On 2014 May 21, David Keller commented:

Red wine and the French Paradox: another beautiful theory murdered by the ugly facts

The French paradox is the presence of low coronary heart disease (CHD) death rates in France, despite high levels of cholesterol and saturated fat in the French diet. This has been explained partially by a number of factors, including: French doctors under-reporting CHD on death certificates (this accounted for 20% of the paradox in one study); the fact that the French ingest ethanol in moderate doses continuously all day, every day, compared with other countries where most ethanol is consumed in binges on one or two days per week (ethanol binges produce less increase in HDL and inconsistent anti-platelet effects); the French eat large amounts of saturated fat from animal sources, compared with Americans who consume slightly less saturated fat overall, but much more of it is hydrogenated trans fat, which is thought to be more atherogenic; a time-lag effect whereby the CHD rates of today reflect fat consumption levels 30 or more years ago, when the French diet was less fatty compared with the U.S.; consumption of possibly protective fruits and vegetables is also higher in France than in the U.S.(1) French serum lipid levels do not explain the paradox: they have been shown to be very similar to levels in countries with lower fat consumption and higher CHD rates (2). The most widely touted theory has been that the French regularly consume red wine, which has antioxidants and anti-inflammatory components, such as polyphenols and resveratrol, which confer greater protection against atherosclerosis than the ethanol in wine can account for. This study provides observational evidence that red wine consumption (for which urinary resveratrol is an accurate marker) does not correlate with lower rates of CHD. A placebo-controlled double-blinded interventional study of pharmacological doses of resveratrol would be more conclusive, but might be hard to justify given these findings. The source of protection enjoyed by French hearts remains debatable.

References

1: Ferrières J, The French paradox: lessons for other countries. Heart. Jan 2004; 90(1): 107–111. PMCID: PMC1768013

2: Law M and Wald N. Why heart disease mortality is low in France: the time lag explanation BMJ. May 29, 1999; 318(7196): 1471–1480. PMCID: PMC1115846

On 2014 May 16, Juan Carlos Espin commented:

This study demonstrates that (normal) dietary resveratrol levels are not correlated with all-cause mortality. And this is very logical. Why? Because resveratrol content in the diet is almost negligible. What is the effect of something that is hardly present in the diet? These results do not change the current evidence for resveratrol. Resveratrol is a component whose contribution in the diet is very low and unpredictable (even in wine drinkers) and despite the common belief, resveratrol does not explain the so-called ‘French Paradox’. In addition, resveratrol metabolism is very fast and a few hours are enough to detect resveratrol metabolites in urine. This means that the detection of resveratrol metabolites in urine is not a consequence of 'constant resveratrol intake for years'.

Taking into account the above, to claim that resveratrol does not have influence on the all-cause of mortality would require the follow-up for 9 years of a cohort with 'normal' resveratrol levels (very low and unpredictable) versus another cohort with a standardized resveratrol supplementation.

For more information: Resveratrol in primary and secondary prevention of cardiovascular disease: a dietary and clinical perspective. Tomé-Carneiro J, Gonzálvez M, Larrosa M, Yáñez-Gascón MJ, García-Almagro FJ, Ruiz-Ros JA, Tomás-Barberán FA, García-Conesa MT, Espín JC. Ann N Y Acad Sci. 2013 Jul;1290:37-51. doi: 10.1111/nyas.12150. Review. PMID: 23855464

Resveratrol and clinical trials: the crossroad from in vitro studies to human evidence. Tomé-Carneiro J, Larrosa M, González-Sarrías A, Tomás-Barberán FA, García-Conesa MT, Espín JC. Curr Pharm Des. 2013;19(34):6064-93. Review. PMID: 23448440

On 2014 May 15, Bill Sardi commented:

None

On 2014 May 15, Bill Sardi commented:

None

On 2014 May 16, Juan Carlos Espin commented:

This study demonstrates that (normal) dietary resveratrol levels are not correlated with all-cause mortality. And this is very logical. Why? Because resveratrol content in the diet is almost negligible. What is the effect of something that is hardly present in the diet? These results do not change the current evidence for resveratrol. Resveratrol is a component whose contribution in the diet is very low and unpredictable (even in wine drinkers) and despite the common belief, resveratrol does not explain the so-called ‘French Paradox’. In addition, resveratrol metabolism is very fast and a few hours are enough to detect resveratrol metabolites in urine. This means that the detection of resveratrol metabolites in urine is not a consequence of 'constant resveratrol intake for years'.

Taking into account the above, to claim that resveratrol does not have influence on the all-cause of mortality would require the follow-up for 9 years of a cohort with 'normal' resveratrol levels (very low and unpredictable) versus another cohort with a standardized resveratrol supplementation.

For more information: Resveratrol in primary and secondary prevention of cardiovascular disease: a dietary and clinical perspective. Tomé-Carneiro J, Gonzálvez M, Larrosa M, Yáñez-Gascón MJ, García-Almagro FJ, Ruiz-Ros JA, Tomás-Barberán FA, García-Conesa MT, Espín JC. Ann N Y Acad Sci. 2013 Jul;1290:37-51. doi: 10.1111/nyas.12150. Review. PMID: 23855464

Resveratrol and clinical trials: the crossroad from in vitro studies to human evidence. Tomé-Carneiro J, Larrosa M, González-Sarrías A, Tomás-Barberán FA, García-Conesa MT, Espín JC. Curr Pharm Des. 2013;19(34):6064-93. Review. PMID: 23448440

On 2014 May 21, David Keller commented:

Red wine and the French Paradox: another beautiful theory murdered by the ugly facts

The French paradox is the presence of low coronary heart disease (CHD) death rates in France, despite high levels of cholesterol and saturated fat in the French diet. This has been explained partially by a number of factors, including: French doctors under-reporting CHD on death certificates (this accounted for 20% of the paradox in one study); the fact that the French ingest ethanol in moderate doses continuously all day, every day, compared with other countries where most ethanol is consumed in binges on one or two days per week (ethanol binges produce less increase in HDL and inconsistent anti-platelet effects); the French eat large amounts of saturated fat from animal sources, compared with Americans who consume slightly less saturated fat overall, but much more of it is hydrogenated trans fat, which is thought to be more atherogenic; a time-lag effect whereby the CHD rates of today reflect fat consumption levels 30 or more years ago, when the French diet was less fatty compared with the U.S.; consumption of possibly protective fruits and vegetables is also higher in France than in the U.S.(1) French serum lipid levels do not explain the paradox: they have been shown to be very similar to levels in countries with lower fat consumption and higher CHD rates (2). The most widely touted theory has been that the French regularly consume red wine, which has antioxidants and anti-inflammatory components, such as polyphenols and resveratrol, which confer greater protection against atherosclerosis than the ethanol in wine can account for. This study provides observational evidence that red wine consumption (for which urinary resveratrol is an accurate marker) does not correlate with lower rates of CHD. A placebo-controlled double-blinded interventional study of pharmacological doses of resveratrol would be more conclusive, but might be hard to justify given these findings. The source of protection enjoyed by French hearts remains debatable.

References

1: Ferrières J, The French paradox: lessons for other countries. Heart. Jan 2004; 90(1): 107–111. PMCID: PMC1768013

2: Law M and Wald N. Why heart disease mortality is low in France: the time lag explanation BMJ. May 29, 1999; 318(7196): 1471–1480. PMCID: PMC1115846