In conclusion, atherosclerosis was common in four preindustrial populations, including a preagricultural hunter-gatherer population, and across a wide span of human history. It remains prevalent in contemporary human beings. The presence of atherosclerosis in premodern human beings suggests that the disease is an inherent component of human ageing and not characteristic of any specific diet or lifestyle.
Some advocates of “paleo” will claim that they are not at all advocating that humans should eat what their paleolithic ancestors ate but that we should use what they ate as a template to figure out what to eat today. That’s a distinction without a real difference because the assumptions upon which the Paleo Diet are based (e.g., that atherosclerosis didn’t exist in hunter-gatherers and that hunter-gatherers were “almost always healthy, lean, fit, disease-free, strong people” and that 10,000 years is too short a time period for humans to have evolved to accommodate a grain-based diet) are more the product of wishful thinking and the “noble savage” myth than anything else. At the very least, Thompson’s study suggests that this assumption is overblown and that there has long been a certain “baseline” level of atherosclerotic disease among humans that is an inevitable part of aging.
This isn't a "take-down" post. It's an even tempered assessment. The hypothesis is that diet effects health but some baseline disease level has been associated with the human condition as far back as we have data. This idea that humans have not adapted to an agricultural lifestyle over 10,000 years is not supported by scientific evidence. It sells books though.