Cellulite refers to the lumpy, degenerated skin that mainly occurs on the thighs, buttocks, and stomach of women, like an orange peel. This symptom was first mentioned in France in 1920 (Dermatol Estetyczna, 2006), and in French it is pronounced as Cellulit. Cellulit and Cellulitis are often used interchangeably, but they have nothing to do with Cellulitis, an inflammatory disease of the subcutaneous connective tissue. Inflammatory factors in cells can cause cellulite, but the term cellulite itself does not mean 'inflammation of cells'.
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| Appearance by Cellulite Severity (Dermatol Surg, 2019) |
It was first published in English in 1968 in France, and was popularized as cellulite around the world. Cellulite is a combination of the Latin words 'cellula' (small cell) and 'ite' (the element that makes up the word), meaning 'cell'.
Cellulite is caused by a variety of factors including gender, diet, exercise habits, hormones, stress, genetic factors, local circulation abnormalities, toxin accumulation, hypertrophy of fat cells, fibrosis of connecting tissue, edema, inflammation, and chronic use of oral contraceptives.(J Cosmet Laser Ther. 2004; J Cosmet Dermatol, 2005).
Although it is true that it is often found in obese people, cellulite is actually different from obesity. It is caused by physiological problems rather than pathological causes, so it does not cause diseases like obesity, but is just a little unsightly.(Anna Acad Medicae Stetinensis, 2014). The pathogenesis is different, and even thin people can have cellulite, so it is not proportional to obesity.
Women are more prone to accumulating subcutaneous fat due to the influence of estrogen, and because fat cells and connective tissues are in a straight line and thin, when fat cells become enlarged, they are unable to hold them properly and are more likely to protrude upward, so cellulite is bound to develop much more easily than men.(J Derma Surg Oncol, 1978).
Cellulite is known to affect 85-98% of women of all races, mostly after puberty.(J Cosmetic & Laser Therapy, 2004). In medical terms, it is called 'gynoid lipodystrophy (GLD)' (female-pattern fatty dystrophy), and it occurs mainly in women because the structure of fat cells and connective tissues in women and men is different due to differences in sex hormones.
In men, the epidermis and dermis are thicker due to the influence of the male hormone testosterone, and the connective tissue of fat cells is formed in a cross shape, which holds the subcutaneous fat well, preventing it from protruding above the skin and forming cellulite. In addition, testosterone also inhibits the accumulation of subcutaneous fat.
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| Structure of fat cells (left: male, right: female) |
Hormones play a dominant role in the formation of cellulite, and several hormones are known to be involved, including insulin, catecholamines, adrenaline, noradrenaline, thyroid hormones, and prolactin, but in particular, imbalances in estrogen are thought to have the greatest impact on the development of cellulite in many ways.(J Eur Acad of Dermatol & Venereol, 2000).
The connective tissue (CT) between the skin and muscles where cellulite occurs is composed of fat cells, fibers, and ground substance (spaces between fat cells). The fibers are mainly composed of collagen, and the ground substance is 10% glycosaminoglycans (GAGs) and the remaining 90% is water. Estrogen deficiency causes microcirculation disorders, causing vascular changes in subcutaneous fat tissue, inhibiting the production of elastin and collagen, weakening the connective tissue and thinning the skin, making cellulite more likely to occur. In general, severe and large cellulite is often the result of estrogen deficiency.
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| Estrogen deficiency causes microcirculatory disorders, making cellulite more likely to develop. (Cellulite cure, 2005) |
Estrogen excess is also a problem. Estrogen that increases due to pregnancy, oral contraceptives, and high-fat food intake induces adipocyte hypertrophy and lipogenesis, and when the level of neutral fat in the body increases, it stimulates the ovaries to induce estrogen secretion again, which repeats a vicious cycle and can worsen cellulite.
Estrogen excess can also induce the accumulation of GAG in the matrix (Acta Pharma Toxicol, 1971). When GAG accumulates, the viscosity of the interstitial space increases, causing problems in the transport of substances such as water and waste products, and inducing fibroblast proliferation (=fibrosis) (Maturitas, 1992), which hardens the tissue and causes circulatory disorders. It is known that these changes in the microcirculation of blood vessels and lymphatic vessels in subcutaneous fat play a fundamental role in the formation of cellulite.
When oxidative stress that is not properly processed, such as smoking or instant food, accumulates, it leads to inflammation within the cell. Inflammatory factors can cause cellulite (Int J Dermatol, 2011), and thus, cellular oxidative stress levels can increase in cellulite patients (Biofactors, 2005). Sodium concentration increases in the inflamed area, and since sodium has a positive charge, it also attracts GAG, which has a negative charge. Since sodium and GAG attract water, water retention occurs, and this causes local blood vessel and lymphatic circulation disorders, which physically increases tissue stress, weakens collagen connections, and can worsen cellulite (J Eur Acad Dermatol Venereol, 2000).
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| In inflammatory conditions, sodium and GAG levels increase within tissues. (R. Soc. open sci. 2019) |
Most toxins are hydrophobic compounds and thus dissolve in lipids. Therefore, lipids are responsible for the movement, distribution, and sequestration of hydrophobic compounds within all tissues (since the body needs to protect itself, if it exceeds the detoxification limit, it is not detoxified but stored and sequestered in adipose tissue) and play an important role in the accumulation of toxic substances in tissues (Environ Health Perspect, 2013).
Most of these toxins are stored in the neutral fat of fat cells (Eur J Histochem, 2010), and the amount of toxins is directly correlated with the amount of neutral fat in the cells, so that the amount of toxic substances is generally quantified by the total lipid content in the tissue (Toxicol Lett, 2013). Greasy foods induce the accumulation of neutral fat in the body, salty foods can cause water retention in the subcutaneous connective tissue, which can cause microcirculation disorders, and a diet high in toxins such as preservatives and alcohol can worsen cellulite by accumulating toxins in fat cells and causing them to swell. In addition, a high-fat diet and increased neutral fat levels in the body also stimulate estrogen secretion.
In Asia, when people used to consume 100g of soybeans (50-300mg of phytoestrogen) a day, there was almost no cellulite (www.mayoclinic.com). Phytoestrogens, which are abundant in soybeans, have a similar structure to estrogen and exhibit similar physiological activities, but are not as effective as estrogen. Therefore, if you eat a lot of foods rich in phytoestrogens and react instead of estrogen, you can minimize the effects of estrogen on subcutaneous fat cells and connective tissue, protecting them and preventing cellulite (Physiology of the skin II, 2001). Since you can control the level of neutral fat in your body through diet control and alleviate estrogen imbalance, it can be said that diet is the biggest cause and solution to cellulite.
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| Cellulite cure, 2005 |
Collagen degeneration plays a big role in the development of cellulite. Collagen degeneration comes from nutritional deficiencies, hormonal imbalances, and toxins. A diet lacking in protein, along with vitamin C, zinc, and especially magnesium, can affect the level of collagen available to cells. Since collagen is made from amino acids in protein, eating less protein will lead to more cellulite. However, since protein synthesis requires many nutrients, a healthy balanced diet with plenty of vegetables is ultimately very important.
Foods to remove cellulite
▷ Eat organic vegetables and eat a natural diet (Eat less meat and seafood. Meat is a top predator and cannot avoid toxin accumulation, and seafood is already polluted, so it is better to eat less. Avoid eating food with food additives as much as possible.)
▷ Eat foods rich in phytoestrogen; Fraxseed, soybeans (natto, cheonggukjang, doenjang, tofu), black beans, and medicinal beans (Note that beans other than soybeans and domestic black beans have almost no phytoestrogen content)
Most modern people spend a lot of time sitting indoors. This lack of physical activity leads to a decrease in muscle strength, a decrease in muscle pump function, which causes local vascular circulation disorders, and the excess calories lead to fat cell hypertrophy, which can worsen cellulite. Subcutaneous fat, where cellulite occurs, does not respond well to diet and exercise, so it may be difficult to effectively remove cellulite with a general low-calorie diet and exercise, but appropriate exercise is very important in stimulating blood circulation and detoxification processes to reduce the level of subcutaneous fat.
Exercise method and massage method
▷ Strength training (Aerobic exercise is only low-intensity strength training, so make sure to do high-intensity strength training instead of aerobic exercise.)
▷ Massage strongly, thinking that it will physically break up the knots (high-frequency massage is also effective).
Cellulite is closely related to mental health conditions to the point that it is called a psychosomatic disease. A stressful lifestyle causes or worsens cellulite through stimulation of adrenoceptors by catecholamines, slowing down the feedback function of the hypothalamic-pituitary-adrenal cortex axis, and increasing blood cortisol (J Eur Acad of Dermatology & Venereology, 2000). It is important to have a habit of managing stress well on a daily basis. Stress is the root of all diseases and is also the root of cellulite.
Liposuction or fat dissolving injections do not target the subcutaneous fat area, but rather the reserve fat layer (an area that responds well to exercise and diet) underneath, so they are not fundamental methods for eliminating cellulite. Since cellulite is closely related to lifestyle, it will come back anyway if you do not change your lifestyle. In other words, if you make an effort, you can return to having firm and smooth buttocks and thighs. There is no royal road to this; the only surefire way is to change your lifestyle, eat a healthy diet, exercise appropriately, and manage stress.