Americans, famous for wanting their cake and eating it too, were delighted to learn that even though French foods seem to be rich in fat, much of it artery-clogging saturated animal fat, the French are not nearly as likely to be cut down in midlife by heart attacks. This intriguing phenomenon, the “French paradox,” has drawn comment, criticism and speculation for much of this decade.
But the latest treatise on the subject, published in The British Medical Journal, suggests the paradox may not be so paradoxical after all. Rather, the authors maintain, it is only a matter of time before the fatty French diet exacts its coronary toll. These scientists, Drs. Malcolm Law and Nicholas Wald, specialists in preventive medicine at St. Bartholomew’s and the Royal London School of Medicine and Dentistry, point out that for decades until 1970, the French ate much less animal fat and had significantly lower blood cholesterol levels than did Britons, who were in no better shape than Americans.
But as the French diet grew richer, French cholesterol levels did too. “Only between 1970 and 1980 did French values increase to those in Britain,” the authors noted, adding that since only about 1 percent of men die of heart disease before age 50, it takes decades of exposure to a high-fat diet to exact this toll.
Though the new British report is the most thorough analysis of this “time-lag hypothesis,” it has been put forward before as an explanation for French diet and health. Marion Nestle, chairwoman of the department of nutrition at New York University, noted several years ago that it was not until 1985 that French consumption of fat caught up to that of Americans.
“There’s been a steady increase in fat consumption in France over the last 20 years as the French diet has become more Americanized,” Nestle said in a recent interview. She noted that the French were now eating more meat and fast foods, snacking more, eating fewer regular relaxed meals, exercising less and drinking less wine than in the past. And, predictably, they are getting fatter.
Wait a few more decades, Nestle predicted, and the French will no longer enjoy a coronary death rate that is less than half that of Americans.
French magic?
Even if the French did not reach American levels of fat consumption until recently, something still seems to have been protecting their hearts. How else could they have gotten away with their apparent penchant for eggs, pats and rich cheeses?
Several health experts, commenting on the report by Law and Wald, have offered possible explanations that could prove helpful to Americans seeking to lower their risk of heart disease without forgoing all the pleasures of dietary fat.
Dr. Meir Stampfer and Dr. Eric Rimm of the Harvard School of Public Health stress in their commentary that coronary disease is not due to any single factor and that preventing it cannot result from only one adjustment in living habits, like eating less saturated fat. Although they do not dismiss the idea that time will take its toll on the French heart, they cite several other differences in dietary habits between the French and Britons (and, by extension, Americans) that studies strongly suggest play an important role in heart disease. For example:
Alcohol: “Law and Wald may be too quick to dismiss the role of alcohol asa partial explanation,” the Boston researchers wrote. Many studies have shown a strong relationship between increased intake of alcohol and a lower level of cardiac deaths. Alcohol raises blood levels of protective HDL cholesterol, which helps rid arteries of fatty deposits. Red wine in particular, the favored beverage in France, contains chemicals that lower the risk of blood clots that could touch off a heart attack. Also important may be the pattern of alcohol consumption.
“The evidence of benefit from moderate consumption of alcohol is very, very strong, and it seems to be strongest when alcohol is taken with meals on a moderate, regular basis as opposed to weekend bingeing or alcohol consumed alone,” Stampfer said in an interview. Moderate consumption means two daily glasses of wine for men and one glass for women.
Fiber: The French consume two to three times more fiber from whole grains and grain products than do Britons and Americans. These cereal fibers have been linked in at least three major studies to a decreased risk of heart disease, most recently this month in a study of nearly 69,000 middle-aged nurses published in The Journal of the American Medical Association. Each increase of 5 grams a day of cereal fiber (the amount in a half-cup of bran-flake cereal) was associated with a 37 percent decrease in coronary risk among these women. Similar associations were found in the Iowa Women’s Study and in men in the Health Professionals Follow-Up Study.
Nuts: The French eat about twice as many nuts as Americans do. Several studies that followed tens of thousands of men and women in this country showed that “even modest amounts of nuts were associated with a markedly lower risk of coronary heart disease, a benefit greater than would be predicted from their effects on serum cholesterol,” Stampfer said. The fat in nuts is the unsaturated kind that reduces harmful LDL cholesterol. “Ironically, many health-conscious Americans have been avoiding nuts because they are high in fat,” he noted.
Folate: When Americans visit France or dine in French restaurants in this country, they tend to eat rich, fancy foods. “But the French people don’t eat fancy foods day to day,” Stampfer said. “They eat many more fruits and vegetables,” including those that are rich in a B-vitamin called folate (or folic acid), which has been associated with a decreased risk of heart disease. Good sources of folate include dark-green leafy vegetables and orange juice.
Glycemic load: Frequent consumption of foods that quickly raise the level of sugar in the blood has been linked to an increased risk of developing heart disease and diabetes. When blood sugar rises, insulin is released to process it, which stimulates the production of a harmful form of triglycerides, a known coronary risk factor. In general, whole foods and minimally processed grains produce a low glycemic load, while sweets, pastries, white bread and potatoes produce a high glycemic load. Americans who snack on sweets and refined carbohydrates raise their glycemic load and, in turn, their risk of heart disease.
Cheese and foie gras: Dr. Serge Renaud, research director at France’s National Institute of Health and Medical Research, maintains that there is something different about the fats in duck and goose liver and in cheese that makes them less damaging and possibly even protective of the heart. His evidence in part comes from the heart of foie gras country, the Gascony region of southwest France, where the coronary death rate among middle-aged men is about half that of the rest of France. He has said that “goose and duck fat is closer in chemical composition to olive oil than it is to butter and lard.” What, if anything, may be special about the fats in cheese is now being studied.
Portion size: Rich foods or not, the French simply eat less than Americans do. French portion sizes tend to be a third to a half of American portions, and until recently, the French sat down to eat leisurely meals three times a day and rarely ate between meals, Nestle said. The French obesity rate is 8 percent; in the U.S. it stands at 30 percent.
Despite their dietary advantages, the French still get heart disease. Dr. Dean Ornish, cardiac specialist at the University of California at San Francisco, has pointed out that while “heart attacks are less frequent in France, they are still the leading cause of death there.”
And as Nestle noted, French habits are changing, and not for the better. Children are now given soft drinks, not wine, to drink; wine consumption overall has dropped to about half of former levels; snacking is now commonplace; more and more family meals are coming from pizza parlors and McDonald’s; and more people are driving to big markets to shop instead of walking to local groceries.
As she and others have said, it is only a matter of time.
