A Case Series on Combining Modified Mediterranean Diet and Ketogenic Diet in a "Sandwich" Approach for Patients with Lipedema and Comorbidities.

A hypocaloric Modified Mediterranean Diet (MMed) over 6 months produced weight loss, reduction in body circumferences, and improvement in body composition in lipedema patients with comorbidities.

• 10 clinical cases with lipedema and comorbidities were subjected to a hypocaloric MMed for 6 months
• All patients were assessed by anthropometric measurements and body composition before and at the end of nutritional treatment
• Patients showed weight loss with reduction in body circumferences at end of 6-month follow-up
• Improvement in body composition was observed across the patient group

Only 2 out of 10 patients required a short period of ketogenic diet (KD) due to poor response to the Modified Mediterranean Diet.

• 8 of 10 patients responded adequately to MMed alone without requiring KD
• The 2 patients requiring KD used it as a temporary 'sandwich' intervention within the broader MMed protocol
• Good results were achieved in the two KD cases, allowing a return to MMed for maintenance
• The 'sandwich' approach refers to temporarily replacing MMed with KD for a short period when necessary

The Ketogenic Diet may cause important drawbacks, especially in cases of comorbidities, making it potentially unsuitable as a first-line treatment for all lipedema patients.

• KD is currently described as the most widely studied nutritional approach for patients with lipedema
• The authors note its use may cause 'important drawbacks especially in case of comorbidities'
• Patients in the series had comorbidities and concomitant pharmacological treatments that influenced dietary choice
• MMed is described as 'more easily adaptable, better tolerated' compared to KD

The Modified Mediterranean Diet provided better metabolic balance and greater compliance compared to the ketogenic diet in lipedema patients with comorbidities and concomitant pharmacological treatments.

• MMed was used as first-line treatment in all 10 patients
• The authors report 'better metabolic balance, greater compliance, and improved body composition' with MMed as first-line treatment
• The presence of comorbidities and concomitant pharmacological treatments was a key factor favoring MMed over KD
• The sandwich approach allowed flexibility to introduce KD temporarily when MMed response was inadequate