For more than a decade, Vivien Lees-Hamilton struggled with painfully swollen legs that often felt unbearably heavy.
At times, says the 66-year-old from West Yorkshire, it felt ‘like I was walking around on tree trunks.’
In February this year, after 12 years of symptoms, Vivien finally discovered the cause: she was diagnosed with lipoedema – a little-understood condition that causes an abnormal build-up of fatty tissue, usually in the legs and sometimes the arms.
But she was reluctant to try the treatments commonly recommended to manage the condition, including tight compression garments and prescription painkillers.
‘And while I know some people find compression garments help with pain and swelling, even the thought of wearing them makes me uncomfortable,’ she says. ‘I’d be tearing them off my legs.
‘And anything prescription-wise always comes with side effects, which made me reluctant to take any strong painkillers.’
Instead, she began researching alternatives and came across a supplement containing two compounds derived from citrus fruits, diosmin and hesperidin.
Already used to treat varicose veins and haemorrhoids, the compounds are thought to improve circulation and reduce fluid build-up.
Within a fortnight of starting to take them, alongside several other supplements, Vivien noticed a difference.
For more than a decade, Vivien Lees-Hamilton, 66, from West Yorkshire, struggled with painfully swollen legs that often felt unbearably heavy
‘The biggest thing I noticed was that my legs felt lighter,’ she says.
So could a relatively inexpensive supplement really help relieve the painful symptoms of lipoedema – a condition that has no cure and is estimated to affect up to one in ten women?
And what does the science say?
Unlike cellulite, which is largely a cosmetic concern, the abnormal fat build-up of lipoedema can cause debilitating pain, tenderness, a feeling of heaviness in the limbs and easy bruising.
In advanced cases, it can also affect the lymphatic system – the network of vessels and organs that drains excess fluid from tissues and returns it to the bloodstream – causing additional swelling.
NHS treatment focuses on relieving symptoms and maintaining mobility, typically through compression garments, exercise, weight management and pain relief.
Specialist liposuction, which removes the abnormal fatty tissue, can provide lasting relief for some patients, but it is not routinely available on the NHS. Those seeking private treatment can face bills of £6,000 to £11,000 per session.
Some people with lipoedema also have chronic venous insufficiency, a condition in which damaged valves in the leg veins allow blood to pool rather than flow efficiently back towards the heart.
Because the venous and lymphatic systems work closely together, researchers have begun investigating whether treatments traditionally used for vein disease, including diosmin and hesperidin, might also ease some lipoedema symptoms.
However, experts caution that it remains unclear whether any benefits come from an effect on lipoedema itself or from treating an overlapping problem with the veins.
Diosmin and hesperidin are thought to improve the function of veins, reduce leakage from tiny blood vessels and support the drainage of excess fluid through the lymphatic system.
They are available together as a supplement costing around £20 for a two-month supply.
Although there have been few studies specifically investigating their effects on lipoedema, a 2021 US expert consensus guideline suggested diosmin could be considered as a treatment to help manage symptoms.
However, this recommendation was based on limited evidence rather than large, high-quality clinical trials.
Valerie Briggs, an occupational therapist and certified lymphoedema therapist with more than 20 years’ experience, says the compounds may be particularly useful for patients who also have problems with their veins or lymphatic system.
At times, Vivien said it felt ‘like I was walking around on tree trunks’. She is pictured with her son, Peter Lees
Vivien with her swollen leg. She then came across a supplement containing two compounds derived from citrus fruits, diosmin and hesperidin, which helped relieve her painful symptoms
‘The fat tissue is accompanied by leaky, fragile blood vessels and sluggish lymphatic drainage, leading to intense fluid build-up, heavy legs and painful bruising,’ she says.
This means that easing fluid build-up might relieve some symptoms, even without affecting the abnormal fatty tissue itself.
Consultant plastic surgeon Vasu Karri said: ‘There is no clinical evidence that diosmin and hesperidin treat lipoedema, and they will not reduce lipoedema fat. However, they are low-cost and well tolerated, so a short trial to manage leg heaviness is a reasonable option.’
Ms Briggs agrees that the supplements may help some patients, particularly those with overlapping venous insufficiency.
But she cautions: ‘No controlled clinical trial has yet shown that they reduce lipoedema tissue, halt disease progression or reliably reduce limb volume.’
Dr Frank Agullo, a US plastic surgeon who treats patients with lipoedema, is also cautious.
‘Diosmin and hesperidin have been used for decades for vein problems such as leg heaviness, aching and swelling from chronic venous disease,’ he says.
‘It appears to work by tightening the tone of the veins, making small blood vessels less leaky, and calming some of the inflammation in the vessel wall.
‘Since lipoedema legs also feel heavy, swell and bruise easily, it makes sense that people would try it.’
However, he stresses that most of the evidence for these benefits comes from studies of venous disease, rather than lipoedema.
‘A supplement like this may ease some of the swelling and heaviness for some patients, but there is no good evidence that it shrinks the abnormal fat itself, which is the heart of the condition.’
For now, experts say larger clinical trials are needed to establish whether diosmin and hesperidin can reliably ease lipoedema symptoms, and which patients are most likely to benefit.
Vivien, meanwhile, is convinced the supplements have made a difference.
‘I noticed that my legs felt lighter,’ she says.
