The Great Cholesterol Myth (38 page)

Lipoproteins
—structures that transport fats, especially cholesterol and triglycerides, from place to place within the bloodstream.

Low-density lipoprotein (LDL)
—one of five major groups of lipoproteins that transport different types of molecules, including cholesterol, through the bloodstream. It’s popularly known as the “bad” cholesterol.

Lumbrokinase (also known as
Boluoke
)
—an extract from earthworms that lowers blood viscosity (thickness), helps thin the blood, and helps prevent clots by breaking down fibrinogen.

Macrophages
—white blood cells that devour foreign invaders such as fungi and bacteria.

Magnesium
—a mineral that helps lower high blood pressure.

Maladaptation
—faulty or inadequate adaptation; a trait that has become more harmful than helpful.

Mediterranean diet
—the general name given to diets from the Mediterranean Sea areas that emphasize fruits, vegetables, whole grains, olive oil, beans, nuts, fish, and small amounts of red meat.

Meta-analysis
—a “study of studies” that combines data from several studies that address a set of related research hypotheses; a statistical procedure for combining data from multiple studies.

Metabolic syndrome
—the name for a group of risk factors that occur together and increase the risk for coronary artery disease, stroke, and type 2 diabetes. It’s also known as prediabetes, and it’s characterized by insulin resistance, high triglycerides, abdominal fat, high blood pressure, low HDL cholesterol, and high blood sugar.

Mevalonate pathway (HMG-CoA reductase pathway)
—the biochemical pathway that produces cholesterol as well as coenzyme Q
₁₀
and other important compounds such as dolichols.

Mitochondria
—the power stations in every cell where energy is produced.

Monocytes
—a type of white blood cell that attacks bacteria or viruses.

Monounsaturated fatty acids
—fats central to the Mediterranean diet; associated with lower rates of heart disease; found in nuts and olive oil; also called omega-9s.

Myocardial infarction
—a heart attack.

Nattokinase
—an enzyme extracted from the Japanese food called natto (fermented soybeans). A natural blood thinner and clot buster (similar in effect to lumbrokinase).

Neurotransmitters
—chemicals produced mainly in the brain that transmit information; examples are serotonin, dopamine, and epinephrine.

Niacin (nicotinic acid, vitamin B
₃
)
—often used to lower LDL cholesterol and/or raise HDL.

Nuclear factor kappa B (NF-kB)
—a “smoke sensor” that detects dangerous threats, such as free radicals and infectious agents, and responds by unleashing inflammatory responses in chronic diseases. It is produced by the mevalonate pathway and inhibited by statin drugs.

Nutraceutical
—combination of the word “nutrition” and “pharmaceutical”; a supplement that provides health benefits.

Omega-3 fatty acids
—a class of polyunsaturated fatty acids that have strong anti-inflammatory properties and are important for the brain and the heart.

Omega-6 fatty acids
—a class of polyunsaturated fats found in vegetable oils. They are pro-inflammatory, especially when not balanced with enough omega-3s.

Oxidation (also known as
oxidative damage
)
—the damage to skin, organs, and arteries caused by free radicals; along with inflammation, one of the initiators of heart disease; implicated in many other diseases as well.

Oxidative stress
—the damage done to cells by free radicals of oxygen molecules; another term for oxidation or oxidative damage.

Oxytocin
—a chemical often called the “bonding” hormone that is released during breastfeeding and sex. It can elicit the urge to connect to others.

Pantethine
—biologically active form of vitamin B
₅
; often used for lowering cholesterol.

Pattern A
—desirable distribution of LDL particles in which the big, fluffy, innocuous particles predominate.

Pattern B
—undesirable distribution of LDL particles in which the small, atherogenic particles predominate.

Placebo-controlled study
—a way of testing in a scientific experiment in which one group (or more) gets the treatment or the drug and another group (the control group) gets an inert substance (placebo).

Plaque (atherosclerotic plaque)
—a deposit of fat and other substances that accumulate in the lining of arterial walls.

Platelet
—a cell-like particle in the blood that is an important part of blood clotting.

Polyphenols
—large class of plant chemicals, many of which have significant health benefits.

Polyunsaturated fatty acids
—large class of fatty acids with many members, including both the omega-3s and the omega-6s; found in vegetable oils, nuts, and fish.

Prenylated proteins
—proteins anchored to membranes.

Primary prevention
—treatment to prevent a first heart attack.

Progesterone
—an important hormone secreted by the female reproductive system.

Protein
—one of the three “macronutrients” or classes of food (the others are carbohydrates and fat).

Pterostilbene
—a chemical related to resveratrol and found in blueberries and grapes; may have significant health benefits.

Randomized study
—a study in which subjects are randomly assigned to either treatment or control groups.

Risk reduction, absolute
—the actual amount of risk reduction from taking a certain drug or eating a certain diet. For example, if 3 percent of all subjects could be expected to die over the course of a decade but only 2 percent of subjects taking a drug
actually
died over the course of the same decade, the absolute risk reduction is 1 percent.

Risk reduction, relative
—risk reduction expressed as the percent difference between expected and observed. In the above example, the difference between 3 percent expected death and 2 percent observed death would be expressed as a 33 percent reduction in
relative risk
, a much more impressive number but very misleading.

Saturated fatty acids
—a fatty acid in which there are no double bonds. Saturated fats are found primarily in animal foods and are solid at room temperature.

Secondary prevention
—treatment to prevent a subsequent heart attack in patients who have already suffered one or more heart attacks.

Selenoproteins
—a class of proteins that contain the essential mineral selenium.

Seven Countries Study
—a study by Ancel Keys purporting to show that cholesterol and fat in the diet are the prime causes of heart disease. It was later criticized for bias and poor methodology.

Squalene
—a metabolic precursor of sterols.

Statins
—a class of drugs used to lower cholesterol. Also known as HMG-reductase inhibitors.

Stress, acute
—a kind of stress that is usually short-term; it can be thrilling and exciting, like a run down a challenging ski slope, or it can be unpleasant, like anger or a headache.

Stress, chronic
—the grinding stress that wears people down day after day, year after year. It is considered a contributing factor in heart disease.

Sugar
—a sweet crystalline substance obtained from various plants, especially sugar beet and sugar cane.

Testosterone
—the major male sexual hormone belonging to the steroid family; produced in the testes of males but also produced (in smaller amounts) by females in the ovaries.

Thrombus
—a blood clot formed within the vascular system, impeding blood flow.

Tocopherols
—a class of four closely related chemical compounds that are part of the vitamin E family.

Tocotrienols
—a class of four potent antioxidants and heart-healthy nutrients that are part of the vitamin E family.

Total cholesterol
—the sum total of all “types” of cholesterol measured in the blood. Includes LDL and HDL cholesterol, as well as lesser known VLDL and IDL; given as one number on a blood test.

Trans fatty acids
—a special kind of fat formed when liquid fats are made into solid fats by the addition of hydrogen atoms; partially hydrogenated or hydrogenated vegetable oils.

Triglycerides
—main form of fat found in the body and in the diet and nearly always measured on a standard blood test; high levels increase the risk for heart disease and are a feature of metabolic syndrome.

Vasodilate
—the dilation (widening) of blood vessels from the relaxation of the muscular wall of the vessels, resulting in lowered blood pressure.

Very low-density lipoprotein (VLDL)
—one of five types of lipoproteins, packages that transport substances such as cholesterol and triglycerides throughout the bloodstream.

Voodoo death
—term coined by physiologist Walter Cannon, M.D., that refers to the phenomenon of sudden death brought on by strong emotional shock, stress, or fear.

Yudkin, John
(1910–1995)—British physiologist and scientist; pioneer researcher examining the link between sugar and degenerative disease; became internationally known for his book on sugar,
Pure, White and Deadly
.

1
. Michel de Lorgeril et al. “Mediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications after Myocardial Infarction: Final Report of the Lyon Diet Heart Study,”
Circulation 99
, no. 6 (1999): 779–85.

2
. Channing Laboratory, “History,” The Nurses’ Health Study,
www.channing.harvard.edu/nhs/?page_id=70
.

3
. Ibid.

4
. Michel de Lorgeril et al., “Mediterranean Alpha-Linolenic Acid-Rich Diet in Secondary Prevention of Coronary Heart Disease.”
The Lancet
, no. 143 (1994): 1454 –59.

5
. John Kastelein et al., “Simvastatin with or without Ezetimibe in Familial Hypercholesterolemia,”
New England Journal of Medicine
358, no. 14 (2008): 1431–43.

6
. F.B. Hu et al., “Primary Prevention of Coronary Heart Disease in Women Through Diet and Lifestyle,”
New England Journal of Medicine
343, no. 1 (2000): 16–12.

7
. Ibid.

1. Matthew Herper, “America’s Most Popular Drugs,”
Forbes
, April 19, 2011,
www.forbes.com/sites/matthewherper/2011/04/19/americas-most-popular-drugs
.

2. Daniel J. DeNoon, “The 10 Most Prescribed Drugs,”
WebMD Health News
, April 20, 2011,
www.webmd.com/news/20110420/the-10-most-prescribed-drugs
.

3
. University of Minnesota, School of Public Health, Health Revolutionary:
The Life and Work of Ancel Keys
, PDF transcript of a video documentary, 2002,
www.asph.org/movies/keys.pdf
.

4
. Ancel Keys, ed.,
Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease
(Cambridge, MA: Harvard University Press, 1980); Ancel Keys, “Coronary Heart Disease in Seven Countries,”
Circulation
41, no. 1 (1970): 1–211.

5
. Malcolm Kendrick,
About Cavemen’s Diet
, online discussion board comments posted to the website of the International Network of Cholesterol Skeptics, February 12, 2002,
www.thincs.org/discuss.cavemen.htm
.

6
. Malcolm Kendrick,
The Great Cholesterol Con
(London: John Blake, 2007), 53.

7
. Uffe Ravnskov,
Ignore the Awkward
(Seattle: CreateSpace, 2010).

8
. I.H. Page et al., “Dietary Fat and Its Relation to Heart Attacks and Strokes,”
Circulation
23 (1961): 133–36.

9
. Gary Taubes, “The Soft Science of Dietary Fat,”
Science
291, no. 5513 (2001): 2536–45.

10
. Ibid.

11
. University of Maryland, “Trans Fats 101,” University of Maryland Medical Center, last modified November 3, 2010,
www.umm.edu/features/transfats.htm
.

12
. Multiple Risk Factor Intervention Trial Research Group, “Multiple Risk Factor Intervention Trial,”
Journal of the American Medical Association
248, no. 12 (1982): 1465–77.

13
. Ibid.

14
. Mohammad Madjid et al., “Thermal Detection of Vulnerable Plaque,”
American Journal of Cardiology
90, no. 10 (2002): L36–L39.

15
. W. Castelli, “Concerning the Possibility of a Nut . . . ”
Archives of Internal Medicine
152, no. 7 (1992): 1371–72.

16
. “The Lipid Research Clinics Coronary Primary Prevention Trial Results,”
Journal of the American Medical Association
251, no. 3 (1984): 351–74.

17
. G.V. Mann, “Coronary Heart Disease—‘Doing the Wrong Things,’”
Nutrition Today
20, no. 4 (1985): 12–14.

18
. Ibid.

19
. Michael F. Oliver, “Consensus or Nonsensus Conferences on Coronary Heart Disease,”
The Lancet
325, no. 8437 (1985): 1087–89.

20
. National Institutes of Health Consensus Development Conference Statement, December 10–12, 1984.