Exercise and Cholesterol Subfractions: What You Should Know

Written by Johnny Nguyen


Most of us know that LDL cholesterol is the “bad” kind and that HDL is the good kind, but this conventional focus on only these cholesterol categories is incomplete and can often be misleading (1).

Cholesterol molecules are carried by different lipoproteins. The American Diabetes Association and the American College of Cardiology endorse assessment of these lipoproteins for superior prediction of cardiovascular disease. For example, apo-B (apolipoprotein-B), a primary lipoprotein in LDL cholesterol, is a much stronger predictor of cardiovascular risk than LDL level or total cholesterols (2).

ApoA-1 (apolipoprotein A-1), on the other hand, is a major lipoprotein in the good cholesterol HDL. It’s the beneficial “roto-rooter” for your arteries. ApoA-1 promotes efflux of fat and cholesterol out of the arterial walls and to the liver for excretion — a sort of “fat remover.”*

So looking solely at LDL or HDL doesn’t tell the entire story; it’s important to have a blood test that breaks down the subfractions of these cholesterols. And among the important things you want to know is the ratio of apoB/apoA-1.

Why is it important to know the ratios of these subfractions? Because a major study published in Lancet shows that apoB/apoA-1 ratio is the strongest among ALL modifiable predictors for myocardial infarction, or heart attacks (3).

Another reason to know: your LDL doesn’t reflect the actual ratios of these subfractions. In other words, you can have seemingly great LDL cholesterols but your apoB/apoA-1 can be darn bad, and you’re one step away from a fatal heart attack. Or, you can have higher “bad” LDL but great apoB/apoA-1 ratios and be healthy (4).

You can decrease total apoB level and lower the ratio of apoB/apoA-1, yet not change your LDL number. That’s why LDL alone doesn’t tell the story. You should get a more thorough assay to know more about your heart health. (See below for some resources.)

And, you guessed it, these positive changes can be accomplished (along with nutrition) through exercise:

  • An inverse association exists between exercise and apoB/apoA-1 ratio (Simonsson M, 2007). More exercise = improved ratio.
  • Exercise also lowers total amount of harmful apoB (O’Donovan G, 2005). Exercise lowers this subfraction independent of others.
  • Higher levels of beneficial apoA-1 is associated with endurance exercise (Olchawa B, 2004).
  • ApoB/apoA-1 ratio is seen to improve significantly with fitness improvement in one year (Holme I, 2007). In sedentary men who started exercising and become fit, their subfraction ratio improves within one year.


There are many important markers of health to measure and know, but the point of this article is to encourage you to care more about numbers beyond the conventional HDL and LDL. Here are some resources, if you’re interested in a thorough analysis of your cholesterols and other cardiometabolic factors. These services can give you vital data that may be useful to your own doctor, as well as to your trainer who ought to know how to structure or modify an exercise program as a result:

www.wellnessfx.com   and/or   www.bhlinc.com

* When there’s damage to arterial walls (and we inevitably experience this damage at varying degrees through food choices, stress and disease), white blood cells move in for healing. White blood cells can become “fat-overload” and transform into foam cells, die, and contribute to artheroma (arterial plaque). So removing or minimizing low density cholesterols such as apo-B is one factor to lowering cardiovascular risk. There are other factors, of course, but this post focuses on cholesterol subfractions.


1.  Genest J Jr, McNamara JR, Ordovas JM, Jenner JL, Silberman SR, Anderson KM, Wilson PW, Salem DN, Schaefer EJ. Lipoprotein cholesterol, apolipoprotein A-I and B and lipoprotein (a) abnormalities in men with premature coronary artery disease. J Am Coll Cardiol. 1992; 19: 792–802.

2.  Brunzell JD, Davidson M, Furberg CD, Goldberg RB, Howard BV, Stein JH, Witztum JL. Lipoprotein management in patients with cardiometabolic risk: consensus conference report from the American Diabetes Association and the American College of Cardiology Foundation. J Am Coll Cardiol. 2008; 51: 1512–1524.

3.  Yusuf S., et al. The Effect of potentially modifiable risk factors associated with myocardial infraction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937-952.

4.  Holme I., et al., ApoB but not LDL-cholesterol is reduced by exercise training in overweight healthy men. Results from 1-year randomized Oslo Diet and Exercise Study. J Intern Med. 2007;262(2):235-243.


Be Mindful – Be Present

written by Holli McCormick

Okay – who hasn’t done the mindless eating? The clock clicks 12, you are sitting at your desk and you think you are hungry so you start moving towards the food. Or you are rushing to get the kids to their next event, stopping by In & Out to fill the tummies and shoving down the food within 10 minutes before arriving. Or you are watching TV late at night, feel the rumble some where down south and head for the cabinets where you grab a box of goodies and resume your zoning out while stuffing your face.

Just so you know you are not alone – we have all done these and more. Even Personal Trainers and Fitness Experts can do our fair share of mindless, unnecessary eating that takes its toll on our bottom line. So if even the experts do it, how can the non-experts avoid it? How can you become more mindful?

The great news is, you can have control over your eating patterns and behaviors and not let them control you.

In fact, I want you to take a moment to stop, go back and re-read that last sentence. Now say it again out loud. (I ask you to do this because your subconscious where most of our behaviors are stored cannot hear your conscious mind read. It can only hear your voice – so saying this sentence out loud allows, many times a day if needed, allows you to start reprogramming your behaviors in positive measures.)

Now that you have the first step down as you move towards mindful eating…let’s define what mindfulness is and why it is important.


1) “Mindfulness is awareness without judgement or criticism.”*

2) Mindfulness is taking the time – after you have determined the need for eating – to slow down to enjoy and chew your food properly while being thankful for the meal.  The science shows that digestion starts in the mouth with tons of digestive enzymes being excreted through the saliva.  Slow, meaningful chewing warms up the tummy, gets the digestive juices flowing and ready to receive the food.  Properly chewed food allows the rest of the digestive system to work more efficiently and effectively.  A pleasant mind allows the stomach and gut room to do their work.  Being “tied up in knots” from anxiety, worry, depression literally can kill the ability of your gut to do it’s job.

Why is this important? The mind is where everything starts…even our automatic behavior patterns we do not have to think of (again stored in the subconscious).  Bringing awareness by engaging our mind, by becoming present in our own bodies in this moment and time – we tackle the largest part of learning how to eventually modify our behaviors.  We do not have to be on automatic pilot; we can slow down, analyze why we do the things we do and change the things we want to change.  By tuning into your mind, you will be able to tune into your body and feel/sense/understand what your body really needs vs. what your mind wants.

How do I do this? As I mentioned in day 1 of this series, simply by stopping and asking yourself questions will help you tune into your body and figure out if now is the time to eat or not.  By asking yourself questions you will be able to decipher whether or not you are truly hungry and need food or if you are simply eating out of routine, or out of a desire to treat yourself or find pleasure, or if it is a way to soothe your stirred up emotional state.

Here is a list of questions you can start using in order to be mindful, to be present and in tune with your body:

  • Am I really hungry right now?  What will happen to me if I ignore the gurgling and those hunger pains for another 5 minutes?  
    Our bodies are suburb at storing food as fat for times of starvation…thus I bet most of us in modern America can skip or hold off eating without harmful effects.  If you don’t immediately feed the “tiger”, your body will find the energy it needs where it is stored.  Waiting another 5-10 minutes simply will allow you to decide if you are truly hungry or if your body is simply used to eating at that point in time and thus is waiting for you to feed it.  Just because the “tiger” is gurgling doesn’t mean you need food.
  • What happened right before I felt myself start to reach for food?  What event just occurred?   How did it make me feel?  What was I thinking when this event happened?  
    These questions will help you put events together with how you feel and with what thoughts actually triggered those feelings.  We often do not have control over our feelings…however WE DO HAVE CONTROL over our thoughts.  When you start to lean into your feelings and back them up to your thoughts that produced those feelings, you can start to change those thoughts and thus your feelings and thus your behaviors.  I will elaborate on this at a later time.
  • Can I eat a smaller amount than I think I actually need then wait 10 minutes before going back for more?
    All about portion control…see our post from the 1st day.

Lastly, I would encourage you to change your internal dialog around the word “failure”.  Instead of seeing any time you mess up as a failure…reword it – and yes out loud -as a “LEARNING OPPORTUNITY“.  Give yourself grace or room when you do not get this or any new behavior perfect.  None of us are perfect, and when we are learning a new behavior we have to give ourselves permission to mess up, to get it wrong…but know that we are works in progress and will keep trying to move forward, learning what we can from our “mess up.”

If you would like to learn more about how to be mindful in all aspects of your life, do not hesitate to contact Elementus.  We are here to work collaboratively with you in formulating a plan on how to modify your life and all the different elements that make you…you.

* Found this great article where there are actually tools – what she calls homework – to help you become a mindful eater.  http://www.psychologytoday.com/blog/mindful-eating/200902/mindful-eating

Portion Control: Don’t Supersize Me

written by Holli McCormick

The first stop on our 10 ways to control your weight is: Portion Control!

When the researchers who started the NWCR, they found that portion control was the #1 way people lost weight but more importantly – kept it off.  Portions have been increasing over the last 20 years – as indicative of many fast food restaurants who want you to “Super Size” your order – giving them more money and you more calories.  Here is a fun link to test your knowledge on portion size.

In order to help you figure out what portions you do need and of what, there is a new “food pyramid” in town found at ChooseMyPlate.gov.  Here is a link to a great article to give you more tips on how to establish your portion sizes as well as maintain them.  “Decrease Portion Sizes

If you want my take, here are the things I have learned over the years to keep this easy:

1) Ask yourself, “Am I hungry right now?”  A lot of times we start moving towards food as an automatic action based on our emotions or just the time of day.  Deciding whether or not you actually need food is a good first step.

2) Start with the vegetables. Instead of leaving salads and vegetables to the end, start off with them…and as many as you want.  If you start filling up on veggies, you are less likely to eat as many calories from the other foods we tend to over eat …so go ahead and get your veggies on!  (NOTE: This does NOT work for fruit since there is sugar – and sometimes lots – in fruit.  Sugar is sugar.)

3) Take LESS than what you think you need & play the waiting game. Once you get to the other parts of your meal, start off with just a little less than what you would normally take.  If you normally eat a full sandwich, cut it in half and bag it for tomorrow.  At a restaurant, ask the waiter to put half of your meal in a to-go box even before it comes out.  Once you have eaten your smaller portion, set a time to wait before you go back for more.  Often times, it takes a few minutes up to a half hour before our tummies register that they have had enough.  I find that if I continue to ASK myself – and yes even out loud – if I really need more, I will be able to answer no.

4) Cut the carbs in half!  Eat only half of the hamburger bun, half of the sandwich, half of the amount of rice and bean you are given….you get the idea.  The body LOVES carbs as its primary energy source.  However, when we have consumed enough calories for the body to run, the rest get stored…as fat.  The other interesting note on carbs, the more you eat the better it gets at storing them…again as fat.  Our bodies are better able to break down protein and fat than they are the excess amounts of carbs and sugars we generally eat.

If you have more questions about portion control or how to help modify your eating behaviors – feel free to contact us here at Elementus.


Series: 10 Ways to Control Your Weight

written by Holli McCormick

Do you believe that making changes are possible?  What type of behavioral changes do you need to make to affect change?   What type of psychological characteristics facilitate change?  Lastly, do those changes last, forming new habits that become “automatic” as part of your life?

The doctors have boiled down the research to some important results for the rest of us.  I will be sharing all 10 here and then will tackle each one, giving more information and tips, in an individual post over the next couple of weeks.  Without further ado:These and other questions are what Dr. Rena Wing and Dr. James Hill set out to answer by starting the National Weight Control Registry (www.nwcr.ws).  Many believe that successful weight loss maintenance is something few of us can fully embrace.  In order to disprove this myth, the registry was started in order to capture and evaluate the behavioral and psychological characteristics of those that maintain weight loss.   The Doctors began the registry in 1994 which has expanded to over 10,000 individuals who have lost significant amounts of weight and kept it off for a significant amount of time.

  1. Control Portions
  2. Be Mindful
  3. Exercise
  4. Check the Scale
  5. Eat Breakfast
  6. Monitor Intake
  7. Turn off the tube
  8. Start today and avoid cheating yourself
  9. Know thy friend
  10. Be Optimistic

Stay tuned for your daily dose of encouragement on the road to improved wellness!

Scar Tissue: When a Solution Becomes a Problem by Ruth Werner

This interesting article comes to us from the magazine “Massage & Body Work” (July/Aug 2012 publication).  The article gives a slightly technical look at what scar tissue is, what it is meant to do, how it differs from collagen…and when a good and vital aspect of our body design turns into a problem.  Our own Daniel Villeda – new to our staff – specializes in the massage and is knowledgeable in this field if you would like to contact him with questions.

Dr. Daniel Villeda


Please click the link to read the full article:  Scar Tissue: When a Solution Becomes a Problem