18

votes

CVD, Saturated Fat, and Atherosclerosis: What is the Paleo Argument?

Answered on September 12, 2014
Created August 02, 2011 at 2:24 AM

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?

  1. 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?

  2. 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?

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 04, 2011
at 06:02 AM

"it is just that most paleos don't have very high LDL, just higher than statin companies would approve of, and their HDL is good." I'll let this statement stand by itself. I don't need to say anything.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 04, 2011
at 05:50 AM

Oxidized LDL tends to correlate with the whole metabolic syndrome and arterial damage/inflammation, though. So if you get a big correlation between oxLDL and severity of atherosclerosis, it might be more due to inflammation and arterial damage than the oxLDL itself, which might only cause some minor lesions. With regards to vitamin c, high dose vitamin c doesn't prevent heart disease, but high vegetables, fruit and spices do. Good quality vitamin E definitely does. Carnivores are probably adapted to a low antioxidant diet, though, and can get by with what they synthesize.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 04, 2011
at 05:47 AM

Plenty of rodents suffer from atherosclerosis if you give them bad diets. However if carnivores don't then that says a lot. I think the literature is pretty clear that antioxidants prevent atherosclerosis and oxLDL is a big risk factor. I guess the question becomes "what kind of combination of protection and LDL level is safe and which will produce too much oxLDL? I do think that when LDL gets way up there it is a risk factor, it is just that most paleos don't have very high LDL, just higher than statin companies would approve of, and their HDL is good.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 04, 2011
at 05:46 AM

It's also possible that the current RDA for Vit C is just too low. And the ice age environment when plaques and fast storage genes ("thrifty genes") would have helped humans survive has fast disappeared. So, coupled with stalled natural selection (modern medicine, interventions, etc.), global warming, and plentiful food supplies everywhere, atherosclerosis could be more or less an inevitable part of aging.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 04, 2011
at 05:35 AM

This seems plausible because, to borrow Stabby's post, only humans and apes suffer from CVD and these 2 are the only ones incapable of self-creating Vit C. You can feed satruated fat all you want to dogs (carnivores, so maybe that's understandable) and pigs (omnivores) but they won't drop dead from a heart attack. And Vit C deficiency could be a proxy for a SF-heavy diet, when little veggies are eaten. If Vit C indeed is the cause, then dogs and pigs should have totally clear arteries, no plaque whatsoever, just like the Koreans, Vietnamese and Pritikin.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 04, 2011
at 05:00 AM

If you took the stance of "saturated fat kinda sorta might result in a few minor lesions that don't progress to anything in all cases" approach I might, might get behind some of the reasoning with some more hard evidence. The "butter-eaters are one infection away from a massive heart attack no matter what" stance doesn't seem particularly tenable. When you control for antioxidants there isn't much difference in LDL oxidation lagtime between mono and sat fats, and high mono diets can be non-atherogenic. Add some more antioxidants and keep the arteries and immune system healthy and decrease athe

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 04, 2011
at 04:55 AM

Let's not conclude that his diet had nothing to do with his suicide either. Brains need cholesterol. http://www.psychologytoday.com/blog/evolutionary-psychiatry/201103/low-cholesterol-and-suicide These things usually have multiple causes. Knowing you're going to die influences depression, and having low cholesterol probably influences depression. And cancer usually causes low cholesterol, which is another thing to consider, cancer powerfully upregulates the LDL receptor. Is a cancer patient really a good example for an atherosclerosis argument?

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 04, 2011
at 02:34 AM

That's another possibility here. The Egyptian nobility supposedly ate a meat-heavy diet and it's just possible that they may have neglected Vitamin C. It's possible that Linus Pauling is right that Vit C deficiency is the real cause of atherosclerosis. The "calcification" or the stiffening of the arteries that give rise to atherosclerosis could be due to Vit C deficiency. This could explain the autopsy results of plaques within Inuits and their absence in vegetarians (the Koreans, Vietnamese, and Pritikin) who presumably consumed sufficient Vit C through fruit and veggies.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 04, 2011
at 02:20 AM

That's pretty much what Cordain says. But like others point out, it's like walking on a knife's edge because inflammation can arise unawares form non-dietary sources. So even if you're eating Paleo, you could have inflammatory episodes due to infections, autoimmune attacks, common colds, etc. Then what? Perhaps accept Cordain's suggestion and eat only lean meats?

6120c989fd5b69f42a0834b69b87955b

(24553)

on August 04, 2011
at 01:19 AM

The original article seems to be pretty dismissive of grain, salt, alcohol, and sugar as possibly adding the atherosclerosis. It was pretty much just an observational study with nutritional CW for the backdrop, so of course SFA would be the bogeyman. Not saying it isn't, just that they didn't consider all of the variables. As far as the arteriosclerosis goes, I tend to think of that as being related to something going awry with the channels of elimination in the body to let the calcium build up. Were they chronically dehydrated? What were the ratios of their electrolytes?

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 11:00 PM

You don't have to worry about my arteries, my inflammation is very low so my saturated fat-eater plaque probably won't rapture and kill me. Thank you for the concern.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 10:58 PM

How on earth can you predict where the next infection will be, which will trigger body's inflammatory reaction? Angioplasties and bypasses are futile. To have a chance, you might as well do the procedure for every coronary artery, every artery that leads to the brain to avoid strokes, etc. So forget atherosclerosis. Be smart. Focus on lowering inflammation.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 10:56 PM

And that hunter-gatherers eating a meat-based diet don't have atherosclerosis because they don't eat a lot of saturated fat but the Inuit, who are hunter-gatherers who eat a meat-based diet, have atherosclerosis because they eat a lot of saturated fat, is completely contradictory.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 10:55 PM

Those who want to believe will interpret the evidence any which way they choose.I don't even know why anybody is looking at mummies and Inuit frozen ladies when there are plausible explanations from wheat and oxidized PUFAs. I would rather take the skeptical stance, not the one that affirms the consequent. Cordain says that hunter-gatherers don't have atherosclerosis due to less palmitic acid, but it could easily be lack of junk, including wheat and other nasty grains, and it could have been all of the antioxidants. All of these purported bits of a evidence have another interpretation.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 10:49 PM

The current thinking is that thrombosis is random and initiated by inflammation. It accounts for 80% of CVD deaths. This is more dangerous than stenosis, which results from uninterrupted progression of atherosclerosis. Inflammation figures in both. But by focusing exclusively on atherosclerosis, you lose sight of the real killer. Btw, this explains why coronary bypasses do not lower the risk of CVD death. It's not atherosclerosis but where the next clot will take place, which is impossible to predict. We're talking about the locus of inflammation. That's the reasoning here.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 10:41 PM

I'm not entirely sure, but I tend to agree w/Cordain. There is a prepondenrance of evidence in medical journals and anecdotal / random autopsy findings of atherosclerosis among hunter-gatherers vs. vegetarians. Atherosclerosis seems to be a rather widespread, if somewhat unavoidable, phenomenon for omnivores. Its danger is mitigated by events that are a lot more dangerous: thrombosis triggered by inflammation. See my post below.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 10:37 PM

But like I said before, atherosclerosis does not equal cardiac events; inflammation will decide that. Your position is SFA is not atherogenic. That's not what Cordain believes.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 10:34 PM

Your last cite beautifully captures Cordain's position. Hunter-gatherers did not get CVD because of their "qualitative differences in fat intake ... relatively high levels of MUFA and PUFA." That is, lower SFA than unsaturated FA. Do you see this here? (U should be able to infer his reasoning from what Cordain deliberately left out here.) This also shows Cordain to be an adherent of the lipid theory: he think lipd #s are important. Cordain believes SFA to be atherogenic. This is an inference but I have him on record saying pemmicans are atherogenic.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 08:15 PM

Therefore, inflammation is more lethal than "mere" atherosclerosis. But inflammation is also implicated in the pathogenesis of atherosclerosis. So we can fully understand here the evolution in thinking of someone like Cordain: it seems a pretty sophisticated positioning and he's not really being inconsistent.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 08:12 PM

This is similar to Paul Jaminet's belief that all diseases, including CVD, start with habitual infections. It is true that this infection-started inflammation model does not seem to specifically implicate SFA. As the Egyptian mummies showed, there is still a lot we don't know: only recently did we find out that cardiac deaths result mostly from "breaking the cap" (thrombosis), not stenosis (estimated at only 20%), which is the natural progression of atherosclerosis. Hence, the deemphasis of atherosclerosis in favor of inflammation.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:52 AM

Actually he also said that low carb and high protein work to reduce LDL http://www.mendeley.com/research/the-paradoxical-nature-of-huntergatherer-diets-meatbased-yet-nonatherogenic/ but apparently that doesn't apply to the Inuit, because, well...?

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:42 AM

d, but muscle meat isn't an adequate representation of the entire fat of the animal. There is a ton of saturated fat in brains, and plenty of other fat on the inside. Clearly if palmitic acid=atherosclerosis whole carcass meat-eaters should have some. After all Cordain says that the Inuit had atherosclerosis because they were eating grass-fed animals, but his paper says otherwise. Which is it?

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:40 AM

Do you personally think that palmitic acid = plaque, or the higher the LDL the more plaque or lesions no matter what else is going on? That it is just A=B and it is inherently atherogenic? We are on paleohacks after all, not cheerioshacks, so like I mentioned in the post, it makes the most sense to look at your personal situation when judging what you are going to do. Do you know that Cordain has a paper something along the lines of Hunter-gatherer Diets Meat-based But Not Atherogenic? Something like that. And then he says that grass-fed meat doesn't tend to raise LDL or have much palmitic aci

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:34 AM

And why if Cordain thinks that saturated fat + SAD is bad but SF + paleo is benign but still causes atherosclerotic lesions, but based his conclusion (presumably) on SAD data, doesn't he consider the possibility that SF + a paleo diet doesn't produce atherosclerosis? I mean all evidence points to various components of the paleo diet being anti-atherosclerotic, so why not consider that? Is it because then he wouldn't get to implicate saturated fat at all anymore, but it would still read in his first book they it should be avoided?

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:22 AM

Do you know of any specifically on atherosclerosis that aren't intervention trials?

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:20 AM

As for Hu, there isn't one study cited in the intro that isn't an intervention trial, which as you mentioned has massive limitations. As Stephan G points out here http://wholehealthsource.blogspot.com/2010/03/leave-your-brain-at-door.html, interventions like with Finnish mental hospital one have many confounding factors Citing those women isn't a cherry-pick because it is the only study of its kind.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:14 AM

I didn't post number 2 and 3 with the intention of using them to support my position, obviously. I commented on number 2 saying that the whole vegan conclusion doesn't follow from palmitic acid being bad because meat has a ton of the fats that are inversely associated. And when I commented on number 3 I was commenting on why I don't think that epidemiology is a good source of evidence in North America. Did they control for the tendency to eat at fast food restaurants? No they didn't, so how can we use them when the health-consciousness effect is so strong>

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 04:04 AM

But I also realize the limitatiosn of these studies and statiscal relatioships. That's why I agree w/Hu that it's unclear. However, there are studies which implicate SFA in association w/atherosclerosis, the 2 you cited among them. Indeed atherosclerosis was found to be associated more with SFA than with MUFA or even PUFA, only your fist cite (and 1 other study) being the exception. You gotta read these thangs carefully.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 03:54 AM

Your cites do not support the position that SFA is harmless or non-atherosclerotic. In fact, they found strong enough association between SFA and atherosclerosis in 2 of the 3 studies. I already commented why your 1st study is a cherry pick, since Dr. Who (Hu?) points that out as an aberration.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 03:52 AM

Stabby, Cordain changed his position to accommodate the new, emerging paradigm. I think he's flexible and is to be admired for doing that. He thinks SFA in a SAD is lethal; in a Paleo type of anti-inflammatory diet, SFA is secondary to more significant risk factors. You may have plaques, but they probably won't rupture. Member, he still eats lean meats.

B0454de6d4f4cdd9ca2e59021dc105bf

(606)

on August 03, 2011
at 01:37 AM

Interesting that you raised the possible role of viral infection. It's certainly possible that viruses could be influencing cellular processes at a subclinical level. The article you linked to mentions vaccination for induction of protective immunity. Could be a big money earner for BigPharma 10-20 years from now.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 02, 2011
at 11:14 PM

And I supplied the study with women and progression because we were talking about atherosclerosis, and progression is related to atherosclerosis and a pretty big deal.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 02, 2011
at 11:07 PM

The claim that "saturated fat is atherogenic" is nonsensical, not because I find it inconceivable that it could be worse than monounsaturated fat for constructing resilient liproteins (although olive oil antioxidants confounds things so I don't know) but because tons of things influence propensity to oxidize. It might result in more oxidized LDL in some situations but not others, or it might not at all compared with other macronutrients.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 02, 2011
at 11:04 PM

How is this good reasoning? Atherosclerosis is a huge factor in CHD, but saturated fat, which causes atherosclerosis, doesn't cause CHD? Zuh? Something is up. Once upon a time Loren Cordain made some baseless assertions and then proceeded to defend his academic ego with abysmal logic. Let's go look for some LDL oxidiation studies that control for antioxidant intake and degradation of the fat. I doubt there are any but that is what you want. I can't find any studies that don't use olive oil to compare with butter/lard or whatever. Olive oil has the antioxidants, but you could eat spices w SF.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 02, 2011
at 10:47 PM

The 2nd one showed that monounsaturated fat and stearic acid were inversely associated. Those consitute the majority of fat in grass fed meat and that is . I don't see how you can say that two of my cites support your hypothesis because the first and second don't, and the 3rd one is correlative epidemiology in the land of low fat snack cakes, so that isn't good evidence, I just thought I would share it. How about posting actual evidence? I understand what you're saying, you just aren't providing actual empirical evidence. Burden of proof is squarely on you to supply actual evidence.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 10:36 PM

Notice that Frank Hu's conclusion of non-association was between SFA and cardiac events (heart attacks, strokes, cardiac events, many of them fatal). His conclusion does not extend to the presence or absence of atherosclerosis.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 10:30 PM

In other words, SFA seems to be athersclerotic. Cordain agrees with this. So does Lustig. I also believe this to be true. That doesn't mean SFA ==> Myocardial infarction. No, there are several more intervening preconditions. But my point was only regarding SFA in inducing possible atherosclerosis.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 10:28 PM

None of these are animal studies, so I don't see where you data are from. But 2 of 3 cites basically support the association between SFA and atherosclerosis. Quote: "Higher habitual intakes of saturated [and trans fats] are independently associated with increased atherosclerosis after age, sex, total energy intake, physical activity, ethnicity, waist-to-hip ratio, smoking, alcohol intake, and height were accounted for."

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 10:24 PM

Your 3rd cite actually found that SFA and trans fats are associated with atherosclerosis, but that alcohol might muffle this association. This explains the French paradox. So if you're eating SFA, might as well down some French dry wine while at it. But we're talking about artery thickening here, not actual cardiac event.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 10:13 PM

Your second cite is largely irrelevant - it's a 1996 study linking MUFA w/less artery thickening, if saturated fat was replaced by MUFA. So how does this show SFA to be not atherosclerotic?

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 10:00 PM

But the main issue here is not atherosclerotic progression but the pathegenesis of atherosclerosis. I think even Cordain and most lipid theory proponents believe that processed carbs and sugar play a major role in the progression.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 09:58 PM

Read the introduction in Frank Hu's study [ http://www.ajcn.org/content/early/2010/01/13/ajcn.2009.27725.abstract ] where he specifically cites your first publication [ ncbi.nlm.nih.gov/pubmed/15531663 ]. This (and another study) was an exception to the majority of studies which found positive or no relationship between saturated fat and CVD. This was one of the reasons why Hu said that there is insufficient evidence for association. The authors actually admit how this result was unexpected. Putting this study in context, however, you also can't conclude the validity of this particular study.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 09:55 PM

Read the introduction in Frank Hu's study where he specifically cites your first publication [ http://www.ncbi.nlm.nih.gov/pubmed/15531663 ]. This (and another study) was an exception to the majority of studies which found either positive or no relationship between saturated fat and CVD. This was one of the reasons why Hu concluded that there is insufficient evidence for association. rule and the authors admit how this result was unexpected. Putting this study in context, however, Frank Hu specifically mentions this study

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 09:44 PM

I think anyone who learns that he has terminal leukemia will become depressed. Especially if double diagnosed. He was in control of his diet but could not ward off leukemia, which was pre-existing prior to his diet. To impute then that he committed suicide because of his diet-induced, lifelong depression, would be incorrect.

64433a05384cd9717c1aa6bf7e98b661

(15236)

on August 02, 2011
at 02:46 PM

great answer! one other thing about animal studies is that apparently atherosclerosis rarely produces a true heart attack because most animals make their own vitamin c and synthesize collagen even as inflammation degrades it

6120c989fd5b69f42a0834b69b87955b

(24553)

on August 02, 2011
at 06:15 AM

This may very well be, I suspect the sources I've read about his depression from benefited from adding a fair amount of spin; much in the same way the anti-Atkins folks say he was done in by suffering a stroke and subsequently slipping on ice, rather than suffering a fatal head injury by slipping on ice.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 05:32 AM

No, he got depressed after learning his leukemia is terminal, via second opinion. He did not become depressed then learned about his terminal leukemia.

6120c989fd5b69f42a0834b69b87955b

(24553)

on August 02, 2011
at 04:58 AM

I thought he had already been clinically depressed and then the leukemia diagnosis pushed him over the edge.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 03:39 AM

Clarification: Pritikin committed suicide after learning of his imminent death from leukemia, which was in remission, largely, he believed, due to his vegetarian diet. It was a calculated decision, not due to being depressed because of his low-fat diet.

50637dfd7dc7a7e811d82283f4f5fd10

(5838)

on August 02, 2011
at 03:25 AM

Excellent question, +1

6120c989fd5b69f42a0834b69b87955b

(24553)

on August 02, 2011
at 03:25 AM

Considering Pritikin's diet induced depression and subsequent suicide, I think atherosclerosis would be the least of his worries. I add this to enrich the conversation at hand, not to distract from it.

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8 Answers

12
Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 02, 2011
at 06:00 AM

I know you're just laying the arguments out there and establishing a basis for hypothesis and discussion, and that's good of you, it's well presented.

But this isn't hard deductive reasoning but soft inductive reasoning and is only suitable for a hypothesis, some people would consider these arguments, but they are a warrant to go look for real evidence.

The reasoning goes: If saturated fat causes atherosclerosis we should expect to find the Inuit mummy, who ate a lot saturated fat, to have atherosclerosis. We do, therefore saturated fat causes atherosclerosis. This is the fallacy of affirming the consequent. Anybody who doesn't know it should look it up. That we observe them together doesn't mean that they are causal, of course. It could be that the oxidized PUFAs from cooking with seal oil were enough to produce atheroclerosis. They would have had a ton of oxidized PUFAs. Yikes. Like Jeff already pointed out, Chris Masterjohn's work argues well for oxidized PUFAs being a problem. We can't know which one it was. Same goes for the Koreans and American GIs. It's an elementary fallacy if employed as anything but a hypothesis.

And of course simply because Pritikin didn't have atherosclerosis it can't be inferred that it was the lack of saturated fat that was responsible. It could be the lack of polyunsaturated fat on a low fat diet. He might have had a very low level of inflammation, good intake of various antioxidants, low blood pressure, etc. I wonder if he was taking B12. Indian vegetarians who don't supplement tend to have a bad problem with atherosclerosis from elevated homocysteine, so I'm guessing that he did take supplements and thus had low homocysteine. His diet would have been rich in copper, which is needed to protect the arteries. I'm certainly not an advocate of a vegetarian diet for optimal health, but it doesn't necessarily cause atherosclerosis. I think I understand most of the mechanisms so it makes more sense to me than, say, the annoying finger-waging PETA chick waving a copy of The China Study.

I really haven't looked into the whole literature. I did find a study on the site Healthy Diets And Science, which is very biased and pushing one side of the story, but the data speaks for itself.

http://www.ncbi.nlm.nih.gov/pubmed/15531663

Saturated fat was associated with the least progression out of all macronutrients and at the highest quartile was inversely associated with progression, the only instance of an inverse association in these chronically unhealthy women. The quartile with the least total fat had the most progression compared with the other quartiles. The second quartile of total fat intake had the least progression, although the 4th had less than the 3rd, so that doesn't seem to be indicative of fat being inherently atherogenic.

Polyunsaturated fat was consistently associated with progression of atherosclerosis.

Granted these women had an average fat intake about half of what paleohackers tend to have, and it might become atherogenic at higher intakes, although we can't tell that from this study. So the exhortation to eat chicken breast or be vegan isn't supported by this study. Stearic acid, mostly from meat, was a little better than lauric, myristic, or palmitic acid, but all were inversely associated. Women are probably distinct from men in some respects, and this was also a hormone replacement trial, so I can't say for sure that this applies to everyone, but it is one of the best designed studies I have seen.

This one is an intervention study where oleic acid and stearic acid are inversely associated, although dietary cholesterol is associated with progression. It doesn't have anything in there about the other ones. Sounds like a prescription for some grass fed beef to me.

These people who have been indoctrinated to believe that saturated fat is going to kill them dead do seem to have a little more atherosclerosis depending upon saturated fat intake http://www.ncbi.nlm.nih.gov/pubmed/18175752 As always I'm going to pat my paleo halo and say that this doesn't apply to me and is indicative of many differences in risk factors that haven't been controlled for. The health-consciousness effect more or less renders North American epidemiology inert.

I don't like animal studies for this sort of thing because the environment in the body is always atherogenic and that is a lot different than what people will experience on the paleo diet. Animal studies are mixed and hard to extrapolate to humans. Oxidative stress, micronutrition, and inflammation are all important factors in the progression of atherosclerosis so it makes sense to view evidence that is reflective of one's own biological situation. I'm not sure that exists, and I'm not even sure of a great quality study in humans that controls for all important risk factors and just isolates serum LDL or dietary saturated fat irrespective of everything else that is going on. Only a statin company could afford to do that kind of study! Of course most of the literature has to do with myocardial infarction since that is where Occam's razor strikes. I care if I'm going to have a heart attack, and I care if I am going to die from anything at all. Lower LDL cholesterol is not associated with a longer life, and it is only associated with more mortality at higher concentrations than most of us have at 1 year of eating this way.

Anyway I do think you have a point that we can't just dismiss saturated fat as a potential risk in some people for atherosclerosis, but I don't think the evidence is there. I am more focused on what we do know is a big deal, which is a lot of things that have a profound effect on the progression of atherosclerosis.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 02, 2011
at 11:04 PM

How is this good reasoning? Atherosclerosis is a huge factor in CHD, but saturated fat, which causes atherosclerosis, doesn't cause CHD? Zuh? Something is up. Once upon a time Loren Cordain made some baseless assertions and then proceeded to defend his academic ego with abysmal logic. Let's go look for some LDL oxidiation studies that control for antioxidant intake and degradation of the fat. I doubt there are any but that is what you want. I can't find any studies that don't use olive oil to compare with butter/lard or whatever. Olive oil has the antioxidants, but you could eat spices w SF.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 02, 2011
at 11:07 PM

The claim that "saturated fat is atherogenic" is nonsensical, not because I find it inconceivable that it could be worse than monounsaturated fat for constructing resilient liproteins (although olive oil antioxidants confounds things so I don't know) but because tons of things influence propensity to oxidize. It might result in more oxidized LDL in some situations but not others, or it might not at all compared with other macronutrients.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 10:36 PM

Notice that Frank Hu's conclusion of non-association was between SFA and cardiac events (heart attacks, strokes, cardiac events, many of them fatal). His conclusion does not extend to the presence or absence of atherosclerosis.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 03:52 AM

Stabby, Cordain changed his position to accommodate the new, emerging paradigm. I think he's flexible and is to be admired for doing that. He thinks SFA in a SAD is lethal; in a Paleo type of anti-inflammatory diet, SFA is secondary to more significant risk factors. You may have plaques, but they probably won't rupture. Member, he still eats lean meats.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 09:58 PM

Read the introduction in Frank Hu's study [ http://www.ajcn.org/content/early/2010/01/13/ajcn.2009.27725.abstract ] where he specifically cites your first publication [ ncbi.nlm.nih.gov/pubmed/15531663 ]. This (and another study) was an exception to the majority of studies which found positive or no relationship between saturated fat and CVD. This was one of the reasons why Hu said that there is insufficient evidence for association. The authors actually admit how this result was unexpected. Putting this study in context, however, you also can't conclude the validity of this particular study.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:22 AM

Do you know of any specifically on atherosclerosis that aren't intervention trials?

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 10:28 PM

None of these are animal studies, so I don't see where you data are from. But 2 of 3 cites basically support the association between SFA and atherosclerosis. Quote: "Higher habitual intakes of saturated [and trans fats] are independently associated with increased atherosclerosis after age, sex, total energy intake, physical activity, ethnicity, waist-to-hip ratio, smoking, alcohol intake, and height were accounted for."

64433a05384cd9717c1aa6bf7e98b661

(15236)

on August 02, 2011
at 02:46 PM

great answer! one other thing about animal studies is that apparently atherosclerosis rarely produces a true heart attack because most animals make their own vitamin c and synthesize collagen even as inflammation degrades it

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:40 AM

Do you personally think that palmitic acid = plaque, or the higher the LDL the more plaque or lesions no matter what else is going on? That it is just A=B and it is inherently atherogenic? We are on paleohacks after all, not cheerioshacks, so like I mentioned in the post, it makes the most sense to look at your personal situation when judging what you are going to do. Do you know that Cordain has a paper something along the lines of Hunter-gatherer Diets Meat-based But Not Atherogenic? Something like that. And then he says that grass-fed meat doesn't tend to raise LDL or have much palmitic aci

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 10:00 PM

But the main issue here is not atherosclerotic progression but the pathegenesis of atherosclerosis. I think even Cordain and most lipid theory proponents believe that processed carbs and sugar play a major role in the progression.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:34 AM

And why if Cordain thinks that saturated fat + SAD is bad but SF + paleo is benign but still causes atherosclerotic lesions, but based his conclusion (presumably) on SAD data, doesn't he consider the possibility that SF + a paleo diet doesn't produce atherosclerosis? I mean all evidence points to various components of the paleo diet being anti-atherosclerotic, so why not consider that? Is it because then he wouldn't get to implicate saturated fat at all anymore, but it would still read in his first book they it should be avoided?

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 02, 2011
at 10:47 PM

The 2nd one showed that monounsaturated fat and stearic acid were inversely associated. Those consitute the majority of fat in grass fed meat and that is . I don't see how you can say that two of my cites support your hypothesis because the first and second don't, and the 3rd one is correlative epidemiology in the land of low fat snack cakes, so that isn't good evidence, I just thought I would share it. How about posting actual evidence? I understand what you're saying, you just aren't providing actual empirical evidence. Burden of proof is squarely on you to supply actual evidence.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 10:30 PM

In other words, SFA seems to be athersclerotic. Cordain agrees with this. So does Lustig. I also believe this to be true. That doesn't mean SFA ==> Myocardial infarction. No, there are several more intervening preconditions. But my point was only regarding SFA in inducing possible atherosclerosis.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 04:04 AM

But I also realize the limitatiosn of these studies and statiscal relatioships. That's why I agree w/Hu that it's unclear. However, there are studies which implicate SFA in association w/atherosclerosis, the 2 you cited among them. Indeed atherosclerosis was found to be associated more with SFA than with MUFA or even PUFA, only your fist cite (and 1 other study) being the exception. You gotta read these thangs carefully.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 10:24 PM

Your 3rd cite actually found that SFA and trans fats are associated with atherosclerosis, but that alcohol might muffle this association. This explains the French paradox. So if you're eating SFA, might as well down some French dry wine while at it. But we're talking about artery thickening here, not actual cardiac event.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 10:13 PM

Your second cite is largely irrelevant - it's a 1996 study linking MUFA w/less artery thickening, if saturated fat was replaced by MUFA. So how does this show SFA to be not atherosclerotic?

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 02, 2011
at 09:55 PM

Read the introduction in Frank Hu's study where he specifically cites your first publication [ http://www.ncbi.nlm.nih.gov/pubmed/15531663 ]. This (and another study) was an exception to the majority of studies which found either positive or no relationship between saturated fat and CVD. This was one of the reasons why Hu concluded that there is insufficient evidence for association. rule and the authors admit how this result was unexpected. Putting this study in context, however, Frank Hu specifically mentions this study

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 02, 2011
at 11:14 PM

And I supplied the study with women and progression because we were talking about atherosclerosis, and progression is related to atherosclerosis and a pretty big deal.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:20 AM

As for Hu, there isn't one study cited in the intro that isn't an intervention trial, which as you mentioned has massive limitations. As Stephan G points out here http://wholehealthsource.blogspot.com/2010/03/leave-your-brain-at-door.html, interventions like with Finnish mental hospital one have many confounding factors Citing those women isn't a cherry-pick because it is the only study of its kind.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:52 AM

Actually he also said that low carb and high protein work to reduce LDL http://www.mendeley.com/research/the-paradoxical-nature-of-huntergatherer-diets-meatbased-yet-nonatherogenic/ but apparently that doesn't apply to the Inuit, because, well...?

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 10:56 PM

And that hunter-gatherers eating a meat-based diet don't have atherosclerosis because they don't eat a lot of saturated fat but the Inuit, who are hunter-gatherers who eat a meat-based diet, have atherosclerosis because they eat a lot of saturated fat, is completely contradictory.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:42 AM

d, but muscle meat isn't an adequate representation of the entire fat of the animal. There is a ton of saturated fat in brains, and plenty of other fat on the inside. Clearly if palmitic acid=atherosclerosis whole carcass meat-eaters should have some. After all Cordain says that the Inuit had atherosclerosis because they were eating grass-fed animals, but his paper says otherwise. Which is it?

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 04:14 AM

I didn't post number 2 and 3 with the intention of using them to support my position, obviously. I commented on number 2 saying that the whole vegan conclusion doesn't follow from palmitic acid being bad because meat has a ton of the fats that are inversely associated. And when I commented on number 3 I was commenting on why I don't think that epidemiology is a good source of evidence in North America. Did they control for the tendency to eat at fast food restaurants? No they didn't, so how can we use them when the health-consciousness effect is so strong>

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 11:00 PM

You don't have to worry about my arteries, my inflammation is very low so my saturated fat-eater plaque probably won't rapture and kill me. Thank you for the concern.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 03:54 AM

Your cites do not support the position that SFA is harmless or non-atherosclerotic. In fact, they found strong enough association between SFA and atherosclerosis in 2 of the 3 studies. I already commented why your 1st study is a cherry pick, since Dr. Who (Hu?) points that out as an aberration.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 10:34 PM

Your last cite beautifully captures Cordain's position. Hunter-gatherers did not get CVD because of their "qualitative differences in fat intake ... relatively high levels of MUFA and PUFA." That is, lower SFA than unsaturated FA. Do you see this here? (U should be able to infer his reasoning from what Cordain deliberately left out here.) This also shows Cordain to be an adherent of the lipid theory: he think lipd #s are important. Cordain believes SFA to be atherogenic. This is an inference but I have him on record saying pemmicans are atherogenic.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 10:41 PM

I'm not entirely sure, but I tend to agree w/Cordain. There is a prepondenrance of evidence in medical journals and anecdotal / random autopsy findings of atherosclerosis among hunter-gatherers vs. vegetarians. Atherosclerosis seems to be a rather widespread, if somewhat unavoidable, phenomenon for omnivores. Its danger is mitigated by events that are a lot more dangerous: thrombosis triggered by inflammation. See my post below.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 10:58 PM

How on earth can you predict where the next infection will be, which will trigger body's inflammatory reaction? Angioplasties and bypasses are futile. To have a chance, you might as well do the procedure for every coronary artery, every artery that leads to the brain to avoid strokes, etc. So forget atherosclerosis. Be smart. Focus on lowering inflammation.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 10:49 PM

The current thinking is that thrombosis is random and initiated by inflammation. It accounts for 80% of CVD deaths. This is more dangerous than stenosis, which results from uninterrupted progression of atherosclerosis. Inflammation figures in both. But by focusing exclusively on atherosclerosis, you lose sight of the real killer. Btw, this explains why coronary bypasses do not lower the risk of CVD death. It's not atherosclerosis but where the next clot will take place, which is impossible to predict. We're talking about the locus of inflammation. That's the reasoning here.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 10:37 PM

But like I said before, atherosclerosis does not equal cardiac events; inflammation will decide that. Your position is SFA is not atherogenic. That's not what Cordain believes.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 03, 2011
at 10:55 PM

Those who want to believe will interpret the evidence any which way they choose.I don't even know why anybody is looking at mummies and Inuit frozen ladies when there are plausible explanations from wheat and oxidized PUFAs. I would rather take the skeptical stance, not the one that affirms the consequent. Cordain says that hunter-gatherers don't have atherosclerosis due to less palmitic acid, but it could easily be lack of junk, including wheat and other nasty grains, and it could have been all of the antioxidants. All of these purported bits of a evidence have another interpretation.

3
64433a05384cd9717c1aa6bf7e98b661

(15236)

on August 02, 2011
at 03:47 AM

I'll throw some ideas into the ring here.... Saturated fat seems to raise LDL and HDL, so it's generally not thought of as problematic. But if someone's LDL is hanging out in the blood for too long then excessive oxidation could occur and plaque can be built up. I've been reading a lot of Chris Masterjohn's work lately and the way I understand it is that you need hypercholesterolemia to induce atherosclerosis but it's not the direct cause. Here are some excerpts from various blogs he's written:

Atherosclerosis is largely driven by the degeneration of lipids which infiltrate the blood vessel and thereby cause inflammation. Inflammation from other sources may accelerate the process or further the degeneration of the atherosclerotic plaques once they are formed, but the initiating factor for fatty plaques appears to be the degeneration of lipids ??? especially the degeneration of PUFAs...

We need to distinguish between the infiltrating idea that it???s just too much lipid, and the degenerative idea that it???s about those lipids breaking down. Once we realize that it???s about the degeneration of these lipids, we can start to understand what the metabolic factors are that effect the degeneration of lipids, and how we move beyond our understanding of the amount of cholesterol in the blood to how do we protect these lipoproteins from degeneration....

What happens in the lipoprotein particle in order to cause atherosclerosis is the polyunsaturated fatty acids in the membrane of the lipoprotein particle are oxidized, which basically means the molecules are falling apart. Once they oxidize they become toxic and in order to protect the blood vessels from these toxic degenerated lipids,the immune system forms an atherosclerotic plaque. This is basically a protective mechanism but over time if these toxic lipids accumulate you get inflammation, the plaques fall apart and this is what ultimately leads to a clot in the blood and then a heart attack....

Likewise, the single man with a PCSK9 nonsense mutation in the study I cited above who developed heart disease died of a heart attack at the age of 68, but had an LDL-cholesterol level of only 53 mg/dl, well below the supposed "no risk" level. He was obese, smoked, and had high blood pressure. This supports Anitschkov's "combination theory" but flatly contradicts his "infiltration theory," in which it is the amount of cholesterol rather than the oxidation of lipoproteins that matters.

2
77515534847d74d15b450525ed060605

on August 03, 2011
at 12:54 AM

Perhaps this link will help us all to understand this issue.

This seem a deadly strategy to always live in the hope of avoiding inflammation since it comes from diet but also things like virus that you cannot always forsee and protect against. If you have too much sat. fat and sat. fat lead to plaques then you can have inflammation from unexpected source and then you get into heart trouble.

Because, as you know, in inflammation white blood cells invade the artery wall to promote the buildup of fatty deposits or plaques, and the sending of chemical danger signals to the body. These signals or ???pro-inflammatory cytokines??? make the liver release other molecules into the blood.

One of these markers of inflammation produced by the liver is C-reactive protein (CRP), which has been studied for several years, as CRP when measured with the high-sensitivity CRP (hs-CRP) blood test can indicate for example, which patients are at higher risk for having a future heart attack or stroke.

This are my opinions. How about you?

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 08:15 PM

Therefore, inflammation is more lethal than "mere" atherosclerosis. But inflammation is also implicated in the pathogenesis of atherosclerosis. So we can fully understand here the evolution in thinking of someone like Cordain: it seems a pretty sophisticated positioning and he's not really being inconsistent.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 03, 2011
at 08:12 PM

This is similar to Paul Jaminet's belief that all diseases, including CVD, start with habitual infections. It is true that this infection-started inflammation model does not seem to specifically implicate SFA. As the Egyptian mummies showed, there is still a lot we don't know: only recently did we find out that cardiac deaths result mostly from "breaking the cap" (thrombosis), not stenosis (estimated at only 20%), which is the natural progression of atherosclerosis. Hence, the deemphasis of atherosclerosis in favor of inflammation.

B0454de6d4f4cdd9ca2e59021dc105bf

(606)

on August 03, 2011
at 01:37 AM

Interesting that you raised the possible role of viral infection. It's certainly possible that viruses could be influencing cellular processes at a subclinical level. The article you linked to mentions vaccination for induction of protective immunity. Could be a big money earner for BigPharma 10-20 years from now.

1
E8c2167284f0cdd16a12bea2741975b4

on October 15, 2012
at 05:48 AM

This is a very good post, im going to reread it but I think it should be pointed out(not sure if the author still frequents here.) that CVD resulting in death doesn't necessarily need to be the end point to deem a quality unfavorable. In other words, having athlerosclerosis is bad news in terms of a myriad of conditions

And this is a great discussion so I'm gladly bumping it

1
85ff2ce79d8b21d2e67e4e5530b696cf

on August 03, 2011
at 11:33 PM

Good discussion. Kudos to everyone.

Dr. Ayers writes: ???Saturated fats appear to be problematical primarily if chronic inflammation is established. Saturated fats are healthy in the absence of inflammation.???

This is why many of the studies on the health effects of saturated fats are flawed. They analyze the impact on coronary health, etc??? of a typical diet(containing copious grains and other refined carbohydrates) versus a typical diet PLUS saturated fats.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 04, 2011
at 02:20 AM

That's pretty much what Cordain says. But like others point out, it's like walking on a knife's edge because inflammation can arise unawares form non-dietary sources. So even if you're eating Paleo, you could have inflammatory episodes due to infections, autoimmune attacks, common colds, etc. Then what? Perhaps accept Cordain's suggestion and eat only lean meats?

1
B0454de6d4f4cdd9ca2e59021dc105bf

on August 03, 2011
at 01:11 AM

I think there's a big genetic component at work as well, which complicates things. If you have certain genes (those that code for Lp(a) and ApoE4, etc.) that's going to change the whole picture regarding the relationship between diet and risk of developing plaque.

1
6120c989fd5b69f42a0834b69b87955b

(24553)

on August 02, 2011
at 04:26 AM

From what I can tell, Dr. Michael Eades points decidedly towards #2 on that list. But then again he rejects the lipid hypothesis, so I don't know if you'd find his work useful in answering your question.

Personally, I don't know, but I think a lot of studies trying to figure this out have failed to take micronutrient levels like chromium and magnesium into account , as well as the addition of medicinal herbs to the diet like garlic.

The story about the Korean and US soldiers atherosclerosis raises a number of questions for me. If I have my food history correct, margarine really caught on in popularity in the US around WWII, and by the time the Korean War rolled around I'm wagering most US soldiers had been eating it for a long time, so I'm not surprised by the degree of atherosclerosis the young soldiers would have had. If teenage boys had the same penchant for soda and candy then that they do now I think that could also have contributed to it. And lastly, there is the difference in the grain of choice between wheat and rice.

I'm also curious about the Inuit, I was under they impression that in general they lived long healthy lives before things like Cheerios were introduced into their diet. I apologize for being a bit off the question here, but if Cordain is correct on this one, would that be an argument for atherosclerosis being a non-issue in the absence of inflammation.

Dr. K also mentioned in passing the other day that he got rid of his atherosclerosis on a diet with plenty of saturated fat, so I'm also curious to know how he went about that. I'm guessing he's going to mention avoiding PUFA's, but if there are other variables I'm all ears.

0
3c6b4eed18dc57f746755b698426e7c8

on August 02, 2011
at 11:08 PM

More recent findings shed light on atherosclerosis and diet. CT scans of Egyptian mummies dating back to about 500 and 4,000 years ago showed significant atherosclerosis in many. Calcification was visible in the arteries of many of these mummies. This seems to show that atherosclerosis is not the exclusive byproduct of modern diets. There were no trans fats nor processed flour in that era, although Egyptians consumed gluten grains (wheat and barley) and corn, but probably not the evil variety and GMOs used today. I am not sure about sugar but I don't think granulated sugar was widely available, probably honey.

Typicaly, only the elites (priests, royalty) were mummified, so their social status would have allowed them to consume considerable animal products. This Lancet article makes an educated guess about how these mummies' arteries were thickening: i.e., their fat-rich diet.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60294-2/fulltext

Notice that atherosclerosis doesn't mean the mummies had heart attacks; it's hard to tell how they died. But the whole point of this thread is the presence or absence of plaques in response to SFA consumption.

See also a Paleoesque response to this interpretation.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60804-5/fulltext

So what's the conclusion: it's hard to tell. It's possible that atherosclerosis results from infections, stress, bacteria, and environmental factors and is simply part of the aging process. But it's also possible that SFA induces it. This is if you believe the aforementioned autopsy results and anecdotal accounts of vegetarians having clear arteries. I tend to think SFA is probably plaque-forming. But then that doesn't mean you should become a vegetarian or eat only leat meats. The risk of a mortal cardiac event is probably a lot less even when you have atherosclerosis (but no inflammation) than when you have both. That really was the whole point of this thread.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 04, 2011
at 05:46 AM

It's also possible that the current RDA for Vit C is just too low. And the ice age environment when plaques and fast storage genes ("thrifty genes") would have helped humans survive has fast disappeared. So, coupled with stalled natural selection (modern medicine, interventions, etc.), global warming, and plentiful food supplies everywhere, atherosclerosis could be more or less an inevitable part of aging.

6120c989fd5b69f42a0834b69b87955b

(24553)

on August 04, 2011
at 01:19 AM

The original article seems to be pretty dismissive of grain, salt, alcohol, and sugar as possibly adding the atherosclerosis. It was pretty much just an observational study with nutritional CW for the backdrop, so of course SFA would be the bogeyman. Not saying it isn't, just that they didn't consider all of the variables. As far as the arteriosclerosis goes, I tend to think of that as being related to something going awry with the channels of elimination in the body to let the calcium build up. Were they chronically dehydrated? What were the ratios of their electrolytes?

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 04, 2011
at 05:47 AM

Plenty of rodents suffer from atherosclerosis if you give them bad diets. However if carnivores don't then that says a lot. I think the literature is pretty clear that antioxidants prevent atherosclerosis and oxLDL is a big risk factor. I guess the question becomes "what kind of combination of protection and LDL level is safe and which will produce too much oxLDL? I do think that when LDL gets way up there it is a risk factor, it is just that most paleos don't have very high LDL, just higher than statin companies would approve of, and their HDL is good.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 04, 2011
at 02:34 AM

That's another possibility here. The Egyptian nobility supposedly ate a meat-heavy diet and it's just possible that they may have neglected Vitamin C. It's possible that Linus Pauling is right that Vit C deficiency is the real cause of atherosclerosis. The "calcification" or the stiffening of the arteries that give rise to atherosclerosis could be due to Vit C deficiency. This could explain the autopsy results of plaques within Inuits and their absence in vegetarians (the Koreans, Vietnamese, and Pritikin) who presumably consumed sufficient Vit C through fruit and veggies.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 04, 2011
at 06:02 AM

"it is just that most paleos don't have very high LDL, just higher than statin companies would approve of, and their HDL is good." I'll let this statement stand by itself. I don't need to say anything.

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 04, 2011
at 05:00 AM

If you took the stance of "saturated fat kinda sorta might result in a few minor lesions that don't progress to anything in all cases" approach I might, might get behind some of the reasoning with some more hard evidence. The "butter-eaters are one infection away from a massive heart attack no matter what" stance doesn't seem particularly tenable. When you control for antioxidants there isn't much difference in LDL oxidation lagtime between mono and sat fats, and high mono diets can be non-atherogenic. Add some more antioxidants and keep the arteries and immune system healthy and decrease athe

Be1dbd31e4a3fccd4394494aa5db256d

(17969)

on August 04, 2011
at 05:50 AM

Oxidized LDL tends to correlate with the whole metabolic syndrome and arterial damage/inflammation, though. So if you get a big correlation between oxLDL and severity of atherosclerosis, it might be more due to inflammation and arterial damage than the oxLDL itself, which might only cause some minor lesions. With regards to vitamin c, high dose vitamin c doesn't prevent heart disease, but high vegetables, fruit and spices do. Good quality vitamin E definitely does. Carnivores are probably adapted to a low antioxidant diet, though, and can get by with what they synthesize.

3c6b4eed18dc57f746755b698426e7c8

(5152)

on August 04, 2011
at 05:35 AM

This seems plausible because, to borrow Stabby's post, only humans and apes suffer from CVD and these 2 are the only ones incapable of self-creating Vit C. You can feed satruated fat all you want to dogs (carnivores, so maybe that's understandable) and pigs (omnivores) but they won't drop dead from a heart attack. And Vit C deficiency could be a proxy for a SF-heavy diet, when little veggies are eaten. If Vit C indeed is the cause, then dogs and pigs should have totally clear arteries, no plaque whatsoever, just like the Koreans, Vietnamese and Pritikin.

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