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, it felt ‘like I was walking around on tree trunks’.
In February of this year, after 12 years of symptoms, Vivien finally discovered the cause: she was diagnosed with lipedema – a little-understood condition that causes an abnormal buildup 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 hemorrhoids, the compounds are thought to improve circulation and reduce fluid buildup.
Within two weeks of starting to take them, alongside several other supplements, Vivien noticed a difference.
For more than a decade, Vivien Lees-Hamilton struggled with painfully swollen legs that often felt unbearably heavy
The 66-year-old faced her legs becoming painfully swollen at times – before she started taking a supplement which helped relieve her uncomfortable symptoms
‘The biggest thing I noticed was that my legs felt lighter,’ says Vivien, from West Yorkshire, England.
So could a relatively inexpensive supplement really help relieve some of the painful symptoms of lipedema – 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 buildup of lipedema 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.
Treatment typically focuses on relieving symptoms and maintaining mobility, usually through compression garments, exercise, weight management and pain relief.
Specialized liposuction, which removes the abnormal fatty tissue, can provide lasting relief for some patients, but insurance coverage varies and patients may face substantial out-of-pocket costs.
Some people with lipedema also have chronic venous insufficiency, a condition in which damaged valves in the leg veins allow blood to pool rather than flow efficiently back toward 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 lipedema symptoms.
However, experts caution that it remains unclear whether any benefits come from an effect on lipedema 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 $25 for a two-month supply.
Although there have been few studies specifically investigating their effects on lipedema, 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 lymphedema therapist with more than 20 years of experience, says the compounds may be particularly useful for patients who also have problems with their veins or lymphatic system.
‘The fat tissue is accompanied by leaky, fragile blood vessels and sluggish lymphatic drainage, leading to intense fluid buildup, heavy legs and painful bruising,’ she says.
This means that easing fluid buildup might relieve some symptoms, even without affecting the abnormal fatty tissue itself.
Vivien said it felt like ‘walking around on tree trunks’ at times (pictured with her son Peter Lees)
Plastic surgeon Vasu Karri said: ‘There is no clinical evidence that diosmin and hesperidin treat lipedema, and they will not reduce lipedema fat.
‘However, they are low-cost and well tolerated, so a short trial to manage leg heaviness is a reasonable option.’
Briggs agrees that the supplements may help some patients, particularly those with overlapping venous insufficiency.
Dr Frank Agullo, a board certified plastic surgeon in El Paso, Texas, who treats patients with lipedema, 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 lipedema 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 lipedema.
‘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 lipedema symptoms and understand which patients are most likely to benefit.
