ABSTRACT: Atheroma is a chronic disease of the arterial tree, the evolution of which leads to severe and potentially lethal ischemic events in different organs (brain, heart, disgestive tract, kidneys and limbs). For complex and largely ignored reasons the retention of lipid particles in the subendothelial space of arteries initiates a local humoral and cellular response which progressively leads to a plaque formation by recruitment of systemic macrophages and multiplication of smooth muscle cells of the artery. This plaque formation is followed by expansion/rupture/calcification and eventually causes thrombosis of the vessel. Diet connection with health was first formulated by Hippocrates (360 BC), connection with atheroma suspected by Keys (1904-2004) and later by Ornish in 1990... They popularised Mediterranean diet and vegan style diet but the recognition of diet as a major part of treatment of atheroma occurred still later. Now it is largely admitted in the literature that atheroma is diet dependent but also paradoxically that it's a "natural" phenomenon in the arterial tree especially with aging. Paleo diet is a rather new topic in medicine although Boyd Eaton described the hypothesis of an evolutionary discordance between industrial diet and our genomics in the NEJM in 1989! Since numerous studies increased our knowledge and shed a very transparent light on what ate our ancestors. Aside the fact that they ate raw fruits, vegetables, meat and fish, the nutrients of these foods were quite different from those present in the products we eat today. We describe the huge differences between paleo food and industrial food and the consequences on human metabolism. Both archeo-anthropology and present studies of populations consuming paleo diets revealed strong evidence about the absence of atheroma in the paleo era despite the fact that life span was shorter. Clinical trials of diets with selected characteristics of paleodiet and also paleodiet trials in humans suggest that paleodiet is far more efficient in preventing atheroma than conventional AHA recommendations or even Mediterranean diet. We conclude that paleodiet should be more extensively studied despite the fact that at the present time no industrial lobby could support these studies, that involving agrobusiness in the production of paleo food is another key issue for public health and eventually that public health policies should take in account paleo diet studies in the body of evidence that roots their recommendations about the prevention of atheroma both primary and secondary, alone or in association with efficient drugs.

COMMEMORATIVE POEM:

"Paleo Life instead of a Life...in”

Instead of delicious raw butter margarin
For bad cholesterol statin
For thick blood aspirin
For diabetes metformin
For high blood pressure nicardipin
As I stopped smoking a full patch of nicotin
And tomorrow a nightmare, imagine!
Don’t be foolish!
Take fresh spinach and fatty fish
Roquette, nuts, kiwis and have a large meal
Pour your glass with red wine and make a deal
After a snap I will go running
Work a bit and get light dining
Smoke a big Havana once a year
And forget doctors forever!

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