‘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 and ate a high protein diet, I felt that my joints were ‘stiffer’.
The biological behaviour of fat (adipose) cells is more complex than we think.
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. As it’s the start of another year, and weight loss is on the mind of many midlife and older women, 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 (saturated) 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. We also learnt that these fascinating cells were inert – they just stored fat for energy.
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 the balance that they body requires to function optimally. This is called ‘homeostasis’.
However, when it comes to the relationship between the over-expansion of adipose (fat) 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 and these changes may then affect surrounding tissues and cells – especially in women who are overweight or obese.
Scientists now believe that this inflammation and increased tissue scarring, may also contribute to the the energy cells (mitochondria) not working as efficiently. Mitochondrial organelles hold oxygen, which is necessary for breaking down stored 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 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 or scar tissue formation.
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 tissues, causing problems with blood flow and therefore, starvation oxygen entering the cell – called hypoxia. Nutrient delivery may also be affected.
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.
Overweight and obese status also down-regulates sex-hormone binding globulin levels in fat 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.
These specific lifestyle solutions is what is available in the MyMT™ Transform Me Weight Loss Program. Women are loving how this program is helping them to better understand midlife weight gain and evidenced weight loss strategies.
These strategies to reduce the size of fat cells and prevent fibrosis are crucial for midlife women. Some of these include:
- The Mediterranean Diet with increased fibre
- Adequate Vitamin D
- 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 substances that act like hormones to control metabolism, immunity, and inflammation.
Fat has an influence on the health of wome – some is good, too much isn’t so good!
I have all these solutions in the MyMT™ Transform Me program for you and you can read about this HERE.
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.
