My key takeaway is that the ratio of saturated:unsaturated fat in the diet does control the concentration of serum cholesterol but any ratio between 1:0 and 0:1 (provided you get enough essential fats) is perfectly normal and does not impact health negatively either way. The function of serum cholesterol is maintaining cell rigidity throughout the body, not just in arteries. I have never heard this explanation before; it makes sense. This claim should be easy to verify experimentally.
The question then turns to the underlying cause of atherosclerosis. The arguments, to me, seem circular. Ultimately, the important question is how much of the plaque is due to a damaging agent like sugar and how much is due to a hyperactive inflammatory response. Measuring inflammation independent of arterial wall damage seems incomplete.
Speaking anecdotally, I put a few logical ideas together from different articles and got an answer that seems to work for me some years ago:
1. Simple carbs like sugar are metabolic stressors
2. Saturated fats, as well as other agents like caffeine can act to accelerate the metabolisation of sugar
3. If you consume a stressor with an accelerator, you are more likely to do damage than if they are spread out or diluted e.g. with fiber, so don't do that
4. (Something something exercise)
This hypothesis, while lacking in rigor, explains why I can have two burgers and be fine, but be miserable if I have a burger, fries and a coffee.
The question then turns to the underlying cause of atherosclerosis. The arguments, to me, seem circular. Ultimately, the important question is how much of the plaque is due to a damaging agent like sugar and how much is due to a hyperactive inflammatory response. Measuring inflammation independent of arterial wall damage seems incomplete.