Subcutaneous fat emerges as a protector of Womans’ brains

Womans’ propensity to deposit more fat in places like their hips, buttocks and the backs of their arms, so-called subcutaneous fat, is protective against brain inflammation, which can result in problems like dementia and stroke, at least until menopause, scientists report.

Males of essentially any age have a greater propensity to deposit fat around the major organs in their abdominal cavity, called visceral adiposity, which is known to be far more inflammatory. And, before females reach menopause, males are considered at much higher risk for inflammation-related problems from heart attack to stroke.

“When people think about protection in women, their first thought is estrogen,” says Alexis M. Stranahan, PhD, neuroscientist in the Department of Neuroscience and Regenerative Medicine at the Medical College of Georgia at Augusta University. “But we need to get beyond the kind of simplistic idea that every sex difference involves hormone differences and hormone exposure. We need to really think more deeply about the underlying mechanisms for sex differences so that we can treat them and acknowledge the role that sex plays in different clinical outcomes.”

Diet and genetics are other likely factors that explain the differences broadly assigned to estrogen, says Stranahan, corresponding author of a study in the American Diabetes Association journal Diabetes.

She acknowledges that the findings are potentially heretical and revolutionary and certainly surprising even to her. “We did these experiments to try and nail down, first of all, what happens first, the hormone perturbation, the inflammation or the brain changes.”

Brain Image (NIH)

To learn more about how the brain becomes inflamed, they looked at increases in the amount and location of fat tissue as well as levels of sex hormones and brain inflammation in male and female mice at different time intervals as they grew fatter on a high-fat diet.

Since, much like with people, obese female mice tend to have more subcutaneous fat and less visceral fat than male mice, they reasoned that the distinctive fat patterns might be a key reason for the protection from inflammation the females enjoy before menopause.

They found again the distinctive patterns of fat distribution in males and females in response to a high-fat diet. They found no indicators of brain inflammation or insulin resistance, which also increase inflammation and can lead to diabetes, until after the female mice reached menopause. At about 48 weeks, menstruation stops and fat positioning on the females starts to shift somewhat, to become more like males.

They then compared the impact of the high-fat diet, which is known to increase inflammation body wide, in mice of both sexes following surgery, similar to liposuction, to remove subcutaneous fat. They did nothing to directly interfere with normal estrogen levels, like removing the ovaries.

The subcutaneous fat loss increased brain inflammation in females without moving the dial on levels of their estrogen and other sex hormones.

Bottom line: The Womans’ brain inflammation looked much more like the males’, including increased levels of classic inflammation promoters like the signaling proteins IL-1β and TNF alpha in the brain, Stranahan and her colleagues report.

“When we took subcutaneous fat out of the equation, all of a sudden the females’ brains start to exhibit inflammation the way that male brains do, and the females gained more visceral fat,” Stranahan says. “It kind of shunted everything toward that other storage location.” The transition occurred over about three months, which translates to several years in human time.

Dr. Alexis Stranahan/CREDIT:Michael Holahan, Augusta University

By comparison, it was only after menopause, that the females who did not have subcutaneous fat removed but did eat a high-fat diet, showed brain inflammation levels similar to the males, Stranahan says.

When subcutaneous fat was removed from mice on a low-fat diet at an early age, they developed a little more visceral fat and a little more inflammation in the fat. But Stranahan and her colleagues saw no evidence of inflammation in the brain.

One take-home lesson from the work: Don’t get liposuction and then eat a high-fat diet, Stranahan says. Another is: BMI, which simply divides weight by height and is commonly used to indicate overweight, obesity and consequently increased risk of a myriad of diseases, is likely not a very meaningful tool, she says. An also easy and more accurate indicator of both metabolic risk and potentially brain health, is the also easy-to-calculate waist to hip ratio, she adds.

“We can’t just say obesity. We have to start talking about where the fat is. That is the critical element here,” Stranahan says.

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She notes that the new study looked specifically in the hippocampus and hypothalamus of the brain. The hypothalamus controls metabolism and exhibits changes with inflammation from obesity that help control conditions that develop bodywide as a result. The hippocampus, a center of learning and memory, is regulated by signals associated with those pathologies but doesn’t control them, Stranahan notes.

While these are good places to start such explorations, other regions of the brain could respond very differently, so she is already looking at the impact of loss of subcutaneous fat in others. Also, since her evidence indicates estrogen may not explain the protection Women have, Stranahan wants to better define what does. One of her suspects is the clear chromosomal differences between the XX female and the XY male.

Stranahan has been studying the impact of obesity on the brain for several years and is among the first scientists to show that visceral fat promotes brain inflammation in obese male mice, and, conversely, transplanting subcutaneous fat reduces their brain inflammation. Females also have naturally higher levels of proteins that can tamp down inflammation. It’s been shown that in males, but not females, microglia, immune cells in the brain, are activated by a high-fat diet.

She notes that some consider the reason that females have higher stores of subcutaneous fat is to enable sufficient energy stores for reproduction, and she is not challenging the relationship. But many questions remain like how much fat is needed to maintain fertility versus the level that will affect your metabolism, Stranahan says.

–Dr. Alexis Stranahan/CREDIT:Michael Holahan, Augusta University

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Women aged above 45 behind surge in post-Covid cosmetic surgeries: Survey

After the stress of the COVID-19 pandemic, many Americans are now investing in themselves through cosmetic procedures, despite an uncertain economy.

The American Society of Plastic Surgeons (ASPS) polled member surgeons nationwide and found more than three-quarters of cosmetic-focused plastic surgery practices are seeing more business than before the pandemic, with nearly 30 percent reporting their business has at least doubled.

“With COVID, we prepared for the worst. But when we were able to reopen our office, we were pleasantly surprised with the incredible surge of demand for our cosmetic services, both surgical and noninvasive,” said Bob Basu, a board-certified plastic surgeon in Houston and board vice president of finance of the American Society of Plastic Surgeons. “I initially thought that we would see some of that demand drop off, and that’s not been the case. We’re actually still seeing very high demand.”

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Basu says there are a variety of reasons behind the increased demand. For many patients, COVID shutdowns and the ability to work from home gave them the time they needed to heal, without disrupting their normal busy routine. Others say the money saved on things like travel and dining out during the pandemic allowed them to invest in themselves.

“COVID changed everything. No one was traveling, vacations got canceled. So I think a lot of families and patients had a lot more disposable income. And so, they found that this is the right time for them to do a cosmetic plastic surgery procedure,” Basu said.

The survey also found that women between the ages of 31 and 45 were by far the most likely to request popular procedures such as breast augmentations, liposuction and tummy tucks. Basu says millennials are not only savvy about their options, but are also more open about their choice to seek plastic surgery than older generations.

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“Millennials are very sophisticated in terms of getting the information they want. They share their experiences with other people through social media platforms or other methods. And so, these procedures are no longer taboo — They’re actually relatable and accessible,” Basu said.  “Because of this open sharing, patients also come in well-versed about the procedures of interest. And so it really allows us to have a really productive discussion about their options.”

Megan Gilbert, 35, was one of those millennials who did her research. When the pandemic halted her young family’s busy lifestyle, they used the opportunity to focus on their health. But after a twenty-five-pound weight loss, Gilbert still had some insecurities when looking in the mirror.

A friend referred Gilbert to Dr. Basu, who worked with her to find the right size and type of breast implant. At the same time as her breast augmentation, he performed a breast lift to give her the look and shape she desired.

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“I couldn’t be happier with the results. Having that confidence back and feeling better about myself resonates in every part of my life, including with my family,” Gilbert said. “I want my kids to be happy and secure in their life and in who they are, and if they don’t see that in me, it’s hard for them to see it in themselves.”

Although the surge in cosmetic procedures may be driven by women under 45, Basu says he’s seeing more patients across every age group and gender who are interested in procedures to help them look and feel their best.

The survey found that over 40 percent of plastic surgeons are reporting longer wait times between consultation and surgery than before the pandemic, so experts encourage anyone considering a cosmetic procedure to plan ahead as much as possible.