Good Calories, Bad Calories

^*41 A triglyceride molecule is composed of three fatty acids—hence, the “tri”—linked together by a glycerol molecule.

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^*42 To be precise, Gofman’s Science paper identified IDL—i.e., intermediate-density lipoproteins—as the class associated with heart disease. He would later decide that LDL was more important than IDL. For the sake of simplicity, I’ve used LDL throughout.

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^*43 One notable case was Theodore Cooper, who was assistant secretary for health in 1976, when he testified about “diet and killer diseases” to the Senate Select Committee on Nutrition and Human Needs. Cooper said that his personal dietary concern was with carbohydrates rather than fats. “If I have a problem, it is a tendency to gain weight,” Cooper explained. “I am classified Type IV. As a Type IV, my lipid levels are much more subject to elevation if I consume large amounts of carbohydrates or alcohol.”

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^*44 This was not because the NIH had any interest in testing the HDL/heart-disease relationship, according to Gordon, but only because Fredrickson, Levy, and Lees’s new measurement technique required that the amount of cholesterol in HDL be known so that the amount in LDL could be calculated.

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^*45 In 2003, for instance, the National Cholesterol Education Program described the shift in emphasis from total cholesterol to LDL cholesterol this way: “Many earlier studies measured only serum total cholesterol, although most of total cholesterol is contained in LDL. Thus, the robust relationship between total cholesterol and [coronary heart disease] found in epidemiological studies strongly implies that an elevated LDL is a powerful risk factor [my italics].”

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^†46 In the technique described by Fredrickson, Levy, and Lees, LDL cholesterol is not measured directly but calculated from the measurements of triglycerides, HDL cholesterol, and total cholesterol.

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^*47 Those that did mention the effect of carbohydrates on HDL cholesterol rejected the relevance to heart disease, on the basis, as the American Heart Association explained, “that epidemiological studies have demonstrated an inverse relation between carbohydrate consumption and risk for CHD.”

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^*48 The nutritional constituents of such a piece of relatively fatty meat can be found in the Nutrient Database for Standard Reference at the USDA Web site, along with those of thousands of other foods.

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^*49 To be precise, Krauss says, he rediscovered this heterogeneity of LDL: Waldo Fisher of the University of Florida, and Verne Schumaker of the University of California, Los Angeles, had discovered it independently a decade earlier, but had not pursued it further.

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^*50 This suggests that saturated fat elevates LDL-cholesterol levels in part by increasing the amount of cholesterol in the LDL, and so making larger and fluffier LDL to begin with, rather than by increasing the number of LDL particles or by increasing the number of small, dense LDL particles.

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^*51 What used to be known as juvenile-onset diabetes, which is characterized by an insulin deficit, is referred to as Type 1 or insulin-dependent diabetes mellitus, IDDM. The less severe form, which is characterized by insulin resistance rather than a lack of insulin, used to be called adult-onset diabetes. It is now called Type 2 or non-insulin-dependent diabetes mellitus or NIDDM. This is the terminology that I’ll now use as well.

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^*52 Named after Frederick Banting, the co-discoverer of insulin, a distant relative of William Banting, of corpulence notoriety.

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^*53 The reports do acknowledge, as the AHA-NIH-ADA conference report put it, that “very high-carbohydrate diets may accentuate atherogenic dyslipidemia”—i.e., small, dense LDL, high triglycerides, and low HDL—but then it recommends a high-carbohydrate, low-saturated-fat diet as the treatment.

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^*54 Ralph DeFronzo, on the other hand, believes that sufficient studies have confirmed Stout’s observations and that insulin itself should thus be considered an “atherogenic hormone.”

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^*55 This hypothesis cannot, however, explain why atherosclerosis among diabetics has remained relatively impervious to the otherwise beneficial effects of insulin therapy to control blood sugar.

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^*56 Those in Cerami’s laboratory at Rockefeller University and the researchers who trained with him get credit for much of the AGE work that followed.

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^*57 There’s also evidence that HDL molecules can become glycated, inhibiting their function and “rendering the HDL more pro-atherogenic.”

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^*58 For this reason, fructose is referred to as the most lipogenic carbohydrate. Credit for this observation dates to 1916, to Harold Higgins of the Nutrition Laboratory of the Carnegie Institution.

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