Dr. Augusto Litonjua, who pioneered the medical subspecialty of Endocrinology in the country, looks more fit than many seniors who are 10 to 15 years younger. At age 87, he still goes around the country giving lectures in medical conventions and lay forums to educate everyone on how to prevent and control diabetes, obesity and their various complications like heart attack, stroke, blindness and leg amputations.
A few days ago, on Wednesday night, we were together in a forum on diabetes in Cebu City together with cardiologist Nelson Abelardo and kidney specialist Albert Chua. It was part of the continuing medical education program of LRI-Therapharma.
Since diabetes frequently damages the heart and kidneys, most discussions on this disease usually involves, not only the endocrinologist or diabetes specialist, but heart and kidney specialists as well. Diabetics should be evaluated also by a heart specialist and a kidney specialist at least once a year to detect any early sign of injury of these vital organs.
Last week, Dr. Litonjua also spoke before the media and lay audience, together with fellow endocrinologists Joy Fontanilla, Bobby Mirasol and Elwyn Fernando. It was part of the public education program of Diabetease magazine, which comes out bimonthly; and is a rich resource of information that can empower diabetics and those with risk factors to develop the disease, by teaching them with practical pointers on how to keep their diabetes at bay.
In their separate lectures, the experts emphasized the importance of lifestyle changes, particularly, maintaining an ideal body weight, cessation of smoking, avoidance of excessive alcohol, stress management, adequate rest, and regular exercise.
But one thing which is not too well known to everyone is how to exercise properly so as to develop one’s brown fat (our good fat), and reduce one’s white fat (the bad fat). Dr. Litonjua stressed that exercising at the right temperature is the key to promote the development of the good brown fat.
White fat makes up the bulk of the fat in our bodies. All the excess calories we consume, especially due to overeating, are stored in the white fat. Consequently, overweight and obese people have more white fat than normal-weight individuals.
Brown fat, usually present in small pockets in the body, is the more ideal of the two types of fat because it burns calories much more efficiently, producing heat under the right conditions. Studies show that the fully activated brown fat generates 300 times more heat than any other tissue in the body.
By itself, brown fat can burn several hundred calories per day; and a mere two ounces of brown fat burns the equivalent of a 30-minute moderate intensity exercise. Our small pockets of brown fat are usually located in the sides of the neck—sometimes up to the shoulder and upper arms, and just above the collarbone. Some worry if they have prominent fatty tissues in these areas; and even ask the cosmetic surgeons to take them off. They should be grateful for these pockets of brown fat.
Brown fat may also be found on the upper back between the shoulder blades and along the sides of the upper spine. The amount is actually so small and lie deep under the skin, so they don’t appear as bulges. Belly fat is definitely not brown fat; it’s likely white visceral fat, which is the exact opposite of brown fat. It can secrete bad hormones that can cause heart attacks and other cardiovascular problems.
Dr. Litonjua does not encourage exercising at room temperature or in a slightly cool, but not cold-enough rooms. Studies show that brown fats are activated during exercise when the room temperature is around 63° to 66° Fahrenheit. This is equivalent to 17° to 19° Centigrade. He advises his patients to wear light clothes during exercise, turn down the thermostat of the aircon and supplement it with electric fans.
In a published Swedish study, researchers—aside from maintaining the room temperature of 63°F to 66°F—also made their subjects immerse one foot in ice water for five minutes at a time, followed by five minutes out of the water. The study showed a significantly higher amount of brown fat as shown by scanning after the study, and that the added exposure to the cold ice water boosted their brown-fat activity 15-fold. The researchers hypothesized that the exposure to lower temperatures increased the activity of a gene in the body that converts white fat to brown.
The benefits of brown fat are well documented in diabetics. Lower blood sugar or glucose levels have been linked with a bigger amount of brown fat. The researchers conclude that brown fat may play a direct role in glucose control.
In a study at Joslin Diabetes Center involving experimental mice, the research team transplanted a small amount of brown fat from one group of mice into the abdomens of another group. After only eight weeks, the mice with the transplanted brown fats became leaner in weight than those in the placebo group (no transplanted brown fat), and their blood sugar levels were more normal.
Aside from regularly exercising at a room temperature of 17° to 19° Centigrade, how else can we increase our brown fat and enhance its activity? Researchers at the University of Iowa isolated a substance in apple peels, which they called ursolic acid; and this has been shown also to boost brown fat even in experimental animals given a high-fat diet.
Turning the thermostat of our aircons lower may cost us a bit more in electricity bills, but if they can reduce our medical bills due to diabetes or obesity-related diseases, we may be saving much more on the long run. So, chillax (chill and relax)!
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