What Explains the French Paradox?

What Explains the French Paradox?
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Why do heart attack rates appear lower than expected in France, given their saturated fat and cholesterol intake? Is it their red wine consumption, their vegetable consumption, or something else?


The so-called French Paradox is a term coined back in the 80’s by three Frenchmen to explain a curious finding. If you chart death from heart attack versus the amount of saturated fat and cholesterol countries consume, there appears to be a straight line. The more animal foods populations eat, the higher their death rates appear to be. Conversely, maybe if we got meat, egg, and dairy low enough, we could bring coronary death rates down to zero. But two countries fell outside the line. Finland seemed to be doing worse than expected, and France appeared to be doing better. Hence, the paradox. How could France have saturated fat and cholesterol intake similar to Finland, but five times fewer fatal heart attacks?

Everyone had their pet theories. Was it the wining? Was it the dining? Yes, animal foods were associated with coronary heart disease mortality, but plant foods appeared protective. So, maybe the fact that the French were eating four times as many vegetables helps account for their lower death rates. But it turns out there’s apparently no paradox at all. As Marion Nestle astutely pointed out, the French had just recently started eating so unhealthy, and chronic diseases take decades to develop. The U.S. had been eating this way for 40 years, whereas the French had just picked it up. It’s like if we all started smoking today and found no measurable increase in lung cancer tomorrow, it wouldn’t mean smoking doesn’t cause lung cancer; it just takes a while.

So, what happens when you actually run the numbers? If you compare coronary death rates to the amount of animal fat and cholesterol levels at the time, France does seem unusually protected, and if you compare death rates to what they were eating two decades before, they’re still pretty far off the line. Ah, but it turns out French physicians under-report ischemic heart disease deaths on the death certificates by as much as 20%, according to a World Health Organization investigation.

So, if you correct for that, then, France basically comes right back in line with the death versus animal fat and death versus cholesterol lines, with about four times the fatal heart attack rates as Japan decades after four times the animal fat consumption.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Ross Websdale via Flickr.

The so-called French Paradox is a term coined back in the 80’s by three Frenchmen to explain a curious finding. If you chart death from heart attack versus the amount of saturated fat and cholesterol countries consume, there appears to be a straight line. The more animal foods populations eat, the higher their death rates appear to be. Conversely, maybe if we got meat, egg, and dairy low enough, we could bring coronary death rates down to zero. But two countries fell outside the line. Finland seemed to be doing worse than expected, and France appeared to be doing better. Hence, the paradox. How could France have saturated fat and cholesterol intake similar to Finland, but five times fewer fatal heart attacks?

Everyone had their pet theories. Was it the wining? Was it the dining? Yes, animal foods were associated with coronary heart disease mortality, but plant foods appeared protective. So, maybe the fact that the French were eating four times as many vegetables helps account for their lower death rates. But it turns out there’s apparently no paradox at all. As Marion Nestle astutely pointed out, the French had just recently started eating so unhealthy, and chronic diseases take decades to develop. The U.S. had been eating this way for 40 years, whereas the French had just picked it up. It’s like if we all started smoking today and found no measurable increase in lung cancer tomorrow, it wouldn’t mean smoking doesn’t cause lung cancer; it just takes a while.

So, what happens when you actually run the numbers? If you compare coronary death rates to the amount of animal fat and cholesterol levels at the time, France does seem unusually protected, and if you compare death rates to what they were eating two decades before, they’re still pretty far off the line. Ah, but it turns out French physicians under-report ischemic heart disease deaths on the death certificates by as much as 20%, according to a World Health Organization investigation.

So, if you correct for that, then, France basically comes right back in line with the death versus animal fat and death versus cholesterol lines, with about four times the fatal heart attack rates as Japan decades after four times the animal fat consumption.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Ross Websdale via Flickr.

Doctor's Note

If you’re wondering about those meta-analyses that show saturated fat is not associated with disease and you thought “butter was back,” check out my videos, The Saturated Fat Studies: Set Up to Fail and The Saturated Fat Studies: Buttering Up the Public.

What about the egg industry studies claiming dietary cholesterol is benign? See Does Cholesterol Size Matter? and How the Egg Board Designs Misleading Studies for more on this.

Were you hoping the lower heart attack rates in France were thanks to red wine? What about that resveratrol compound in grape skins? See my video, Resveratrol Impairs Exercise Benefits.

And, for an overview of heart disease, see How Not to Die from Heart Disease

In 2018, I released a new series on alcohol. Check out:

If you haven’t yet, you can subscribe to my videos for free by clicking here.

144 responses to “What Explains the French Paradox?

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  1. I wanted to share something as the year comes to an end.
    For our non-Spanish speaking friends, I’ve taken the
    liberty of putting together a respectable translation, imho.
    But, trust me, you won’t really need it.


    Gut Bliss You, Everyone!
    Fare Thee Well, Joseph.
    You will be missed, but not forgotten.

    “Far Beyond” – Gloria Estafan

    When you give without hesitation,
    When you want the truth.
    When you offer forgiveness
    instead of resentment
    there is peace in your heart.

    When you feel empathy
    for a friend and his/her pain,
    When you see a star
    that is hidden by fog
    there is peace in your heart.

    Far beyond the bitterness of tears and pain,
    Shines the light of love within each heart.
    Christmas, give flight to your hopes and dreams,
    Planting peace provides the love that the whole world
    wants more of.
    (Because the magic is where we want it, this Merry

    When a prayer arises,
    when you accept a mistake.
    When you find a place
    for freedom
    there is one more smile.

    When reason arrives
    and misunderstanding goes away.
    When you want to fight
    for an idea
    there is one more smile.

    There is a ray of sun
    through the glass.
    There is a better world when
    you learn to love.


    When you move away from fear
    and you lavish your friendship
    When you join your voice
    and sing the same song
    there is peace in your heart.

    When you seek with passion
    and discover your truth.
    When you want to build
    a better tomorrow
    there is peace in your heart.


    May your dreams always come true.
    Merry Christmas!

      1. What are you puzzled about? If it’s about the French Paradox, there is no paradox. The “French Paradox” is based on faulty data. If it’s something else, please let us know and we’ll try to help.

        Dr. Ben

  2. Plants are the most powerful medicine known to man of all time, and the human body is the most amazing healing machine. Great piece!

  3. What an interesting video. I never felt comfortable with the French paradox–I knew it couldn’t be the wine! This information is going to disappoint a lot of people (you mean we can’t eat steak, eggs and cheese as long as we drink lots of red wine?).

    1. Julie: re: “This information is going to disappoint a lot of people…”
      Oh yes. I can remember a few conversations on NutritionFacts with people who were convinced that the French example proved that eating lots of saturated fat and cholesterol has nothing to do with heart disease. I sure wish I had this video to point to back then. And am plenty glad I have it to refer to now.

    1. I have no idea! I think we’d have to read more into the research to get a better understanding, Everything is available in the sources cited section. I’d recommend checking out the WHO investigation.

    2. It needn’t be pecuniary, although, following the money is great place to start. It may be as simple as there is some cultural bias at play. Heart attacks could be considered a horrific way for a loved one to die, which it is.

      1. 50% of cardiac failure happening out of hospital have a survival at 5 years because of the general rescue system with medical doctor part of the team ( SAMU) With the general healthcare system cardiac patients are registered and a cardiac rescue team with special device are coming when the patient is identified during an attack. This lower the number of patients death with cardiovascular diseases. Financial support for improvement of treatment is given in regards of cause of death. If a cardiac patient has a cancer he will be registered with the disease who causes his death, cancer or heart depending of the certificate of death.

        1. Thank you for the clarification Claude, although, I am not sure this explains a 20% under reporting of death due to heart attack. In another of Dr. Greger’s video, the research indicates that ~50% of first time cardiac events in the USA result in death.

          Regardless, France has the #1 health care system in the world as ranked by the WHO while providing universal care for all of its citizens all for a fraction of what we pay as a nation in the USA. France has little to apologies for as far as health care is concerned. I would gladly take that deal.

          1. Trump himself mentioned the French quality and cost health care as a model to evaluate, for that he is right. The way we record death in France is easy to underscore cardiac disease , with a 10 years extra longevity from Americans it is easier to die from something else. What is sure for me as I worked with UCLA urology department, is that French have ED problem starting at 52 when Americans got it significantly earlier du to vascular diseases. When I was part of the ED pump in Boston , American and French patients were different in range of diseases and ages, I was involved through different engineering knowledge to comply with biomateriau , but also as a clinician for my MS patients and other specific diseases. in America ED is really a vascular problem restored with a one year specific diet.No need of pump and pills until a senior age for French men.

            1. Promises made by presidential hopefuls in US politics during the run up to election have much in common with those made by a would be lover wooing a woman’s affection in that those promises are often forgotten after the goals have been achieved, and usually with the same outcome for the promisee. I don’t believe Trump would put much effort into universal health care. To do so would require slaughtering a lot of sacred cows costing powerful interests a lot of money if it were to look anything like France’s health care system. It would be nothing short of a revolutionary. Such changes are usually accompanied by more than just a little hand wringing.

              1. I changed the teaming of MS world wide was invited by the American of MS, did a cooperation in Chicago U where I was receiving numbers of phone calls. Anne Romney is one of exemple to had my treatment through my articles and meeting with neurologists, then I was solicited to experiment few treatments which I declined knowing the danger and saying I prefer to be poor than criminal. Then I had to develop my immune expertise in other field and I ended up with an American patent, and again this patent is against 2 billion spending yearly in the US and I have to write my nutrition books, which is a good thing because there is a need. Change may happen if a group of interest may gain from your invention. Healthcare has to be change but nutrition looks an individual motivation, it can be supported by food production facing contamination, boycott etc. We will see how we can manage, but a modest blog with meetings and books to sell directly touring information is certainly an uptodate tool. An elected congressman explain to me and to a friend of mine when we were playing golf and we were asking why polities anywhere vin the world are doing nothing for public health? the answer was an off very cynical: we politics all over the world we are playing golf with you outstanding doctors. We know that we will have always a Good” doctor to take care for us or our family, just because to be a good doctor is that. So to be in politics we need to be elected and to serve different interests,we are not Mother Theresa’s followers “. From that time I assume that Medical Doctors can bring progress if they are their own engin of progress with their patients. America can change if there is a financial beneficiary of the change. Today it is clear than ordinary people have to awake to take care of their destiny, My follower on Facebook page are young, I am starting to publish ebooks on the advice of my followers. Stark Naked health

              2. Not wanting to get involved in politics here, but would like to make this comment. I am not saying that Trump would or could make the needed changes in health care in the U,S, if given the opportunity, but i doubt that he could care less about anyones sacred cows and who he would have to step on to get it done.

                1. Alan, What I find amazing is just how charged food has become. I think twice before bringing diet up in polite company. It often causes a stir. Many believe that Ancel Keys was a charlatan. That saturated fat is the healthiest kind of fat one can eat. That dietary cholesterol intake has nothing to do with serum cholesterol. That serum cholesterol has nothing to do with vascular disease, and it is grain intake that is causing most of diet related diseases of the western world.

                  The point is food is already politicized. Powerful, well financed interests are willing to use their resources and influence to protect their position, or to thwart the efforts of those who work against them. The food libel laws come readily to mind.

                  The healthcare, insurance and pharmaceutical industries are all powerful, well connected and rich. Those wanting to be president of the US are more apt to victimize and demonize the weak and vulnerable than to antagonize the powerful because chances are they are soliciting or have received contributions from them. It’s much safer to vent one’s vitriolic rhetoric towards groups such as undocumented workers from south of the boarder or some unpopular religious minority. These people are not lions. They are sycophants and bullies.

                  1. Joe, replying more to the first part of your reply. I am not convinced that most people actually down deep believe that saturated fat is healthy and that cholesterol has nothing to do with vascular disease. As Dr McDougall says “People love to hear good news about their bad habits.” I personally believe that most people still believe that they are bad habits, but they have a false science to back them up and go on down the road to destruction.

                    1. You may very well be right Alan. Perhaps deep down, they know their habits are causing them harm. It may be cognitive dissonance, and that is why some experience strong emotional reactions.

                    2. I agree, but it’s mind boggling to me. I like what Dr. Greger said in “How Not to Die.” “Does your food reverse heart disease?” If it doesn’t why are you eating it? I’d add to that, does it prevent CA. If not why eat it?

                      The “paleo” people disgust me.

                  2. It costs 1.5-2$ billion to run for U.S. president. .That money is not “small donations’ by the working class, it is the result of Citizens United, the S.Ct. decision saying any corporation can fund any candidate as much as they want. No limits.

                    I’m an M-L so I’ve never voted, why bother, none of those jerks represent my interests. Unless of course your interests include, like you said, making the working class and poor worse off than they already are, decimating unions, privatizing public schools, keeping health care a for-profit enterprise, and the unending imperialist actions and illegal invasions. Trump got thrown out into the mix to see how much fascism would stick. He pulls the other candidates including the D’s, to the right, not the left. Sanders is not a leftist, he’s an imperialist. They can all go to hell. I want to see the manufacture of guillotines come back!

                    1. I agree with you. Between Citizens United, corporate personhood and the redefinition of campaign contributions as a form of political speech, there is no way to vote against the interests of ExxonMobil, Goldman Sachs, Lockheed Martin and Monsanto. There really is not much difference between the Democrats and Republicans. Come election day they all make pretty sounding promises, but they are both selling us down the river while selling their access to the same corporate elites for a piece of the political contribution pie. The will of the majority of mean little to them.

                      That being said, I believe that the disaffected should cease voting for the least worst between them, pick a third party, and start voting for them. There a lot of people not currently voting. Enough people start doing that, and things could get interesting. BTW, what’s an M-L?

                    2. Marxist-Leninist.

                      Obama probably pulled in more disaffected and unregistered voters than any in modern history, and look how that ended up. He used his “mandate” to continue dropping bombs on the Middle East, destroy Libya, orchestrate a fascist coup in Ukraine, overthrow an elected leader (Zelaya in Honduras), continue the imperialist funding of ISIS and anti-Assad counterrevolutionaries in Syria, and saber rattle Iran. Those who vote for capitalists simply aren’t conscious yet. Voting won’t solve a thing, we need radicalization outside of bourgeois democracy.

                      The “least worst” who makes it onto a national ballot is still a capitalist. Sorry, but the imperialists will never represent my interests. Maybe if Trump gets elected, we’ll see the return of that liberal “antiwar” movement that was kneecapped by Obama’s election. LOL. Cue the pro-imperialist Code Pink.

                      I’ve never voted, but the Workers World Party is running Monica Moorehead and Lamont Lilly, both revolutionary communists. :) They won’t be appearing at any bourgeois debates, thanks to capitalist “democracy.” You can check out their platform on YouTube. We’re non-revisionist MLs.

                    3. Doh! I didn’t think of that one. Yes, well you don’t have to be a Marxist-Leninist to find these policies despicable. I don’t think of these “least worst” guys as capitalists. They are just their highly compensated sock puppets fighting for their place at the trough.

                      Even if there is truth to Emma Goldman’s observation that, “If voting changed anything they’d make it illegal,” it does not mean that one should stop doing it, if for no other reason than to annoy them.

                      I’ll be sure to give the WWP’s platform a listen. Thanks for the tip. Best Regards, Joe

                2. Trump doesn’t act in a vacuum and neither does any other capitalist politician. They have to answer to those who brought them to the table. The HMOs are a powerful group and they do not want their Obamacare subsidies to end, so the only way we are getting a French type of health care (single payer/nationalized) system is with a revolution in the streets. Not protests that go away after a Sunday afternoon, but ongoing millions parked at the gates of the White house day in and day out, and there would likely be violence because of the ruling class will not tolerate that level of pushback on the capitalist system. Not going to happen, the imperialist core is not revolutionary enough, amerikkkans are the least class conscious in the entire developed world.

                  For what’s it worth, even with Obamacare, my monthly premiums are 640$ and that’s not even the cadillac plan in my HMO. This cost is largely due to my age — and I’m healthy! Plant(evidence) based diet, don’t smoke, wear a seat belt, exercise regularly, no drugs, no ETOH, BMI 18.6. I’m one of the lucky ones – I can afford it. Many of my friends my same age cannot. I’m in my mid-50s, still too young for Medicare.

                  People my age are probably not going to live long enough to see single payer in the U.S. Neoliberal capitalism is getting worse here, not better. Keynesianism isn’t even on the table, and even that is reformist capitalist. It’ll take a socialist revolution to change the health care system. Capitalists aren’t going to hand you anything.

    3. It would appear that many doctors simply do not understand the significance to decisions governing diagnosis, treatment, of their reporting mortality and adverse effects of drugs and medical devices. This is one of the reasons that “evidence-based medicine” is a figment: the evidence has holes in it. Their belief that current medical practices are grounded solidly in medical science, is as empirically correct as the belief that the Sun revolves around the Earth.

    4. I’ve read that it is a cultural issue. Plant Positive mentions this. But even accounting for the under reporting, France is still lower than most.



      If you increase France’s ischemic heart disease death rate by 20%, don’t you bring it up to only about 36/100,000, in line with Ethiopia and Portugal? So no longer lower than Japan, but still comparatively low??

      1. Note: An increase by 20% does not correct a decrease of 20% from the original numbers (e.g. decrease 100 by 20% you get 80, increase 80 by 20% is 96) food for thought when trying to correct the data given.

  4. it is true that with paleo diet, yo can eat meat but doing a lot of sport keep your cholesterol Low? because it is what you heard in Paleo blogs.
    i know the other effects of meat consuption, but if cholesterol keep low under 150 saturated fat and dietary cholesterol it have a negative effect for the circulation and heart disease?

    1. This is probably the wrong place for discussion of the “paleo diet” as it is “packaged and sold” to the masses. The educated have actually argued that actual paleo man ate a much more plant-based diet than common propaganda implies.

      1. i know that probably we have eat much more vegetables than meat but i wonder witch is the risk of what we know as “paleo diet” today, (i mean non processed foods, no diary ,no sugar, no process carbohydrates and meat) the only difference with Wfpb it is the meat and probably they eat less grains too . and some people argue that you can manage a low cholesterol if you do a lot of exercise or fasting every ones in a wile.but i dont know what they mean by low cholesterol if it is under 150 or not.
        I’m not a paleo diet follower i want to know what the science says it is the best and witch are the risk for health of different foods.

        1. Noe: I’m neither a vegan nor a paleo. I’m just an innocent by-stander and observer of the debate on human nutrition. i agree with you. There’s one thing common about veganism and paleo, which is the emphasis on whole food. There’re many variations of paleo; the ones I have seen are all mostly plant foods.

          1. One thing that people eating paleo and vegan diets do have in common is the avoidance of dairy. Of course they will both eat fruits and vegetables.

            1. Dairy was responsible for many years of suffering on my part. Even had an EEG run on my head-there was no MRI back then, to see if my brains were okay. Sinus troubles Spring and Fall and sometimes Summer and eating Sinus Pills all the time, sometimes prescriptions.

              ALL THAT VANISHED when I moved away from home and couldn’t keep fresh milk. As the milk wouldn’t keep at the rate my roommate and I drank it, we quit buying it altogether. Some years later I learned of the connection between Cow Milk and mucous thickening. I then realized that my miraculous recovery from 20 years of sinus problems had completely vanished when I quit drinking milk regularly.

              Now when I indulge in cheese or ice-cream on the weekend or holiday, sometimes I get a little stuffy! But it always passes fairly quickly.

              And folks are out there suffering, taking pills and potions, and having their sinuses routed out (surgeries) for sinus issues and REFUSE to think about giving up moo cow milk. Bovine mammary gland discharge… I had a 70-year-old friend say, “No I’d rather suffer than stop drinking milk.” I simply don’t get that.

            2. I saw a post once on “Mark’s Daily Apple” that someone had made casein cupakes. Made me want to hurl. There’s no redeeming value to dairy, but take the worst part of it (the protein/casein part) and cook something from it? Makes me sick!

          2. It seems like the paleos are undoing the benefits of the plant aspects of their diets by eating all that meat and butter and don’t forget their disgusting “bulletproof coffee.” The plant based diet literally heals the damage of the bad food IF YOU STOP EATING THE BAD STUFF. It’s like with cigarette smoking – the healing of the lungs begins minutes after your last cigarette and will continue as long as you don’t smoke again. If you continue engaging in the bad habit, all bets are off.

            The paleos all seem wedded to it so I don’t bother having discussions about food anymore in general conversations with people. I just think “paleo” is repackaged Atkins. Atkins got smeared after his death so they had to change the name of the high fat diet to something palatable and hip and they landed on “paleo.”

        2. I’m no vegan either, although that’s the way I eat Monday-Friday, and usually Saturday of each week. Exceptions are made for Sundays and for holidays and other celebrations. This whole site is dedicated to the nutrional facts as Dr. G finds them. WFPB is the current theme and I’m down with that with 90% or better compliance.

          Every single time you eat meat your body goes through unavoidable negative processes, as shown in lots of videos and articles here. Veggies and greens and fruit offset most of those issues–if you eat enough of them. If you only eat the plants, then you avoid the negatives inherent in meat (no matter how wonderfully and organically grown, or even game and wild fishes (my meats of choice), there are negatives inherent in eating flesh period).

          IOW as I see it, the more meat one eats the more plants foods are necessary to bring one’s balance back up to zero. When you avoid animals, the positive aspects of plant eating allow your body stay in the positive side of the register, for optimum nutrition, and thus health.

          as to “low cholesterol”. Yes “our” definition here is 150 or lower. Any reference to cholesterol being “low” is meaningless without some numbers to show exactly what they mean, as the American Standard is far too high.

            1. If I’m visiting my parents, it’s supermarket fare of the normals (SADs). Mom is yet counting calories and doesn’t fully comprehend the negatives of animal products and Sunday is her “no counting” day. She knows I’m going to LEAN hard on the Veggie portions (like everybody takes a little tiny bit of salad and then I eat everything left in the serving bowl, they eat a tbsp or two of dressing and I might eat a tsp if any at all.) Then I’ll have a “serving size of flesh (size of deck of cards) plus the cooked veggies and bread. She has learned that I’m not taking any meat home, no matter how much is left over. Give it to the dogs, they LOVE it.

              If I’m preparing the meal at home/ or camp, it’s from wild-harvested and self-processed game/fish. I quite realize that this doesn’t make it much better nutritionally speaking, but it goes a LONG way to reducing contamination and COMPLETELY sidesteps the atrocities of meat-product farming, and the contagion factories that those are.

              I cannot escape cravings for greens and nuts and veggies and fruit these days though. My gut is converted-obviously.

          1. Generally I’m down to a few ounces of meat…recently started whole grains…though I need to keep portions small. Am about to start reducing the meat altogether for the most part…it’s such a small portion I can’t really tell I it’s in the food any more.

            Problem being the people I associate with in my family…who keep eating the SOS. So once every 7-10 days I get to be reminded of “the old ways”.

            Gave one of Dr. Greger’s DVD to a sister to watch…she still hasn’t figured out whether it is a DVD or a CD….she’s not stupid…just intransigent. Wants to play games and protect her ego. Inertia and ego protection. I live amongst flatlanders…I try to get along with them, but realize they are a kind of uninformed zombie.

            I ask myself…what’s going to make a difference in my life over the next 10 years….going ahead and making changes in my own life or diddling around trying to “help” the intransigent? It’s the actual changes that are needed that are what’s difficult….so I’m best served putting the energy into my own life.

            Reminds me of some advice I got one time when I was out on a lake trying to collect driftwood to carve…guy said to not try to pick up any waterlogged stuff…it could pull you under.

            Recently heard of 2 people who are friends or relatives of the family who had their colons removed….sounds like a fun way to live…not.

            1. I love your driftwood picking analogy. I have decided for myself that the only way I can convince my loved ones to embrace a WFPBD is to show them how well it is working for me. I feel a bit angry that I didn’t have all this information years ago. Many thanks to Dr. G and his team.

            2. Fred: Great post. You are in the same position that so many others find themselves in: re at the point of being able to make changes in one’s own life, but family is not supportive. I applaud your decision to focus on you for now. That’s really all you can do. Some day your sister will listen to that video – or not. You have done what you can and by being a role model, you will continue to do more to help your family in the future.

            3. Eating “the old way” once every 7 or 10 days isn’t going to harm your overall health by my experience and learning. It’s what you do MOST of the time that counts the most. Teetotaling is too extreme for me and for most everyone who needs to transition, so I never push that approach. One meal. Then one whole day. Then string a few of those days together. It quickly becomes apparent how EASY it is and how QUICKLY your body responds. Even at 48.

              1. Teetotaling works if you let it, because your taste buds will eventually change. I have a hard time eating in restaurants with friends because everything is drenched in salt and oil. I really can’t eat salty food anymore, that stuff really is like a drug in its density of flavor or whatever. In many restos, I’ve found the chefs are delighted to put something together for me that fits my guidelines (WFPB, no SOS). I’ve had some beautiful and interesting plates of food from eager chefs this way – probably because it gives them an opportunity to flex their creativity a little more.

            1. Absolutely. I consider my non-plant consumption to be so far below the thresholds of any serious complications, that I waste no time fretting over it. My cravings are entirely different now and I like that.

              1. It sounds like that you use very few non plant foods. I am glad that your cravings have changed for the better. It sure is nice when we desire healthy food over unhealthy food. Keep on keeping on !!!

  5. The days quote from Dr. Gregor’s how not to die book. “It felt like I was drinking someone’s lawn”. Page 270. I really did laugh out loud.

    1. Your comment brings to mind Ann Wigmore’s free download book, somewhere out there in cyberspace, called Why Suffer? In it she described having been involved in a terrible accident which injured her lower legs or ankles so much that the doctors wanted to amputate them. She wouldn’t let them and she was of age so they couldn’t force it, even though she was facing gangrene. Her parents, old country tough-non-love types, shunned her and wouldn’t even feed her, trying to force her to have the feet amputated. Her uncle took pity on her and, every morning before leaving for work he would carry her outside to sit in the grass and sunshine. He gave her part of his lunch, but she didn’t have any other food. So she ate grass. That is, she chewed the grass and spit it out. Pretty soon her injuries began healing, she grew well, and never did have her amputation. The chlorophyll, proteins, and other nutrients in the grass healed her!

      Years later she developed the practice of using wheatgrass to heal many ailments.

      1. And all this raw green stuff is full of natural folate which is a major nutrient involved in the methyl cycle, which repairs DNA among other things (like making and breaking down neurotransmitters and more). Folate comes from the word foliage. Most people don’t get enough folate because most people eat veggies, even green leafy ones, cooked, which of course destroys most, if not all of the folate. Having said that, another major nutrient player in the methyl cycle is B12, which is not found in plant foods. (Yes, I know, most on this list will argue with me but even Dr. G advices taking a B12 supplement if one is going to avoid all animal-based foods.) The third major player is B6, but of course all the nutrients are involved as well. (The co-factor for mthfr enzyme is B2).

        1. Linda, thanks for this reminder of the importance of methylation. Six years ago I was diagnosed with an aggressive triple negative breast cancer. I subsequently learned that I’m homozygous for the MTHFR gene (two bads, one from each parent). This causes methylation difficulties, which then seriously compromise detoxification. I think that must have been the greatest cause of the cancer.

          At that time I began eating a raw food vegan diet, juicing, and doing many things to help detoxify better. I no longer eat only raw food, because I couldn’t keep warm in our climate, and my protein levels began falling, but I do think all the veggies are an important part of why I’m still alive.

          Most people have never heard of this genetic anomaly, and that includes many doctors I’ve talked with. Yet it affects a huge percentage of the population. Depending on which “expert” you read, it can be as many as 40% of Americans have one gene, with detoxification compromised by half and 30% more have two genes, with 70% less detoxification.

          I’m sure the final word hasn’t been written on that subject, but I have no doubt it caused several weird things that have happened to me over my lifetime. An example would be that I used Equal (aspartame) in coffee one night while on a trip to Las Vegas, and later had a major seizure and work up 32 hours later in a hospital. Another time, a dentist bullied me into using nitrous oxide. I was so sick I had to lie on a couch in his waiting room two hours before I could drive the 17 miles home.

          1. I too have snps in the MTHFR gene. I am compound heterozygous, which means I have one bad copy each for th 677 and the 1298. Took both of Dr. Lynch’s methyl ation courses and also studied both nutrition and biochemistry and more. Most sources say the 677 gene results in a 70% reduction in enzyme activity when one is homozygous, and many sources say compound heterozygous is also close to 70 reduction although others are not so sure

            But I have other snps in almost all parts of the genes that code for the enzymes that run the methyl cycle, and am homozygous for the gene that codes for gut genes that break down histamiine. I have had all the weird and horrible reactions you can think of just like you including such horrid sickness from anesthesia plus shock that the hospital staff had no idea what to do. BP so low that it was shock and vomiting out of one end and diarrhea out the other. Why they did not give me adrenaline I have no idea but years later I am kind of grateful that they did not as it is in the same biochemical pathway that breaks down histamine and they might have finished me off that way! LOL! From the link to “Methylation overview for health professionals (link below) ”

            Methylation and Anesthesia
            The levels of various metabolites of the methylation pathway are important for protection from side
            effects of anesthesia. As early as 1942 it was
            recognized that the addition of methionine is
            preventative for side effects from the use of ch
            loroform. Methionine affo
            rds protection from liver
            injury as a result of chloroform anesthesia. Methio
            nine also protects against effects of nitrous oxide
            anesthesia. Nitrous oxide disrupts the activity of methionine synthase, a central enzyme in the
            methylation cycle. Again, preloading with methionine appears to accelerate recover and reduce side
            effects associated with this form of anesthesia.”
            You might want to look into whether or not you have snps in the genes that code for breaking down histamine…called ‘Diamine Oxidase”. However, having said that gene snps in the methyl cycle also set one up for “histamine intolerance” Knowing what other snps you might have can be very helpful.

            I also do not eat a raw food only diet, and methionine is an amino acid that is also a key player in the methyl cycle, and it is found in much greater abundance in animal protein, although some nuts and nut butter are good sources as well. With histamine intolerance I have to have low protein diet (because histadine is converted to histamine in the body) but have to have some as my protein needs are still quite high. A catch 22 to be sure so I supplement with methionine, and occasionally also SAMe for biochemical reasons too lengthy to go into here.

            I do not believe in an all raw food diet any more than I believe in an all cooked food diet. I make sure I have a balance of both. Some nutrients are destroyed by cooking but others are made more bio available by cooking (such as many carotenes, and minerals.)

            And I absolute do not believe any one diet is right for everyone. Individual Biochemistry has proven that time and time again, regardless of what any specific diet promoter says (Including Dr. G and the paleo people)!

            Here are some sites you might want to check out:



            Good luck to you!

  6. Goes to show how any bit of evidence manipulated can change the outcome of the analysis. How many hours were wasted, papers and books written, on what this analysis clears right up?

    How may other “self-reporting” incidents are there in the “accepted” and “reviewed” medical literature? How many other conclusions rest on marginal data?

    I do believe that we are on the right track here, but I’m sure these sorts of errors and omissions can be found in all areas.

  7. Read about how French dairy products are from old fashioned A2 milk cows – not the improved A1 types. Milk from A1 cows is highly associated with heart disease and type 2 diabetes. If this information were to be acted upon, it would destroy US dairy industry.


      1. That article is all kinds of funny. All these big questions about A1 and A2 affecting different diseases and conditions.. why not just not drink milk and see if things improve? Is not having milk such a radical concept?
        That American milk is all kinds of gross though, could be so many things that affect people that other countries don’t have.

    1. That is interesting, but it doesn’t seem to fall inside what the good Dr. G is discussing here.
      How do you think this is relevant? If I wanted to buy A1 … is it? … milk or cheese in the US
      how would I do that ?

      1. The link is a website that will explain how A1 milk is highly correlated with milk from some newer breeds of cattle. The French preferred their older type of cattle – who happen to produce A2 milk. Nobody will know what you are asking for if you request it in the market. It is not off topic because it relates to how the French can avoid high levels of cardiac disease by just consuming A2 dairy products. A1 dairy, I have read, has a higher correlation with cardiac disease than cigarettes. The study didn’t differentiate between A1 and A2 dairy. Goat’s milk is also A2.

    2. The business of milk comes attached with eating meat. Milk choice comes from the animal meat (steak) flavor. I’ll try to explain. Female animals need to be pregnant to lactate milk. The male offspring becomes meat while female offspring becomes a perpetuating lactating animal keeping the business running. Thus, the choice of milk depends on the meat flavor given by the male offspring. For example, milk from dogs would require the consumption of the male baby dogs (as dog steak). The choice is cows and goats based on the meat flavor. Everything else is secondary choice.

    1. Brux: America is the richest country in the world, but our diet is pathetic. I’m an immigrant from a poor Asian country. Where I come from, peasants eat a more wholesome diet than the average American.

    2. It most decidedly does spread through money. Save yourselves! Send your money to me. ;-)

      On a more serious note, the dissemination of US culture, farming practices, patented seeds & herbicides and fast food restaurants have done much to spread misery and unhealthy eating habits around the world, and are considered by many to be cultural imperialism.

  8. Of my patients that drink heavily, they tend to have HDL cholesterols higher than their LDL levels. Of course, they don’t hardly eat and tend to suffer from ill effects of their high alcohol consumption.

  9. Dr. Greger is the myth slayer. That was a great piece.

    A while back, a health professional during a clinic visit tried to convince me that saturated fat did not harm vascular health, and she tried to draw a sketchy parallel by saying that some Europeans don’t have the North American cancer rates and yet they drink more alcohol. She said it must be our genes. Thankfully, I was already armed with hours of NutritionFacts.org information when this happened. Which makes me think:

    Doc, there’s been calls among the more responsible MDs to have more nutrition courses in medical schools. However, if this happens, who will be designing the courses? Dietitians have loads of nutrition training, and still tell people to eat things that can make them sick. I’m afraid nutritionally-smarter MDs will bring even more problems, by giving ill advice with a tone as if they’d been mandated by God (I’m sure you’ve encountered the term ‘medical narcissism’ in the literature…). What weight will have a few responsible MDs against the power of industry in influencing the curriculum and information given to doctors?

    1. Igor: Personally, I wouldn’t go so far as to say that the situation/data had been used to trick people in a malicious way. I would say that the data was a mystery about which people had different opinions. Now the mystery is solved. And thank goodness. Those mysteries can cause so much confusion and result in the spread of bad information.

      That’s just my 2 cents.

  10. I believe the French still live longer than is expected on their diet. Could it be from the Iodine factor that they introduced to the world? Certainly there is a little something there, they improved the health of the world with their discovery of Iodine, medicine, and Iodized salt, related to France, improved the fates of all for always. Life expectancy in France is 82 years.

    1. Life expectancy at birth rank by country : Monaco 1, Japan 2 France 19 European union 38 USA 43 Yes French medical school explained nutrition in biochemistry, We learn all the cycles with the organs and the food involved. We also have an extensive biophysique course. We have 8 years with just medical purpose to integrate all environment detail to health concern. Iodine is an old concept perfectly demonstrated with the population eating seaweeds and what we call fruit de mer. Go to Paris in winter, eat 12 just opened oysters I can tell you it helps to not be sick , same observation in Japan, have Sashimi your fatigue will fad away. in the US I eat 3 times a week Salmon roe, and seaweed soups. My American friends admit that I eat differently with some good energy.

  11. France just started eating large amounts of saturated fats? I am surprised to learn that. I thought French food has been high in saturated facts for a very long time.

  12. The key maybe cold pressed olive oil and grape seed oil to cut heart disease.

    Cleveland Clinic researchers have demonstrated – for the first time – that targeting microbes in the gut may prevent heart disease brought on by nutrients contained in a diet rich in red meat, eggs and high-fat dairy products.

    This novel approach centers around the research team’s previous discovery that TMAO – trimethylamine N-oxide, a byproduct formed in the gut during digestion of animal fats – is linked to atherosclerosis and heart disease. Now, the team has identified a naturally occurring inhibitor called DMB – 3,3-dimethyl-1-butanol, found in some cold-pressed extra virgin olive oils and grape seed oils – that reduced levels of TMAO and reduced atherosclerosis in mice.

    This discovery may represent a potential new therapeutic approach for the prevention of heart disease, the No. 1 killer in the United States, as well as other metabolic diseases linked to gut microbes, such as diabetes.

    The current research will be published both online and in the Dec. 17 print edition of Cell.

    “Many chronic diseases like atherosclerosis, obesity and diabetes are linked to gut microbes,” said Dr. Hazen. “These studies demonstrate the exciting possibility that we can prevent or retard the progression of diet-induced heart diseases starting in the gut. This opens the door in the future for new types of therapies for atherosclerosis, as well as other metabolic diseases.”

    TMAO is a gut metabolite formed during the digestion of the nutrients choline, phosphatidylcholine (lecithin) and carnitine, which are abundant in animal products. Blood TMAO levels are associated with heightened risk of heart attacks, stroke and death in clinical studies. Carnitine is abundant in red meat and liver, while choline and lecithin are abundant in beef, lamb, liver, egg yolk and high-fat dairy products.

    The present study suggests that targeted inhibition of the first step in TMAO generation, commensal microbial trimethylamine (TMA) production, can help to prevent diet-induced atherosclerosis. The research team inhibited TMA production using 3,3-dimethyl-1-butanol (DMB) in mice fed a high choline or carnitine diet. The mice treated with the inhibitor had less TMAO and developed less atherosclerosis. DMB is not an antibiotic. This important fact suggests that a treatment could target a specific microbial pathway while protecting the gut flora and avoiding antibiotic overuse and resistance, which is a worldwide health crisis.

    “We were able to show that ‘drugging the microbiome’ is an effective way to block this type of diet-induced heart disease. The inhibitor prevents formation of a waste product produced by gut microbes, leading to lowering of TMAO levels and prevention of diet-dependent atherosclerosis.” said Dr. Hazen. “This is much like how we use statins to inhibit cholesterol synthesis in human cells.”


        1. I did a quick read of your link Flip.

          not all deaths caused by CHD in France were classified as such. It was argued that French physicians, in the absence of autopsy data, tended to certify some deaths that may have been attributable to CHD as death from unspecified or unknown causes [45]. Whether that undercertification bias may, at least partly, account for the low prevalence of CHD in France (as seen through the national statistics) as compared with Britain has been further investigated in a recent British study [46]. The authors eventually concluded that the excess proportion of all deaths attributed to unspecified causes in France was equivalent to 19% of the difference in mortality from CHD between France and Britain (Table 4). After correcting for that bias, mortality from CHD in France was about one-third of that in Britain in 1992, while the major classic risk factors of CHD were similar [46]. Thus undercertification definitely cannot explain the French paradox.

              1. They are no superfood, they are plants. Plants are the best food/medicine. We all know that and we also know that reductionist science has extreme limitations, but that they keep trying to do it that way.

    1. “Cleveland Clinic researchers have demonstrated – for the first time – that targeting microbes in the gut may prevent heart disease brought on by nutrients contained in a diet rich in red meat, eggs and high-fat dairy products.” Why not just stop eating red meat, eggs, and high-fat dairy products? Wouldn’t going WFPB be a simpler approach?

      ” … the team has identified a naturally occurring inhibitor called DMB – 3,3-dimethyl-1-butanol, found in some cold-pressed extra virgin olive oils and grape seed oils – that reduced levels of TMAO and reduced atherosclerosis in mice.” This sounds like it may be another “reductionist” search for another “silver bullet”? Are we going to see a new expensive pharmaceutical pill full of DMB? Just trying to think through this logically.

    2. I am all about gut microbes and fermentation, and have even wondered if the consumption of naturally brewed alcoholic beverages as opposed to their manufactured counterparts, don’t play some role in the conflict. Overall, though I do occasionally enjoy some fermented alcoholic beverages, I think it is safer to err on the side of caution, no?

      1. Absolutely, I’m in the moderation camp of 1 or 2 drinks a day, any more and you risk getting some damage.
        I pick up plenty of the grapes when I find them on sale though.. (getting harder to do this yr)

    3. When I advice to eat clean it is all the French concept of the French cuisine bourgeoise , where people were preparing the food with cloves and other spices to be sure to avoid all contamination. To use clean tools etc… There is not only calories in nutrition , Quality is the essence of good nutrition. We found that in Japan as in upper class cuisine in France.

  13. I am French born, Medical doctor graduated from Paris Medical School France. I was invited to did a fellowship at the Chicago University in the Brain department, introduced by the president of American MS society about my thesis on immunoclinic on MS. Being a Clinical Immunologist , with a long expertise on memory and aging, I have different ideas about the so call French Paradox. I am also a woman from a family were eating and taking care of education is a long tradition. Cooking French at home is far different from cooking French as Julia Child explained. Making a weekly menue means to combine food to fulfill the nutrition needs than just food to eat.I observed the same in Japanese traditional food , looking why Japanese women do not have breast cancers, and the general population not neuro degenerative diseases. There is more to understand in the nutrition to be healthier. French are leading in cost and longevity because MD as I am add nutrition to their prescription and that makes difference. For fatal cardiac failure , French have cardiac rescue teams with device. I patented a rescue device , moved to the US and was block to go to mass production when the American patent was granted. This rescue blood pumps are part of positive statistics.

      1. Legal medicine is different in France and in USA and general practice. With the rescue system people are dieing in France and in Germany 50 % less from fatal cardiac failure out of hospital than in the US. When you are rescued from a cardiac failure in a public place you can die from an other accident, a stroke or a car accident or a cancer or any other cause called natural disease. The report will be the last death cause.

    1. Hi Claude ,
      symptoms of menopause such as hot flushes are rare among Japanese as well , but I wonder how long it’ll last with the increasing westernization of their diet and traditions being forgotten …hopefully with the increased awareness about WFPB they’ll try and bring their traditional diet back into their homes. I once saw an old propaganda film from the 30s (black & white) and the women of this Japanese village were basically being told off for cooking “old fashioned food” and was taught to go to the supermarket to buy more sophisticated & packaged food, as well as being taught to use lots of refined flour instead of rice they harvest from their local village. I saw this just after discovering Nutritionfacts.org and had just gained more awareness , so it was quite sad to see this unfortunate part of history in that film where things began to go downhill for a nation that had the right idea about nutrition & diet.

      1. I am genetically old French. I used with a group of other women medical MD Japanese modification in my diet , I never ever had a hot flash and was menopause at 56. I am preparing a serie of books about nutrition, combining food and metabolism. I have still a number of fact checking for women’s health, I will present Men’s health shortly as I practice more in urology. Yes I was obliged to learn the family recipes , before to enter Medical School. I gave cooking class in Texas. Speaking about change okinawa island is an exemple to be one of the longer longevity to American alike. Food is really the first medicine, It is not obvious to make right.

  14. Discussions, particularly by saturated fat and cholesterol apologists, of the “French Paradox” tend to be overly simplistic. Dietary saturated fat and cholesterol are not the only risk factors for coronary heart disease. The discussions also frequently do not take account of countervailing factors such as exercise and, as discussed by Dr Greger, vegetable consumption. Identifying risk factors and studying the interrelationship between them is complex. Dietary actors may possibly include, for example, the effect of different trans fat consumption rates, the ratio between polyunsaturated fat and saturated fat consumption and alcohol. Given the importance of all these different variables, it is hardly surprising just two variables (sat fat and cholesterol) do not correlate exactly to cardiovascular death rates in all countries.

    This Canadian study cited below illustrates some possible relationships (IMT = carotid artery intimal medial thickness) ………………….
    “For every 10-g/d increase in saturated fat intake, IMT was 0.03 mm higher (P = 0.01) after multivariate adjustment. A 1-g/d higher intake of trans fat was associated with a 0.03-mm higher IMT (P = 0.02) after multivariate adjustment. The ratio of polyunsaturated to saturated fat (P:S) was inversely associated with IMT after multivariate adjustment (change in IMT: −0.06 mm; P < 0.01). Saturated and trans fat intakes were independently associated with IMT thickness (change in IMT: 0.03 mm; P < 0.01 and 0.02, respectively; P for interaction = 0.01). Polyunsaturated, monounsaturated, cholesterol, and total fat intakes were unrelated to IMT. The relation between saturated fat intake and IMT strengthened (β = 0.0066, P < 0.001) in persons who never or rarely consumed alcohol as compared with moderate or heavy drinkers (β = 0.0001, P = 0.79, P for interaction = 0.01)."

    1. I agree Tom. I have been to France 3 times, and my wife is from a French family. French people have less stress than Americans, are more socially connected, and enjoy their food, as opposed to stuffing down a Big Mac while driving. Work, money and success are a part of life, but not all of life. There is a sense of tradition and time, connected to agricultural history, as seen in the Blue zones books. These are all correlated with longer healthier lives and less CVD.

      1. “The past is past”.

        Modern France is far lagging behind the USA in per-capita GDP, productivity, innovation, a highly taxed welfare/socialist state. City life is the ‘American fast-food lifestyle’.

        1. When you go to France, you look around and say, “Where do you hide your poor people?” They say, “These are the poor people!” They don’t have huge parts of their population that are starving, unemployed and killing with guns. French people mostly work around 40 hours a week, because they aren’t as controlled by overpowering bosses-they still have a union movement. They get much better vacations, health care and education. A poor French person has a much better chance of becoming prosperous than an American, because of health care and education, but also because their culture is not completely controlled by corporations. French people in cities don’t eat fast food mostly, just somewhat more than French in small towns. In short, French people have a much healthier and more balanced culture and life than Americans, because their whole lives aren’t dedicated to working like slaves. John

          1. It’s still a capitalist imperialist country (what they did to Syria after the bombing in Paris was unconscionable, they’ve also been funding the counterrevolutionaries in Syria to topple Assad), but their form of capitalism is not as pernicious as the neoliberal version in amerikkka. Their working class is more class conscious, however.

  15. Wondering where I can find the Marion Nestle quote at 1:18. Does she get the credit for suggesting the time-lag hypothesis before Law & Wald confirmed it in 1999? Anyone know?

        1. Looks the same to me if it’s at 1:18, but it’s a 1992 lancet article and now I am not sure why he mentions Marion Nestle it may be a goof. Thanks so much for pointing out if indeed it is let me know if you’d like a free DVD!

          1. I appreciate you following up! Yes, I think it must be Nestle responsible for the time-lag hypothesis (from internet searching). My only concern was that if you look closely, you see the 1992 Nestle article doesn’t seem to the same one Dr Greger excerpts from. He reads from: “Sir, Trends in food balance…”(1:21), whereas the Nestle article begins “Sir, Dr Renaud…”(stop at 1:18). If we had access to the full Nestle article we could probably resolve this, but it is of minor importance. Thanks, Tom and Joseph.

            1. Aaaah, yes, well spotted – I’d missed that. It does indeed seem to be from a different letter to that shown on the screen and your explanation seems the most likely one. Merry Xmas!

  16. I remain skeptical about Dr. Greger’s thesis: that the French Paradox has no basis in fact, and that once you account for the under-reporting of IHD, the French mortality figures (at least for the cohort studied, middle-aged men) are in line with other countries. I doubt that this under-reporting could have been as high as 20%, but I also have other doubts–meaning, I still give some credence to the French Paradox, and rather think that there are other mitigating factors, such as wine or more vegetables, or even olive oil in moderation. One reason is that French men are (or were) notoriously heavy smokers–their mortality should have been higher than the norm for their saturated fat intake, not less. In this regard, the French are rather similar to the Japanese: the men are also big smokers, yet have a pretty good (low) CHD mortality rate. Some people have suggested the high green tea consumption in Japan is protective as some make the same claims about red wine for the French. But I suspect a bigger factor is a) that the French eat more fruits and vegetables and have lower obesity rates than many other developed nations, and also have an excellent healthcare system; and, b) the Japanese are still lower in saturated fat intake and are even less obese–though, granted, their diets are becoming ever more Westernized. So we are still talking about what people were eating 20-40 years go, not what they’re eating today.

    1. Yes. There was also a Spanish study which similarly found low rates of heart disease despite the high prevalence of standard risk factors such as elevated cholesterol. Even so, those standard risk factors were still predictive of risk within the population studied. The researchers suggest that the explanation is most likely to be found in unidentified protective factors (such as higher rates of fruit and vegetable consumption as you suggest). This seems a very reasonable explanation and I think would also be the most probable explanation for the “French Paradox£.

      “Despite high prevalence of vascular risk factors, incidence rates were lower than those reported for other countries and other periods, but similar to those reported in the few population-based studies in Spain. Effect measures of vascular risk factors were mainly as reported worldwide and support the hypothesis that protective factors not considered in this study must exist as to explain low rates.”

  17. There was nothing mentioned about type of exercises been used in tests, no the age of athletes, …
    Also for precise data, they don’t suppose to use any supplements during experiment…
    Resveratrol is a very powerful supplement, particularly, in cancer prevention…,which is another story..
    But I think, genetics here will take it’s turn….

  18. The 2004 article that you cite does not provide support for the time-lag hypothesis. It appears to agree with the theories regarding the protective effect of moderate wine consumption and other lifestyle factors. Why do you discount this article’s conclusions in favor of the conclusions drawn in the 1999 article?

    Also, I find your inclusion of the 2011 article somewhat misleading. The title is provocative, but the actual content of the article has very little to do with what you are discussing here.

  19. The “under reporting” element is interesting. Anecdotally, we had a quite elderly native French lady as our neighbor. She had a joke she used to tell. “Do you know how many French people die of cancer? None. Cancer is too expensive to treat.” Perhaps this too gets to the heart of the cultural under reporting.

  20. One must also consider the European diets also have much higher vitamin K2 intake due to their dairy (specifically Brie & Gouda style) and organ meat intake as well as access to fresh produce, not to mention a more physically active lifestyle, you may also consider health care availability and legislation on food labelling and chemicals permitted… a little wine or resveratrol isn’t going to be the biggest factor in that paradox… it’s many things brought together that create the benefit not single things in isolation


    I would like to report a simple explanation for the so-called `French Paradox`. As it goes, French

    people who drink red wine regularly have a rather high free blood cholesterol level,

    nevertheless are not prone to coronary heart diseases (CHD). A glimpse at the available

    litterature shows that there was no clear explanation for that phenomenon. The consensus

    appears to be that red wine intake reduces the probability of platelets aggregation (1).

    Antioxydative substances and polyphenols in wine have also been postulated to play a

    significant role (2). But what about the rise in free cholesterol? I want to report a simple

    explanation for The French Paradox which is at the antipodes of current thinking. Following a

    routine health check (and a laboratory analysis), my general practioner found out a high free

    cholesterol blood content as well as as the usual elevated HDL/LDL ratio with no heart problem

    whatsoever. I was then a heavy drinker of red wine (about 2.0 to 3.0 liters per day) .

    As the head of a Clinical Biochemistry Laboratory, I decided to look into two blood parameters,

    namely free cholesterol and Gamma Glutamyl Ttransferase (GGT) which both are integral

    components of the hepatocyte membrane, by opposition to peripheral ones, those which are

    loosely bound to the membrane. The peripheral membrane components can be removed by

    gentle methods such as the use of urea or guanidine hydrochloride, while the integral ones

    require more powerful chemicals such as SDS (sodium dodecyl sulfate). GGT is elevated in all

    types of liver diseases. Cholesterol is a key component of all biological membranes, a

    precursor of steroidal hormons and a precursor of sex hormons.

    While still drinking wine, I had those two parameters determined. The analysis confirmed what I

    expected: the free cholesterol reached 8 nmol/liter and the GGT rose to 83 units/ml. The normal

    values are : 4.02-5.02 mmol/liter for cholesterol and 0-40 units/liter for GGT. Following two

    months of wine withdrawal, I had those parameters determined again. The free cholesterol

    reversed to 4.0 nmol/liter and the GGT to 8 units/liter. The HDL/LDL ratio also reverted to

    normal values.

    What do those results suggest? My explanation is a simple one. Ethanol and/or some red wine

    constituent damages severely the hepatocyte membranes releasing among other components

    cholesterol and GGT, just as SDS does. This plasma membrane derived cholesterol has no

    effect on the heart because it is EXOGENOUS cholesterol. This is in contrast with

    ENDOGENOUS cholesterol, the one which is synthesized de novo from small precursors. I

    believe that it is the endegenously generated cholesterol which is harmful to the body since it is

    readily incorporated in LDL within the hepatocyte in the endoplasmic reticulum and quickly

    discharged in the bloodstream, increasing the LDL/HDL ratio. The synthesis of this cholesterol

    can be effectively blocked by specific inhibitor (statins), under conditions of hypercholesterole-

    mia, while there are no other means than its metabolism (3) for eliminating the cholesterol

    generated by wine consumption, once it is used by the body for metabolic purposes,

    if any. I entertain the hypothesis that this cholesterol is disposed of by the body as free

    cholesterol or as bile salt, in a manner similar to dietary cholesterol. Thus, this exogenous

    cholesterol is circulated through known pathways until its level reduced so that the gene coding

    for HMG-CoA reductase, the first enzyme in the de novo pathway, is de-repressed (please see

    ref 3). As a consequence, cholesterol generated by wine consumption is NOT harmful to the

    body. Is The French Paradox a paradox at all? The free cholesterol associated with wine

    consumption should be considered as dietary cholesterol. The condition may then be

    appropriately coined Amplified dietary Cholesterol (ADC). As such, cholesterol-free food means

    nothing, the healthyorganism being fully able to dispose of any surplus:( that is the beauty of a

    finely regulated organism), via hormons for tissues and organs and through enzymes control

    at the cellular level. That is untill disease and/or senescence override the mechanisms of

    organs, tissues and cells regulation. When mothers breastfeed their infants with dilluted milk,

    natural milk containing 3.25 % fats then will become obsolete.The addition of chemical

    compounds to natural food is also a cause for concern, like enriched white flour as an example,

    Mother Nature should not be messed up with.

    1. Renaud S. deLorgeril M.
    Lancet. 1992; 339: 1523-6
    1. Ferrieres J.
    Heart. 2004 Jan; 90 (1): 107-11
    1. Michael W King/IU School of Medicine/mking@medicine.indstate.edu.,

  22. if Cholesterol causes heart disease how do we explain the Aborogine paradox, very low cholesterol at an average 4.9 but sky rocket heart disease. In fact taking data from the MONICA project shows, when mapping cholesterol levels to heart disease, a graph that jumps around like jack rabbit.Switzerland for example very high cholesterol at 6.4 but low rates of heart disease

    1. I think you will see that for Switzerland, they have excellent health care, blunting the negative effect of cholesterol. Those numbers you were looking at may indicate cvd mortality rather than prevalence? Another factor might be the altitude, as this affects the atherosclerotic process.

      As for the aboriginal Australians, they seem to have high burden of other risk factors as well as hypercholesterolemia.
      47% smoking!
      “Almost 70% of the burden of CVD among Indigenous people is directly associated with these [modifiable] risk factors [12]. The highest contributor is tobacco smoking followed by overweight and obesity, high blood cholesterol, physical inactivity, and high blood pressure. ”

      1. Is it not possible that cholesterol is simply an agent that gets involved when endothelial damage occurs. This damage is implemented by all the other factors you cite above. If I am correct then it is a sad fact that most people are concentrating on cholesterol. Ask any number of people in the street what causes HD and the majority will say Cholesterol

            1. I’ve seen, sorry but he’s ill informed =(
              Genetically high fibrinogen in humans does not increase risk – this tells us that it is merely a marker of disease, not a cause of it. In mice, knocking out fibrinogen doesn’t reduce atherosclerosis (caused by, ofc, high cholesterol). Likewise, increasing fibrinogen in mice also doesn’t increase atherosclerosis.
              (btw it should be clear to everyone that the claim that a deep fried mars bar has “almost no fat in it” is not correct)

                1. “as predictive as elevated cholesterol levels”, wow, that’s a lot! :p

                  But seriously, that’s just association. Elevated LDL is confirmed as a causal factor through genetic studies, animal models and multiple types of interventions. Fibrinogen is confirmed as NOT a causal factor in genetic studies and animal models. Kind of hard to argue that it’s causal

                  Here, mice with high LDL-C had induced atherosclerosis (standard model), that was actually worsened in fibrinogen-deficient mice. I’m having a hard time explaining that based on the hypothesis that LDL-C is benign and fibrinogen is causal…

                  1. So why is it that according the WHO world data lower cholesterol is linearly connected with greater rates of CVD death

                    The relationship exists for both men and women and the curve is slightly steeper for women

                    1. Thanks. I believe data is driven by better healthcare in richer countries, and by negative factors in poorer countries; alcohol, smoking, social stress.

  23. According to a paper in The Dialogues of Medicine, the French Paradox is indeed a myth:
    The clear conclusion, driven by the facts as summarized by Pierre Ducimetière, is that the rates of CHD are not so low in France, animal fat intake is not so high, and the diet-heart concept is not so unique that the existence of a “French paradox” can be sustained, except for satisfying cultural fantasy or for wine enthusiasm and marketing. Thus, the real paradox is why the French paradox continues to exist as a concept, when it should be replaced by the less mystifying view, namely, “the more Mediterranean, the better”. [1]

    This journal has a long article examining the French Paradox.

    There are strong regional variations in diet and disease patterns in France. A north-south-east gradient exists for all-cause mortality, cardiovascular mortality, hypertension, obesity, and high lipids.[2]

    A study involving French women born between 1925 and 1950 showed that the north has a greater consumption of: fat products, butter, margarine, potatoes, processed meat, alcohol, coffee, and saturated fats; and has a lower consumption of fiber than the rest of France.[3]

    There is also a higher prevalence of multiple sclerosis in the north-east and a lower prevalence in Paris and the Mediterranean.[4]

    Richard Harding
    Wise Nutrition Coaching

    [1] Tunstall-Pedoe, H. (2008). The French Paradox : Fact or Fiction? Dialogues in Cardiovascular Medicine, 13(3), 159–179.
    [2] Cottel, D., J. Dallongeville, A. Wagner, J. B. Ruidavets, D. Arveiler, J. Ferrières, A. Bingham, N. Marécaux, P. Ducimetière, and P. Amouyel. 2000. “The North–East–South Gradient of Coronary Heart Disease Mortality and Case Fatality Rates in France Is Consistent with a Similar Gradient in Risk Factor Clusters.” European Journal of Epidemiology 16 (4): 317–22.
    [3] Kesse, E., M.-C. Boutron-Ruault, F. Clavel-Chapelon, and *and the E3N group. 2005. “Regional Dietary Habits of French Women Born between 1925 and 1950.” European Journal of Nutrition 44 (5): 285–92.
    [3] Salem, G., Rican, S., & Jougla, E. (2000). Atlas de la Santé en France – Volume 1 : Les causes de décès.
    [4] Fromont, Agnes, Christine Binquet, Erik a Sauleau, Isabelle Fournel, Audrey Bellisario, Johan Adnet, Alain Weill, et al. 2010. “Geographic Variations of Multiple Sclerosis in France.” Brain : A Journal of Neurology 133 (7): 1889–99.

  24. The Kesse paper [1] shows eight significantly different dietery regions in France. Comparing countries is not as productive as comparing different regions.

    Richard Harding
    Wise Nutrition Coaching

    [1] Kesse, E., M.-C. Boutron-Ruault, F. Clavel-Chapelon, and *and the E3N group. 2005. “Regional Dietary Habits of French Women Born between 1925 and 1950.” European Journal of Nutrition 44 (5): 285–92.

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