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ORGANIZATIONS
The British Dietetic Association. 5th Floor Charles House
148/9 Great Charles Street Queensway Birmingham B3
3HT.www.bda.uk.com.
The British Nutrition Foundation 52-54 High Holborn,
London WC1V 6RQ. http://www.nutrition.org.uk.
The Food Standards Agency.www.food.gov.uk.Emma Mills, RDFrench dietseeNorthern European diet
French paradox
Definition
The French Paradox refers to the low rate of
coronary heart disease(CHD) in France despite the
diet being rich in saturated fat.Origins
2002 data from the Food and Agriculture Organ-
ization of the United Nations (FAO), showed that
although the intake of saturated fat in France was
higher than in the United States (US), 108 grams (g)
compared to 72g per day, France had a 30–40% lower
risk of CHD. Over the years, studies suggest that one
of the reasons the French have a lower rate of CHD,
despite higher saturated fat intakes, may be related to
their regular consumption of red wine.
Links to alcohol and heart disease were first
observed in 1976. English Physician William Heber-den’s classic descrition of angina pectoris, included
‘‘wines and liquors... afford considerable relief’’.
This led to the assumption that alcohol was a coronary
vasodilator.
The French Paradox was first noted by Irish car-
diologist Samuel Black in 1819. He found that the
French had lower heart rate deaths compared to the
Irish and attributed this to ‘‘the French habits and
modes of living, coinciding with benignity of their
climate and the peculiar character of their moral affec-
tions’’. This was the beginning of more current think-
ing that other dietary and lifestyle factors may play a
part in the risk for heart disease.
In the 1970s, epidemiological studies began to
show that moderate intakes of alcohol were associated
with a low rate of CHD. In 1997, a large American
study by Thun et al., demonstrated that at least one
drink a day reduced death risk from CHD, but more
than three drinks daily was associated with an increased
death rate. McElduff et al. followed this up in the same
year and found that frequency was as important as
quantity in risk for heart disease. Lowest risk was
among those who drank moderate of alcohol amounts
4–6 days a week. At the time there were issues with
defining heavy and moderate drinking and as of 2007
there is still some debate. However, there is a general
agreement that 3 unit of alcohol a day for men and 2 or
more a day for women is considered unhealthy.
It was not until the 1990s that the French Paradox
was looked at again. Dr. Serge Renaud, a scientist
from Bordeaux University in France, coined the term
‘‘French Paradox’’ after his 1992 study. This was a
large study of middle age French men. He found they
have a long life expectancy despite a diet high in satu-
rated fat. Although the diet included butter, cheese,
eggs and cream, contributing to 15% of calories from
saturatedfats, the incidence of CHD was only 40% of
the American incidence of CHD. He concluded that
two to three glasses of wine a day wine reduced death
rates from all disease by up to 30%, but four glasses a
day were found to have an adverse effect on health. He
suggested that the combined effect of the alcohol and
antioxidantsin wine played a role in reducing CHD.
The French Paradox became internationally recog-
nized when in 1991 he, together with another French
Paradox supporter Dr. R. Curtis Ellison of Boston
University School of Medicine, outlined the research
on the ‘‘60 minutes’’ documentary in the USA. Inter-
estingly,soon after this, red wine sales in the United
States increased by 40%.
Further studies have supported this hypothesis,
including the 1995 Copenhagen Heart Study that ran
from 1976 to 1988 and confirmed the health benefits ofFrench paradox