Exposing the French paradox

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: A friend told me that her husband, who is 80, is claiming that the French eat a lot of butter, cream, cheese, pastries and red meat, and have the lowest rate of heart disease in the world. That seems crazy to me, and I’m wondering if there’s any truth to it. She does all of the food shopping and cooking, and he is complaining that their meals are boring and that their diet, which sounds pretty healthy to me, is unnecessarily strict. ANSWER: France does not have the lowest rate of heart disease in the world — Japan and South Korea are lower — but it does have the lowest rate in Europe. France also has a high rate of saturated fat consumption, and that discordance is called “the French paradox.” Some, like your friend’s husband, interpret the paradox to mean that these rich foods are not bad for you at all, and while there remains some controversy about how bad saturated fat is for you, there are many other proposed reasons why French have lower rates of heart disease. Wine has long been proposed, and while it is true that moderate wine drinkers have lower rates of heart disease, there aren’t definitive data supporting wine reducing heart disease risk. Since wine (like any alcohol) is definitely harmful in excess, I recommend no more than modest wine drinking. Obesity rates are much lower in France (24%) than the U.S. (34%), and the French eat far more fruits and vegetables. French exercise more as a part of their daily lives. French consume far less sugar, especially in sugar-sweetened beverages. French eating has traditionally emphasized quality over speed and quantity, and portion sizes are much smaller in France than the U.S. Finally, diets in France have changed over time, and it takes decades to see the changes in heart disease reflect dietary changes. Many authorities expect that heart disease rates in France may increase as their diets (and exercise) trend closer to less-healthy North American norms. A healthy diet does not need to be boring, and it can include all of the foods your friend’s husband wants, but in proper proportion and as part of a diet that is mostly plant-based, appropriate in size and combined with regular moderate exercise. *** DEAR DR. ROACH: Does eating late at night make you gain weight? — M.S. ANSWER: There is a myth that calories eaten late at night are somehow more important than those eaten at other times. Eating late at night does not necessarily lead to being overweight. It remains how much you eat and how much you exercise that ultimately determines weight gain or loss. However, there are patterns of eating that are more associated with unhealthy eating and with weight gain. Night eating is one that is commonly associated with poor eating habits. Nighttime eating may also be considered a specific eating disorder. In this group, with strict criteria for diagnosis, treatment with an antidepressant led to 2.9 kilogram (over 6 pounds) of weight loss in overweight people with nighttime eating. While not everyone with nighttime eating will gain weight, many people choose poor foods late at night, which tend to make weight gain more likely. There is also good evidence that latenight eating is not good for dental health. So, if you are going to eat late at night, choose healthier foods and practice good dental care.