The Mediterranean Paradoxes

The 'French Paradox' has been well documented over the years. This paradox describes the low levels of heart disease enjoyed by the French, despite the fact that they eat an 'unhealthy' high-fat diet. This is, of course, seen as a 'paradox' because conventional wisdom has it that such a diet should increase heart disease rates.

Many hypotheses have been devised to try to explain this paradox over the last couple of decades:

• The use of olive oil
• They drink red wine
• Their use of garlic
• Their low-fat diet (despite the obvious fact that they actually eat a high-fat diet — otherwise there would be no paradox)
• Their high consumption of fruit and vegetables

And on and on, because all these turns out to be false when looked at critically. The part of France where heart disease is least is that part where animal fats are eaten the most.

It now turns out that the French are not alone in this paradoxical situation. There is also a Spanish Paradox.

The Spanish paradox

A study published in 1995 noted that heart disease deaths in Spain from 1966-1990 dropped by 25% for men and by 34% in women.(1) The study published a table which indicated that between 1964 and 1991:

• bread consumption fell by 55%,
• rice consumption fell by 35%,
• and potato consumption fell by 53%.

At the same time consumption of

• beef went up 96%,
• pork went up by 382%,
• poultry was up by 312%,
• and full-cream milk went up by 73%.

Under the circumstances, you might expect that the authors would suggest that these changes might have been responsible for the changes in patterns of heart disease. But paradoxically, they didn't. To say such a thing, when 'everone knows' that fats and meat are bad for you, is'nt politically correct.

What they did say in their conclusions was:

"Nevertheless, our results, in the context of current knowledge about the relation between diet and health, suggest several dietary recommendations that might be applied to the prevention of CVD in Spain:

• Promote moderate consumption of all meat (beef and pork in particular)
• Increase consumption of foods rich in complex carbohydrates (bread ... rice)
• Encourage use of skim milk and low-fat cheese?."

In other words, stop the Spanish eating their protective diet, and get them to change to our version of 'healthy eating'!

The British Medical Journal published another Spanish study in its 13 September 2003 edition.(2)

The authors say they "found unexpectedly high numbers of plaques in young Spanish men, similar to the prevalence in populations with much higher rates of coronary heart disease". So the Spanish diet did not prevent the build-up that is thought to be the cause of heart attacks. They go on to point out that "In Spain, coronary atherosclerosis evolves more slowly. Although a time lag to increased rates of coronary heart disease could be approaching its end, unknown protective factors might also prevent coronary plaques from becoming unstable in this population."

Could it be the Spanish high-fat, low-carb diet that protects them as it does other populations throughout the world?

Or would it be heresy to suggest such a thing?

References

1. Serra-Majem L, Ribas L, Tresseras R, Ngo J, Sallerus L. How could changes in diet explain changes in coronary heart diease mortality in Spain? The Spanish paradox. Am J Clin Nutr 1995;61(suppl):1351S-9S.

2. Bertomeu A, García-Vidal O, Farré X, et al. Preclinical coronary atherosclerosis in a population with low incidence of myocardial infarction: cross sectional autopsy study. BMJ 2003;327:591?2.

Last updated 14 September 2003