Monday, November 7, 2016

The French paradox at 25

 November 17 2016 will mark twenty-five years since the CBS television show 60 Minutes christenedthe term “French paradox” and ushered in the modern era of research on wine and health. It was a provocative idea at the time, attributing the French custom of regular imbibing to health and well-being. It still has its naysayers; as recently as 2015, England’s chief medical officer Sally Davies scorned the idea and proclaimed it an “old wives’ tale.” (She suggested a cup of tea instead, presumably with pinky finger raised.) Then there are those who reduce the idea to a simple question of nutritional biochemistry and proclaim that all of wine’s health benefits can be put into a pill, conveniently and properly skipping the alcohol. Is there still a useful truth underlying the paradox?

Why the French Paradox is still true

As with many questions in the realm of lifestyle and health, the answers are often nuanced and conditional. Government authorities in both America and Europe challenged the authors of the French Paradox –Curt Ellison in Boston and the late Serge Renaud in Bordeaux – who were challenged to defend the idea. Their work drew from both epidemiology and basic science, laying the groundwork for a legion of researchers who followed. The French paradox is now so well ingrained that it risks becoming a cliché and its true meaning lost. Despite all of the advances in understanding the components of wine and how they contribute to health, at its heart the paradox is a reflection of a lifestyle. Wine is a food, squarely affixed in the quotidian rituals of the Mediterranean diet.
The science that grew from the seed planted by the French paradox idea has grown far beyond what any of the early researchers could have predicted. Polyphenols from the skins of wine grapes have emerged as vitally important elements of an anti-aging diet. Among the best known is resveratrol, about which there were 2 articles in the scientific literature in the year of the original broadcast of the story; there a more than 2 every day now. Resveratrol provides a handy explanation for why wine drinkers have lower odds of developing Alzheimer’s, diabetes, osteoporosis, and pretty much all of the diseases of aging. It helps break up the protein plaques in the brain associated with Alzheimer’s, prevents cholesterol from aggregating into concretions in the arteries, kills cancer cells (while protecting normal ones), even improves insulin sensitivity in diabetics. Resveratrol certainly appears to be a miracle molecule, as I dubbed it in my book Age Gets Better with Wine. There are huge international conferences on resveratrol, and tomes on resveratrol market conditions.

It's not just resveratrol

But there remains a problem with giving resveratrol all the credit: there isn’t very much of it in wine, and less in anything else we might consume. Resveratrol has little if anything to do with the French paradox. Data still support the benefits of regular wine consumption, but is lacking when it comes to the use of resveratrol in supplement form. This brings us back to the role of wine as a lifestyle factor. Wine drinkers tend to do a lot of health things besides having a daily tipple with dinner, and wine contains a lot more than the pittance of resveratrol, including alcohol. It is the synergies of these various things that release the power of the paradox. 
In 1979 a paper was published in the famous medical journal The Lancet.(1) The article found a clear correlation of average wine consumption by country to lowered rates of heart disease, and it became an iconic reference. No one knew at the time why this should be so, but the authors concluded the article by observing that if the ingredient in wine should ever be identified, “we consider it almost a sacrilege that this constituent be isolated. The medicine is already in a highly palatable form (as every connoisseur will confirm.)”
1    1. St Leger AS, Cochrane AL, Moore F. Factors associated with cardiac mortality in developed countries with particular reference to the consumption of wine.  Lancet. 1979 May 12;1(8124):1017-20.