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Harvard Commentaries
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Reviewed by the Faculty of Harvard Medical School

Food for Thought Food for Thought

The French Paradox -- Should We Be More Like the French?

October 14, 2012

By Beth Klos, R.D., L.D.N.
Brigham and Women's Hospital

As the sun rises over Paris, the irresistible scent of buttery croissants drifts out of all the little pastry shops and fills the narrow streets. In the afternoon, tiny cheese shops, bustling with local shoppers, offer a variety of painstakingly crafted cheeses. The American visitor can't help but think of the so-called French paradox — low rates of heart disease despite a cuisine that is rich in saturated fat.

Early research explored the possibility that something in red wine that the French drink protects the heart. A story on prime time TV in the early 1990's touting this information caused red wine sales in the United States to spike. Americans were willing to give it a try.

But can a glass of red wine after a morning croissant and afternoon piece of Camembert cheese somehow cancel out the risks of heart disease, like a broom sweeping away dirt? Why are heart disease rates lower in France than in other countries where people eat similar amounts of saturated fat? Why do French people have longer life expectancy than Americans? The answers are still open to debate but here's a look at the facts, which show that there is something to be learned from French habits.

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Red Wine

A few key ingredients in red wine have been shown to be heart-healthy:

  • resveratol – an immune factor found in small concentrations in the skin of grapes
  • polyphenols – an antioxidant that is abundant in the red skin of a grape
  • ethanol – the type of alcohol in wine and other alcoholic beverages

When used in moderation — two 5 ounces glass of wine per day for men and up to one 5 ounce glass per day for women — some research shows that red wine and it's various components:

  • raise the "good" cholesterol (HDL or high density lipoprotein)
  • reduce the tendency of the "bad" cholesterol (LDL or low density lipoprotein) to form plaques
  • may have a blood thinning effect
  • decrease all causes of death about 25%.

In France, making and drinking fine red wine is a treasured part of the culture. But alcohol is far from a panacea. Along with its higher consumption comes a higher rate of drinking problems and the some severe health consequences. It's estimated that 9% to 15% of the French people are problem drinkers. Creative researchers in different countries have found that non-alcoholic wine and small amounts of red grape juice still provide benefits from the phytochemicals they contain.

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Body Weight

Not surprisingly weight may play a role in the French paradox. People have traditionally been thinner in France than in the United States. While French rates of obesity and overweight are rising, they are still about half the rates in the U.S.: 37.5%, of French people are overweight or obese compared with 65%, or about two-thirds, of all Americans, according to the National Health and Nutrition Examination Survey NHANES.

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Eating Style

The French people eat slowly and savor every bite. In 2003, researchers staked out McDonald's restaurants in Philadelphia and Paris during lunch, which is traditionally an important meal in France. Parisian lunch-goers spent 22 minutes eating, while Philadelphians spent about 14 minutes. If Parisians lingered that long over American-style fast food, imagine how long they spend savoring and enjoying a tasty dinner at home, finished off with a piece of fine cheese! Older research published in the 1970's found that they linger over meals for almost 100 minutes a day, compared with the 60 minutes hurried Americans spend eating.

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Portion Sizes

The same group of researchers compared American cookbooks, actual restaurant portions and portions of individual packaged foods, including such diverse foods as yogurt, oranges and Haagen-Dazs ice cream bars. American portions measured larger at every turn. In fact, a well-known restaurant guide listed more references to larger portions in the Philadelphia versus the Paris guide. As the last culinary straw, while 3% of the restaurants in the Philadelphia guide mentioned having buffets or all-you-can options, there were none in Paris. Looking at larger portions typically makes people want to eat more, so larger portions are a recipe for larger waistlines.

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The Best of Both Worlds

It isn't likely that the debate over the French Paradox will die down soon. With longer lives and lower rates of heart disease among the French, there are some elements of their approach that would be beneficial for Americans to imitate.

  • Try to pay more attention to what you're eating and spend more time eating. These are likely to make food more enjoyable, which naturally helps to keep portions the right size.
  • Give yourself at least 20 minutes to absorb the flavor and essence of your meal.
  • Drink alcohol only in moderation. If you do not drink alcohol, alternatives are available to give you similar benefits.

Combining French style and substance is likely to enhance your health and make eating a pleasure.

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Beth Klos, RD, LDN is a Senior Nutritionist at Brigham and Women's Hospital. She completed her undergraduate degree at University of Rhode Island and her dietetic internship at Brigham and Women's Hospital. She counsels patients with a wide variety of conditions and enjoys teaching counseling to Brigham and Women's class of 12 dietetic interns.

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