Sarcopenic obesity (skinny fat), is where an excess amount of visceral fat is stored around the truncal and abdominal area of the body. Alongside that, muscle mass is far lower, in areas such as the chest, arms, shoulders, back, glutes and legs than that of a typical XY person. Most people with Klinefelter’s Syndrome are skinny fat. Dressed they look fit and healthy; undressed the difference can be quite marked. The problem is that looking healthy is not enough as although their BMI and weight maybe within a normal range the fat stored around the body is a serious cause for concern.
Sarcopenic obesity is an inflammatory condition which is caused when adipose tissue, primarily visceral fat, accelerates muscle catabolism (muscle loss) and produces inflammatory cytokines. This is a vicious cycle because as muscle catabolism increases then visceral fat increases also, thus sustaining sarcopenic obesity.
Conditions that can affect the klinefelter’s condition include (but are not limited to) osteoporosis, diabetes, rheumatoid arthritis, IBS, varicose veins, and bronchitis. All these conditions are defined as inflammatory conditions.
Osteoporosis
This condition is effectively low bone mass and an increase in bone fragility. Osteoporosis is associated with endocrine, metabolic and mechanical factors. Your bones are constantly renewing, breaking down and rebuilding new bone but when your bones can’t renew as fast as they break down, this is called osteoporosis. Recent studies have shown that inflammation also has a major influence on bone turnover. Various inflammatory cytokines have been shown to cause chronic inflammation which also affects the immune system.
Diabetes
Hyperglycaemia is an inflammatory condition and is a major cause of vascular damage. Inactivity and obesity increase the risk for diabetes and internal inflammation causes diabetes. When the body doesn’t make enough insulin or the body can’t use insulin effectively, diabetes occurs. Insulin also impacts on tissue in the body and factors that cause this include obesity and fat around the belly and major organs leading to the fat cells causing inflammation.
Inflammation cytokines are higher in people with diabetes or even high in people with pre-diabetes, which is an uncomfortable level that people with KS can be in on a regular basis when TRT, taken to treat KS causes other side effects, especially when diet and liquid intake are not adequate.
Rheumatoid Arthritis
RA is an autoimmune and inflammatory disease, which means the immune system attacks healthy cells by mistake causing inflammation. RA normally attacks the joints of the hands, knees and wrists, causing damage to joint tissue which can cause long lasting pain.
RA also affects other tissues including problems with the lungs, heart and eyes. Genetic conditions and obesity (amongst others) are two of the most common risk factors of RA.
IBS
Irritable Bowel Syndrome (IBS) is a functional bowel disorder. Childhood abuse and post-traumatic stress disorder (PTSD) is associated with adults developing IBS in later life. Stress, anxiety and depression stimulates inflammatory cytokines which is a well-known risk factor for IBS.
IBS is also linked to a condition called visceral hypersensitivity. This is where previously disrupted intestinal issues that cause IBS create either a localised or radiating pain in the internal organs, such as the kidneys, bladder or gallbladder. Over the counter medications such as NSAIDs can alleviate the pain, as can complementary therapies.
Varicose Veins
Varicose veins are twisted, enlarged veins that most commonly become varicosed in the legs. Most varicose veins are mild and are more a cosmetic concern, but for some people they cause aching pain and discomfort. They are worsened when sitting or standing for a long time, can itch around the site and can throb, burn, cramp or cause swelling.
Risk factors include age, sex, family history and obesity. They can lead to ulcers, blood clots and bleeding. Prevention includes exercise, weight loss, changing from sitting to standing regularly and elevating your legs.
Bronchitis
This is an inflammatory condition that affects the breathing tubes (bronchi). There are several types of bronchitis but the most common are acute and chronic. Chronic bronchitis is normally related to Chronic Obstructive Pulmonary Disorder (COPD) and acute bronchitis is often referred to as a chest cold.
As a child I experienced several bouts of acute bronchitis every year until I got my asthma under control. TRT rid me of my asthma, and I’ve not had a bronchitis episode for years.
Sarcopenic obesity, osteoporosis, diabetes, rheumatoid arthritis, and IBS all have 3 things in common –
- women are more likely than XY males to suffer from these conditions later in life;
- people with klinefelter’s syndrome (XXY) are at a significantly greater risk of developing these conditions;
- they are all linked to inflammatory cytokines and pro-inflammatory cytokines.
Varicose veins and bronchitis, although inflammatory conditions are not linked to cytokine production.
In 2019 research was carried out on a range of people (XXY males {39 ∓ 8 years}, XY males {30 ∓ 5 years} and women {28 ∓ 4 years}) and it was found that KS males had higher levels of inflammatory cytokines, much the same as is found in women. These inflammatory cytokines can lead to the conditions mentioned above.
Inflammatory cytokines and pro-inflammatory cytokines play an important role in the body. When it’s working well it fights off foreign invaders, heals injuries and gets rid of foreign particles that cause infection. Some inflammatory cytokines have roles that act as growth factors.
When the immune system is not working well (klinefelter’s and autoimmune diseases), inflammatory cytokines go into overdrive and cause excessive production of inflammatory cytokines which can cause inflammatory diseases such as atherosclerosis and cancer. Pro-inflammatory cytokines can trigger pathological pain and can make the disease or symptoms worse by causing fever, inflammation, tissue degradation and in some cases shock and death.
Pro-inflammatory cytokines may be responsible for obesity. Cytokines in adipose tissue serve as regulators for your hormones and studies have shown that in obese people there are more pro-inflammatory cytokines. These create a damaging cycle of excess nutrients in the body, which activates macrophages in visceral fat which continuously release pro-inflammatory cytokines and causes inflammation.
Pro-inflammatory cytokines can cause excessive damage to the kidneys, heart, lungs (asthma), adipose tissue, osteoarthritis and can cause complications in people with cystic fibrosis.
References
Nicolas Lefevre, Francis Corazza, Joseph Valsamis, Anne Delbaere, Viviane De Maertelaer, Jean Duchateau, Georges Casimir 2019, The number of X chromosomes influences inflammatory cytokine production following toll-like receptor stimulation, viewed 1st July 2021,<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521177/>.
Matthew A Schrager, E. Jeffrey Metter, Eleanor Simonsick, Alessandro Ble, Stefania Bandinelli, Fulvio Lauretani, Luigi Ferrucci 2006, Sarcopenic obesity and inflammation in the inCHIANTI study, viewed 15th July 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645665/
Wikipedia, Inflammatory cytokine, viewed 1st August 2021, https://en.wikipedia.org/wiki/Inflammatory_cytokine
