I think this argument need to be refined. Many people are saying things which they don't understand or heard second-hand from someone else. We know that the most recent "meta-study" conducted by Frank Hu did not "link" saturated fat to cardiovascular disease (CVD). http://www.ajcn.org/content/early/2010/01/13/ajcn.2009.27725.abstract I believe the proper word here is "association": CVD was not found to be meaningfully "associated" with saturated fat.
Now, the absence of association does not mean that saturated fat is innocuous. For example, there could be too much "noise" in the variables examined, resulting in less than meaningful relationships. Or saturated fat might be secondary to something else more closely linked to CVD. I actually think this is what Loren Cordain and others proponents of the lipid theory believe.
In other words, saturated fat leads to atherosclerosis. However, since CVD is a complex disease, atherosclerosis does not always result in a cardiac event. The buzzword today is indeed "inflammation", and Cordain has modified his stance to embrace this new paradigm: the catalyst for most cardiac events seems to be "inflammation", not the existence or build-up of plaques in your arteries.
Ok, so far so good. But what about the role of saturated fat in inducing atherosclerosis? The vegan and vegetarian argument is that it's directly atherosclerotic: you can't have plaque build-up if you're on a strict vegan or vegetarian diet. The inflammation paradigm, in other words, is only relevant if you are an omnivore. A strict vegan may have to supplement what he can't get from a plant-based diet, but he will not have atherosclerosis. And those consuming lean meats will have less plaques than those who consume saturated fat with abandon.
At least, this seems to be the argument against saturated fat. Cordain seems to believe this as well. Why burden yourself with plaques if you can largely avoid them by eating lean cuts? Or, if you wanna go vegan, why eat animals at all? There are several arguments from the vegetarian perspective:
During the Korean and Vietnam Wars, for example, it was found that the dead Korean and Vietnamese soldiers (presumably on a plant-heavy diet) rarely had atherosclerosis (1-3%). However, when autopsies were done on our GIs, 80% had "gross evidence of atherosclerosis" -- heart disease that you could see without a microscope. These dead soldiers' average age was only 20. [Cited by Drs. Caldwell Esselstyn and Kirk Hamilton] http://www.prescription2000.com/Interview-Transcripts/2009-09-02-caldwell-b-esselstyn-transcripts.html. That was 50 years ago, so imagine what the arteries of an average 20 year old GI would look like now.
Nathan Pritikin, when he died, had an autopsy done. Pritikin had quite a following in espousing a low-fat, mostly vegetarian diet (later, he incorporated omega-3 fats). His autopsy showed that his coronary arteries were "totally clear of atherosclerosis": no plaque whatsoever. (Published in the New England Journal of Medicine, July 4, 1985;52) http://www.nejm.org/doi/full/10.1056/NEJM198507043130119
Autopsy results of Greenland Inuits, who basically ate marine mammals and fish, showed atherosclerosis, according to Cordain. However, they did not suffer heart attacks. The reason is that saturated fat is probably not immediately precipitating when you follow a Paleo type anti-inflammatory diet, where Omega 6 to 3 ratios are in balance, trans fats, gluten grains and starchy foods are taken out. But if you're eating a standard American diet (SAD) that's inflammatory, then saturated fat isn't just atherosclerotic; it could kill you. http://www.thelivinlowcarbshow.com/shownotes/3728/paleo-week-guest-2-dr-loren-cordain-episode-449/ [Listen 18:40-22:00]
So what exactly is the "saturated fat is harmless" argument?
It's harmless because practically all omnivores are atherosclerotic more or less and inflammation is the "cap event"? So we should focus on reducing inflammation instead: lower CRP, Sed Rate, Ferritin, and liver enzymes by avoiding processed and refined carbs and sugar?
Or is it actually that saturated fat is NOT in fact atherosclerotic?
Drs. Cordain, Lustig, and other lipid theory adherents seem to believe in #1 They've chosen to bite their tongues because inflammation seems to be the straw that breaks the camel's back. Not that saturated fat does not lead to plaque formation or is totally harmless. It might, indeed, be a precondition for the "break," especially if you believe the vegan argument that without atherosclerosis, you're not likely to have coronary artery disease.
What do you guys think about this summary? Is saturated fat really totally harmless? Or is it more like, yes but ...... How strong, then, is the Paleo argument against saturated fat and atherosclerosis?