French paradox

Glass of red wine

The term French paradox refers to the observation that while both the French and Americans have a diet high in saturated fats, smoke cigarettes and exercise little - all risk factors for cardiovascular disease - the French have a significantly lower risk of getting cardiovascular disease than the Americans: 36% compared to 75%.

The recognition by scientists and the public of the potential health effects of moderate drinking increased approximately two decades ago from reports of the so-called `French Paradox': high levels of risk factors (such as a diet high in saturated fats, smoking cigarettes and little exercise) among the French but very low rates of coronary heart disease (CHD). 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.

When Prof. Serge Renaud in 1991, on a national television programme in the US 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; 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 evident from many consistent research studies that moderate drinkers, especially of wine, have lower rates of many diseases, in particular cardiovascular disease, and live longer. Most have shown a J-shaped relation between the intake of alcoholic beverages and subsequent morbidity/mortality, indicating that there are both beneficial and harmful effects of ethanol on health.

Furthermore, a large number of mechanisms have been identified, including effects of drinking on blood lipids, endothelial function, coagulation, inflammation, glucose metabolism, and gene expression. In many studies, moderate wine consumption seems to show more benefits compared to other alcoholic beverages and it is suggested that the polyphenolic substances in wine – more abundant in red wine than in white wine - may play a role. However, the mechanisms are complex and not only the amount of alcohol, the beverage type, the specific ingredients of wine such as the polyphenols but also the drinking pattern may be responsible.

In contrast to moderate drinking, heavy or binge drinking is associated with an increased for all diseases.

For most middle-aged and older adults, unless there are contraindications to alcohol, moderate wine drinking with the meal can be considered part of a `healthy lifestyle'.

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