The two most frequent topics we get asked about here at Metabolic Effect are belly fat and lower body fat (specifically What Causes Cellulite). I have already written pretty extensively on the physiology of belly fat (You can read those blogs HERE, and HERE and also HERE).
In this blog I want to attack the issue of lower body fat and address the "what causes cellulite and getting rid of cellulite" issues particularly. I can't tell you how often I have been asked question regarding cellulite and the variety of ways I have been asked: What causes cellulite? How do you get rid of cellulite? And is it even possible to get rid of cellulite?
Cellulite is really the combination of two factors, fat and collagen fibers. The problem is that this fat and collagen is a little different than the fat and collagen found on a man's body and even different than fat found on different areas of the female physique.
What causes cellulite?
Compared to men, women have collagen fibers in their lower body that run vertically up and down like a picket fence. This straight up and down distribution of collagen fibers is the major reason females get cellulite and men don't. (Estimates are 90% of women have some degree of cellulite compared to 10% of men.) The superficial collagen of men forms more of a mesh. If women have the picket fence distribution of collagen, men have the "chain link fence" distribution. Where women's fibers run up and down, male fibers crisscross.
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This is important because the vertical distribution of female collagen fibers, more prevalent in the female lower body, form a sort of pocket in which fat cells then grow (see the picture above). As the fat cells grow in size they are essentially corralled in and packed tightly together by the collagen fibers. Picture a Nerf football stuffed in between links in the fence. This tight packing of fat inside the "collagen pockets" creates the characteristic puckering and dimpling of cellulite. If you are still having trouble picturing this, imagine filling your pockets stuffed full with marbles and rub your hand along the outside. Feel the bumpy protruding marbles? That gives you an idea of what I am talking about.
Get rid of cellulite
One of the things many women wonder is how come some women have cellulite and others don't? And how come some overweight women don't have as much cellulite as some skinny women? These are great questions and underscore the need to move beyond the simple fat loss models many experts cling to. Cellulite is not just an issue of gaining fat or losing fat. It is an issue of doing something to address both fat loss and collagen strength and health.
The reason some women get cellulite and some women don't has a ton to do with genetics. Some women have collagen fibers that are more like a man's (a picket fence & chain link hybrid), and some have extreme versions of the vertical distribution. So, getting rid of cellulite is perfectly possible for some women and far more difficult for others. However, no matter the genetic luck of the draw, the appearance of cellulite can always be improved upon.
There are ways to address the collagen issue, but none of them are very good. I will get to that in a minute. First, let's talk about the other aspect of cellulite, the fat.
Female lower body fatâ€¨â€¨
The fat in the lower body of women is also different than that in men. Women have about 9 times more alpha-adrenergic receptors associated with their fat tissue compared to beta-adrenergic receptors. Adrenergic receptors are bound by the body's most potent fat burning hormones - catecholamines (adrenaline and noradrenaline for our UK peeps and epinephrine and norepinephrine for us here in the US).
When the catecholamines interact with beta-receptors, fat is released from fat cells. When they bind to alpha-receptors, fat release is drastically slowed. I know I may be losing the non-science folks, so just think B for beta=burn and A for alpha=anti-burn.
You can thank the hormone estrogen for the large amount of alpha-receptors in the lower body of women compared to men. Interestingly, the study of transgender populations, those undergoing hormone therapy to transition from female to more male like, or from male to more female like, has taught us a ton about hormones and their impact on where we store fat. Studies, and working clinically with these populations, give us the first hints of the female hormones and how they impact where fat is stored. Males undergoing heavy estrogen and progesterone therapy will see increased fat deposition around the lower body and yes, increased prevalence of cellulite as well.
What this means for women is that when they lose weight they will often lose weight faster from the upper body (bust, waist, and arms) compared to the lower body (hips, thighs, and butt). If you have ever gone into one of those marathon running programs and realized you were losing every where except your hips and butt, you know exactly what I am talking about. Maybe you even know someone that this has happened to.
A few other things
That is the double whammy of cellulite. Vertical collagen fibers combined with a tendency to store fat primarily in the lower body and a more difficult time losing it is what causes cellulite.
But, that is not the end of the story because another prevalent aspect of the fat tissue in the lower body for women (also in the love handles of men) is the issue of blood flow. This fat is relatively hypoxic, which means it is starving for oxygen. This is because the prevalence of alpha-receptors along with the poor blood vessel perfusion means it does not get as much blood supply. This is in contrast to the very oxygen satisfied belly fat (one of the reason why middle belly fat is often the first thing to go in weight loss programs in both men and women).
The other issue is that there is pretty much a direct association of muscle with its fascial lining (the connective tissue sheath that lines muscle) and the collagen tissue in the skin. This means that well developed muscles have the ability to impact the tightness and tone of the connective tissue in the skin. This is one of the reasons weight lifting tightens the body even when weight is not lost. When you think cellulite exercises, think weight training.
Now the question is how to get rid of cellulite, or how to reduce cellulite? Can you "burn cellulite"? Well, sort of. You can certainly burn the fat part of it, but that is only part of the issue, as any skinny girl who has suffered from cellulite will tell you. The collagen issue is much more tricky and controversial.
The truth of the matter is to get rid of cellulite really takes a more nuanced approach than just losing lower body fat. And, I am going to be honest with you, it is not easy. What I can say with certainty is that even those with the worst cellulite can substantially reduce its appearance. I address this in my clinic with what I call the 4 F's (fat, fibers, flow, and firm).
The first thing to do to get rid of cellulite is to burn the fat. To do this you need to do what you can to block or bypass the alpha-adrenergic receptors in the lower body. This can be done through a very low carb diet along with smart supplementation. Carbohydrates are the major simulators of the hormone insulin, and insulin is a promoter of alpha-adrenergic receptor activity. So, lower the carbs and you lower the insulin and suppress the action of the alpha-adrenergic receptors speeding fat release from the lower body. Now the speed of lower body fat release is more in line with the upper body.
At the same time there are two very good supplements I use in my clinic that have mechanisms of action similar to the catecholamines (for the science nerds they turn on the intracellular activity of cyclic AMP, the same thing catecholamines do when they bind the adrenergic receptors). They basically allow us to bypass the adrenergic receptors all together and avoid activating the alpha receptors in the first place. These are green tea extract (I use a 50% EGCG standardized product) and coleus forskohli (standardized to 20% forskolin). You can find the products we use in our clinic HERE. Keep in mind these supplements will do little unless the carbohydrate intake of the diet is low.
There are also a few herb derived compounds that will directly block alpha-adrenergic receptors. These include yohimbine, epinephrine, and berberine. Again, the major caveat here is: THESE SUPPLEMENTS DO NOT WORK OUTSIDE OF A LOW INSULIN ENVIRONMENT!! I tell you that because insulin is a far more powerful promoter and controller of the adrenergic receptors than any supplement. So to work they need to be taken under a low carb state. We have our own protocol on how we manage this, which I am not going to take the time to go into here. I will give you one clinical pearl though. Keeping total carb intake under 100g for the day and exercising on an empty stomach using a mix of intervals, then weights and then following it with a long slow cardio session, like walking, is what delivers our best results.
Strengthen and remodel the fibers. This is the hardest part and while there are some "low tech" ways to accomplish this, your best results will come with combining the fat burning techniques above with some of the up and coming best cellulite treatments, which attempt to address the collagen issue through deep tissue stimulation including heat, vibration, and light therapy. These cellulite treatments attempt to strengthen and reorganize the collagen through what is often referred to as "collagen remodeling". It is currently debatable as to the impact and effect of these treatments, but for those who want the low-tech version, deep tissue massage and self-deep tissue massage (i.e. foam rolling) are options.
Clinically, some women swear by this, but given they were doing all the other things described here, the fact that I don't yet have enough clinical evidence to say either way, AND the fact that there is no research at all suggesting it works, makes this an unknown. One thing to note, pretty much any massage type treatment will reduce the appearance of cellulite for a short time given the ability of massage to move lymph and increase blood flow. This is constantly reported by the women we see in our clinic. We explain this as a temporary fluid distribution shift out of the subcutaneous tissue. It is believed fluid, like fat, accumulates in the collagen pockets and can increase the dimpling effect. So, removing this fluid may decrease the appearance of dimpling and puckering. Knowing this is comforting to women who want a quick solution to decreasing the appearance of their cellulite. It is a short-lived effect however.
Increase blood flow to the lower body. The major ways to increase blood flow to an area are to move that area and to heat that area. Exercise does both and so does massage. Increased blood flow to an area means increased ability to move released fat to distant sites to be burned. Increased blood flow also is wonderful at removing fluid from the area and essential for the health and strength of the collagen fibers. We use several techniques here. Hyperthermia (hot baths & sauna) and contrast hydrotherapy (alternating hot and cold applications). Many women are familiar with this through some of the hot and cold dipping pools utilized in many high-end spas. These are surprisingly effective, at least in the short term appearance of cellulite. Clinically, these treatments create an almost immediate reduction in the appearance of cellulite likely due to the fluid effect mentioned above.
Firm or build the muscle underneath. The final piece, and probably the second most important, is the building of muscle. Weight training is the only form of exercise capable of strengthening muscle and tightening the connective tissues of the body and the only effective "cellulite exercises". A lower body resistance-training program that focuses on muscle growth is essential here. Although, in some this requires more than just a blind weight lifting strategy. This is especially true in under-muscled thin women with cellulite. For best results for those with underdeveloped butt muscles, learning to activate the butt muscle appropriately is essential as failing to do so may result in disappointing results from weight training. I would refer those who fall into this category to the strength and conditioning specialist Brett Contreras (known as the glute guy). He specializes in this and is a great educational source on maximizing booty development.
So that's it. Everything you wanted to know about getting rid of cellulite. I realize this is a lot and a bit technical at times, but hopefully it gives you some things to think about. Real quick, here are the most important points in bullets:
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