Progressive Lipodystrophy: An Irrefutable Argument That Calories Do Not "Count"?

Patients with lipodystrophy suffer from abnormal fat metabolism. The causes of the underlying problem can vary widely, but the very existence of the disorder poses serious challenges to the mainstream hypothesis about what makes people overweight.

The Caloric Balance Hypothesis tells us that, when you eat more and exercise less (increase "Calories In" and decrease "Calories Out"), this should cause you to gain weight. But it doesn't tell us why, for instance, fat accumulates where it does.

The Lipophilia Hypothesis tells us that the cause is reversed. When you gain fat, this drives a positive caloric balance. The ultimate regulator of fat is the hormone insulin, which is secreted whenever we eat carbohydrates – particularly refined carbs. Insulin can also be manipulated by genetic, endocrinological, and other physiological mechanisms.

Okay, so we have two competing explanations for thus condition.

What does the evidence tell us?

1. On page 361 of Good Calories Bad Calories, Gary Taubes presents a full body picture of a woman who suffered from progressive lipodystrophy.[1] She lost the ability to store fat subcutaneously in the upper half of her body but remained obese from the waist down. So the top half of her body looks emaciated while the bottom half of her body looks obese.

If you believe in the Caloric Balance Hypothesis, how can you possibly explain this? Did this woman "overeat" from the waist down and "under eat" from the waist up? Her case is so bizarre from the Caloric Balance standpoint that it alone seems entirely capable of refuting the notion that "calories count."

However, if you argue that fat deposits are hormonally regulated -- as Lipophilia does -- then this case does not present a paradox. Clearly, some progressive physiological problem caused the irregular distribution of the woman's fat tissue.

Here are some articles on the disease which lend more credibility to the Lipophilia interpretation:

2. "Partial lipodystrophy and insulin resistant diabetes."[2]

The authors write that:

"Coexistence of partial lipodystrophy of unusual distribution (limbs, back, and head) with insulin resistant diabetes in severe retinal, renal, neurological, and arterial complications is reported."

3. "Lipodystrophy reactions to insulin: effects of continuous insulin infusion and new insulin analogs."[3]

These authors say that "lipoatrophy or lipohypertrophy can develop at the site of insulin injections."

They also tells us that "lipohypertrophy remains a frequent complication of insulin therapy irrespective of the insulin source and the mode of administration."

To translate that into "non-science speak:" These authors are telling us that, when you inject insulin, you will gain fat tissue at the site of the injection. How do you explain that from a Caloric Balance perspective? You cannot. Caloric Balance offers no reason why fat might appear at the sites of insulin injections.

But this observation totally jives with the Lipophilia Hypothesis. Lipophilia tell us that insulin drives fat accumulation. Hence, when we see "lipohypertrophy" at the site of insulin injections, it makes complete sense.

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1. Taubes, Gary. "Good Calories, Bad Calories." p 361. New York: Knopf (2007).

2. Oscar Rubio-Cabezas, Vishwajeet Puri, Incoronata Murano et al. "Partial lipodystrophy and insulin resistant diabetes." EMBO Molecular MedicineVolume 1 Issue 5, Pages 280 - 287. Published Online: 5 Aug 2009.

3. Radermecker RP, Piérard GE, Scheen AJ. "Lipodystrophy reactions to insulin: effects of continuous insulin infusion and new insulin analogs." Am J Clin Dermatol. 2007;8(1):21-8.

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