When you gain weight, the fat reservoir in your fat cells gets bigger. Although the fat cell itself will also increase in size, the rest of the cell contents - the nucleus, mitochondria and other important maintenance organelles get squashed into a corner of the cell.

This impairs the access of oxygen and nutrients into these vital parts of the cell and the elimination of the waste products.

Plus, as the fat cells expand, they can actually outgrow their own blood supply. They become so large that oxygen from nearby capillaries can't reach the center of the cell. This creates a state of hypoxia (oxygen deprivation).

Chronic Inflammation

Because these oversized cells are ‘suffocating' and stressed, they start sending out SOS signals. They release pro-inflammatory proteins called cytokines. This recruits immune cells (macrophages) to the fat tissue:

• Instead of being a healthy energy storage site, the fat tissue becomes a source of low-grade, chronic inflammation that travels through your bloodstream and upsets your whole body.

• The extracellular matrix (the ‘scaffolding’ that holds your cells together and supports them around your organs) becomes stiff and scarred, a process called fibrosis. This makes it even harder for the tissue to function normally or for the body to mobilize that fat later for energy.
  

Insulin resistance

When a fat cell is overstuffed, it becomes insulin resistant. Essentially, it stops listening to the hormone that tells it to store fat and starts leaking fatty acids back into the blood.

• These fats then end up in places they don't belong, like your liver, pancreas, and muscles.

• This ‘ectopic fat’ is a primary driver of Type 2 diabetes and non-alcoholic fatty acid liver disease (NAFLD).

• Luckily your fat cells are incredibly resilient: when you reduce your weight by following a balanced, lower calorie diet, they ‘deflate’, the inflammation calms down, and their metabolic signaling begins to normalize.

Visceral vs. Subcutaneous Fat

Not all fat is created equal. Your body stores fat in two main ways, and they behave like two completely different organs when they get ‘overstuffed’.

The Personal Fat Threshold

Think of your subcutaneous fat as your primary ‘bathtub’. It’s designed to hold water. As long as that tub has room, your metabolic health stays relatively stable.

However, everyone has a ‘personal fat threshold’. Once your subcutaneous ‘bathtub' is full:

1. visceral fat starts to expand rapidly.

• Visceral fat cells are much more sensitive to stress hormones like cortisol and have a higher density of receptors that trigger fat breakdown. When they get too fat, they become hyperactive, dumping inflammatory signals directly into your internal systems.



• This is why ‘belly fat’ is often used as a primary marker for health risks—it’s a sign that the safe storage areas are full and the ‘over-flow’ is starting to affect your organs.

When you cross your personal threshold, the fat has nowhere safe to go. This is when ‘ectopic fat’ occurs. The fat begins to spill over into organs that are not designed to store it:

   2. the liver becomes ‘fatty’, leading to inflammation and poor glucose control. This triggers the liver to produce more glucose and ‘bad’ LDL cholesterol, leading to a metabolic domino effect;

   3. the pancreas - fat buildup here can damage the beta cells that produce insulin;

  4. the muscles - fat interferes with the muscles' ability to take in glucose for fuel. This ‘insulin resistance’ leads to further stress on the body to try to remove excess glucose from the blood stream.

Why the Post-Menopausal Context Matters

Menopause changes the way your body handles fat. When oestrogen levels drop:



1. Fat Redistribution: Fat shifts from the hips and thighs (subcutaneous) to the belly (visceral).
2. Liver Sensitivity: Oestrogen is actually protective of the liver. Without it, the liver becomes more prone to storing "ectopic fat" (fat that has over-flowed from overstuffed fat cells).
3. Metabolic Slowdown: The body becomes slightly less efficient at processing glucose and fats, making it easier to hit your Personal Fat Threshold.

• Luckily, dropping even a small amount of weight (5–10%) can ‘empty the tub’ enough to clear the fat out of the liver and pancreas, often reversing metabolic issues.

Patient Example: what your blood results show

When you start to reach or exceed your personal fat threshold, your blood chemistry acts like an early warning system. Long before a doctor might diagnose you with a disease, these markers show that your fat cells are ‘full’ and beginning to affect your health.

This is an analysis of an example set of blood results.

Lipid Profile

When fat cells are overstuffed, they leak fat back into the bloodstream. This is often the first sign of trouble.

Triglycerides 

Standard Normal (non-fasting): Under 2.3mmol/L.

Optimal (Heart UK): Under 2.0mmol/L (non-fasting). 

• Your result: A level of 2.58mmol/L suggests that your fat cells may be struggling to store more energy, and ‘fat’ is beginning to linger in your bloodstream.

TC/HDL Ratio

This is calculated by dividing your Total Cholesterol by your HDL (‘good’) cholesterol.

Optimal Marker: Below 6

Optimal: Below 4 (TC<5/HDL>1.2). 

• Your result: A ratio of 5.58 is a signal of increased risk of cardiovascular disease.

Insulin Resistance

HbA1c

This measures your average blood sugar over 3 months.

Optimal Marker: Below 42 nMol/Mol. Anything from 42 to 47 is considered pre-diabetes (the ‘tub’ is officially overflowing).

• Your result: 34 mMol/Mol. This shows that your pancreas is managing your blood sugar levels well.

Liver Health

When you exceed your personal fat threshold, the liver is the first place ‘ectopic’ fat settles.

ALT (Alanine Aminotransferase)

ALT is a liver enzyme that is a specific marker for liver cell injury. Raised levels are associated with higher fat mass levels and, in post-menopausal women, fat redistribution from the gluteofemoral (hips) to the abdominal region (‘belly’ or visceral fat).

Standard Normal: Less than 34 U/L.

Optimal Marker: Below 25 U/L (Men) or 20 U/L (Women). Even if it's in the ‘normal’ range, a rising ALT often indicates fat is physically accumulating in the liver.

• Your result: 33 U/L. This is a classic example of a result that is normal by lab standards but not optimal by metabolic standards.

GGT (Gamma-Glutamyl Transferase) 

GGT is an enzyme found in the liver that is extremely sensitive to toxins and oxidative stress.

Standard Normal: Less than 38 U/L

• Your result: 19 U/L. This is excellent. A low GGT suggests that your liver is not currently dealing with significant oxidative stress, heavy alcohol use, or bile duct issues. It also suggests that while there may be some ‘ectopic fat’ settling in the liver (causing that ALT of 33), it hasn't progressed to a state of significant inflammation or liver stress yet.

The Triglyceride Connection

When you pair your TG level of 2.58 mmol/L that with an ALT of 33 U/L, a clear picture emerges:

1. Your fat cells are likely at their limit (hypertrophy).
2. The ‘overflow’ is circulating in your blood as high Triglycerides.
3. That overflow is now beginning to settle in your liver, causing the ALT to creep up.

• GGT (Gamma-Glutamyl Transferase) of 19 U/L and HbA1c of 34 mmol/mol are actually very positive news: while your Triglycerides (2.58 mmol/L) and ALT (33 U/L) are hinting at some metabolic ‘overflow’, these GGT and HbA1C values provides some important context that your liver and overall metabolism aren’t under major stress.

Interpreting your blood results

Your TG level of 2.58 mmol/L and ALT level of 33 U/L, indicate that you are in a ‘amber’ zone: you are in a state that researchers sometimes call ‘Metabolically Healthy, but at the Threshold’. Because your HbA1c is so good, your pancreas is still winning the battle to keep your blood sugar normal. However, the high Triglycerides and the creeping ALT tell us that your pancreas is likely working overtime to keep it that way.

Your ‘Subcutaneous Bathtub’ is full, and the ‘over-flow’ is just starting to reach the liver. The good news is that you’ve caught this at the perfect time. Since your blood sugar (HbA1c) hasn't moved into the pre-diabetic range yet, your body is still very ‘plastic’ and responsive.

• Since your HbA1c (34 mmol/L) is excellent but your Triglycerides (2.58 mmol/L) are high, your body is effectively saying, "I can handle the sugar for now, but I've run out of room to store the fat."

So your body isn't yet dealing with the ‘sticky' damage that high blood sugar causes (glycation). This means:

• Your insulin sensitivity is likely still decent in your muscles, so increasing your muscle mass will help to increase your fat burning potential.
• Plus, muscle acts like a ‘sponge' for glucose. The more muscle you have, the more slack you give your metabolic system, effectively raising your threshold for handling excess energy.

• Focused efforts to lower those Triglycerides (like reducing refined carbs/alcohol or increasing movement) will likely result in a very quick drop in ALT.

Other results

Low Free Thyroxine may be related to low vitamin D levels. Retest after taking your vitamin D supplement for three months.

What can be done?

The liver is the most resilient organ in the body. If you lower the ‘pressure' on your fat cells, the liver is usually the first place to clear out.

• Focus on reducing the ‘over-flow’: Reducing refined carbohydrates and sugars (especially fructose) can lower Triglycerides quickly, which stops the "inflow" of fat to the liver.
• The 5% Rule: Research shows that losing just 5% of body weight can significantly reduce liver fat and bring ALT levels back down into the optimal range.

The ‘Post-Menopausal Pivot’

In the post-menopausal phase, your body is essentially ‘re-wiring' how it stores energy. Because your GGT is healthy, you are in a prime position to reverse these trends before they become a more serious issue (like non-alcoholic fatty liver disease and/or Type 2 Diabetes).

The fact that your ALT is elevated but your GGT is low often points directly to fructose (table sugar, cakes, sweets) and refined carbohydrate (bread, pasta, rice) intake rather than general liver damage.

Fructose is processed almost exclusively in the liver and is a primary driver of high triglycerides and elevated ALT in the absence of high GGT.

In post-menopause, weight loss can be stubborn. So focus on 'Triglyceride lowering'. This often feels easier—it's less about the scale and more about clearing the 'gunk' out of your blood.

1. Cut out fructose

Fructose is a unique sugar because it bypasses your muscles and goes straight to the liver to be turned into fat. This is the fastest way to drive up both Triglycerides and ALT.

• You don't need to give up whole fruit (which has fibre), but look for hidden fructose in processed foods, flavoured yogurts, and sweetened drinks (even ‘healthy’ ones like orange juice).

2. Swap ‘white’ for fibre

Since your triglycerides are high, your liver is likely converting excess starches into fat. Fibre acts like a broom that helps clear excess fats and bile from your system.

• Focus on fibrous carbohydrates, carbs that are still trapped inside a plant cell wall. Think beans, lentils, berries, and cruciferous vegetables (cauliflower, cabbage, broccoli) rather than bread, pasta, or rice.

3. Omega-3 fatty acids

Think of omega-3s as the ‘anti-sludge’ for your blood. They help the liver stop producing excess triglycerides and help with chronic inflammation, killing two birds with one stone.

• Incorporate oily fish (salmon, sardines, mackerel) twice a week, or consider a high-quality fish oil supplement.

5. Movement:

Because your ‘bathtub' of fat is full, you want to use your muscles as the ‘over-flow drain’.

• The ‘After-Dinner Burn’: A simple 15-minute brisk walk after dinner.
• Why it works: When you move your muscles right after eating, they ‘eat’ the glucose and fats directly from your blood before your liver has a chance to turn them into triglycerides.
• High intensity exercise using your whole body will increase your muscles’ ability to absorb glucose and fat.

Summary Checklist 

1. Reduce: Added sugars and refined flours.
2. Increase: Fibre and Protein (to protect muscle).
3. Add: Omega-3s and a post-meal walk.



• A Note on Alcohol: If you enjoy a glass of wine, be aware that alcohol is a primary driver of high Triglycerides and ALT.