Le not-so Paradoxical French Paradox?
I finished my last midterm last night and decided to reward myself for a week of library-dwelling with a glass of lovely Argentine Malbec. Which got me to thinking: for some time, observers have noted what is referred to as the “French Paradox”: the fact that rates of coronary heart disease in France are relatively low despite the fact that the French diet is relatively high in saturated fats…which we know to be directly associated with heart disease. It has been suggested that this phenomenon could be explained by the relatively high consumption of red wine that the French drink, and it argued by many (particularly those employed by the wine industry, I imagine) that red wine was a healthy and cardio-protective beverage.
This has always bothered me. The data on alcohol consumption and health is quite conflicting, with some research showing that moderate drinking is associated with some protective effect against heart disease… but also an increased risk of certain types of stroke. Not to mention that that any drinking at all appears to be associated with an increase of certain cancers (particularly breast). Also, there’s a direct link between chronic alcohol intake at more-than-moderate levels and liver disease. Finally, there are some other very significant differences between Americans and the French besides our drinking habits. So what’s this hoopla all about?
According to the WHO’s Global Status Report on Alcohol (2004), France has the 6th highest per-capita consumption of alcohol, which places it behind Uganda, Luxembourg, the Czech Republic, Moldova and Ireland. The average French person over age 15 consumes 59% more alcohol than Americans (13.5 liters versus 8.5 in the U.S.).
And indeed, it’s true: there are 106.5 per 100,000 Americans who die of heart disease annually versus 39.8 per 100,000 French people. Those statistics mean than an American is 2.7 times more likely to die of heart disease than a French person. Interestingly, though, two countries that actually have HIGHER per capita alcohol consumption than France, Ireland and the Czech Republic have even higher rates of death by coronary disease than the US: 152.6 and 148.6 deaths per 100,000 people, respectively. I have no expertise on or particular insight into these countries, but if alcohol is indeed a factor in these stats, this might be good evidence as to the dark side of alcohol’s role on cardiovascular health: namely, how in large quantities it increases risk for hemorrhagic stroke and hypertension. Indeed, a 2004 study of ~35,000 French men by Renault et al examined whether the type of alcohol mattered when it came to health protection or risk, and the answer was yes. The authors found that only moderate amounts of red wine (versus large amounts of red wine and versus any amount of alcohol in general) were associated with a reduced risk of death from all causes, and they attribute that protective effect to the phytochemical found in red wines called resveratrol. Strangely, they excluded cirrhosis (liver disease) and violent death from their analysis; it seems to me that the total death numbers may not have looked as impressive for red wine drinkers if they had included these outcomes, tied so closely as they are to alcohol intake. But who am I to argue? The strongest protective effects were seen as 2-3 glasses/day for men, though they did not specify how large a glass was. (Sounds silly, but my experience has been that a wine glass in your typical American restaurant is way bigger and fuller than the ones served at a French bistro…)
The red wine variable would, then, seem to help account for the difference in heart disease mortality rates among the Czech Republic, Ireland and France, as the Czechs and Irish are the world’s #1 and #2 beer consumers, respectively. But I still wanted to know whether the wine-drinking French actually live longer, or do they just die of different things?
The answer is: generally, yes they do. The average French person’s life expectancy at birth is 80.87 years, which ranks it at #9 in the world. (Not bad!) In the U.S., our average life expectancy at birth is 78.14 years (#47 in the world). But if you’re a French male, your life expectancy is quite lower: 76.8 years, versus 74.89 years for American males. (The women pull up the average substantially: 84.23 years for French women and 81.13 years for Americans.)
So what are the French dying of?
Cardiovascular disease (heart disease and strokes) are still the top causes of death in France, accounting for about 17% of all deaths. (They account for about 32% of all deaths in the US). Lung cancer and pulmonary diseases comprise another 8% of deaths (all that wine goes so well with a cigarette, after all!). And while it didn’t make the top 10, I thought it was worth mentioning liver disease, since it was sneakily excluded from that 2004 French wine-drinker study and is directly linked to long-term, chronic alcohol intake. As it turns out, the French die of cirrhosis 57% more than Americans (which ties nicely to the fact that the average French person drinks 59% more by volume than the average American does.) That’s not very paradoxical at all. Similarly, a 2007 article in the Journal of Hepatology reported the mortality rate of cirrhosis among French men in 2000-2002 to be 14.45 per 100,000 men, versus 9.73 per 100,000 men in America. That’s about 48% higher.
And what if the reason the French live longer has nothing to do with the wine? There are other differences between our populations besides our drinking habits, you know. 33% of the US population is obese, compared with only ~9% of the French population, for example. That means an American adult is 3.7 times more likely to be obese than a French adult, which should help to account for the 2.7 times greater mortality rate from heart disease in the US, shouldn’t it? According to several research articles in the Journal of the American Medical Association, obesity is related to ~112,000 “excess” deaths in the US annually, with the vast majority of those deaths from cardiovascular disease. Couldn’t this be a key factor behind the reason that the French have such a lower rate of heart disease mortality? And if so, then what’s the fascination with the red wine? Maintaining a healthy body weight as a heart disease risk prevention strategy may not be as fun as drinking a half bottle of red wine every night, but it sure produces fewer hangovers. (And fewer adverse health effects). Sorry to be such a buzzkill, but it does stand to reason.
I’ll admit that these musings raise more questions than they answer. So as far as whether to drink or not drink, here’s what I make of it all:
- If you currently drink ~2 drinks/day or less (males) or 1 drink/day or less (females), you may get a slightly protective benefit against heart disease, so enjoy! It seems that red wine may afford an even better benefit, though any type of alcohol should do the trick. If you’re drinking more than this amount, you may want to consider cutting down.
- But bear in mind that “one drink” is not necessarily one glass of wine as poured by your neighborhood bartender in a monster-sized red wine goblet. It’s 5 fluid ounces of wine. In other words, 1 bottle of wine is 5 standard servings. So if you’re used to splitting a bottle every night with your best friend or spouse, try inviting a few more people on on the fun, or buying yourself a really pretty bottle stopper to save some for tomorrow.
- If you don’t drink at all now, I wouldn’t start doing so for ‘health reasons,’ as there are plenty of ‘health reasons’ not to drink, too.
- If you’re obese, drinking red wine is not a silver bullet for helping to reduce your risk of cardiovascular disease. In fact, it can make it worse by aggravating high blood pressure and increasing your triglyceride levels.
- If you have a family history of breast cancer, you may want to seriously consider whether drinking at all is worth it to you. (And even if you don’t have a family history, if you’re overweight or have other risk factors for breast cancer, I’d proceed with caution.) There’s a lot you can do to reduce your risk of developing breast cancer, including getting regular exercise, maintaining a healthy weight, not drinking, and making sure to get adequate Vitamin D in your diet (try supplementing 1,000 IU/day).
- Next time around, let’s all try to be born in France.
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