Overview

Dercum’s disease, classified as adiposis dolorosa, is a rare, chronic disorder characterised by the development of painful lumps of fat in the tissues. Usually, they accumulate in the legs, arms, and trunk.¹ This disease is predominantly associated with in adults aged 35-50 years, but the ratio of women affected, after reaching menopause, is greater than men (5-30:1).² The daily reality of an individual suffering with this includes symptoms of persistent fatigue, weakness, and a range of psychiatric disturbances (e.g. sleep disturbances, mental and emotional instability).¹ Due to this condition being rare, there is a limited availability of information and sources which would help a patient feel more understood or find solutions themselves to ease these symptoms. 

While there is a current lack of, and limited treatment options, healthcare professionals approach a focus on pain management and suggest supportive strategies to help relieve symptoms. Nutrition and diet, in particular, can play an important role. Although diet changes alone cannot eliminate the conditions, the food you eat has the support to reduce inflammation, elevate energy levels, and promote overall well-being. 

This article explores the different types of nutrition and diet approaches that people living with Dercum’s disease have found helpful. The information found below will provide answers in ways that an individual can seek comfort from and improve their quality of life by starting tomorrow with a new meal plan.

Understanding dercum’s disease and its symptom triggers

People with Dercum’s disease can experience a wide variety of symptoms, but there is no consistent pattern that applies to all. Painful lipomas (fatty lumps) often develop on the trunk, arms, legs, back, or thigh, while the face and hands are usually spared.¹ The skin coverage over these areas may feel tender, look glossy, or show enlarged surface veins, with reports of abnormal sensations such as tingling and a heightened sensitivity to pain.³ 

Beyond the lipomas, many non-specific symptoms have been described, including easy bruising, sleep problems, fatigue, memory difficulties, and brain fog.⁴ Less common reports include changes in body hair, hot flushes, cardiovascular and respiratory problems, and swelling.¹

Dercum’s disease is usually classified into four main types:

1. Generalised diffuse - widespread painful fat without lipomas
2. Generalised nodular - painful fat with multiple lipomas across the body
3. Localised nodular - painful fat limited to areas
4. Juxta-articular - painful fat deposits near large joints (e.g. the knees)⁵

The exact cause of Dercum’s disease remains unclear. Several theories suggest it may be linked to fat metabolism dysfunctions, nerve compressions from growing lipomas, traumas, or imbalances in the nervous system. Most cases report the condition to be inherited through family generations, often in an autosomal dominant pattern of genes. To date, however, no specific genes have been identified as responsible.⁶

Nutritional goals in managing dercum’s disease

The core goals of managing Dercum’s Disease identify through:

• Reducing inflammation: easing pain and fatigue
• Supporting a healthy weight: prevention of fat deposit growth
• Stabilising energy and blood sugar: to help manage fatigue and brain fog
• Nourishing immune and lymphatic systems: to keep your body strong⁷

While this may feel overwhelming to achieve, certain foods and diets discussed below are simple to maintain and can act as couple to provide dual action.

Anti-inflammatory dietary strategies

Chronic inflammation is thought to be a key factor in Dercum’s disease. While inflammation is the body’s natural response to injury, when it becomes constant, it can cause pain and fatigue. However, the good news is that many foods, specifically whole, minimally processed foods, have natural anti-inflammatory properties. Sources suggest following a RAD (rare adipose disease) diet, which focuses on the goal of reducing inflammation by implementing these sources of food: ⁸

• Healthy fats: Omega-3 fatty acids found in, for example, fatty fish, flaxseeds, and walnuts, which may help lower inflammation and ease pain by lowering the proportion of excessive inflammatory cell mediators⁹
• Vitamin-C rich fruits and vegetables: The ascorbic acid in vitamin C acts as an antioxidant (fights the harm caused to the body's cells), helps modulate pain and supports the function of collagen strength¹⁰
• Whole grains: Foods such as quinoa, brown rice, and wholemeal bread have high fibre contents, which promote fat metabolism and release energy more steadily than refined grains¹¹
• Herbs and spices: Turmeric, ginger, and garlic are examples of culinary herbs and spices that have anti-inflammatory potential by helping to modulate metabolic syndromes and chronic inflammation¹²

It’s important to notice foods that can worsen inflammation and cause tiredness, these include processed meats, fried foods, and refined sugars. 

Exploring different dietary approaches

Some people with Dercum’s disease experiment with structured diet patterns. While there is no one-size-fits-all solution or personalised diet plans, a few approaches are worth noting:

The mediterranean diet

The main features of a Mediterranean diet include primarily plant-based foods, such as fruits and vegetables, whole grains, and nuts, the replacement of butter with healthy oils/spreads (e.g. olive oil), fatty fish (e.g. salmon), and the use of herbs and spices to reduce salt. A small 3-week study measured the effects of the Mediterranean diet on individuals' change in fat composition and quality of life. The results were promising, showing anti-inflammatory and antioxidant effects that regulated inflammation, the immune system, and the gut microbiota balance. After three weeks, the weight and body mass index (BMI) significantly lowered, with fat mass reductions seen in the arms and legs (the typical sites of fat accumulation in Dercum’s disease). Improvements were also reported in the ability to perform daily activities with enhanced performance and reduced fatigue, pain, and anxiety, which translates to the Mediterranean diet can offer a better quality of life for patients.¹³

Low-carbohydrate or ketogenic diets

Ketogenic diets limit the carbohydrate intake found in, for example, breads, pastas, and refined sugars to less than 20g/day.¹⁴ This results in the absence of glucose (sugar molecules sourced from carbohydrates) to be effectively digested for energy, causing the body's state to undergo a process known as ketosis. Ketosis is a metabolic state in which the body burns fat for fuel instead of carbohydrates, often resulting in weight loss.¹⁵ A promising study proved that adopting a ketogenic diet can improve symptoms and manage the clinical observation of weight loss in a patient. It showed lowered body circumference measurements and even improved the quality of sleep and mental freshness.¹⁶

Intermittent fasting

Intermittent fasting (IF) is an eating approach where the focus is on when to eat rather than how much, with an example of a 16:8 IF. Research indicates that IF may support health in a few ways, including reducing inflammation in the body by lowering stress on the cells, and eating in line with your body’s natural hunger cues may help your metabolism operate more effectively. Fasting also often triggers a switch to burning fat for fuel (ketosis), which may help with weight management and improve blood sugar.¹⁷ However, it’s best to start gently, listen closely to how your body responds, and speak with a healthcare professional first, especially if you already experience chronic pain or fatigue. 

Managing pain, fatigue, and cognitive symptoms through nutrition 

Beyond inflammation, daily symptoms like pain, tiredness, and mental cloudiness can sometimes be eased with dietary support. 

• Vitamins: vitamin D offers support with muscle function, related to improving energy, also usually associated with vitamins B and C¹⁸
• Magnesium-rich foods: good dietary sources include green leafy vegetables, whole grains, nuts, seeds, and legumes. If magnesium levels are too low, it can lead to symptoms such as fatigue, muscle weakness, decreased blood sugar, and poor bone density¹⁹
• Limiting alcohol and caffeine: While caffeine and alcohol may give a temporary energy boost, they can lead to rebound fatigue and cognitive impairment, with the risk of dementia increasing in the long term. Alcohol often worsens pain and inflammation²⁰

Frequently asked questions (FAQs)

What foods should I avoid with dercum’s disease?

Whilst there is no one-fits-all diet, many people may find it helpful to limit:

• Highly processed foods
• Refined sugars
• Fried foods 
• Excess alcohol

These can promote inflammation and contribute to weight or energy imbalances. 

Is weight loss important for managing dercum’s disease?

Weight management can be helpful, but a sole focus on it can be mentally damaging and dangerous. Strict dieting can be harmful without noticing its effects on the body. Gentle, sustainable changes, and staying active within your comfort level, alongside working with a dietitian, can offer more support and rewarding milestones than focusing only on weight loss. 

Can sufficient nutrition and diet cure dercum’s disease?

Unfortunately, there is currently no cure for Dercum’s disease, and diet alone cannot successfully treat this condition. However, the right nutrition strategies may help suppress symptoms, including inflammation, fatigue, and mental instability. 

Summary

Dercum’s disease (adiposis dolorosa) is a rare condition with limited information sources. It can be classified through observations of painful fatty lumps deposited in the arms, legs, and trunk. Behavioural symptoms can include fatigue, weakness, and brain fog. Living with this condition can be isolating, especially as treatment options remain limited. However, nutrition and diet can play an important role in easing discomfort and improving quality of life. 

Research shows that anti-inflammatory foods, such as oily fish, fruits, vegetables, and whole grains, may help reduce pain and fatigue. Dietary approaches like the Mediterranean and ketogenic diets, as well as intermittent fasting, can help to support energy balance and facilitate weight loss. 

Though diet alone cannot cure this disease, careful and approachable nutrition strategies can provide control, comfort, and a hope for better daily living.