Updated: Aug 5, 2019
No one is talking about an "American (health) Paradox." Instead, the one most commonly noted is the "French Paradox."
The “French Paradox” is simply that 55 million people in France live much longer compared to Americans and have 1/3rd the heart disease yet they do just the opposite of what the American Heart Association says is “heart friendly.” Let’s explore what the French are doing to have healthy hearts and great longevity.
The French paradox, coined in the late 1980s, is the apparently paradoxical epidemiological observation that French people have a relatively low incidence of coronary heart disease (CHD), while having a diet relatively rich in saturated fats. ([i])
Paradox definition, a statement or proposition that seems self-contradictory or absurd but in reality expresses a possible truth.
[i]Ferrieres, J. (2004). "The French Paradox; Lessons for other countries". Heart. 90 (1): 107–111. PMC 1768013 Freely accessible. PMID 14676260. doi:10.1136/heart.90.1.107.
France and the French Paradox
The French Paradox is actually easy for doctors who practice “root-cause” medicine to explain. We know that health is not one big thing; rather, it is the constellation of little things – the removal of one risk at a time. Creating health is like a symphony warming up. At first the sounds lack coordination and harmony, but slowly, over time the beauty that is the symphony is revealed. This applies equally as well to our bodies.
A paper titled, “Dietary patterns in the French adult population,” provides a credible summary of the many health-enhancing attributes of the French lifestyle. ([i]) Only about 13% of the French population, mostly younger people, subscribe to a SAD-like diet (Standard American Diet). Here are the attributes common to the other 87%:
Portion control / eating slowly
No fear of full fat
Little reliance on processed foods
Eat fish regularly
Imbibe wine modestly and regularly
Consume “healthy” fresh foods without preservatives
Snacks are much healthier compared to American counterparts
Basic foods are consistently consumed including: cheese, eggs, potatoes (with sauces including butter), butter, yogurt (full fat – not processed) and animal fat, organ meat, as well as bread. Note that dairy, eggs and organ meats are high in menaquinone (K2) that activates proteins to chelate calcium from soft tissue. ([ii])
[i]Gazan, R., Bechaux, C., Crepet, A., Sirot, V., Drouillet-Pinard, P., Dubuisson, C., & Havard, S. (2016). Dietary patterns in the French adult population: a study from the second French national cross-sectional dietary survey (INCA2)(2006–2007). British Journal of Nutrition, 116(2), 300-315.
[ii]Geleijnse, J. M., Vermeer, C., Grobbee, D. E., Schurgers, L. J., Knapen, M. H., Van Der Meer, I. M., ... & Witteman, J. C. (2004). Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease: the Rotterdam Study. The Journal of nutrition, 134(11), 3100-3105.
Indeed adopting these eating habits in America will improve health but there is slightly more to it than is captured in these bullets. There is a complete absence of commercially grown GMOs in French agriculture. ([i]) Although there is industrial farming, there are still many farmers who have decided to use traditional techniques and bio-farms.
The French eat micronutrient-dense meats with Pâté (liver and other organ meats) being a staple. The French government banned sales of beef parts susceptible to disease, like brains and spinal cords, for human consumption in 1996 but “exotica” animal body parts is once again becoming chic. According to the “Offal-Eater’s Handbook,” “Among Europeans at least, no one relishes organs more than the French, and their restaurants in the States tend not to shrink from serving them. Don’t forget, it was the French who invented foie gras, an extreme liver preparation that involves forcibly cramming provender down the throat of a goose.” Few Americans are up to this dietary challenge.
Have you been to a French boulangerie? Yes the French consume breads with lots of butter. But if you arrive at the boulangerie after noon, the entire product is gone, except for a few sticks of bread that are too stale to consume. Their bread is very low in gluten compared to ours and become “stale” very quickly. Our breads stay “fresh” for weeks. This is not natural.
Many believe that wine is a significant part of the paradox. Be careful of reductionist (single-minded) thinking and view modest wine consumption as a small contributor to health. The Sirtris Pharmaceuticals team exposed the danger of this mono-approach to the fountain of youth even though GSK bought into the idea for $720MM and scrapped the project after futile attempts to reproduce the claims.
Another very interesting observation about the French is their smoking addiction. 28% of French adults smoke today compared to 14% of American adults. And French smoking controls are relatively new meaning that heart disease statistics are really based on even higher rates of French smokers. We know smoking is a significant risk for inflammation and heart disease. This just provides more proof that simple health-creating measures counteracts the adverse effects of single risks. Our bodies are in a constant state of repair. Great nutrients – like the French consume – helps with that repair process and keeps them ahead of decay.
The main target of the French by the American Heart Association is saturated fats, and by extension, their obsession with cheese. Let’s look at the facts on cheese/saturated fat consumption and health. They demonized coconut oil on June 16, 2017 - a primarily saturated fat.
The trend is obvious, eat more cheese and live longer and decrease mortality from coronary heart disease. Will someone please inform the AHA that France, a country of 55,000,000 people, provides much better health data compared to the 6000 person Framingham study with “selected” data only, used to draw conclusions? It was the Framingham study that started the entire low-fat trend in America.
Thus, the real reason for the so-called French Paradox is that the French consistently enjoy a wide range of good healthful foods and beverages as staples including saturated fats and high nutrient containing organ meats. And they are no paradox, with Korea and Japan at about the same low level of cardiovascular disease ~28 deaths/100 person years compared to the U.S. at ~77 deaths.
The American Paradox
In my Health Ministry classes I start every meeting with a simple question
“Where did you learn that?”
The implied point is that everyone should dig “under the covers” to find the motives behind the sponsors of a concept. In the French Paradox, the sponsor is the Ancel Keyes legacy. And this powerful force, contrary to health, reemerged last June 16thwhen the AHA proclaimed coconut oil an enemy of your heart. ([i]) The American Heart Association is in essence a sponsor of the term “French Paradox” and helps perpetuate the notion that saturated fats are harmful.
Root cause doctors should ignore this term and instead mount a campaign to explain the true paradox – The American Paradox, which is:
America has the worse chronic healthcare
and for the
The Organization of Economic Cooperation and Development (OECD) () complies data, including health statistics, on the 36 most developed nations on the planet. America ranks near the bottom in health but first in spending per capita by a wide margin. The most important health attribute is a long life. And the benefit of long life is a longer “health span.” People who live to 100 experience a lifespan of 20 years over someone who passes at 80, but their health span is 30 years longer. ([ii]) Thus, the most important statistic for root-cause doctors is longevity. The Figure below illustrates the “American Paradox.” In this longevity-to-cost chart, the French Paradox suddenly doesn’t look quite so paradoxical but America is the clear outlier.
Life expectancy for the U.S. population in 2015 was 78.8 years, a decrease of 0.1 year from 2014. ([iii]) Fish and fermented food eating countries like Korea are seeing steady and significant increase in longevity. “Future life expectancy in 35 industrialized countries: projections with a Bayesian model ensemble,” published in Lancet ([iv]) indicate that women in South Korea, France, Spain, and Japan have a high probability of living to 90, on average. Of the 35 countries studied, the USA, Sweden, Greece, Macedonia, and Serbia have some of the lowest projected life expectancy gains for both men and women.
[i]Sacks, F. M., Lichtenstein, A. H., Wu, J. H., Appel, L. J., Creager, M. A., Kris-Etherton, P. M., ... & Stone, N. J. (2017). Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation, CIR-0000000000000510.
[ii]Hall, Stephen, S. “New Clues to a Long Life.” National Geographic Magazine. May, 2013.
[iv]Kontis, V., Bennett, J. E., Mathers, C. D., Li, G., Foreman, K., & Ezzati, M. (2017). Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble. The Lancet, 389(10076), 1323-1335.
Statin - Cholesterol Lowering Drugs
Statins drugs lower your Liver's ability to produce LDL. LDL is a soap-like structures that carries fats throughout your body to where it is needed. An important role of these fats is to repair damaged tissue and reduce inflammation. Statins drugs REDUCE the benefit of the healthy French diet. Thus the American Heart Association offers two strikes against heart health.
1. They encourage an unhealthy carbohydrate-based diet
2. They encourage lowering of LDL - that transports healthy fats through your body.
The French Paradox does NOT have meaning in the context of health and medical programs. The French practice many risk-lowering lifestyle behaviors - common to other developed nations. The United States is the outlier with the self-proclaimed best healthcare system but the worse outcomes, by far, compared to essentially every other nation on the planet when viewed from a cost/benefit perspective.
Solution: Become a little bit French. Eat whole, unprocessed (unpackaged) foods. Simply put, these are foods that don’t require a label because they contain just one ingredient – the vegetable, fruit, or protein source. And eat plenty of fats, especially from quality animal sources - with special emphasis on fish.
Think "repair and recovery" with (almost) every bite!