Many of us who follow a low fat, plant food diet are often confronted with the question, "but what about the French Paradox" or the "Mediterranean" diet. In France, mortality from heart disease is about a quarter of that in Britain and also less then that in the US. The major risk factors are no more favorable in France, and so this "French Paradox" exists, though it has not been satisfactorily explained yet.

Despite the difference in mortality from heart disease between these countries, similar levels of animal fat consumption, serum total cholesterol and high density lipoprotein cholesterol concentrations, blood pressure, and (in men) smoking exist.

The French paradox is usually attributed to the higher consumption of alcohol in France, notably of wine, and some have suggested a specific effect of red wine. However, low levels of ischaemic heart disease in France is not due to drinking red wine, suggest researchers in last weeks British Medical Journal.

In their paper Dr Malcolm Law and Professor Nicholas Wald from the Wolfson Institute of Preventive Medicine in London present a new hypothesis to explain why the French population has experienced such a low incidence of heart disease and provide supporting evidence. The crux of their hypothesis is that animal fat consumption and serum cholesterol are a relatively new phenomena in France and that there is a time-lag in the effect they have on health which we haven't fully seen yet.

Animal fat consumption and serum cholesterol concentration have only increased in the French population in the last 15 years, say the authors. For decades up to 1970 France had lower animal fat consumption and serum cholesterol and only between 1970 and 1980 did French levels increase to those in Britain and the US.

Law and Wald explain that French mortality from ischaemic heart disease is nevertheless still only about a quarter of that in Britain and the US because of a "time lag" effect. They estimate that the time lag between an increase in fat consumption and its effect on heart disease is somewhere between 25 to 35 years and explain that the time lag is similar to that which is seen in relation to lung cancer risk and smoking.

The authors examine previous explanations of the "French paradox" including the under certification of heart disease deaths by French doctors (which they say could account for about 20 per cent of the difference in mortality rates); smoking; alcohol intake (especially red wine); the consumption of garlic and onions and the moderately warmer climate in France. They conclude that apart from smoking in women, these factors explain little of the difference and that the most important explanation lies in the time-lag hypothesis.

Law and Wald emphasize that the consumption of animal fat leads to a slow increase in the risk of mortality from heart disease, but, as with smoking and lung cancer, these risks decrease rapidly on cessation.

Also, despite the supposed protective effect of alcohol on heart disease amongst the French men, alcohol related deaths from other causes among French men almost nullifies this benefit. In comparison with Britain, the amount of alcohol related deaths in France is 3x that in Britain. So, any protective effect that alcohol may be offering in relation to heart disease is cancelled out by other alcohol related deaths (including increased mortality from cancers of the mouth, pharynx, esophagus, liver, larynx and also alcohol related mortality from cirrhosis and alcohol dependence). Mortality statistics from all causes, bears this truth out.

Also, there have been some recent media reports stating that a new study from Lyon, France showed that people who ate a "Mediterranean Diet" had fewer heart attacks then those who ate a "low-fat" diet. There are some problems associated with these reports. First, there is no clear cut definition of what exactly the "Mediterranean Diet is. And, the so-called "Mediterranean Diet" that has been touted for its health benefits, doesn't exist anymore, (not even in the "Mediterranean) if it even ever did.

Part of the reason for this was the community was very economically depressed as they were recovering from a recent time of war. Additionally, they were very active, walking an average of 9 miles a day.

This dietary and exercise pattern, that was evident on the Isle of Crete in the late 50's, no longer exist there (nor anywhere else in the Mediterranean). Rates of obesity and heart disease on the Isle of Crete have risen since the original study, as their diet and fitness patterns have changed.

Second, in the above mentioned study from Lyon, France (Circulation, 99: 733, 779, 1999) the so-called "low-fat" diet actually had more fat and saturated fat in it, then the so-called "Mediterranean" diet. To this date, no study has pitted a "Mediterranean" style diet against a truly healthy version of a low-fat" diet.

Many reports have attempted to show that the "French" or "mediterranean" diets may be more healthful then a lowfat diet. And, many of us may have been swayed by these reports in an attempt to do what is most healthful.

Well, for those of you who may have been (or are being) swayed by the reports in the news of the "Mediterranean" diet and/or the "French Paradox", you can sit back and relax and know that the best advice for your health hasn't changed. You can't fool Mother Nature. Stick to a whole foods plant based (or plant exclusive) diet based on whole unrefined, unprocessed foods. Choose small amounts of the good fats that we have discussed, and get lots of physical activity and exercise.