The French Paradox: Myth, fact and challenges

B. Chandru

Group Clinical Pharmacist, Kauvery Hospitals, Trichy, Tamil Nadu

Abstract

Coronary Artery Disease (CAD) is one the prominent causes for mortality. High intake of saturated fat is positively related to atherosclerosis and onset of coronary artery disease (CAD). But both phenomena are not generally seen in French people even though they are high consumers of animal fat, dairy milk products (Butter is an integral part of French cuisine), nicotine and alcohol. This unique phenomenon is attributed to a popular and controversial term called ‘French Paradox’. This review will discuss the actual scientific facts and polyphenols that plays a potentially important role in that paradox.

Keywords: French, polyphenol, red wine, resveratrol, cardio protective

Introduction

A paradox is a seemingly impossible concept, proposition, or theory that is often difficult to understand or explain yet ultimately correct or true. How is it possible, for example, that oxygen “a toxic environmental poison” could be also indispensable for life!

The French paradox is the term that was generated in 1992 based on epidemiological data from French people who had a low incidence of coronary heart diseases (CHD) despite the consumption of a diet in high saturated fat. Researchers proposed that moderate red wine consumption (almost 57% of the overall alcoholic drink consumption in France) will decrease platelet aggregation that  may be the main factor with a favorable  impact on  CHD [1]. Red wine has an antioxidant, anti-inflammatory, anti-proliferative, and anti-angiogenic effects because of the presence of a polyphenol called ‘Resveratrol’.

Epidemiologically proven Data

Artaud-Wild and colleagues examined the relation between the CSI (cholesterol–saturated fat index) and CHD mortality (per 100,000 men aged 55–64 years) for 40 countries. France had a CSI of 24 per 1000 kcal and a CHD mortality rate of 198, whereas Finland had a CSI of 26 per 1000 kcal and a CHD mortality rate of 1031. [2]

It is interesting to compare the World Health Organization dietary recommendations for saturated fat (< 10% of total energy). In in France saturated fat intake was 15–16% of the total energy.

The French Paradox and Wine Drinking

This term evolved because the researchers noticed a low incidence of CHD in French people despite the consumption of a diet in high saturated fat. Then many studies confirmed that low to moderate wine intake was associated with lower mortality from cardiovascular and cerebrovascular diseases. The French peoples are the most devoted and consistent wine drinkers in the world.

The mean serum total cholesterol concentrations were similar in France, USA, and UK. The French male displays lowest cardiovascular disease incidence while comparing with other Western industrialized nations (36% lower than the USA and 39% lower than the UK). [3]. The custom of drinking wine with the meal may confer protection against some of the adverse effects of the food.

Moderate consumption only benefits

Polyphenols extracted from red grapes or red wine exert beneficial effects, but the amount of wine needed to get enough resveratrol’s to produce a significant effect is not known  Moderate consumption of alcohol is associated with a slightly reduced death rate from heart attack. [4]

In France, alcohol consumption is rather homogeneous throughout the week whereas in Northern Ireland, Fridays and Saturdays account for 66% of total alcohol consumption. The blood pressure levels are higher in Ireland people and constant in French people.

The “binge” drinking pattern observed among drinkers in Northern Ireland leads to disadvantageous consequences regarding blood pressure levels, consistent with a higher incidence of CHD on Mondays and Tuesdays and a lower incidence on Fridays. [5]

Resveratrol

Resveratrol (3,4′,5-trihydroxy-trans-stilbene, RSV) is a polyphenol and has been classified as a phytoalexin produced by a wide variety of plants. In grapes, especially when infected with Botrytis cinerea, RSV is exclusively synthesized in the leaf epidermis and in the grape skins, but not in the flesh. Because the grape skins are not fermented in the production process of white wines, only red wines contain considerable amounts of this compound. This polyphenol plays cardio protective agent due to its anti-atherosclerotic properties, inhibition of low-density lipoprotein oxidation, suppression of platelet aggregation and estrogen-like actions. [6]

Myth, Fact and Challenges

The Myth is lower rates of CHD in French people are only because of drinking red wine, but its ultimately not. They eat more saturated fat but they also eat a lot more vegetables, fruits and herbs. They are also a stress free population compared to other western nations.

Oxidative damage and reactive species (RS) are strongly implicated in the pathogenesis of cardiovascular diseases. Resveratrol seems to increase vascular oxidative stress resistance and preventing oxidative stress-induced endothelial cell death and it has been proposed that the antioxidant and anti-apoptotic effects of resveratrol.

On other hand the main challenge is alcohol content in red wine. Only moderate consumption will yield benefit. Drinking higher levels will apparently not only elevate the CV risk but also increases risk of cirrhosis and other complications.

Resveratrol was heavily advertised as a heart-protecting and anti-aging supplement, but there’s zero evidence of any benefit for people who take resveratrol supplements. Evidence indicates that red wine is naturally fortified by several ingredients. Red grapes are specifically noted for their enrichment with resveratrol.

Consumption of red wine to prevent heart disease may not be work for all. Age-related changes, including a diminished ability to metabolize alcohol, make higher amounts risky regardless of gender. [7]

Conclusion

This review clearly states that French people’s lower CV risk is not only due to red wine, its more related to their diet rich in fruits and vegetables, and along with stress free lifestyle. Apparently the red wine is beneficial when it consumed moderately, but more studies needed to conclude this strongly. The culture background and gene are also important factors in preventing cardiovascular risk.

Healthy diet and lifestyle always stand out in disease prevention.

References

  • Ferrières J. The French paradox: lessons for other countries. Heart. 2004 Jan;90(1):107-11.
  • Artaud-Wild SM, Connor SL, Sexton G, Connor WE. Differences in coronary mortality can be explained by differences in cholesterol and saturated fat intakes in 40 countries but not in France and Finland. A paradox. Circulation. 1993 Dec;88(6):2771-9.
  • Renaud S, Gueguen R. The French paradox and wine drinking. Novartis Found Symp. 1998; 216:208-17; discussion 217-22, 152-8.
  • Bianchini F, Vainio H. Wine and resveratrol: mechanisms of cancer prevention? Eur J Cancer Prev. 2003; 12:417-25.
  • Marques-Vidal P, Arveiler D, Evans A, et al.Different alcohol drinking and blood pressure relationships in France and Northern Ireland. The PRIME study. Hypertension 2001; 38:1361–6.
  • Catalgol B, Batirel S, Taga Y, Ozer NK. Resveratrol: French paradox revisited. Front Pharmacol. 2012 Jul 17; 3:141. doi: 10.3389/fphar.2012.00141.
  • Semba RD, Ferrucci L, Bartali B, et al. Resveratrol Levels and All-Cause Mortality in Older Community-Dwelling Adults. JAMA Intern Med.2014;174(7):1077–1084.

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