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The French paradox is an apparently paradoxical epidemiological observation that French people have a relatively low incidence of coronary heart disease (CHD), while having a diet relatively rich in , in apparent contradiction to the widely held belief that the high consumption of such fats is a risk factor for CHD. The paradox is that if the thesis linking saturated fats to CHD is valid, the French ought to have a higher rate of CHD than comparable countries where the per capita consumption of such fats is lower.
It has also been suggested that the French paradox is an illusion, created in part by differences in the way that French authorities collect health statistics, as compared to other countries, and in part by the long-term effects, in the coronary health of French citizens, of changes in dietary patterns that were adopted years earlier.
In 1991, Renaud extended his studies in partnership with then junior researchers, cardiologist and dietician . The three enhanced Renaud's study, with their paper concluding that: a diet based on southwestern Mediterranean cuisine (which is high in omega-3 oils, antioxidants and includes "moderate consumption" of red wine) created lower cases of cancer, myocardial infarction and cardiovascular disease; partly through increasing HDL cholesterol whilst reducing LDL cholesterol.
First, Law and Wald attributed about 20% of the difference in the observed rates of CHD between France and the United Kingdom to the under-certification of CHD in France, relative to the UK.
Second, Law and Wald presented a time-lag hypothesis: if there is a delay between increasing serum cholesterol concentrations and any subsequent increase in ischaemic heart disease mortality, then the current rate of mortality from CHD is more likely to be linked to past levels of serum cholesterol and fat consumption than to current serum cholesterol levels and patterns of fat consumption. They wrote,
We propose that the difference is due to the time lag between increases in consumption of animal fat and serum cholesterol concentrations, and the resulting increase in mortality from heart disease—similar to the recognised time lag between smoking and lung cancer. Consumption of animal fat and serum cholesterol concentrations increased only recently in France, but did so decades ago in Britain.Evidence supports this explanation: mortality from heart disease across countries, including France, correlates strongly with levels of animal fat consumption and serum cholesterol in the past (30 years ago) but only weakly to recent levels. Based on past levels, mortality data for France are not discrepant
In addition, the French population has become increasingly overweight. A study published by the French Institute of Health and Medical Research (INSERM) revealed an increase in obesity from 8.5% in 1997 to 14.5% in 2009, with women showing a greater tendency toward obesity than men.
This was seen most dramatically when, in 1991, an early account of the then-novel concept of the French paradox was aired in the United States on 60 Minutes. The broadcast left the impression that France's high levels of red wine consumption accounted for much of the country's lower incidence of cardiac disease. Within a year, the consumption of red wine in the United States had increased by 40% and some wine sellers began promoting their products as "health food."
The cultural impact of the French paradox can be seen in the large number of book titles in the diet-and-health field that purport to give the reader access to the secrets behind the paradox:
Other books sought to boost their credibility by reference to the French paradox. The American edition of Dukan Diet, written by Pierre Dukan, a Paris-based doctor, is marketed with the subtitle, "The real reason the French stay thin".
Some researchers have thrown into question the entire claimed connection between natural saturated fat consumption and cardiovascular disease. In 2006, this view received some indirect support from the results of the Nurses' Health Study run by the Women's Health Initiative. After accumulating approximately 8 years of data on the diet and health of 49,000 post-menopausal American women, the researchers found that the balance of saturated versus unsaturated fats did not appear to affect heart disease risk, whereas the consumption of trans fat was associated with significantly increased risk of cardiovascular disease.
Similarly, the authors of a 2009 review of dietary studies concluded that there was insufficient evidence to establish a causal link between consumption of saturated fats and coronary heart disease risk.
Clower tends to downplay the common beliefs that wine consumption and smoking are greatly responsible for the French paradox. While a higher percentage of French people smoke, this is not greatly higher than the U.S. (35% in France vs. 25% in U.S.) and is unlikely to account for the weight difference between countries.
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