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English whine and hard cheese

Boz magazine, 62: 18, July 1999.

Brian J Ford

Everyone has been talking about the French Paradox. It has puzzled doctors for years. The statistics show that French people have much less heart disease than we do. It's the red wine, you see: full of healthy components that keep the arteries free of deposits and give a youthful zeal to everyone who drinks it. Now we have the latest revelation from the British Medical Journal—the reason the French have so little heart disease isn't anything to do with drinking red wine, after all. The real answer is because they only recently started eating a lot of animal fats, and they are simply waiting to catch up with the British data. It's not the wine which controls the levels of heart disease, it's the diet.

Wrong again. Saturated fats are not causally related to heart disease. The cholesterol in your blood is made by your liver, and is largely unaffected by the levels in your food.

Diet or Microbes

In my view the greatest mistake is to imagine that there is only one factor behind heart disease. There must be many. I can list some here. One consideration is your diet as a foetus—nutrition in pregnancy may have a part to play. In India, for example, heart disease is rapidly becoming the number one killer, and nobody eats beef. Another is the role played by microbes. An organism named Chlamydia has recently been incriminated. It is found in many post-mortem specimens from victims of heart disease. One of the reasons why heart disease has decreased in some populations may be because they have prescribed antibiotics over the past few decades, which have helped wipe out the Chlamydia infection.

Then there are psychological factors. Several surveys have shown that there is a relationship between hostility or depression and the incidence of heart disease. Clearly, one's state of mind may play a part on one's heart.

French paradox

Let's try to make sense of all this. Before anybody tries to plump for a single cause of the French Paradox, we must take stock of the other issues. Although Frenchmen drink lots of red wine, their death-rates are comparable to ours. They suffer greatly raised levels of alcoholism, which balances out the supposed benefits. The women do better, with death-rates lower than in Britain, largely because they don't drink too much. We need to know about the incidence of Chlamydia. Is it as widespread in France as it is in England? Does the French way of life help or hinder its transmission—is there something in the diet which acts against the germ, for example? Have they been using antibiotics that knock out the organism?

All in the mind

Then there is the question of psychology. As a family with homes both in France and Britain, we do see the differences. The French are a cocky lot—their detractors would describe them as arrogant. Certainly their sense of inner confidence and positiveness is distinctly different to ours. If depression is related to heart disease, then high levels of self-esteem might well have the converse effect.

Now let's look at life-style. The French have a far better developed social structure. When do people drink wine? When they are with friends, that's when. If you invite people round, or spend time sitting in a social setting, discussing affairs of state or the problems of the young, then you have time to open good wine and drink it socially. It may be that a relaxed and cheerful attitude to socialising is the real protective against heart disease. The fact that drinking wine goes hand-in-hand with this life-style is an indicator of enjoyment, rather than a cure in its own right.

I'd guess that a range of factors really influences the incidence of heart disease, but a crucial component is a general sense of relaxation, well-being and contentment. Aiming at that can only improve life—and if it brings a lowered risk of a heart attack, then what a bonus that would be.

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