The little-known supplement made from citrus fruit that could help to banish lipoedema

For more than a decade, Vivien Lees-Hamilton struggled with painfully swollen legs that often felt unbearably heavy. The 66-year-old says that at times it felt ‘like I was walking around on tree trunks’.

In February, after 12 years of symptoms, she 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 treatments commonly recommended to manage the condition, including tight compression garments and prescription painkillers.

She says: ‘I know some find compression garments help with pain and swelling, but even the thought of them makes me uncomfortable. I’d tear 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 cut fluid build-up.

Within a fortnight of taking them, alongside several other supplements, Vivien, from West Yorkshire, noticed a difference. ‘The biggest thing was that my legs felt lighter,’ she says.

So could a relatively inexpensive supplement really help relieve the painful symptoms of lipoedema, which has no cure and is estimated to affect up to one in ten women?

Unlike the fat build-up of 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 abnormal fatty tissue, can provide lasting relief for some but it is not routinely available on the NHS. Private treatment can cost £6,000 to £11,000 per session.

Some lipoedema patients also have chronic venous insufficiency, in which damaged valves in the leg veins allow blood to pool rather than flow efficiently back towards the heart. As 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 lipoedema symptoms.

But experts caution it remains unclear whether 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 blood vessels and support drainage of excess fluid through the lymphatic system. They are available together as a supplement costing about £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 to help manage symptoms.

Valerie Briggs, a lymphoedema therapist with more than 20 years’ experience, says the compounds may be particularly useful for those 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 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 says: ‘There is no clinical evidence diosmin and hesperidin treat lipoedema and they won’t reduce lipoedema fat. However, they are low-cost and well tolerated, so a short trial to manage leg heaviness is a reasonable option.’

Dr Frank Agullo, a US plastic surgeon who treats patients with lipoedema, is also cautious.

‘Diosmin and hesperidin seem to work by tightening the tone of the veins, making small blood vessels less leaky and calming some vessel wall inflammation,’ he says. ‘Since lipoedema legs 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,’ he adds.

Experts say larger clinical trials are needed to see whether diosmin and hesperidin can reliably ease lipoedema symptoms, and which patients are most likely to benefit.