What About the French Paradox?

The so-called French Paradox is a term coined back in the 1980s by three Frenchmen to explain a curious finding: If you chart death from heart attack versus the amount of saturated fat and cholesterol countries consume, there appears to be a straight line. The more animal foods populations eat, the higher their death rates appear to be. Conversely, maybe if we got meat, egg, and dairy intake low enough, we could bring coronary death rates down towards zero.

As I discuss in my video What Explains the French Paradox?, two countries didn’t fall in line with that straight line. Finland seemed to be doing worse than expected, and France appeared to be doing better than expected. Hence, the paradox. How could France have saturated fat and cholesterol intake similar to Finland, but five times fewer fatal heart attacks?

Everyone had their pet theories to explain the paradox. Was it the wining? Was it the dining? Yes, animal foods were associated with coronary heart disease mortality, but plant foods appeared protective. So, maybe the fact that the French were eating four times as many vegetables helps account for their lower death rates?

Well, it turns out apparently there’s no paradox at all. As Marion Nestle astutely pointed out, the French had only recently started eating so unhealthily, and chronic diseases take decades to develop. Americans had been eating this way for 40 years, whereas the French had just picked it up. If we all started smoking today but found no measurable increase in lung cancer tomorrow, it wouldn’t mean smoking doesn’t cause lung cancer—it just takes a while.

What happens when you actually run the numbers? If you compare coronary death rates to the amount of animal fat and cholesterol levels at the time, France does seem unusually protected. And, if you compare death rates to what they were eating two decades before, they’re still pretty far off the line. How is that possible? It turns out French physicians under-report ischemic heart disease deaths on the death certificates by as much as 20 percent, according to a World Health Organization investigation.

So, if you correct for that, France basically comes right back in line with the death versus animal fat and death versus cholesterol lines, with about four times the fatal heart attack rates as Japan decades after four times the animal fat consumption.


If you’re wondering about those meta-analyses that show saturated fat is not associated with disease and you thought “butter was back,” you guessed it—I’ve got videos for you: The Saturated Fat Studies: Set Up to Fail and The Saturated Fat Studies: Buttering Up the Public.

What about the egg industry studies claiming dietary cholesterol is benign? See Does Cholesterol Size Matter? and How the Egg Board Designs Misleading Studies for more on this.

Were you hoping the lower heart attack rates in France were thanks to red wine? What about that resveratrol compound in grape skins? See Resveratrol Impairs Exercise Benefits and The Best Source of Resveratrol.   

And, for an overview of heart disease, check out How Not to Die from Heart Disease.

In health,
Michael Greger, M.D.

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