Tuesday, January 04, 2011

Cryolipolysis: What is it and does it work?

In the last couple weeks, I've realized that if I still lived back home, I'd probably be blogging a lot more often.  Talking to my family always gives me great ideas for new topics to cover on here!

This time, we have cryolipolysis (I think I've heard it called "cold lipo" as well).  This procedure involves exposing fat "problem areas" (like love handles) to intense cold.  It's non-invasive, and may seem like a nice alternative to people who are put off by the somewhat disturbing, violent procedure that is liposuction.  For people who are in good shape but still have some remaining problem areas they'd like to get rid of, it can be tempting.

The low temperature forces your adipocytes (fat cells) to undergo apoptosis (programmed cell death).  The idea is that killing these adipocytes will get rid of the fat they contain and thus reduce the amount of fat in the area.  A study from July 2009, entitled Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves looked at the procedure.  A search in PubMed for cryolipolysis didn't bring up any more recent studies for its efficacy in humans, which leads me to believe that this may have been something of a dead end (1.5 years and no larger trials to test the procedure?), but it's worth looking into. 

Before getting into the results of the study itself, let's consider what happens after an adipocyte undergoes apoptosis.  When an adipocyte dies, it releases its contents (fat) into the surrounding tissue.  From there, the fat can be taken up by the surrounding surviving adipocytes or picked up by the lymphatics and returned to the blood. From here, the fat has a few options:
  1. Stay in the blood.  This would be bad.  What use is reducing your love handles if you give yourself high cholesterol instead?
  2. Be "burned" for energy/calories.
  3. Be transported throughout the body for storage, including back to the original site.
  4. Excreted from the body.
Now it can get a little more complicated than that considering what else needs to happen to the released fat (lipids) before they can be stored or used for energy, etc., but that's enough for a general idea of what's going on.

The appropriate question now is to ask, "Which of the above scenarios is most likely?"
  1. Probably not.  Your body handles increases in lipids in the blood all the time (after a fatty meal, for instance).  There's little reason to expect this would be any different.
  2. If there's an increased energy demand and your body's glycogen stores (a small reservoir of readily available energy for your cells) are depleted, this is a possibility.  But similar to how your body needs ~30 minutes of cardiovascular exercise to deplete its glycogen stores before starting to burn through your fat stores, this is unlikely to be any different from doing exercise without the procedure being done.
  3. This is essentially what happens with any increase in lipids in the blood.  Unless it's required as energy for exercise, it'll be stored.
  4. Unlikely.  There's no reason to expect your body to magically excrete these excess lipids just because you want to get rid of your love handles.
So, with a little critical thinking, it seems that Option #3 is most likely.

Let's see how this prediction compares to the results of the study.  They had 6 subjects with follow-ups at 2 and 6 months (they started with 10, but 4 failed to follow up at 6 months).  The subjects all had problem areas like love handles that were visible on the flanks.  They tracked weight and used ultrasound to monitor the fat layer thickness before treatment and at 2 months and 6 months.  The results are summarized in Table 2, shown below.  Also worth noting is that no change in lipid profiles was observed, so our conclusion regarding Option #1 was valid.

Summary of results from Clinical efficacy of noninvasive cryolipolysis and its effects on peripheral nerves by Coleman et al.
There was negligible gain/loss in weight for the subjects, and the average fat layer reduction was 20.4% at 2 months and 25.5% at 6 months, although with a considerable range for the subjects at both times.  As you might have expected, the procedure doesn't do much for weight -- without removing the fat from the body or increasing the body's energy expenditure, we wouldn't expect to see any change in weight.  The fat layer reduction varied greatly and was unrelated to each subject's weight gain/loss.  Additionally, 3 independent blinded reviewers compared before and after (4 months) photos of the subjects and correctly identified the baseline image 93% of the time (example below).  The article itself includes a few more pictures as well if you're able to access it.
"Before" and "After" (at 4 months) photos for one of the subjects.  I deliberately did not label them.  You can probably tell the difference, but I don't find it to be very significant.

Now, the importance of this fat layer reduction is subjective.  In my view, I don't find it to be very significant, especially given the wide range of reductions observed.  If you're the person with a 37.5% reduction at 6 months, that might be worth the money if you have it lying around.  But if you end up with only a 10.7% or 18.2% reduction, you might be sorely disappointed.  Especially if you still gain weight -- and remember, the weight changes are in kg, not pounds here, so Subject 1 gained 7.7 lb and Subject 5 gained 9.9 lb!  However, note that based on the limited scope of this study, it's hard to say what the results might have been if the subjects had followed various exercise and diet regiments.  Like the authors point out, weight change was not related to fat layer reduction, so even though it fits for a few subjects, you can't say with any certainty that those subjects would have experienced additional fat layer reduction if they had improved their diet or exercise.  Afterall, simply losing another 8-10 lb might have been enough to reduce their love handles without the cryolipolysis!

The authors concluded that cryolipolysis "causes substantial reductions in subcutaneous fat volume and changes in the contour of the treated love handle without damage to the skin."  There was some modest, transient nerve damage leading to numbness that returned to normal within 1-2 months after treatment as well.

The cost for the procedure varies by geographic location, doctor, and areas treated, but some Googling turned up prices ranging from $600-$3,000+.  Is the cost worth the mild decrease -- I find 25% far from substantial, but that's admittedly subjective -- in fat in your love handles?  In my opinion, not really.  I'd expect one would have better results by varying their workout and diet.  Another study showed that increasing meal frequency shows little to no effect on feelings of appetite/satiety and/or food intake (a common belief that I shared until finding that new article; I'll need to read it more closely another time).  I had difficulty tracking down a study that dealt with the effects of increased meal frequency on metabolism (another common belief), so the specifics of that situation might take more time to narrow down.

The bottom line is that if you want to lose fat, you need to control your calorie intake while maintaining an adequate exercise schedule.  It's unhealthy to go to either extreme (excessive exercise or starving yourself), but with a visit to your doctor and some common sense, you can probably get it figured out.  Cryolipolysis, unfortunately, is not the magical solution to zap your unwanted fat.  It does appear to give some modest results that are noticeable visually, but they aren't very pronounced (see the images above).

If you or someone you know has been considering cryolipolysis, I hope you've found this helpful.  It appears to have made a noticeable difference for these particular subjects, but keep in mind that it's fairly expensive and that you most certainly should not expect any miracles!  If you're on a budget, perhaps adding some variety to your exercise regiment and reassessing your diet would be a wiser use of your time and money.


Alexandra Cely said...

Very well written, co ngratulations!!. it is always nice to find sensible people trying to bring light to the darkness and teaching good critical thinking to the kids

Unknown said...

Thank you for the very detailed and objective review. As someone who is unable to exercise various body parts I was looking into this possibility, and your information has been very helpful (IOW keep looking)