The French Paradox: is Saturated Fat a hoax??

The French eat a lot of saturated fat yet they have low risk of heart disease. Does this French Paradox mean saturated fat is harmless and scientists have been wrong all along? A look at the science behind the French Paradox and saturated fat and heart disease.

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References:
1-https://www.ahajournals.org/doi/pdf/10.1161/01.CIR.88.6.2771
2-https://www.sciencedirect.com/science/article/pii/014067369291277F
3-https://www.lycotec.com/wp-content/uploads/2018/03/PDF-5.pdf
4-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115846/pdf/1471.pdf
5-https://www.niussp.org/health-and-mortality/smoking-inequalities-in-france-and-the-united-states/
6-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10168602/
7-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5781309/
8-https://europepmc.org/article/med/2082460
9-https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011737.pub3/full

Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author’s knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.

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0:00 The French Paradox
1:14 Digging deeper
3:03 Competing theories
3:56 Ecological data
6:23 Stronger science
7:26 Strongest science

The French eat a lot of saturated fat and yet  they have a low risk of heart disease. this   is known as the French paradox. scientists have  been interested in this phenomenon for decades.   this study looked at 40 countries. countries with  higher intake of saturated fat and cholesterol had  

More deaths from coronary heart disease. the  scientists thought this was pretty striking,   especially since these countries were scattered  all over the world, from North America to Europe,   South America, Africa, Asia. but this correlation  was not perfect, there was significant scatter,  

The countries did not fall in a perfect straight  line. the two biggest outliers were France, which   fell under the trend line, so lower mortality,  and Finland, which fell above the trend,   so higher mortality. in fact, the scientists  titled the study “differences in coronary  

Mortality can can be explained by cholesterol and  saturated fat intake in 40 countries but not in   France and Finland”. so they set out to try and  figure out why these two countries deviated the   most from the norm. they went through dozens of  dietary factors looking for any that could explain  

The differences. now, of course the causes  don’t have to be limited to dietary factors,   and we’ll come back to this in a minute. okay, so  what did the science find? several specific Foods   correlated with coronary heart disease deaths. one  example was milk and butter fat. they plotted the  

40 countries again as a function of milk intake  this time, and now Finland and France fell much   closer to the trend line and no longer seemed like  such outliers. other dietary factors that also   correlated well included vegetables, which were  consumed four times more in France than Finland,  

Unsaturated fats, for example polyunsaturated  fats from vegetable oil were consumed eight   times more in France than Finland. olives and  peanuts were other examples, also consumed more   in France. the conclusion of the authors was  that the French paradox might be explained by  

Increased consumption of plant Foods, including  small amounts of liquid vegetable oils and more   vegetables. this idea is plausible but honestly,  given the type of evidence that they relied on   here, these raw comparisons between different  countries, it was basically just a hypothesis.   that’s because when we compare different  countries, there are so many differences,  

From genetics, to standard of living, to health  care, to pollution, to culture etc etc etc,   that it’s just impossible to establish cause  and effect from this type of evidence. in fact,   there have been many other theories put  forward to try to explain the French paradox,  

From red wine to cheese to smaller portion sizes  to gardening and exercise. some scientists even   suggested that there was never a paradox at  all, that it was all basically an illusion,   that the French just started eating more saturated  fat later compared to other countries and so the  

Effect on heart disease just hadn’t been observed  yet, just hadn’t gone up yet. this became known as   the time lag hypothesis. everyone and their mom  had a pet theory, and they were all reasonable,   and that’s precisely because comparing entire  countries to each other involves so many  

Differences. this type of evidence is called  ecological data or ecological associations,   when we look at different countries or  different populations somewhere in the world,   like an indigenous population somewhere in the  Amazon or in an island somewhere, and we try   to look for associations, correlations between  their behavior and their health. the blue zones  

Are another famous example. and ecological data is  ranked lowest among the types of human evidence,   right above experiments in lab animals,  precisely because it’s so confounded,   because it has so many variables. now, ecological  associations are super popular on social media, in  

General with a lay audience they’re very engaging,  because they just sound intuitive, it just sounds   like it should be right. people in Japan eat  a lot of food X and they’re pretty skinny,   they live long lives, so food X is probably  healthy to eat. this just feels like common sense,  

It just feels like it should be correct, but  the truth is, scientifically these this type   of association is notoriously unreliable. here’s  another example that really helps drive this point   home: France has one of the highest smoking  rates in the world, approximately a third of  

French people smoke. it’s the highest rate of any  country in western Europe. even the United States,   not exactly the poster child of health, is much  lower. we could easily call this the French   paradox. they smoke a lot and yet they have low  risk of heart disease. does that mean that smoking  

Is not a risk factor for cardiovascular disease,  for heart disease? of course not, we know it is   from much stronger data sets. what it means is  that heart disease is multifactorial, multiple   things affect it, and you can have one thing be a  little worse, if four or five are better the net  

Effect is still going to be an improvement. even  if it’s not great, cardiovascular disease is still   a major cause of death in France, but it’s going  to look better than some other place that’s doing   even worse. exact same thing is true of saturated  fat, it’s one risk factor among several and just  

Like with tobacco, we have much stronger data sets  to ask what is the effect of saturated fat intake   than these country to Country comparisons. the  first level up from comparing entire countries   would be to look inside a given country, look at  different populations in the same country. not a  

Perfect experiment but less genetic and cultural  variation than comparing France to Scandinavia   or Japan or something like that. so this type  of demographic study has been done in France,   for example. they found that areas that had a  lower risk of heart disease, like the region  

Of Toulouse for example, in the south of France,  if anything ate a little bit less saturated fat   than other regions that had higher risk. and  of course there were also other differences,   both dietary and otherwise. more wine consumption  in the South, more fruits and vegetables, more  

Cheese Etc. many differences. so this would still  be essentially an ecological Association, looking   at these different regions. better, cleaner, but  still tons of variables. where the rubber really   meets the road is with cohort studies, where we  can carefully adjust for dozens of variables, and  

Of course with randomized controlled trials. those  are much stronger data sets, different league,   and those data sets tell us that there is nuance,  it matters how much saturated fat, it matters the   source of saturated fat, it definitely matters  what foods we’re comparing the saturated fat to.  

But in general these data sets show that people  eating large amounts of saturated fat have higher   risks of heart disease and that moderating that  saturated fat intake tends to reduce the risk   of cardiovascular disease, especially compared  to other foods that are more cardioprotective.  

So these types of evidence are in a different  league from ecological associations. if you’re   interested in an in-depth look at these data sets,  we did exactly this type of overview in a previous   video. and here’s more dietary tips to lower your  heart disease risk. meet me over there, bye bye