Do fruit and vegetables explain the “French Paradox”?

Dr. Ayala

For years I've been watching with jealousy our French friends across the ocean, who indulge in meats, butter, rich pastries, full-fat cheese and other foods high in saturated fat (the classic repas français), yet are thinner and enjoy lower rates of heart disease and diabetes than us Americans.

There's been a lot of interest in the "French Paradox" and plenty of controversy about it. (Some even doubt its existence.) We'd all love to draw practical lessons from the French. Red wine was suggested as one protective food the French consume in plenty. But there are many other differences between the average American diet and the French one: the French eat smaller portions, consume less added sugar and more fish, indulge in less prepared and snack food, drink less sugary beverages and snack less between meals. All of these dietary differences may be part of the explanation of why the French have less heart disease.

The bad news is that the French people aren't as thin as they used to be. They still enjoy better health than their US counterparts, but the obesity epidemic has spread among them too. One in ten French kids will be obese by the age of 10 years, and 16% of French kids are overweight (compared to about a third of American kids who are overweight).

We know that people who eat more fruits and vegetables (F&V) are less prone to obesity, heart disease, cancer and many other chronic illnesses. France is technically a Mediterranean country, and the typical diet in the olive-growing South of France is richer in F&V, but further north the diet pattern is less plant based and more buttery.

Might the French paradox be explained (at least in part) by their F&V consumption?

A study in the current print edition of the European Journal of Clinical Nutrition compares the F&V consumption of French and US adults.

The results don't paint a pretty picture. Neither Americans nor the French ate their recommended minimum of five servings a day (the study actually looked at the frequency of consuming fruits and vegetables, not at quantity), but there were significant differences between the two populations.

  • French women ate the most F&V, followed by French men. In third place were American women, followed by American men, who ate the least F&V.

  • The distribution of the Body Mass Index (BMI, a measurement that estimates a healthy body weight based on how tall a person is) in the two countries was strikingly different: 31% of the US subjects were obese, compared to 8% of the French subjects.

  • There was a negative association between fruit and vegetable intake and BMI; in other words, the higher the F&V intake, the lower the BMI.

  • Education was correlated with F&V intake for Americans (the higher the education the more F&V people ate), but to a lesser degree in the French, indicating that maybe culture and dietary habits are more important in determining F&V intake in France than is education or that F&V were readily accessible to people of lower socioeconomic strata.


Overall, the Americans sampled in this study had much greater rates of higher education than the French. The authors write:

"Based on our findings, the consumption frequency of fruits and vegetables of the least formally educated group in France is comparable to even the most formally educated group in the United States."

I personally believe no single food ingredient is responsible for the French Paradox. It's dietary pattern-not a dietary ingredient-that's responsible for better health. I believe that's true for all people, including the French.

If we look to the French and want to learn from them how to eat for better health it's tempting to adopt only the attractive message of "drink more wine." In fact, we have to look at the rest of their dietary pattern, which includes amongst all the differences mentioned above perhaps the most important lesson-"eat more fruits and veggies!"

Dr. Ayala