‘In the state of overweight and obesity, fat cells become dysfunctional and increased inflammation causes them to become fibrotic.’ [Zhang, Lu et al., 2024]
It all makes so much sense to me now. With a relatively new article arriving in my inbox backing up what I was feeling at the time – the increased fat roll directly under my diaphragm during menopause, was impacting my liver health and my lung function. I never gave fibrosis a thought.
But reflecting on this yesterday, I now better understand why my dipahragmatic fat was problematic to my breathing and my flexibility and why, when I took collagen supplements, I felt that my joints were ‘stiffer’.
The biological behaviour of fat (adipose) cells is more complex than we think and for many years now, I have stated that women who are overweight and obese do not need additional oestrogen – their fat cells are not only saturated with fats, but they are also hormonally active and producing oestrogen.
That’s why this newer article caught my attention. I was trying to understand the link between diaphragmatic fat deposistion during menopause and altered lung physiology.
And it all comes down to the inter-relationship between over-sized fat cells, inflammatory changes and fibrosis (tissue scarring).
When I was at Otago’s School of Physical Education many years ago and studying anthropometry (body-typing or somato-typing), I learnt that adipocytes (fat cells) were stand-alone cells that couldn’t proliferate. In other words, if you were born with a certain number of fat cells, then you had this number for the rest of your life.
Today, thanks to the incredible work of scientists studying adipose tissue physiology, we now know that adipocytes (fat cells), not only expand in size, but that this expansion (especially in overweight or obesity status), may lead to fibrosis.
Because fat cells demonstrate a certain degree of plasticity, they also develop their own micro-environment in order to maintain homeostasis. However, when it comes to the relationship between the over-expansion of adipose cells and the function of other organs, such as the lungs, liver, heart, joints and muscles, this increased plasticity may do more harm than good.
Fat Cells and Fibrosis
Fibrosis is the formation of scar tissue. It’s the excessive build-up of fibrous connective tissue in organs or tissues. Whilst this process is a normal part of healing, the fibrosis of fat cells may contribute to chronic inflammatory changes, which affect surrounding tissues and cells, contributing to the down-regulation of mitochondrial organelles, which of course, hold oxygen, which is necessary for metabolising fats for energy production.
In other words, overweight and obesity status during and after menopause, contributes to a cross-talk between adipose tissue and other organs, promoting local fibrosis of the adipose tissue (Zhang et al., 2024].
Alarmingly, this interconnection and cross-talk causes even further proliferation of fat cells, which not only become hormonally active and produce their own oestrogen [Kuryłowicz, 2023], but also leads to increased collagen production – a necessary precursor of fibrosis.
If overweight or obese women are taking collagen supplements and finding that their joints have become worse, or they have developed varicose veins, then this is a word of caution for them to consider stopping collagen supplements, especially if they are also at risk for endometriosis.
This is because the cross-talk between adipose cells and the immediate organ environment may be influential on the development of other metabolically-related diseases, especially cardiovascular disease, fatty-liver disease and lung disease.
Inflamed fat cells can directly influence neighbouring tissues.
Damaged and inflamed fat cells can infiltrate surrounding tissuess, causing problems with blood flow and therefore, hypoxia (low oxygen delivery) as well as affecting nutrient delivery.
This is what happens when women have a large amount of diaphragmatic fat too. Many overweight or obese women in menopause or post-menopause have told me that they feel really breathless and can hardly bend forwards because of the fat around their diaphragm. The same thing happened to me as well.
It’s the same with endometriosis and breast cancer – this is why midlife weight gain, is a high risk for these two conditions. Obesity up-regulates aromatase expression. Aromatase expression is the production of the aromatase enzyme, which is crucial for converting androgens into oestrogens. This occurs in a number of tissues, including the ovaries and adipose tissue.
But overweight and obese status also down-regulates sex-hormone binding globulin levels in adipose tissue, resulting in an elevation of circulating (free) oestrogen and increasing the risk for metabolic syndrome and Type 2 diabetes, especially if fatty liver is present. [Stangl et al., 2024].
This is why weight loss, including a focus on lifestyle solutions for turning unhealthy white adipose tissue (WAT), into healthy brown adipose tissue (BAT) is important. This improves levels of sex-hormone binding globulin levels in adipose tissue, which in turn improves metabolism, which in turn improves weight loss.
This is the information I have for you in the certified MyMT™ Menopause Weight Loss Coach Course, Levels 1 and 2. Practitioners are loving how this course is helping them to better understand midlife weight gain and weight loss strategies.
These strategies to reduce the size of fat cells and prevent fibrosis are crucial to apply in midlife women. Some of these strategies include:
- The Mediterranean Diet with increased fibre
- Adequate Vitamin D
- Cold-water thermogenesis, (which stimulates brown adipose tissue)
- Reduction of excessive fat intake, especially saturated (animal) fats.
- Aerobic exercise (if tolerated)
- Stretching and diaphragmatic breathing exercises (this helps to improve lung function and diaphragm function in women who have excessive fat stores around their diaphragm).
A woman’s menopause transition can be such a challenging time for weight gain, with so many questions as to why this is. Many women don’t understand that adipose tissue is an active endocrine (hormonal) organ, which makes and secretes a variety of adipokines.
Adipokines are signaling proteins and they act like hormones to control metabolism, immunity, and inflammation. Fat has an influence on the health of women, and this is why the work that we do to offer overweight women evidenced solutions, that gets results is so important.
I have all these solutions in the courses for you.
Dr Wendy Sweet (PhD)/ Member: Australasian and British Societies of Lifestyle Medicine.
References:
Zhang Q, Lu C, Lu F, Liao Y, Cai J and Gao J. (2024) Challenges and opportunities in
obesity: the role of adipocytes during tissue fibrosis. Front. Endocrinol. 15:1365156.
