The French Health Paradox

By: Jocelyn Spizman

The French Paradox is a phrase used to reflect the opposing epidemiological reality in which the French have lower incidences of Coronary Heart Disease (CHD), non-communicable diseases (NCD), and mortality due to NCD while generally eating a diet rich in saturated fats, cholesterol, and alcohol.[2]

When comparing cholesterol and saturated fat levels to CHD mortality rates in other countries, Ferrières et. al found that even though diets consisting of a higher percentage of saturated fat were positively correlated to higher rates of mortality due to CHD, the French population showed an inverse relationship.[2] Ferrières hypothesized that greater cardiovascular health could be due to the greater amounts of red wine drank by the French.

According to nutrition researchers Leasa Stanley and M.J. Patricia Mazier, red wine raises HDL (good) cholesterol, and leads to a 24-31% decrease in all-cause mortality. This could be due to the antioxidants, and chemical components of red wine such as resveratrol and polyphenols. Alternatively, the French have a higher dietary content of fruit and vegetables, which contain higher levels of folate. High folate is only one of the many known important nutrients found in fruits and vegetables. The high density of daily fruit and vegetable consumption is hypothesized to contribute to their greater health outcomes.[2] This trend follows that all European cities that have a higher consumption of fruits and vegetables consistently have lower mortality rates due to CHD.[2]

Alternatively, we must consider the socio-cultural factors that contribute to the French health paradox. The following socio-cultural practices in French culture contribute to their better health outcomes:

• The quality of the food tends to be fresher, as the French tend to grocery shop more often (everyday or every other day) and only buy things they will use in the following couple of days. With no expectation for foods to stay fresh for long, the French have less preservatives and chemicals in their foods. 
• They eat meals in a social setting, which leads to less binge-eating (and positive mental health effects as well). 
• Although the French do drink more alcohol, they tend to drink a majority of wine and do not binge drink massive amounts within a short time period. Binge-drinking is more stigmatized in France and therefore less common at all ages. Drinking wine at home usually begins for children at a younger age, and therefore is introduced in a safe and healthy setting.[1]

• They eat a higher percentage of fresh fruits, vegetables, and less processed foods and hold a high standard for the quality of the food they buy.[2]
• The French tend to have a more active lifestyle, with more physical movement spread out throughout the day. 
• Their healthcare system provides great preventative healthcare measures and physician care is more individualistic and accessible. 
• The French tend to have less chronic stress as a part of their lifestyle, a known epidemiological determinant to developing non-communicable chronic diseases. 
• Many other factors that are yet to be explored, such as gene-environment interactions and various other social determinants of health.

The French paradox of health outcomes is also seen in other southern European countries and could be attributed as well to the high polyunsaturated fat and healthy fruits and vegetables in the Mediterranean diet.[2]

Although we may aspire to live with these healthy habits as the French do, epidemiologist Jean Ferrières indicated that there may be an under-reporting of ischemic heart disease deaths by French physicians, making the paradox not such a paradox at all.[2] Yet scientists still report that even with a high rate of underreporting the French still seem to have a protective effect against non-communicable diseases.[2] Furthermore, with the globalization of fast-food and other modern unhealthy habits influencing French culture, rates of all non-communicable diseases are beginning to rise in comparison to two decades before. 

References:

1. Stanley, Leasa L., and M.j. Patricia Mazier. “Potential Explanations for the French Paradox.” Nutrition Research, vol. 19, no. 1, 1999, pp. 3—15., doi:10.1016/s0271-5317(98)00167-5.
2. Ferrieres, J. “The French Paradox: Lessons for Other Countries.” Heart, vol. 90, no. 1, 2004, pp. 107—111., doi:10.1136/heart.90.1.107.