French paradox

French paradox

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The French Paradox is the observation that French people
French people
The French are a nation that share a common French culture and speak the French language as a mother tongue. Historically, the French population are descended from peoples of Celtic, Latin and Germanic origin, and are today a mixture of several ethnic groups...

 suffer a relatively low incidence of coronary heart disease
Coronary heart disease
Coronary artery disease is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium with oxygen and nutrients. It is sometimes also called coronary heart disease...

, despite having a diet relatively rich in saturated fat
Saturated fat
Saturated fat is fat that consists of triglycerides containing only saturated fatty acids. Saturated fatty acids have no double bonds between the individual carbon atoms of the fatty acid chain. That is, the chain of carbon atoms is fully "saturated" with hydrogen atoms...

s. The term French Paradox was coined by Serge Renaud, a scientist from Bordeaux University in France.

When a description of this paradox was aired in the United States on 60 Minutes
60 Minutes
60 Minutes is an American television news magazine, which has run on CBS since 1968. The program was created by producer Don Hewitt who set it apart by using a unique style of reporter-centered investigation....

in 1991 with the speculation that red wine decreases the incidence of cardiac diseases, the consumption of red wine increased 44% and some wineries began lobbying for the right to label their products "health food
Health food
The term health food is generally used to describe foods that are considered to be beneficial to health, beyond a normal healthy diet required for human nutrition. However, the term is not precisely defined by national regulatory agencies such as the U.S...

."

The authors of a review of dietary studies concluded that there was insufficient evidence to establish a causal link between consumption of saturated fats and coronary heart disease risk, and statistics collected by the WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...

 from 1990–2000 show that the incidence of heart disease in France may have been underestimated, and may in fact be similar to that of neighboring countries.

Overview



According to FAO
Fão
Fão is a town in Esposende Municipality in Portugal....

 data, the average French person consumed 108 grams per day of fat from animal sources in 2002 while the average American consumed only 72. The French eat four times as much butter, 60 percent more cheese and nearly three times as much pork. Although the French consume only slightly more total fat (171 g/d vs 157 g/d), they consume much more saturated fat because Americans consume a much larger proportion of fat in the form of vegetable oil, with most of that being soybean oil. However, according to data from the British Heart Foundation
British Heart Foundation
The British Heart Foundation is a charity organisation in Britain that funds research, education, care and awareness campaigns aimed to prevent heart diseases in humans.-Foundation:...

, in 1999, rates of death from coronary heart disease
Coronary heart disease
Coronary artery disease is the end result of the accumulation of atheromatous plaques within the walls of the coronary arteries that supply the myocardium with oxygen and nutrients. It is sometimes also called coronary heart disease...

 among males aged 35–74 years were 115 per 100,000 people in the U.S. but only 83 per 100,000 in France.

Wine


It has been suggested that France's high red wine consumption is a primary factor in the trend. This hypothesis was expounded in a 60 Minutes
60 Minutes
60 Minutes is an American television news magazine, which has run on CBS since 1968. The program was created by producer Don Hewitt who set it apart by using a unique style of reporter-centered investigation....

broadcast in 1991. The program catalysed a large increase in North American demand for red wine
Wine
Wine is an alcoholic beverage, made of fermented fruit juice, usually from grapes. The natural chemical balance of grapes lets them ferment without the addition of sugars, acids, enzymes, or other nutrients. Grape wine is produced by fermenting crushed grapes using various types of yeast. Yeast...

s from around the world. It is believed that one of the components of red wine potentially related to this effect is resveratrol
Resveratrol
Resveratrol is a stilbenoid, a type of natural phenol, and a phytoalexin produced naturally by several plants when under attack by pathogens such as bacteria or fungi....

.

Alcohol in wine


Research suggests that moderate drinkers are less likely to suffer heart attack
Myocardial infarction
Myocardial infarction or acute myocardial infarction , commonly known as a heart attack, results from the interruption of blood supply to a part of the heart, causing heart cells to die...

s than are abstainers or heavy drinkers (see alcohol and cardiovascular disease
Alcohol and cardiovascular disease
Excessive alcohol intake has been associated with an elevated risk of liver disease, heart failure, some cancers, and accidental injury, and is a leading cause of death in industrialized countries...

 for details). Therefore, the alcohol in wine might be a factor in the French Paradox.

However, the difference between U.S. annual per capita alcohol consumption (8.6 litres per year) and French consumption (11.4 litres per year) is only 2.8 litres per year more. Wine consumption in France is lower than in Luxembourg
Luxembourg
Luxembourg , officially the Grand Duchy of Luxembourg , is a landlocked country in western Europe, bordered by Belgium, France, and Germany. It has two principal regions: the Oesling in the North as part of the Ardennes massif, and the Gutland in the south...

 (15.6 litres), the Czech Republic (13.0 litres), Hungary (13.6 litres), Germany (12.0 litres), and Croatia
Croatia
Croatia , officially the Republic of Croatia , is a unitary democratic parliamentary republic in Europe at the crossroads of the Mitteleuropa, the Balkans, and the Mediterranean. Its capital and largest city is Zagreb. The country is divided into 20 counties and the city of Zagreb. Croatia covers ...

 (12.3 litres) where no similar paradoxes are observed.

There is a lack of medical consensus about whether moderate consumption of beer, wine, or distilled spirits has a stronger association with longevity. Of ten major studies, three found stronger evidence for wine, three for beer, three for liquor, and one study found no difference between alcoholic beverages.

Resveratrol


Wines, particularly red wines, are a source of low levels of resveratrol
Resveratrol
Resveratrol is a stilbenoid, a type of natural phenol, and a phytoalexin produced naturally by several plants when under attack by pathogens such as bacteria or fungi....

. High doses of resveratrol have been linked to longevity and cancer prevention in other species.

In 2008, a study found that high doses of resveratrol (a constituent of red wine) mimicked some of the benefits of caloric restriction (including reduced effects of aging) in mice.

Procyanidins and polyphenols


Although research continues on resveratrol, the concentration in wine seems too low to account for the French Paradox. Professor Roger Corder and team have identified a particular group of polyphenols, known as oligomeric procyanidins, which they believe offer the greatest degree of protection to human blood-vessel cells. Tests with 165 wines showed that these are found in greatest concentration in European red wines from certain areas, which correlates with longevity in those regions.
The highest procyanidins are found in wines from the Tannat
Tannat
Tannat is a red wine grape, historically grown in South West France in the Madiran AOC and is now one of the most prominent grapes in Uruguay, where it is considered the "national grape". It is also grown in Argentina, Australia, Brazil, Peru, and in Italy's Puglia region where it is used as a...

 grape, grown in the Gers
Gers
The Gers is a department in the Midi-Pyrénées region in the southwest of France named after the Gers River.Inhabitants are called les Gersois or Gersoises.-History:...

 area of southwest France.

Unlike resveratrol, procyanidins are present in wine in quantities that seem to be high enough to be significant: "Procyanidins are the most abundant flavonoid polyphenols in red wine – up to one gram per litre is found in some traditional style red wines." "… clinical trials of grape seed extract, which have shown that 200–300 mg per day will lower blood pressure. Two small glasses (125 ml glass) of a procyanidin-rich red wine, such as a Madiran wine from southwest France, would provide this amount." However, more than 200mg of procyanidin can also be consumed by eating a Red Delicious
Red Delicious
The Red Delicious is a clone of apple cultigen, now comprising more than 50 cultivars, that was recognized in Madison County, Iowa, United States, in 1880...

 apple.

Other research suggests that polyphenols in wine reduce the absorption of malondialdehyde
Malondialdehyde
Malondialdehyde is the organic compound with the formula CH22. The structure of this species is more complex than this formula suggests. This reactive species occurs naturally and is a marker for oxidative stress.- Structure and synthesis :...

, which is implicated in arteriosclerosis
Arteriosclerosis
Arteriosclerosis refers to a stiffening of arteries.Arteriosclerosis is a general term describing any hardening of medium or large arteries It should not be confused with "arteriolosclerosis" or "atherosclerosis".Also known by the name "myoconditis" which is...

, cancer, diabetes and other diseases.

French diet comparisons


In his book, The Fat Fallacy, Will Clower suggests the French Paradox may be narrowed down to a few key factors, namely:
  • Good fats versus bad fats — French people get up to 80% of their fat intake from dairy and vegetable sources, including whole milk, cheeses, and whole milk yogurt.
  • Higher quantities of fish (at least three times a week).
  • Smaller portions, eaten more slowly and divided among courses that let the body begin to digest food already consumed before more food is added.
  • Lower sugar intake — American low-fat and no-fat foods often contain high concentrations of sugar. French diets avoid these products preferring full-fat versions without added sugar.
  • Low incidence of snacks between meals.
  • Avoidance of common American food items, such as soda, deep-fried foods, snack foods, and especially prepared foods which can typically make up a large percentage of the foods found in American grocery stores.


Clower tends to downplay the common beliefs that wine consumption and smoking are greatly responsible for the French Paradox. The French diet tends to cause Americans to lose weight while visiting even if they are not wine drinkers. While a higher percentage of French people smoke, this is not greatly higher than the U.S. (35% in France vs. 25% in U.S.) and is unlikely to account for the weight difference between countries.

Mireille Guiliano
Mireille Guiliano
Mireille Guiliano is a French-American author.Mireille wrote French Women Don't Get Fat which reached #1 on the New York Times "Advice, How-to and Miscellaneous: Hardcover bestseller" list, followed by French Women for All Seasons...

, author of the #1 bestseller French Women Don't Get Fat, agrees that the weight differences are not due to French smoking habits. She points out that the smoking rates for women in France and the U.S. are virtually identical. Guiliano explains the key factors to the French woman's ability to stay slim as:
  • Smaller portion sizes
  • Savoring food to increase the feeling of satisfaction, choosing a small amount of high quality food rather than larger amounts of low quality food
  • Eating 3 meals a day and not snacking
  • Taking in plenty of liquid such as water, herbal tea and soup
  • Sitting down and eating mindfully (no multitasking and eating while standing up, watching TV, or reading)
  • Emphasizing freshness, variety, balance, and, above all, pleasure

Climate and lifestyle


Geographical and lifestyle factors may also go some way towards explaining the paradox. France from the Centrale region southwards has a warm Mediterranean climate
Mediterranean climate
A Mediterranean climate is the climate typical of most of the lands in the Mediterranean Basin, and is a particular variety of subtropical climate...

. The effects of good weather will encourage outdoor leisure pursuits (often physical) to a greater extent than predominantly inclement weather. Ferrieres cites a study by Scarabin et al. (2003) comparing activity and health statistics in men from Toulouse and Belfast that shows although the total levels of physical activity are similar for both cities, French men performed more physical activity in their leisure time, possibly accounting for decreased incidence of CHD compared to Northern Ireland.

In addition to the beneficial cardiovascular effects of such exercise, being outdoors also exposes the body to the sun. Exposure of the skin to sunlight leads to higher levels of vitamin D
Vitamin D
Vitamin D is a group of fat-soluble secosteroids. In humans, vitamin D is unique both because it functions as a prohormone and because the body can synthesize it when sun exposure is adequate ....

, which has been shown to reduce the risk of coronary artery calcification.

Under-certification


Another possible explanation for the paradox is under-certification of coronary heart disease related deaths by French physicians. However, when the possible bias was accounted for and corrected, CHD mortality rates were still significantly lower than other similar western countries.

Time lag hypothesis


The time lag hypothesis states that if there was a delay in serum cholesterol concentrations increasing and a subsequent increase in ischaemic heart disease mortality, then the rate of current disease mortality must relate to past levels of serum cholesterol and fat consumption much more than current levels. Law and Wald (1999) used Criqui and Ringel's (1994) study of alcohol and diet in explaining the French Paradox. On analyzing past and recent data of serum cholesterol and fat consumption (when earlier data were entered and adjustment was made for under-certification of CHD), they found that France fits in with the trend of other countries with similar cholesterol and fat intake. Also, recent data prediction for CHD mortality rates showed that France was similar to other countries.

Hydrogenated and trans fats


In the book, Cholesterol and The French Paradox, there is another explanation given by clinical nutritionist and naturopathic physician Frank Cooper. He argues that the French Paradox is due to the lack of hydrogenated and trans fats in the French diet. The French diet is based on natural ‘saturated fats’ such as butter, cheese and cream that the human body finds easy to metabolise, because they are rich in shorter saturated fatty acids ranging from the 4-carbon butyric acid to the 16-carbon palmitic acid. But the American diet includes larger amounts of artificial ‘saturated fats’ made from a process of hydrogenating vegetable oils that produces mostly 18 and 20-carbon long fatty acids. These hydrogenated vegetable oils also contain fatty acids with an unusual molecular structure that the human body finds difficult to metabolise. In addition, these hydrogenated fats include small quantities of trans fats that have a dangerous molecular structure that the human body sees as foreign, and cause damage to the structure of the cells in the body. Trans fats are well known to cause diabetes, heart disease, and macular eye disease.

Whole diet


In the book In Defense of Food
In Defense of Food
In Defense of Food: An Eater's Manifesto is a 2008 book by journalist and activist Michael Pollan. It was number one on the New York Times Non-Fiction Best Seller List for six weeks. The book grew out of Pollan's 2007 essay Unhappy Meals published in the New York Times Magazine...

, Michael Pollan
Michael Pollan
Michael Pollan is an American author, journalist, activist, and professor of journalism at the UC Berkeley Graduate School of Journalism. A 2006 New York Times book review describes him as a "liberal foodie intellectual."...

 suggests the explanation is not any single nutrient, but the combination of nutrients found in unprocessed food; not any one nutrient, nor the amount of carbohydrates or fats or proteins, but the whole length and breadth of nutrients found in "natural" foods as opposed to "processed" foods.

Validity questioned


Nevertheless, the medical causes of the French Paradox are still not entirely clear and research continues. Meanwhile, some researchers have questioned the validity of this paradox altogether, particularly the connection between natural saturated fat consumption and cardiovascular disease. This view has recently received broad support through the results of the Nurses' Health Study
Nurses' Health Study
The Nurses Health Study, established in 1976 by Dr. Frank Speizer, and the Nurses' Health Study II, established in 1989 by Dr. Walter Willett, are the most definitive long-term epidemiological studies conducted to date on older women's health. The study has followed 121,700 female registered...

 run by the Women's Health Initiative
Women's Health Initiative
The Women's Health Initiative was initiated by the U.S. National Institutes of Health in 1991. The objective of this women's health research initiative was to conduct medical research into some of the major health problems of older women...

. After accumulating approximately 8 years of data on the diet and health of 49,000 post-menopausal American women, the researchers found that the balance of saturated versus unsaturated fats does not affect heart disease risk, while the consumption of trans fat
Trans fat
Trans fat is the common name for unsaturated fat with trans-isomer fatty acid. Because the term refers to the configuration of a double carbon-carbon bond, trans fats are sometimes monounsaturated or polyunsaturated, but never saturated....

 results in significantly increased risk of cardiovascular disease.

See also

  • French cuisine
    French cuisine
    French cuisine is a style of food preparation originating from France that has developed from centuries of social change. In the Middle Ages, Guillaume Tirel , a court chef, authored Le Viandier, one of the earliest recipe collections of Medieval France...

  • List of paradoxes
  • Mediterranean diet
    Mediterranean diet
    The Mediterranean diet is a modern nutritional recommendation inspired by the traditional dietary patterns of southern Italy, Crete and much of the rest of Greece in the 1960s....

  • Mexican paradox
    Mexican paradox
    The Mexican paradox is the observation that the Mexican people exhibit a surprisingly low incidence of low birth mass, contrary to what would be expected from their socioeconomic status...

  • Stroke Belt
    Stroke Belt
    Stroke Belt or Stroke Alley is a name given to a region in the southeastern United States that has been recognized by public health authorities for having an unusually high incidence of stroke and other forms of cardiovascular disease...

  • Wine and health
    Wine and health
    The issue of wine and health is a topic of considerable discussion and research. Wine has a long history of use as an early form of medication, being recommended variously as a safe alternative to drinking water, an antiseptic for treating wounds and a digestive aid, as well as a cure for a wide...


Other sources

  • Perdue, W. Lewis, et al. the French Paradox and Beyond. Sonoma, CA: Renaissance, 1993.

External links

  • How To Live Forever The Economist
    The Economist
    The Economist is an English-language weekly news and international affairs publication owned by The Economist Newspaper Ltd. and edited in offices in the City of Westminster, London, England. Continuous publication began under founder James Wilson in September 1843...

    3 January 2008