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A scroll through Aurora McCausland’s wildly popular social media accounts — she has more than 300,000 followers across TikTok and Instagram — shows an active young mom dancing, cleaning and tackling major renovation projects in her Utah home.

Behind the scenes, though, is a painful reality: McCausland has lipedema, a progressive and debilitating disease that causes fat in connective tissue to build up disproportionately, most often in the legs, ankles and hips.

She said her legs throb with pain, swell unpredictably and feel heavy, like they’re filled with cement. It’s a major source of frustration for the mother of two young children. Standing up can cause her to black out.

“Things that I feel like I should be able to do cause pain pretty quickly, and then I kind of have to tap out,” said McCausland, 30, of West Valley City, Utah. “Getting down to play with my kids is really hard.”

She’s tried to manage the pain with compression garments, lymphatic drainage and anti-inflammatory diets.

“Those are helpful at potentially slowing down the disease,” her physician, Dr. David Smart, said. “But really, only surgery helps to reverse the disease process.”

Smart is a dermatologic surgeon at the Roxbury Institute in Murray, Utah. He performs a specialized type of liposuction that removes the diseased tissue to restore mobility.

The procedure is not cosmetic, and despite the buildup of fat, lipedema is not related to obesity. It’s not caused by overeating or inactivity. It’s a hormonally-driven inflammatory condition, one that’s largely resistant to diet and exercise.

“It goes against the more traditional health dogma that’s out there about normal fat,” Smart said.

Lipedema is almost exclusively seen in women, but scientists don’t have a good handle on how many are affected. Some estimates suggest it may affect up to 11% of women.

“There are no large-scale, population-based epidemiologic estimates. We don’t have blood tests. We don’t have imaging studies,” said Dr. Aaron Aday, co-director of vascular medicine at Vanderbilt University Medical Center in Nashville, Tennessee.

Denied relief

Many women first notice symptoms of lipedema at puberty, and the disease often worsens during major hormonal shifts like pregnancy or menopause.

McCausland said her symptoms first appeared during her early teens: leg pain, swelling and bruising from the slightest touch. “I thought it was just growing pains,” she said. Fat built up around her ankles. No matter how physically active she was — dancing and CrossFit were two hobbies — she couldn’t make the fat in her lower legs go away.

Still, she was told it was just excess weight. “That if I worked out more, ate less, it would go away,” she said. “But no matter what I did, my legs just hurt more. I was doing everything right and getting worse.”

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McCausland’s five sisters experienced similar symptoms. She said none knew what the problem was until one of the sisters got liposuction to slim down her lower legs.

But lipedema fat isn’t the same as typical fat. Instead of feeling soft, it can feel like hard nodules under the skin. Regular liposuction can be risky to use on lipedema patients.

It took far longer than it should have for her sister’s doctor to do the procedure, McCausland said.

“The doctor ended up giving her third-degree internal burns all on her legs, because he didn’t know that it wasn’t normal fat. He just kept going, having to go over and over and over trying to remove it,” she said. “It was just this horrible thing that happened. Obviously the doctor had no idea that she had this condition, and neither did my sister.”

Aday — who hasn’t treated McCausland — said that a specialized type of liposuction, performed by a surgeon with extensive knowledge of lipedema, is the most effective way to treat the disorder. It can reverse symptoms in many people. Some patients, he said, may have to have the procedure repeated.

The Roxbury Institute said that McCausland would need two liposuction surgeries, totaling more than $35,000. But her former insurance provider, Cigna Healthcare, denied coverage for the procedure twice.

In an emailed statement, a Cigna representative said: “Lipedema is a painful condition that disproportionately impacts women, and we cover a range of treatment options, including liposuction, for patients that meet evidence-based clinical criteria. Ms. McCausland’s case was carefully reviewed by multiple doctors, including a plastic surgeon with expertise in lipedema. Based on the information submitted by her doctor, she did not meet the clinical criteria for liposuction at that time.”

McCausland believes her coverage was denied because she didn’t look sick enough, adding that she suspects it’s based on her social media posts.

They said “that it’s not medically necessary,” McCausland said. “That’s absurd. They’re not looking at how I live. They’re looking at a photo and deciding I don’t look bad enough to be helped.”

Cigna told NBC News that social media isn’t considered when making coverage decisions. “Our coverage decisions are based on the clinical information submitted by a patient’s treating physician in accordance with coverage policies and the patient’s plan design,” the representative said.

Her health insurance has since switched to MotivHealth, because of her husband’s new job. McCausland said MotivHealth has already suggested to her in a phone call that it’s not a procedure it usually covers but she can submit additional documentation. A representative for the company did not respond to several requests for comment.

A long under-recognized disease

Lipedema is categorized in four stages, based on visual appearance. Stage 1 looks like minor fat accumulation and Stage 4 appears as severe leg disfigurement. Appearance, however, doesn’t always match the severity of symptoms.

“You can have a Stage 1 patient that has very severe and crippling symptoms of pain and swelling, and somebody who is maybe more progressed visibly that doesn’t have such severe symptoms,” Smart said.

McCausland is a prime example. She doesn’t look sick, according to some commenters on her social media videos.

“I’ve gotten a handful of people saying, ‘Well, I’ve looked at your other videos, and I agree with your insurance company,’” she said.

“This is very likely the reason why lipedema has been so under-recognized for such a long time,” Smart said. “So many people, so many insurance companies, so many physicians, have been telling lipedema patients for decades to just ‘work out, eat better, lose weight,’ when that’s not actually the problem.”

He said waiting until the condition progresses is dangerous. Without treatment, lipedema advances, causing more inflammation, worsening pain and permanent joint damage. The longer surgery is delayed, the harder it is to restore mobility in later stages.

“It’s really unfortunate for Aurora, because at that early stage, it is less likely that she gets insurance coverage,” Smart said. “They’re not looking at the severity of her symptoms. They’re not looking at the severity of her pain, the decrease in mobility, her lack of ability to be able to perform those daily activities of living.”

Jonathan Kartt, chief executive officer of the Lipedema Foundation, said that the pain experienced by women with lipedema can be measured objectively.

Using a tool to measure how patients perceive stimuli like temperature and touch, researchers in Germany found that women with lipedema had a lower pain threshold compared with other women. The pain was specific to areas affected by the disease.

“The differences were so stark,” Kartt said, that it’s possible to use “this test to actually diagnose or confirm a diagnosis of lipedema.”

Aday, of Vanderbilt, is leading an effort to create a national biobank of information on lipedema patients. The team takes blood samples and urine, as well as fat and skin biopsies.

“It’s meant to be a living research resource,” he said. “We want other investigators to use these data, build upon it and generate new data.”

There is also growing excitement in the lipedema field to see whether the blockbuster GLP-1 drugs, like Ozempic and Wegovy, might be useful. The drugs are mainly used to treat Type 2 diabetes and obesity, but have been shown to provide benefits for other diseases. Aday is working to secure funding for such a study.

Thanks to the introduction of a vaccine in 1963, measles was declared eliminated in the US in 2000. Now the highly contagious disease has reemerged as a threat as declining vaccination rates fuel outbreaks around the country. Measles cases have now reached a level not seen in more than three decades.

The US Centers for Disease Control and Prevention on July 9 reported 1,288 confirmed infections so far in 2025, the most since 1992. Three people have died from measles infections since the outbreak began in January, including two unvaccinated children in Texas. The vast majority of cases have been among unvaccinated people.

Background

Despite breast and lung cancer being the most common malignancies in women, the occurrence of double primary cancers has been rarely reported in the literature. It is well established that an earlier age of diagnosis in patients with breast cancer is linked to more aggressive phenotypes, highlighting the importance of early screening in this demographic group. There is a deficiency in the literature related to secondary thoracic malignancies among this high-risk group.

Materials and Methods

This retrospective case series reviewed a cohort of 8 patients with double metachronous, primary breast, and lung cancers at the Sylvester Cancer Center. Data on patient demographics, diagnoses, treatment modalities, and outcomes were obtained from electronic health records.

Results

All 8 patients were biologically female with a median age of 58.5 years. Racial distribution was Asian (25%), Black (12.5%), and White (62.5%). Of these, 80% of patients who were White identified as the Hispanic/Latinx ethnicity. Additionally, 62.5% of patients were never smokers, and 12.5 % were light, former smokers. The median age of diagnosis of breast and lung cancer was 60 years and 62.5 years, respectively. The average time between both diagnoses was 1.9 years (range, 0.33-4 years). The majority (87.5%) of genetic profiles indicated a hormone receptor–positive mutation, with 33% of this genetic subset also showing an EGFR mutation. Overall, 75% of lung tumors were PDL-1 negative. Our review also indicates a decrease in concern for smoking. Despite no statistical significance between ethnicity and age of diagnosis of breast or lung cancer (P = .157), there was a trend demonstrating patients who were Hispanic/Latinx as being diagnosed at an earlier age for both. There was no statistical significance between ethnicity and smoking status (P = .465) or ethnicity and time between diagnoses (P = 1).

Conclusion

In this diverse, real-world cohort of patients with metachronous and synchronous lung and breast cancers, we noted interesting, hypothesis-generating observations. Trends indicated an earlier diagnosis of both breast and lung cancer in patients who are Hispanic/Latinx. Of the cohort, 75% had a dual diagnosis of breast ductal carcinoma and lung adenocarcinoma, 87.5% of individuals in our cohort displayed a hormone receptor–positive profile, and 75% had a PDL-1 negative prevalence. This case series confirms the importance of screening patients with breast cancer with low-dose CT for early detection of lung cancer. Since double primary breast and lung cancer is rare, molecular profiling with next-generation sequencing could also provide insightful information.

Beans have been big news in recent years. Wall Street Journal articles praised the high protein, high fiber, low fat bean, crowning them as America’s “new nutrition obsession” and calling them “the new kale,” but neglected specific mention of the dopaminergic fava beans.^1-3 Fava beans contain L-DOPA, the precursor to dopamine. L-DOPA passes through the blood-brain barrier and is converted to dopamine in the brain.⁴

Yet, fava beans are also very old news. The contemplative and mathematically-inclined Pythagorean sect, who lived in a Mediterranean region where glucose-6-phosphate dehydrogenase (G-6-PD) deficiency is endemic, banned these beans, perhaps because potentially excitatory dopaminergic foods might interfere with their aspired meditative states—or perhaps to protect against potentially deadly hemolytic anemia (favism) that can occur when individuals with this X-linked genetic disorder eat fava beans.

Elsewhere in Italy, and especially in Sicily or places populated by Italian immigrants (such as New Orleans), fava beans remain prominent because legend says that the easy-to-grow, early-to-mature beans saved residents from starvation when famine put other food in short supply. To honor their patron Saint Joseph, who was credited with protecting the fava bean harvest, the locals continue to observe St. Joseph’s Day (March 19) by offering beans at altars.⁵

We can trace fava beans still further back in history. Known as “pol” or “ful,” they are mentioned in the Hebrew Bible, and have been found at 6000 year old archaeological sites in Israel. Some sources even cite 10,000 year old sites. Pol is mentioned as a food source for David and his warriors in 2 Samuel 17:28, and in Ezekiel 4:9. Ezekiel is instructed to mix broad beans with grains and lentils to make a coarse bread that symbolizes famine conditions. Moving ahead many centuries, we find discussion of fava beans’ cultivation and preparation in the Talmud and the Mishna, the Jewish “Oral Law” that comments on the Pentateuch. This confirms that ful/pol was a significant part of the Middle Eastern diet from the 4th century CE, if not earlier.

Curiously, the Talmudic techniques for cooking fava beans are strikingly similar to recipes for the modern Middle Eastern dish, “Ful Mudammas.” Porridge-like, it is eaten with garlic and olive oil, possibly mixed with parsley, cumin, lemon, or herbs, or judiciously-dosed with hot chili peppers or zaatar. Sometimes, tomatoes, onions, cucumbers, eggs, or pickles are added to the concoction, along with sesame-seed based tahini and the obligatory pita bread.

Ful medames is the national dish of Egypt. It is enjoyed as a breakfast in many more Levantine or East African or North African countries. Local street stands sell ful-based treats; Falafel recipes—especially Egyptian falafel—often add ful to the customary chickpeas. With its filling nature, and possible appetite-suppressant effects that come courtesy of its dopaminergic properties, ful-based breakfasts that are eaten before sunrise can sustain people during long fasts like Ramadan.

In contemporary times, fava beans are a farmer’s favorite because they fix nitrogen to produce “green manure,” which enhances the soil between seasons and promotes better harvests. Fava beans also ward off pests that infest other produce. In the US, most fava bean harvests are diverted to livestock as animal feed, so it can be an insult to serve fava beans to guests, both in America and in many parts of Europe. In some places, these beans, which require extensive preparation and labor-intensive shelling, are luxuries, although some chefs claim that the shells of older beans can be consumed without undue discomfort.

Current Concerns About Fava Beans

As psychiatrists, most of us are probably less versed in agriculture and are more conversant with our chosen medical specialty, but we probably remember fava beans from psychopharmacology lectures, where we learned that tyramine-rich foods—such as fava beans or broad beans—can cause fatal hypertensive crises when ingested by persons taking monoamine oxidase inhibitor (MAOI) antidepressants.⁶ Hematologists, on the other hand, are more familiar with the less deadly “favism,” and the hemolytic anemia that strikes patients with G-6-PD deficiencies after eating these particular beans.

Those who found psychopharmacology courses less than entertaining may better recollect fava beans on film, where the fictional, highly cultured psychiatrist and arch-villain from Jonathan Demme’s The Silence of the Lambs (1991) trumpeted his affection for fava beans (and for other unappealing entrees that earned him the moniker, “Hannibal the Cannibal”).⁶ Dr Hannibal Lecter proclaims that “I ate his liver with some fava beans and a nice chianti.” These other 2 foods are also high in tyramine and are off-limits to individuals treated with MAOIs.

Anecdotal reports (along with some small, controlled studies) show that these ancient legumes produce measurable L-DOPA blood levels that are comparable to standard L-DOPA medication doses. Thus, these beans can provide short-term relief from the motor symptoms of Parkinson disease.^7-10 They may also be useful for treating depression and attention-deficit/hyperactivity disorder—2 other common conditions that may respond to dopamine-raising medications. Some individuals attest that the beans can offset sexual dysfunction, be it serotonin reuptake inhibitor-induced or otherwise.

While complete confirmatory data about fava beans’ utility as dopamine substitutes is “not ready for prime time,” and it is too soon to discard more mainstream approaches, it is still worth examining the potential of these natural and affordable adjunctive treatments; especially at a time when more and more patients ask for (or demand) natural treatments for mood disorders and when so many inquire about diets that decrease depression, we can predict that further research will be beneficial.¹¹

Not all fava beans are created equal when it comes to their dopaminergic properties, though. Vicia faba grows well in temperate regions, where it is the most common variety. In cooler parts of North America and Europe, it germinates in early spring, even before peas sprout. Vicia faba causes L-DOPA production reliably, but not nearly as abundantly as its cousin Mucuna pruriens, which thrives in warm and sunny climates of India and Iran. In India, M. pruriens is an Ayurvedic staple, and is a standard traditional medicine prescription for Parkinson disease. Because of Mucuna’sperceived (but unproven) potential for building muscle mass and increasing endurance for strenuous exercise, some bodybuilders seek out Mucuna through online suppliers for much the same reasons that some of them misuse medicinal L-DOPA.

There are further nuances to note in the production of these beans. Young beans yield more L-DOPA than aged beans. Bean pods, when picked from the vine before the beans mature, have more L-DOPA than the beans themselves. Beans that are pretreated with specific fungi, or that are microwaved before planting, have increased yields of L-DOPA.¹² Scientists are currently researching ways to increase the L-DOPA content and are developing ways to measure L-DOPA as plants grow in the fields, with the hopes of creating plant products that are more marketable.¹³

Unlike commercial medications, which are manufactured in controlled environments and monitored by the US Food and Drug Administration (FDA) and other government overseers in the US, natural plant products are not always reliable. Their potency and quantity can differ from season to season because of changes in climate, soil conditions, competitive plants, and so on. This variability theoretically limits their use by more “evidence-based” resources. Although, it is worth noting that The Office of Dietary Supplements reports that as of April 2024, Americans spent approximately $60 billion a year on even less reliable nutraceuticals and that number is expected to increase. Like fava beans, and unlike prescription drugs, these natural plant supplements do not need FDA approval for efficacy and therefore have much in common with fava beans or Mucuna.

Despite these important limitations, we have impressive data documenting the beans’ efficacy in relieving mild Parkinsonian motor symptoms. These motor changes are easier to quantify than are changes in mood or mentation. Fava beans can also offset the troubling on-off effect of standard Parkinson disease medications, and may even enhance absorption of medicinal L-DOPA, since more L-DOPA is absorbed in the presence of carbohydrates. To further confirm the beans’ dopaminergic potency, reports of neuroleptic malignant syndrome following abrupt discontinuation of fava beans have been published. These effects parallel related results from when medicinal L-DOPA is stopped suddenly.

Several websites tout the benefits of fava beans, some of them more credible than others. A guru of alternative medicine, Andrew Weil, MD, reserves his recommendations, but notes that an adequate anti-Parkinson dose requires consumption of an entire can of fava beans; though, a nutritionist who posts detailed calculations concluded that that 2 tablespoons canned beans daily are sufficient. To me, even a teaspoon of canned fava beans is too much, not because of the excess dopamine, but because of the unappealing taste of the unadorned beans. Moreover, fresh fava beans have more L-DOPA than dried, but they are expensive, if they can be found at all, and shelling the beans is no easy matter. But these details are immaterial, since fresh off the vine fava beans are best, both for flavor, L-DOPA yield, and ease of use.

Considering that it is easy to grow fava beans, is inexpensive, and it is fun to pluck the beans from the flowering vines after the pods form (when the L-DOPA content is highest and when there is no need to shell the beans), why would we revert to worse tasting canned products with insufficient L-DOPA content to boot? Equally importantly, planting and harvesting fava beans can be a form of “behavioral activation,” which itself is an extremely effective adjunct to antidepressant medications. An individual with depression who simply engages in (presumably safe) pleasurable activities, via “behavioral activation,” has a 74% chance of achieving full remission from depression. That number is far more impressive than the respective 64% or 56% remission rates obtained from CBT or psychodynamic therapies, as reported in New England Journal of Medicine.

In summary, the next time patients ask about better diets for depression, do not forget to mention fava beans—as well as the behavioral activation that comes from planting them, activation that results from cooking them, and the social support from inviting guests to a fava-bean based dinner.

Dr Packer is an assistant clinical professor of psychiatry and behavioral sciences at Icahn School of Medicine at Mount Sinai in New York, New York.

References

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2. Petersen A. Sorry kale, beans are the new nutrition obsession. Wall Street Journal. November 20, 2024. Accessed July 7, 2025. https://www.wsj.com/health/wellness/beans-health-benefits-diet

3. Chaker AM. Beans: the superfood you’ve always known. Wall Street Journal. March 19, 2018. Accessed July 7, 2025. https://www.wsj.com/articles/beans-the-superfood-you-ve-always-known-1521284401

4. Fuentes-Herrera PB, Herrera-Cabrera BE, Martínez-Ayala AL, et al. Plants content and yield of L-Dopa and bioactive compounds of broad bean plants: antioxidant and anti-inflammatory activity in vitro.Plants (Basel). 2023;12(23):3918.

5. Abala K. Beans: A History. Bloomsbury; 2017.

6. MAOIs and diet: is it really necessary to restrict tyramine? Mayo Clinic. January 31, 2025. Accessed July 7, 2025. https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/maois/faq-20058035

7. Packer S. Cinema’s Sinister Psychiatrists. McFarland Books; 2012.

8. Kempster PA, Bogetic Z, Secombei JW, et al. Motor effects of broad beans (Vicia faba) in Parkinson’s disease: single dose studies. Asia Pac J Clin Nutr. 1993;2(2):85-89.

9. Hu D, Qing G, Liu X, et al. A study and in vitro evaluation of the bioactive compounds of broad bean sprouts for the treatment of Parkinson’s syndrome.Molecules. 2024;29(21):5160.

10. Ljungberg T, Bondza E, Lethin C. Evidence of the importance of dietary habits regarding depressive symptoms and depression.Int J Environ Res Public Health. 2020;17(5):1616.

11. Swainson J, Reeson M, Malik U, et al. Diet and depression: a systematic review of whole dietary interventions as treatment in patients with depression.J Affect Disord. 2023;327:270-278.

12. Yilmaz H. Enhancements in morphology, biochemicals, nutrients, and L-Dopa in faba Bean through plant growth promoting rhizobacteria and arbuscular mycorrhizal fungi.Sci Rep. 2025;15(1):7390.

13. Renna M, De Cillis F, Leoni B, et al. From by-product to unconventional vegetable: preliminary evaluation of fresh fava hulls highlights richness in L-Dopa and low content of anti-nutritional factor.Foods. 2020;9(2):159.