Week of Jan. 24, 2004; Vol. 165, No. 4

A Swiss Paradox?

Janet Raloff, Science News

link to article

Gstaad, Switzerland, has gained renown for its challenging ski trails and celebrity sightings. Come summer, however, the area's slopes host cows, not skiers. It now appears that milk from those cows produces cheeses rich in some heart-healthy nutrients.

Mention omega-3 fats and most people think of fish. Indeed, oily fish from cold ocean waters offer an especially rich source of these heart-healthy fats, which is why the American Heart Association recommends including fish in your diet.

However, some plants also produce omega-3 fats in abundance. The carbon-chained backbone of these plant fats tend to be shorter than the 20- and 22-carbon version typical of fish oils, so the omega-3 fats are different. On the other hand, chemical reactions in the body can elongate some plant fats to fishy lengths. Moreover, even at 18 carbons, the plant-derived alpha-linolenic-acid (ALA) omega-3 can contribute to heart health, research has shown.

In general, cheeses are fatty foods. However, Jürg H. Beer of the Canton Hospital in Baden, Switzerland, and his colleagues now report finding that cheeses produced in alpine areas around Gstaad hold a more heart-healthy mix of fats than do cheeses made from the milk of cows grazing at lower altitudes. Not only were alpine cheeses highest in omega-3 fats, such as ALA, but they also had relatively low concentrations of saturated fats and arachidonic acid, a fatty acid that can promote inflammation in the body. As an unanticipated benefit, cheeses made from the milk of grass-fed alpine cows exhibited the highest concentrations of the unusual trans fatty acid, conjugated linoleic acid, that a number of studies have linked with cancer prevention.

Beer acknowledged to Science News Online that even alpine cheeses "can't compete with fish" as a source of omega-3 fatty acids. The plant-derived omega-3s aren't as abundant nor as consistently of the preferred length as the fatty acids from fish are. However, Beer notes, for people concerned about mercury contamination of fish or who just like cheese, alpine varieties appear to be a heart-healthy choice.

Beer's team reports its new findings in the Jan. 6, 2004 Circulation.

The alpine answer to the French paradox?

Over the years, many studies have highlighted a conundrum: Though the typical French diet contains large amounts of butter, cream, and other foods rich in typically artery-clogging saturated fats, the French incidence of fatal heart attacks is low. To tease out why, epidemiologists have probed other aspects of the regional cuisine. At present, the leading candidate to explain what has come to be known as the French paradox is wine—a beverage that's a Gallic favorite and rich in heart-sparing antioxidants.

Beer notes that alpine regions also have developed a reputation for longevity—something the locals attribute to their dairy-rich diet. Realizing that the grass-fed livestock might be grazing on omega-3–endowed plants, the internist decided to collaborate with the Federal Institute of Technology in Zurich to profile the fats in various cheeses.

Altogether, the researchers sampled 12 alpine cheeses from the Gstaad region, 7 commercially made English Cheddars, 6 cheeses from cows whose diets had been supplemented with omega-3–rich linseeds, 7 commercially made Emmentalers (what North Americans refer to as Swiss cheese), and 8 alpine cheeses made from the milk of cows that had received silage corn. The alpine cheeses are traditionally hard cheeses, unlike typical Emmentalers or Cheddars.

The researchers observed a trend. Cheeses from the milk of purely grass-fed alpine cows had the best fat profile, followed by cheeses from silage-fed alpine cows and linseed-supplemented cows. Lowest in omega-3 fatty acids were the Emmentalers and then the Cheddars. Grass-based alpine cheese contained four times as much of the plant omega-3 ALA as did the Cheddar, more omega-3 fats in general, three times as much conjugated linoleic acid, and 20 percent less of the saturated fat palmitic acid.

"Surprisingly," Beer's team notes, cheese from the milk of cows getting the linseed omega-3 supplement contained only half as much ALA as did cheeses from grass-fed alpine cows. Emmentalers contained only 40 percent as much of this omega-3 fatty acid as alpine cheeses did.

Most people living in industrialized countries consume an average of 55 grams of cheese per day, the researchers say. That much Cheddar would supply 62 milligrams of ALA daily—a mere 22 percent as much as an equivalent amount of alpine cheese. In other words, just swapping one cheese for the other could increase daily ALA consumption by 210 milligrams. The Swiss researchers cite data from a 1999 Harvard study indicating that increasing the ALA content of the U.S. diet by 210 milligrams per day might cut the population's risk of fatal heart attacks by 15 to 20 percent.

To test whether the ALA-rich alpine cheeses actually translate into beneficial changes in heart risk for people, Beer's team has begun a year-long study with local volunteers. If alpine cheeses indeed prove heart healthy, the researchers say they'll next try to answer the important questions of what aspects of climate, altitude, and livestock diet contribute to the dairy products' unusual fat profile.

«Over the years, many studies have highlighted a conundrum: Though the typical French diet contains large amounts of butter, cream, and other foods rich in typically artery-clogging saturated fats, the French incidence of fatal heart attacks is low. To tease out why, epidemiologists have probed other aspects of the regional cuisine. At present, the leading candidate to explain what has come to be known as the French paradox is wine—a beverage that's a Gallic favorite and rich in heart-sparing antioxidants. »

I love those «paradoxes»...As someone who knows lots of people from France, I can attest that they have a delicious culinary tradition, with plenty of saturated fats indeed, and are slim and healthy. However, the next generation might not be so healthy, as they are increasingly turning to MickyDs and other crap instead of traditional foods and cooking...
The secret to the French's health does not lie in a protective effect from wine or any other rubbish...they eat REAL food, take the time to cook and share meals with the familiy, have a very relaxed way of life in general (even though that is changing also) and also leave lots of room for regional culinary spacialties and small producers...hence better quality food, hence better health!

Couldn't it possibly ....just possibly ... be due to the fact that heart disease got absolutely nothing to do with fat ??

«Couldn't it possibly ....just possibly ... be due to the fact that heart disease got absolutely nothing to do with fat ??»

IMPOSSIBLE!!! HOW DARE YOU SAY SUCH A THING???
Seriously, you are so right...

Here is part of an article from Barry Groves' site (www.second-opinions.co.uk) about those so-called «paradoxes»

THE MEDITERANNEAN PARADOXES

The 'French Paradox' has been well documented over the years. This paradox describes the low levels of heart disease enjoyed by the French, despite the fact that they eat an 'unhealthy' high-fat diet. This is, of course, seen as a 'paradox' because conventional wisdom has it that such a diet should increase heart disease rates.


Many hypotheses have been devised to try to explain this paradox over the last couple of decades:


The use of olive oil
They drink red wine
Their use of garlic
Their low-fat diet (despite the obvious fact that they actually eat a high-fat diet – otherwise there would be no paradox)
Their high consumption of fruit and vegetables

And on and on, because all these turns out to be false when looked at critically. The part of France where heart disease is least is that part where animal fats are eaten the most.

It now turns out that the French are not alone in this paradoxical situation. There is also a Spanish Paradox.

The Spanish paradox
A study published in 1995 noted that heart disease deaths in Spain from 1966-1990 dropped by 25% for men and by 34% in women.(1) The study published a table which indicated that between 1964 and 1991:
bread consumption fell by 55%,
rice consumption fell by 35%,
and potato consumption fell by 53%.

At the same time consumption of
beef went up 96%,
pork went up by 382%,
poultry was up by 312%,
and full-cream milk went up by 73%.

Under the circumstances, you might expect that the authors would suggest that these changes might have been responsible for the changes in patterns of heart disease. But paradoxically, they didn't. To say such a thing, when 'everone knows' that fats and meat are bad for you, is'nt politically correct.

What they did say in their conclusions was:
"Nevertheless, our results, in the context of current knowledge about the relation between diet and health, suggest several dietary recommendations that might be applied to the prevention of CVD in Spain:

Promote moderate consumption of all meat (beef and pork in particular)
Increase consumption of foods rich in complex carbohydrates (bread…rice)
Encourage use of skim milk and low-fat cheese…."
In other words, stop the Spanish eating their protective diet, and get them to change to our version of 'healthy eating'!

The British Medical Journal published another Spanish study in its 13 September 2003 edition.(2)

The authors say they "found unexpectedly high numbers of plaques in young Spanish men, similar to the prevalence in populations with much higher rates of coronary heart disease". So the Spanish diet did not prevent the build-up that is thought to be the cause of heart attacks. They go on to point out that "In Spain, coronary atherosclerosis evolves more slowly. Although a time lag to increased rates of coronary heart disease could be approaching its end, unknown protective factors might also prevent coronary plaques from becoming unstable in this population."

Could it be the Spanish high-fat, low-carb diet that protects them as it does other populations throughout the world?

Or would it be heresy to suggest such a thing?

References
1. Serra-Majem L, Ribas L, Tresseras R, Ngo J, Sallerus L. How could changes in diet explain changes in coronary heart diease mortality in Spain? The Spanish paradox. Am J Clin Nutr 1995;61(suppl):1351S-9S.

2. Bertomeu A, García-Vidal O, Farré X, et al. Preclinical coronary atherosclerosis in a population with low incidence of myocardial infarction: cross sectional autopsy study. BMJ 2003;327:591–2.

One thing about the French diet is that I think it is pretty high in refined carbs as well as fat. They probably eat a baguette a day, croissants, etc.

I'm thinking maybe the reason they've stayed so healthy is they walk a hell of a lot. Their metro system is all stairs. You have to go up/down so many stairs to get on or off the metro, then walk to the store. If they ever replace the stairs with escalators.

One of my theories is that eating carbs is fine, if you're also balancing them with plenty of fat and protein and ... here's the important part... exercising a lot. That's what I think most of us lack. In our fairly sedentary lives we simply don't exercise enough to metabolize all that glucose properly.

When I was there, I ate incredibly well of their wonderful fat/carb concoctions and lost a lot of weight simply from all the exercise of walking and stairs. I started gaining it in London though, they had escalators to the subway.

I was surprised that when we visited Washington D.C. On average people are thinner than we are in our rural town. While there we walked often and climbed stairs. We couln't help but notice the difference.

Nancy LC,

while you are absolutely right that people in Paris eat a good deal of processed carbs and walk a lot, they are more stressed than the rest of the coutry, and smoke a lot more also. I was talking more about the rural population, which doesn't exercise a lot, and are still slim and healthy.

One thing that you forget ..... France doesn't have a fast food society like the Americans do. While you can find fast food outlets, and they are popular with the younger crowd, French people as a whole shun them. And why shouldn't they when they have such a wide variety of delicious food to choose from. Why choose something that is removed from real food, I have to wonder if it's food at all.

Food for the Frenchman is nothing but fast. It's something that is to be savored and enjoyed. Not wolfed in supersized quantities while driving down the highway on your way to work.

There is no one factor that makes diet and lifestyle less likely to cause heart disease. There are many things and these are cumulative. If one has read Dr. Atkin's books, he explains that on a low-carb diet, the body uses fat as its favoured energy source instead of glucose. That being the case, fats are going to be digested rather than deposited on the artery walls but that clearly doesn't mean that heart disease has "nothing to do with fat". As far as the Mediterranean diet goes, there is no question that certain fats have protective qualities. This is not a theory, it has been proven by clinical studies. There is one thing that no one has taken into account. France has the highest incidence of alcoholism in Europe. Alcoholsim kills faster than heart disease. You can't die of heart disease if you're already dead from alcoholism.

"One thing about the French diet is that I think it is pretty high in refined carbs as well as fat. They probably eat a baguette a day, croissants, etc.

I'm thinking maybe the reason they've stayed so healthy is they walk a hell of a lot. Their metro system is all stairs. You have to go up/down so many stairs to get on or off the metro, then walk to the store. If they ever replace the stairs with escalators."

I think one explanation is often overlooked: when French people gain weight they starve themselves to get thin. It's the other side of the coin and it's often not pretty and has led to high rates of anorexia. Yes, they walk alot, but I think it has more to do with the quality of food they eat (they actually have higher per capita car ownership than the US, surprisingly). I lived in Europe (French Switzerland) for five years and I've thought about it alot. I've finally come to the conclusion that most of the difference is accounted for in the quality of food - there are many things allowed in fooes here that are not allowed there - colorings, preservatives. And, yes, they eat way more of the good saturated fat. It would be interesting to compare Parisians with New Yorkers, for instance, because that could be the only fair comparison in terms of walking and lifestyle.

Well, I posted that 4 years ago, my opinion has changed a bit. I too think there's no paradox and it isn't the walking. It's the fat that makes them healthy despite the carbs.

Mais, non.

I've lived in: France, Holland, England and Ireland. For several years each. While it's true that the average European walks more than the average American, it's equally true that despite the 'walking' there are many European countries where the walking population has even higher rates of heart disease than here.

The French 'paradox' is the food, just the food. In three ways:

-- All portions of all courses are small. Compared to American portions, minute. The idea that a typical French woman would eat a baguette a day is hilarious. A small croissant (loaded with butter, then topped with more butter and a bit of jam) with coffee for breakfast, perhaps - and a small slice or two of a baguette (only 3 inches in diameter) with a meal later, mais qui! But that's it, and that little would be slathered in good French butter, which has a higher fat content than ours. It's also eaten with multi-course meals that contain a lot of other fat, and almost never on its own.

-- All meals except breakfast are loaded with saturated fat, contain a moderate amount of protein, and a small amount of carbs, complex or otherwise. They eat a lot of dairy in the form of cheese, cream, yogurt and butter. The proportion of fat to carb is very high - and I believe this is a main key to the mystery.

-- All meals except breakfast often have a dessert of some kind, very small, comprised of good things like chocolate and fruit (in addition to yes, some sugar), and again is rarely eaten on its own but in conjunction to a meal containing many different small courses that contain a good amount of saturated fat. And is usually followed by a cheese course with lots more fat. Meals are eaten over an hour or two. Or three. Snacking and fast foods are a fairly new phenomenon, but were almost unknown when I lived there many years (okay, decades) ago. And last but not least - they drink a lot of coffee and wine. I believe both these foods contain heart-protective aspects, and we may learn someday that the protective nature increases when we consume them with . . . fats.

The paradox is that we know all this, scientifically speaking, but still insist on crippling or killing off a large portion of our population by spewing contrary information so that the nutrient-medical-media-pharmaceutical complex can continue to make billions in profit.

Lisa

"American, it's equally true that despite the 'walking' there are many European countries where the walking population has even higher rates of heart disease than here."

Yes, this is ALWAYS overlooked. Europeans in general have very high rates of heart disease, I believe matching US levels or higher. Eastern Europeans have a very low life expectancy and they walk alot. It i merely a French paradox - and there are a lot of other factors that could be at work.

Europeans and especially Eastern Europeans smoke a lot - inside and while walking outside. Even when out hiking to enjoy the fresh air and nature!

One has to look at morbidity and mortality overall in any discussion of any medical topic which attmpts to determine an aetiology. If a certain part of France has a lower incidence of heart disease than the rest of the country, which has to mean there are fewer deaths from heart disease, what DO they die of and what diseases are most prevalent in the area (morbidity)? Any discussion of the topic is useless without this data. Alcoholism? Lung or other cancer? Degenerative or infectious diseases? etc. As in any any type of statistical analysis, one has to rule out other causes for the phenomenon, i.e. as I said above - other diseases that get 'em before heart disease does..