Is the ‘French paradox’ really a paradox?

Anyone who takes more than a passing interest in the role of diet in health will inevitably become aware of inconsistencies and contradictions that crop up from time to time. One famous and oft-quoted nutritional anomaly in the so-called French Paradox: while the French consume more than their fair share of fat and tend to run elevated levels of cholesterol in their blood streams, their propensity to heart disease remains stubbornly low. While a few explanations for this phenomenon have been mooted, including a preponderance of red wine in the diet, it remains a mystery why our European neighbours appear to get away with a diet famously rich in cheese, red meat and foie gras.

This week, I thought I’d have a stab at getting to the bottom of the French Paradox, starting with a look at the premise on which it is based. Conventional wisdom dictates that a diet rich in saturated fat found in animal products such as meat, eggs and dairy products, and the higher blood levels of cholesterol this is said to induce, increase the risk of the artery-furring process that gives rise to heart disease. This concept dates back to 1953, when an American researcher by the name of Ancel Keys published a study showing that the higher the level of animal fat in a nation’s diet, the greater its rate of heart disease. Other research performed over the last half-century have shown similar results, and have been bolstered by additional studies linking higher levels of cholesterol in the bloodstream to increased risk of heart disease too.

However, the case against saturated fat and cholesterol may not be as open-and-shut as we have been to believe. When Keys published his seminal study 50 years ago, he focused on just a handful of countries. However, at that time, data from 22 countries existed, which suggests Keys had been a tad selective about the evidence he presented. Actually, much of data Keys omitted did not fit into the neat little concept he was keen to popularise. For instance, despite similar fat intakes, heart disease deaths in Finland were found to be seven times higher than in Mexico. Also, subsequent studies have found enormous variance in heart disease rates within countries, despite consistent blood cholesterol levels. A wider look at the evidence suggests that the association between animal fat and heart disease is far from clear cut.

There is evidence, though, that cholesterol-reducing medications known as statins can reduce the risk of heart disease. These findings are often cited as evidence that fat and cholesterol really do cause heart disease. However, some researchers have suggested that the disease-protective benefits of statins come not from their cholesterol-quelling action, but from other biochemical effects they are known to have in the body. This concept is supported by the fact that studies designed to assess the effects of cholesterol-reducing diets have failed to find consistent benefits. The bottom line is that eating animal fat and having lofty levels of cholesterol in the bloodstream may not be the potent risk factors in heart disease they are generally regarded to be. The real explanation for the French Paradox could well be that it is really no paradox at all.

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