioglitazone), Avandia (rosiglitazone)

Thiazolidinediones (also called glitazones) are a class of medicines that may be used for the treatment of type 2 diabetes. They are a type of oral hypoglycemic (a medicine that lowers blood glucose levels). They bind to a receptor called the peroxisome proliferator activated receptor-gamma in adipocytes (fat cells) and promote maturation of fat cells and deposition of fat into peripheral tissues. Thiazolidnediones increase subcutaneous adipose tissue and should be avoided in people with lipedema.

Kajita, K., Mori, I., Hanamoto, T., et al. (2012). Pioglitazone enhances small-sized adipocyte proliferation in subcutaneous adipose tissue. Endocrine Journal, 59(12): 1107–1114.
Thiazolidinediones. (n.d.).

Thyroid hormone

Coming soon!

Recommended by Dr. Karen Herbst.

Thyroid hormone treatment. (n.d.). American Thyroid Association.


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Turmeric is an antioxidant with a wide range of antiinflammatory properties.

Ubiquinol – see Coenzyme Q10

Gallbladder disease


Vasculera is a medical food containing purified diosmin, a flavonoid isolated from hesperidin, which is found in citrus. Vasculera’s proprietary formula combines diosmin with alka-4 complex (diosmiplex). Alka-4 complex works with diosmin to maintain the integrity of vein walls and also counters the local acidosis produced in venous disease. You would need to eat approximately 140 oranges a day (rind included) to consume the equivalent amount of diosmin packed into one easy-to-swallow Vasculera tablet.

Chronic venous disease (CVD) is a chronic, progressive disease of the veins that can lead to a variety of health issues such as leg edema, varicose veins, leg ulcers, stasis dermatitis and hemorrhoids. Vasculera addresses the metabolic changes that occur on the biochemical pathway, triggering the inflammatory processes that can effect the integrity of the vein walls.

Vasculera is dispensed by prescription and is to be used under a physician’s supervision. Learn more here.

Recommended by Dr. Karen Herbst, one 630mg tablet daily.

Primus Care Direct is a hassle-free, mail-order pharmacy service where patients can get their Vasculera prescription for $49 for a 30-day supply or $117 for a 90-day supply ($39 per month), Medicare patients included. This is the lowest possible price available and includes free home delivery. If you have insurance, you may pay even less. In addition to patient savings and convenience, Primus Care Direct saves time for healthcare practitioners by helping to increase fill rates and eliminating call-backs for prior authorizations. Vasculera is also available at retail pharmacies, but Primus Care Direct guarantees patients will pay the lowest possible price on their prescription.

Vasculera Prescribing Information – Primus Pharmaceuticals


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Systemic enzyme which reduces fibrotic tissue and swelling in the body.


Coming soon!
Systemic enzyme which reduces fibrotic tissue and swelling in the body.

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