Comparison of French and American eating habits points to a new paradox. It may be very difficult to meet the U.S. Dietary Guidelines' recommendation to eat a wide variety of foods, or to meet the Food Guide Pyramid suggestion to choose from all five food groups daily, and, at the same time, meet our national goal to eat a diet low in fat, saturated fat and cholesterol.
The French have unusually low death rates from heart disease, despite their high saturated fat diets. So the cause of this "French paradox" has been the subject of both wild speculation and serious scientific research for several years.
The American "silver bullet" approach to disease cause and effect has been to seek out the one food responsible for this
phenomenon. To date, lower incidence of heart disease among the French has been associated with olive oil, foie gras and red wine.
But a group of researchers, led by Dr. Adam Drewnowski from the University of Michigan, has taken a broader approach. They suggest that if the French paradox does have a dietary explanation, it is in overall diet quality, rather than the magic of any one food. Consequently, they have joined researchers in Paris to analyze the eating habits of 837 French adults who are generally representative of the French people. Some of their findings were published recently in the Journal of the American Dietetic Association and offer an interesting view of the similarities and differences between French and American diners.
Through detailed diet histories, French dietitians collected information similar to nutrition facts gathered from Americans during national nutrition studies. Then they compared dietary quality, dietary variety and dietary diversity in the two countries.
Based on this comparison, French and American adults averaged the same number of calories and the same total fat daily, but the French ate more saturated fat. So far, this is what we expected.
"Dietary quality" was based on five factors being promoted as healthful to Americans: eating less than 30 percent of calories from fat; eating less than 10 percent of calories from saturated fat; eating less than 300 milligrams of cholesterol daily; eating at least 50 percent of calories from carbohydrates; and eating less than 10 percent of calories from sugar (sucrose).
Sixty-three percent of the French interviewed met none or only one of those goals. But for those who had good diets -- that is, they met three or more of the goals -- a strange thing happened. They tended to have lower scores on dietary variety.
"Dietary variety" has no universal definition. In this study, each person's food repertoire consisted of a possible 73 foods eaten regularly. Both French and U.S. adults average about 30 different foods. Now here's the strange part. In both countries, as variety increased, fat, saturated fat and cholesterol increased, while carbohydrates decreased. That means that, by current U.S. standards, people were unlikely to have both a good diet and a varied diet.
No wonder we're frustrated. And it gets stranger.
"Dietary diversity" was evaluated by counting the average number of food groups each person ate. Food groups included dairy, high protein, grain, fruit and vegetable. Almost 90 percent of the French chose foods from all five groups each day. Only 33 percent of Americans hit that mark. In both countries, the food group most likely to be missing was fruit, followed by dairy, then vegetables. And as diversity increased, variety also increased, but so did calories.
It's hard to know what to make of this. This is only one study, adding to the body of knowledge, and its findings will have to be validated by other research projects. In the meantime, we can try to integrate this information with what we already know.
Clearly, in the United States, as blood cholesterol levels have declined over the past 20 years, deaths from heart disease have also declined. So it seems wise to keep working on those fat-reducing skills.
On the other hand, we're still a long way from meeting our national goal of eating two fruits and three vegetables daily. Over a hundred studies have linked more fruits and vegetables with lower heart disease and cancer rates.
So for now, just add a loaf of bread with a dab of foie gras, a glass of wine with a nibble of cheese, and a great big salad with a touch of olive oil to your apple a day to keep the doctor away. That's variety, quality and diversity. Maybe it's not so difficult after all.
Colleen Pierre, a registered dietitian, is the nutrition consultant at the Union Memorial Sports Medicine Center and Vanderhorst & Associates in Baltimore.
Pub Date: 8/06/96