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The French Paradox: Was it Really the Wine?

By Stefano Vendrame

Here we go again. I’m reading the billionth newspaper article referring to the “French paradox,” with the author explaining that “in spite of their high saturated fat intake, the French die less of coronary heart disease thanks to their higher consumption of red wine.”

It’s an old story that keeps coming back. I’ve heard it time and again from TV shows, newspapers, books and magazines, even university professors. It has been told so many times that in the back of their minds a lot of people still believe the concept that drinking red wine can prevent cardiovascular disease. It all dates back to the early nineties, when Serge Renaud and Michel De Lorgeril published a paper in Lancet entitled “Wine, alcohol, platelets, and the French paradox for coronary heart disease” (1).

Presenting epidemiological data, the authors observed that French people had a high consumption of saturated fat, and yet their mortality for coronary heart disease (CHD) was low. In the US and the UK, where consumption of saturated fat was substantially equivalent to France, mortality for CHD was much higher. They called this the “French paradox.” There was, however, a difference; in France, they would also drink more red wine. Since alcohol does have some fibrinolitic and atheroprotective effects, and red wine contains some protective polyphenols, such as resveratrols that come straight from red grapes, they hypothesized that higher red wine consumption could explain the apparent paradox. To further support this hypothesis, there were some striking data from three different cities within France itself. CHD mortality per 100,000 men was much lower in Toulouse compared to Strasbourg and Lille (78 vs 102 and 105, respectively), in spite of cheese consumption being higher (51 g/day vs 34 and 42 g/day, respectively). However, wine consumption in Toulouse was also significantly higher compared to the other two cities (383 g/day vs. 286 and 267 g/day, respectively). Again, wine consumption appeared to “counteract the untoward effects of saturated fats,” to use the words of the authors.

In the 1990s, wine sales in Europe were inexorably declining, with many young people in traditionally wine-drinking countries steadily switching to beer, considering wine drinking an old-fashioned habit. The wine industry jumped on the “French paradox” story, promoting an epic marketing campaign which instilled in a lot of people the idea that drinking red wine is good for your heart. It was so effective that I know people who didn’t drink alcohol at all, and started drinking a glass of red with their meals for fear that not doing so would increase their risk of dropping dead from a heart attack.

Not surprisingly, a great deal of research ensued. Indeed, when polyphenols are extracted from red grapes or red wine they exert beneficial effects, but the amount of wine needed to get enough resveratrols to produce a significant effect would be incompatible with the toxic effects of alcohol (2,3). And while a moderate consumption of alcohol is associated with a slightly reduced death rate from heart attack, it is also associated with a slightly increased death rate from cancer, liver cirrhosis and car accidents (4,5). Tough choice.

Anyone who has visited France will notice they enjoy their cheeses and sauces and foie gras, they always eat them with plenty of vegetables and grains, and a visit to any morning market in France will strike for the abundance of colors coming from all sorts of fruits, vegetables and herbs, and for the customers eagerly filling their baskets with them. So, was it really wine that was the key to explain the French paradox? A mere look at the rest of the Toulouse-Strasbourg-Lille table published in that very Lancet article would have provided good clues that wine was not necessarily part of the answer, and even if it was, it was certainly not all of it!

Granted, in Toulouse they drank more red wine than in Strasbourg and Lille, while eating slightly more cheese, but they also ate a lot more vegetables (306 g/day vs. 217 and 212 g/day, respectively), a lot more fruit (238 g/day vs. 149 and 160 g/day), half the butter (13 g/day vs. 22 and 20 g/day), more vegetable fat (20 g/day vs. 16 and 15 g/day) and more bread (225 g/day vs. 164 and 152 g/day). In other words, they were eating more fruits and vegetables and they ingested more dietary fiber, less saturated fat, more polyunsaturated fat and more grains. Still surprised that their deaths were less often attributed to cardiovascular disease?

The popular narrative of the French paradox gets the premise and the conclusion wrong. It is wrong to assume that saturated fat is all that matters to predict cardiovascular risk, since we know very well that it is just one of the many dietary factors involved. And it is dead wrong to suggest that drinking a few glasses of red wine is all you need to make it better. If anything, the whole story proves once more the concept that the balance of diet in general is more important than any single component in preventing disease and ensuring good health. You can eat a little bit more cheese, but if you eat a lot more fruits and vegetables, you are still doing fine. I propose a toast to this basic rule of nutrition, and I’ll be happy to toast with a glass of good French red wine, as they do in Toulouse. But just like them, I’ll get plenty of fruits and veggies afterwards to prevent CHD. Cheers!

References
1. Renaud S, de Lorgeril M. Wine, alcohol, platelets, and the French paradox for coronary heart disease. Lancet. 1992; 339:1523-6.

2. Bianchini F, Vainio H. Wine and resveratrol: mechanisms of cancer prevention? Eur J Cancer Prev. 2003; 12:417-25.

3. Goldberg DM, Yan J, Soleas GJ. Absorption of three wine-related polyphenols in three different matrices by healthy subjects. Clinical Biochemistry. 2003; 36:79-87.

4. Norström T, Ramstedt M. Mortality and population drinking: a review of the literature. Drug Alcohol Rev. 2005; 24:537-47.

5. Klatsky AL. Alcohol and cardiovascular diseases. Expert Rev Cardiovasc Ther. 2009; 7:499-506.

Coconut Oil

By: Emily C.

Giving saturated fat another chance.

Saturated fat has long held a bad rep and been noted for its potential to contribute to cardiovascular disease. So you might understand why I was a bit skeptical of all the hype surrounding the supposedly miracle-working power of coconut oil, which is composed of saturated fatty acids. However, if there’s one thing I have learned as a nutrition student, it is that research has the potential to change our views as we continue to expand our knowledge and make new discoveries.

So, why should you try this stuff?

Coconut oil is a medium chain fatty acid (MCFA).

Because coconut oil is made of primarily medium chain (and some short chain) fatty acids, it is broken down immediately for use rather than stored. MCFA aren’t packaged into chylomicrons for circulation through the lymph like long chain fatty acids (LCFA). Instead, they are transported in the portal blood to the liver for conversion into energy. This quick conversion process may prevent weight gain as long as the calories consumed as coconut oil do not exceed the body’s caloric needs. Coconut oil has also been found to speed metabolism and increase energy expenditure and is of great interest for its potential as a weight loss aid.

Coconut oil may prevent and alleviate disease.

Both research and clinical studies have shown that MCFA may be useful in treating and preventing diseases such as diabetes, osteoporosis, virus-related dieases (mononucleosis, hepatitis C, herpes, etc.), gallbladder disease, Crohn’s disease, and cancer. The smaller size of MCFA (compared to LCFA) allows them to be digested more easily, making them ideal for those suffering from digestive diseases. Coconut oil may assist in the absorption and retaining of calcium, thereby benefiting bones.

Coconut oil has antimicrobial, antiviral, and antifungal properties.

Lipid-coated bacteria and viruses contain a lipid coat which encloses their DNA among other cellular materials. When consumed by humans, coconut oil disrupts the lipid membrane, killing the pathogens without damaging the host or harming health-promoting intestinal bacteria. The antimicrobial properties stem from the monoglycerides and free fatty acids (mainly lauric acid and capric acid) that compose coconut oil.

Need more reasons to start consuming coconut oil?

Pure coconut oil is easily absorbed, prevents free radical damage, and can improve the appearance of skin and hair. Coconut oil, which becomes liquid when heated above 75°F, can also be substituted into your favorite baked goods {such as the delicious looking cupcakes I created using coconut oil below}.

With all the benefits that coconut oil can provide, it’s definitely worth trying. And if you find that you don’t quite like the taste, I hear it makes a fantastic conditioner.

References:
Fife B. (2004). The Coconut Oil Miracle. New York: Avery.
Papamandjaris A, MacDougall D, Jones P. Medium chain fatty acid metabolism and energy expenditure: obesity treatment implications. Life Sciences 1998;62: 1203-121.