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.


Physiologic Changes with Aging, and How You can Prevent Them

written by Johnny Nguyen


As we age, we naturally undergo many physiologic changes. The 3 changes that are relevant and significant to your health and function are:

1. Decreased muscle tissue

2. Changes at the location where nerves innervate muscles

3. Reduced oxidative capacity of muscle


The good news is that exercise slows the decay and even reverses the condition of these physiologic templates that support our long-term capacity to live a healthy and physically independent life.

Let’s briefly break them down…

Decreased Muscle Size and Contractibility

Decreased muscle tissue means that we lose body shape and the structural support that muscle provides our frame. And since muscle fibers carry contractile elements, we also lose the ability to produce sufficient forces to perform normal, daily functions.

Structural and Functional Changes Where Nerves Innervate Muscles

The junction where a nerve communicates with a muscle fiber is called a motor unit. As we age, we lose many of these motor units, leaving many muscle fibers “orphaned” and without nerve innervation. The remaining nerves, therefore, must share their innervation with orphaned muscle fibers through “collateral sprouting.” The result is that motor characteristics suffer greater variability — movement becomes shaky, less precise, and weakened.

Motor-unit changes are profound because they produce exponentially greater loss of strength than mere loss of muscle mass. Structural and functional changes in the motor units are worse news for us than mere loss of muscle tissue.

Reduced Oxidative Capacity in Skeletal Muscle

The loss of muscle and muscle function greatly reduces capillary numbers, lowering nutrient and oxygen influx and waste removal, thus compromising metabolism and the regulation of energy. Among many negative effects, this reduction leads to diminishing aerobic capacity, which is strongly associated with premature morbidity and all-cause mortality.

The good news is that this can be significantly reversed with exercise. Exercise training in older people can improve aerobic capacity by up to 125%.

But I believe in exercising, regardless of age, to create a physiologic headroom. It gives us a good functional and health reserve to age with, and a safe margin in case of unexpected illness or trauma — as those with high fitness levels also enjoy the greatest survival odds against endogenous shock and illness.

Exercise is, On Average, the True Fountain of Youth

Research shows that regular exercise of adequate intensity can reduce — or reverse — some of the most important physiologic effects of aging in the neuromuscular system. The key here is in the words “sufficient intensity.”

But I also believe that, given modern life’s restriction on time and all-day activity, the types of exercise (when we workout) become more important, because only certain kinds can facilitate the physiologic and metabolic load that he change a body that otherwise encounters too much sedentary time.


The Science & Why of Meditation

written by Holli McCormick
Reading time approximately 2-3 minutes 

Continued from What is Meditation?

“Many of us are slaves to our minds. Our own mind is our worst enemy. We try to focus, and our mind wanders off. We try to keep stress at bay, but anxiety keeps us awake at night. We try to be good to the people we love, but then we forget them and put ourselves first. And when we want to change our life, we dive into spiritual practice and expect quick results, only to lose focus after the honeymoon has worn off. We return to our state of bewilderment. We’re left feeling helpless and discouraged. It seems we all agree that training the body through exercise, diet, and relaxation is a good idea, but why don’t we think about training our minds?”

~ Sakyong Mipham
Turning the Mind into an Ally

Yesterday we discussed what meditation is not and what it is.  Today we will move on to the actual science behind the brain and then develop why meditation is a useful practice.

In our culture, we tend to be on automatic pilot, going through the motions of the day – while there are tons of voices going off in our head daily, clouding our thoughts and making us unproductive.  While we do our daily life, our mind is either shut off or hyper aware of our past guilt and shame or busy planning for the future.  Therefore, we become reactive – versus proactive – to our present environment.

If you are living in a chronic state of reactiveness (i.e. on automatic pilot), you are most likely living in the part of the brain that is responsible for the “fight or flight” response.  This is an older part of the brain and is responsible for getting the adrenaline kicking and pumping throughout the blood.  Whether it is the actual hormones or the overload of thoughts from information/stress/business, there is a phenomenon called “flooding the brain”.  When the brain is flooded – you cannot think.  When you cannot think, you cannot formulate choices.  When you cannot formulate choices, you feel trapped or controlled by outside forces – causing your stress hormones to continue to go off in a viscous cyclical cycle.  There is evidence that remaining in this state can have long-term, chronic negative effects on the body.

On the other hand, when you learn to live proactively, you are able to stay in the frontal cortex of your brain.  The frontal cortex is the more evolved part of the brain where executive – or high level – thinking can happen.  This part of the brain allows you to formulate choices for any given decision that needs to be made.  When you have choices for decisions, you have more of a sense of control.  When you have more of a sense of control, your mind is calmer.  When your mind is calmer – your body, your breathing, your heart rate, your blood pressure and your hormones will follow.

Meditation is a way to help tune your mind into your present environment – to learn to stay in the frontal cortex.  Training with meditation allows you to go from reactive to proactive in your life by learning to calm your mind.  When you train your brain, your entire body is benefiting – just like when you train your body, your mind benefits.  Therefore we can say when you train with meditation, you are reaping the physiological effects of exercise.  It is a two way street.

Like anything else, the benefits of meditation do not happen overnight; however, with practice – even with just 5-10 minutes a day – you can learn the art of focusing the mind.  When compared to physical training, meditation will help you implement clearer thinking in high stress times.  The outcome allows you to take that art of being present out into your everyday life, providing you with a sense of control.


What is Meditation?

Written by Holli McCormick
Reading time approximately 2-3 mins 

“Many of us are slaves to our minds. Our own mind is our worst enemy. We try to focus, and our mind wanders off. We try to keep stress at bay, but anxiety keeps us awake at night. We try to be good to the people we love, but then we forget them and put ourselves first. And when we want to change our life, we dive into spiritual practice and expect quick results, only to lose focus after the honeymoon has worn off. We return to our state of bewilderment. We’re left feeling helpless and discouraged. It seems we all agree that training the body through exercise, diet, and relaxation is a good idea, but why don’t we think about training our minds?”
~ Sakyong Mipham
Turning the Mind into an Ally 

Last week we here at Elementus hosted our first THRIVE: WELLNESS WORKSHOP event with P.E. for Your Mind: Introduction to Meditation. Our teacher for the evening was Fern LaRocca – a student of meditation for more than 30 years.  Fern’s gentle, non-judgmental, non-critical approach to sharing her practice with others helped us all fill at ease as we learned about this age old practice.  Here is the first glimpse of what we learned.  In the next post, couple of posts I will share the science behind meditation and then will outline some of the instructions Fern shared to help us formulate our training with meditation.

With all the buzz of yoga, spirituality and mental health these days – the word “meditation” itself can bring both good and bad thoughts to mind.  Many people have had opportunities to “practice” meditation – however due to a lack of guidance and/or instruction and the fact that meditation does not come naturally in our hyper-connected world – our attempts to try meditation might not have been fulfilling or seen as worthwhile.

Sometimes starting with what something is NOT is helpful in order to understand what it is:

  1. Meditation is NOT to necessarily relax.
  2. Meditation is NOT to make you feel all good and peaceful.
  3. Meditation is NOT an attempt to empty your mind or stop all your thoughts from happening.
  4. Meditation is NOT opening yourself up to the unknown that might be harmful for your spirit or your religion.
  5. Meditation does not have to be done for an hour+ a day to receive the benefits.

Now let me try to illuminate on what I picked up on what meditation actually is using the same number system to correlate to the above:

  1. Meditation is a PRACTICE of keeping the brain focused on the PRESENT moment.  We performed our practice sessions with eyes open, most of us sitting while also acknowledging the sounds from the street and parking lot outside – recognizing that our days are full of similar noises and distractions.
  2. Meditation is an attempt to take your feelings and honor them…not to make them into anything but what they are: feelings of how you are doing in this present moment.
  3. Meditation is an attempt to simply recognize your thoughts as thoughts: they are neither good nor bad, right nor wrong.
  4. Meditation is an attempt to tune into your own inner world with the goal of taking that mindfulness/”presentness” practice out into your real life experiences, giving you room to expand on your practices within your own spirituality or religion.
  5. Meditation, like the science has found with exercise, can be practiced in smaller, regular amounts with great benefits.

Continued with the Science and Why of Meditation

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