Paris, France or Paris, Texas?

Philip J. Goscienski, M.D.

December 2006

More than 4800 miles separate Paris, France and Paris, Texas. The culinary chasm that separates the two is as wide as the cultural one. Texans are famous for their chili while the French are praised for their paté. There's also a huge discrepancy between the rates of heart disease in the two cities.

The French Paradox was described in the early 1990s when someone noted that the incidence of coronary heart disease was about 4 times as high in British men (and Americans) than in their friends across the channel. There is a high intake of saturated fat and cholesterol in all 3 countries. Scientists scurried back and forth between them looking for answers and came up with several theories.

Could reporting methods explain it? Physicians in each country do report causes of death somewhat differently but not nearly enough to explain the discrepancy. Tobacco was the obvious next target, yet Frenchmen smoke even more than Englishmen and Americans do.

Many French families eat more fruits and vegetables than Texas families do because they raise their own in small backyard gardens and there is a definite correlation between fruit and vegetable intake and a lower risk of coronary artery disease.

In France, especially beyond the cities, much work is still done by hand that Americans accomplish with the latest tools from Home Depot.

Supersizing is still not a French phenomenon. A steak in Paris, France weighs about 6 ounces; a steak in Paris, Texas weighs 16 ounces. It's no surprise that Texas has one of the highest rates of obesity in the United States. Obesity contributes heavily (pardon the pun) to heart disease.

Wine-lovers ardently believe that their favorite drink is responsible for the difference. A higher intake of wine correlates with a lower intake of heart disease, up to a point. A small amount of alcohol daily raises good cholesterol (HDL). Red wine seems to be protective against heart disease through other mechanisms, including a reduced tendency to form blood clots. The specific compound in red wine that many scientists feel is heart-protective is resveratrol, a polyphenol that is abundant in red grape skins. There is 10 times as much resveratrol in red grapes (which includes purple) as in the white varieties.

There are thousands of polyphenols in wine, including some that protect the lining of blood vessels and others that block the absorption of cholesterol into the bloodstream. Some reduce inflammation, which recent discoveries implicate in the development of heart attacks. Substances in red wine enable blood vessels to dilate quickly and to increase blood flow during physical or emotional stress.

Frenchmen pay a price for their high intake of wine. They suffer from a greater incidence of alcohol-related diseases, offsetting the heart disease advantage. What is more ominous as the French acquire the fast-food lifestyle of America is that their heart disease incidence is rising while their alcohol problems persist.

There is no simple explanation for the French Paradox. But if the American lifestyle included smaller food portions, several times as much fruit and vegetables and a lot more physical activity our rates of heart disease would match theirs so closely that we'd be asking "What paradox?"

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.