The French Paradox: myth or reality?

Philip J. Goscienski, M.D.

June 2005

It's true that the incidence of coronary artery disease among Frenchmen is lower than that in their American counterparts even though they eat richer, fattier foods. The reported death rate from heart disease among Frenchmen is about one quarter that of persons living in the United States or Great Britain. This is called the French Paradox. About one third of Americans are obese but only about 10 percent of the French are. It seems unfair until you take a close look.

The French eat more saturated fat than we do but their energy intake overall is less than ours by about 100 to 200 calories per day. Looking conservatively at the lower figure that amounts to about 10 pounds per year!

The French eat 75 percent of their meals at home but Americans eat almost half of theirs (44 percent) away from home, largely in fast-food places that are not particularly well known for nutritional excellence or restraint. Dining out in America is a big deal. Whether it's a burger joint or all-you-can-eat Chinese, a serving in America is 25 to 100 percent larger than a similar dish in France.

So why aren't the French hungry all the time? One answer is cultural. Eating is almost a ritual experience in France. They take the time to prepare meals from scratch, not from a can or box, and their vegetables are likely to be home grown. They also eat slowly. Two hours for lunch is more the routine than the exception. That gives their appetite control mechanism plenty of time to work as it's supposed to. We Americans short-circuit ours by bolting down our food.

Their high-fat diet is actually an advantage in controlling hunger. Fats are more filling than carbohydrates and don't cause the roller coaster swings in blood sugar (glucose) that lead to cravings and eventually to type 2 diabetes. The fruits and vegetables that form a large part of the diet in France contain carbohydrates but they don't affect blood glucose the way that refined flour and sugar do.

The French diet is richer in heart-protective antioxidants than ours because of those fruits and vegetables. Leafy green vegetables contain folic acid, a nutrient that is associated with lower levels of blood pressure, a major risk factor in heart disease.

Could drinking wine make a difference? Red wine lowers the concentration of a substance called endothelin that is harmful to the lining of blood vessels. Red wine also contains beneficial antioxidants. Persons who average one drink per day of any alcoholic beverage lower their risk of heart disease. The benefits diminish as the amount of alcohol one takes increases, and alcoholism is a serious problem in France. Alcohol-related deaths are three times as numerous in France as in the United Kingdom.

In a generation or two the French Paradox may no longer exist. They are catching up with us. As they adopt more of our lifestyle - fast food, sitting in front of a TV set or computer - their blood cholesterol levels and rates of coronary artery disease are beginning to approach ours.

The French Paradox is becoming, as the French would say, passé.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.