The Man Who Ate Everything - Jeffrey Steingarten [22]
A considerable time after both Dolnick and I had published our pieces, le paradoxe français was “discovered” by both the New York Times and 60 Minutes on CBS—on the same Sunday. The 60 Minutes piece simplistically insisted on the red wine theory, and over the succeeding month, sales of red wine in America increased by 50 percent—not, I think, because people were trying to cure their heart disease, but because they felt that permission to drink more had been granted by a higher authority.
The French Paradox is not, of course, a true paradox, but the sort of seeming contradiction between scientific theory and real-world facts that is supposed to lead to progress. Most of the American nutrition establishment behaved otherwise, because the new facts threatened to destroy the hypotheses on which many of them had built their careers—principally those regarding the influence of dietary fat on the health of our arteries and consequently on the rate of premature cardiac deaths; and after a year or two of engaging in what was meant to pass for scientific discourse, they were happy to let the Paradox fade from the foreground.
But they never laid a glove on it. Some nutritionists were happy to believe that the French do not know how to count heart attacks. The only basis for this charge was a technical study by a statistician at the National Cancer Institute showing that in one regard the French do not “code” their death certificates as World Health Organization protocols instruct: when the French have the choice between attributing somebody’s death to cancer or to heart disease, they incorrectly favor the former. But how often do these errors occur? The answer is critically important to the WHO’s MONICA project (Multi-national Monitoring of Trends and Determinants in Cardiovascular Disease), whose purpose is to standardize and compare cardiac risk factors and fatalities across national boundaries. An emergency meeting was held, a study was performed, and a resulting MONICA report demonstrated that the French inclination to undercount heart fatalities is too small to matter. Correcting for it does not budge France from its standing right behind Japan in the coronary heart disease sweepstakes.
Just the idea that French cholesterol levels are the same as ours—while their rate of heart attacks is less than half—is enough to drive American nutritionists crazy. But not the Europeans, who, though taking cholesterol and saturated fat very seriously, assign to them only about one-sixth the influence we do here. Whether blood lipids end up as arterial plaques depends partly on whether they are oxidized; a major MONICA study, largely ignored in this country, showed that circulating levels of vitamin E, an antioxidant, statistically overwhelmed the influence of circulating levels of cholesterol in our bloodstreams. Besides, serum cholesterol may contribute to narrowing of the arteries, but for a heart attack to occur, the blood must clot—thrombosis must occur. Fat intake seems to have no connection with thrombosis. And other blood factors, such as circulating levels of the amino acid homocysteine, are now believed to be at least as important as cholesterol; consumption of folic acid (which occurs in greatest quantity in the liver of web-footed fowl!) effectively lowers homocysteine, but whether this is an effective therapy or merely suppressing the messenger has yet to be discovered.
A large number of heart attacks appear to result from spasms of the blood vessels, or unexplained ischemia; the causes are unknown, and diet has not been implicated. Finally, a group at Harvard has recently characterized the arterial damage that can lead to a heart attack as an inflammatory disease; again, the marker for this