The French Paradox: 20 Years Later

Abstract

The recognition by scientists and the public of potential health effects of moderate drinking increased approximately two decades ago from reports of the so-called ‘French Paradox’: high levels of risk factors among the French but very low rates of coronary heart disease (CHD). Literally thousands of publications since then have confirmed that moderate drinking, especially of wine, is associated with a lower risk of many of the diseases of ageing. Further, a large number of mechanisms have been identified, including effects of drinking on blood lipids, endothelial function, coagulation, inflammation, glucose metabolism, and gene expression. When a national television program in the US in 1991 informed the public that moderate wine consumption may lower the risk of CHD, it was the first time that a reliable major news source had even suggested that there may be beneficial, rather than just harmful, effects of a beverage containing alcohol. This information immediately led a number of ‘scientists’ and ‘experts’ to attempt to explain the reported lower rates of CHD among the French by factors other than wine intake: the French do not know how to diagnose CHD; heart disease rates in France are no lower than in many other parts of the world (usually citing developing countries); the French do not consume a high-fat diet; even if there is less CHD, many more people die of alcohol abuse and we cannot encourage drinking. These criticisms have not stood the test of time. It is clear from an immense, and amazingly consistent, amount of research that moderate drinkers, especially of wine, have considerably lower rates of many diseases and live longer. For most middle-aged and older adults, unless there are contraindications to alcohol, moderate drinking can be considered as one component of a ‘healthy lifestyle’.