Does diet or alcohol explain the French paradox?

Summary The low rate of coronary heart disease (CHD) in France compared with other developed countries with comparable dietary intake has been called the French paradox. We explored this paradox by looking at alcohol, diet, and mortality data from 21 developed, relatively affluent countries in the years 1965, 1970, 1980, and 1988. We assessed wine, beer, and spirits intake separately. France had the highest wine intake and the highest total alcohol intake, and the second lowest CHD mortality rate. In univariate analyses, ethanol in wine was slightly more inversely correlated with CHD than total wine volume. In multivariate analyses, animal fat tended to be positively correlated, and fruit consumption inversely correlated, with CHD. Beer and spirits were only weakly inversely correlated with CHD. The strongest and most consistent correlation was the inverse association of wine ethanol with CHD. However, wine ethanol was unrelated to total mortality. We conclude that ethanol, particularly wine ethanol, is inversely related to CHD but not to longevity in populations. Although light to moderate alcohol consumption may improve longevity, alcohol abuse—which sharply reduces longevity—is correlated with average alcohol consumption in populations. Thus, while the risk/benefit ratio varies for individuals, the use of alcohol for cardioprotective purposes should not be encouraged as a public health measure.