Monday, December 05, 2005

Is There a French Paradox?

Paradox - par·a·dox - 'par-&-"däks
1 : a tenet contrary to received opinion
2 a : a statement that is seemingly contradictory or opposed to common sense and yet is perhaps true b : a self-contradictory statement that at first seems true c : an argument that apparently derives self-contradictory conclusions by valid deduction from acceptable premises 3 : one that possesses seemingly contradictory qualities or phases


For decades many within the scientific and medical communities have called the French a "paradox" because both their eating habits and lifestyle foster an enviable life expectancy, significantly lower rates of heart attacks, cancer, diabetes, degenerative disease, and a lower incidence of obesity in their population when compared with other industrialized nations even though their diet is high in fat (38-45% of total calories, as much as 40% of fat from saturated fats).

To give you a quick idea of the difference in health - the French:
  • Rank #16 in the world at 79.28 years (the US ranks #48 with 77.14 years) for life expectacy
  • Have an obesity rate of 9.4% (the US has an obesity rate hovering around 33%)
  • Average 47 litres of wine per person annually (the US averages 7 litres per person)
  • Average 52 litres of soft drinks per person annually (the US averages 216 litres per person)
  • See a rate of 39.8 deaths per 100,000 from heart attack (the US sees 106.5 deaths)
  • Consume just 7-pounds of added sugar per person annually (the US consumes 152-pounds per person annually)

I think one of the most striking differences is deaths from heart attacks - the very health problem we are told again and again a low-fat diet will help prevent. Put another way, if you eat and live like the French, your odds of dying from a heart attack is rare despite a high-fat diet.

Amazing, isn't it?

Yet, rather than open the door to thinking about the possibility that the French are on to something, the medical and scientific communities hold this population is a paradox - that is they should not be enjoying the health they do because they are eating and living in a style that is contradictory to everything they believe to be true. The idea the set of beliefs is flawed is an impossible idea to grasp.

Which probably explains the eager reserach study to examine, over eight years, 12,741 middle-aged men and women in France to see if nutritional supplements make any difference in the rates of heart attacks or cancer while also following any changes made in diet. The results of this study, the Supplement en Vitamines et Mineroux Antioxidants (SUVIMAX) study, were published this month in Journal of the American Dietetic Association in the article, "Nutrition and Health in France: Dissecting a Paradox"

Dr. Bellisle starts out describing the state of health and longevity of the population in France:

France has the longest life expectancy in the Western world (second only to Japan among developed countries). Prevalence of obesity and overweight is relatively low. In French adults, the frequency of obesity in adults was 11.3% in 2003. Overweight was present in 41.6% of adults. These figures are lower than those of many developed countries, particularly those of the United States.

Her findings over eight years are telling. Rather than provide the cliff notes version, I'll provide what she wrote since it is important to know the details:

In the SUVIMAX population, the daily energy intake observed in 1995 was about 1,900 kcal in women and 2,500 kcal in men. Total daily energy intake has decreased linearly since the beginning of the study, not only when considering the same subjects longitudinally, but also when comparing same-age groups over time.

This decrease in energy intake parallels a decrease in total fat. In 2001-2002, the percentage of participants who ingested less than 35% of their daily energy as fat had increased dramatically, in comparison with 1995-1996 (52.1% of women and 69.2% of men in 2001-2002, vs 19.4% and 34.1%, respectively, in 1995-1996). However, the nature of fats did not change over the study period and saturated fats represented 40% to 41% of total fats in both men and women.

The intake of carbohydrates increased over time, particularly intake of simple carbohydrates.

Fiber (about 22 g/day in men and 18 g in women), protein (16% to 18% of total energy), and alcohol (about 9% of daily energy in men, and 4% to 5% in women) intake appeared constant between 1995 and 2002.

Intake of fruits increased regularly over the course of the SUVIMAX study in both men (from 235 to about 250 g/day in 2001-2002) and women (from 217 to about 230 g/day in 2001-2002). While intake of vegetables did increase over time in longitudinal comparisons of the same individuals, the comparison of same-age groups at different moments of the study indicated a decrease in vegetable intake.

Over the time of the study, the percentage of participants ingesting the recommended five fruits or vegetables a day increased from 1995-1996 to 2001-2002 (14.6% to 22.5% in men; 17% to 27.5% in women).

Over time, the intake of cereal products, legumes, milk and dairy products, and alcohol remained stable. In contrast, intake of animal products (meats, fish, and eggs) decreased in both men and women, while consumption of added fats was dramatically reduced (25.6 g to 15.2 g/day in men and 20.3 to 12.8 g/day in women).

The striking dietary changes over time reported in the SUVIMAX participants were the large decrease in dietary fats and the increased proportions of people ingesting five fruits/vegetables a day. These changes clearly reflect nutritional recommendations made to the French public, suggesting that the efforts made by public health authorities had the desired impact.

Let me see if I have this right...

Over eight years of investigation:

  • Energy intake decreased
  • Fat intake decreased
  • Intake of animal products decrease
  • Added fats were significantly reduced
  • Carbohydrate intake increased
  • Fruit intake increased
  • The number of subjects including 5 or more servings of fruits and vegetables increased

What researcher wouldn't be giddy with these dietary modifications?

Ahhh, but something else happened too - those in the study got fatter! I kid you not!

One very disturbing fact about the French nutrition and health situation is the very rapidly increasing rates of overweight and obesity. Although France lags behind most other countries, the rate of increase is extremely alarming.

In 1997, the prevalence of obesity in the adult population was 8.2%; in 2000 it was 9.6%, and it reached 11.3% in 2003. This corresponds to a 5% increase per year. Overweight in adults rose from 36.7% to 41.6% in 6 years. Morbid obesity doubled between 1997 and 2003. All age groups are affected, with a particularly rapid deterioration in people over 65 years of age. Children are also a very vulnerable group. Children in France are not as fat as US children, but they are catching up rapidly.

Again - eating less calories, less animal products, less fat, less added fat while altering the diet to include more carbohydrate, more fruit and more people eating 5-servings of fruits and vegetables each day resulted in WEIGHT GAIN in the population.

Do you think the researchers were able to see the forest for the trees?

Not exactly. In fact, the recommendation was this: More remains to be done, as vegetable intake could be increased and the proportion of saturated fats could be decreased in this same population.

Hello? Is anybody home?

1 comment: