What Explains the French Paradox?

The so-called French Paradox is a term coined back in the 80’s by three Frenchmen to explain a curious finding. If you chart death from heart attack versus the amount of saturated fat and cholesterol countries consume, there appears to be a straight line. The more animal foods populations eat, the higher their death rates appear to be. Conversely, maybe if we got meat, egg, and dairy low enough, we could bring coronary death rates down to zero. But two countries fell outside the line. Finland seemed to be doing worse than expected, and France appeared to be doing better. Hence, the paradox. How could France have saturated fat and cholesterol intake similar to Finland, but five times fewer fatal heart attacks?

Everyone had their pet theories. Was it the wining? Was it the dining? Yes, animal foods were associated with coronary heart disease mortality, but plant foods appeared protective. So, maybe the fact that the French were eating four times as many vegetables helps account for their lower death rates. But it turns out there’s apparently no paradox at all. As Marion Nestle astutely pointed out, the French had just recently started eating so unhealthy, and chronic diseases take decades to develop. The U.S. had been eating this way for 40 years, whereas the French had just picked it up. It’s like if we all started smoking today and found no measurable increase in lung cancer tomorrow, it wouldn’t mean smoking doesn’t cause lung cancer; it just takes a while.

So, what happens when you actually run the numbers? If you compare coronary death rates to the amount of animal fat and cholesterol levels at the time, France does seem unusually protected, and if you compare death rates to what they were eating two decades before, they’re still pretty far off the line. Ah, but it turns out French physicians under-report ischemic heart disease deaths on the death certificates by as much as 20%, according to a World Health Organization investigation.

So, if you correct for that, then, France basically comes right back in line with the death versus animal fat and death versus cholesterol lines, with about four times the fatal heart attack rates as Japan decades after four times the animal fat consumption.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

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Images thanks to Ross Websdale via Flickr.