The French Paradox and the Japanese Paradox

By now, you’ve cer­tain­ly heard about the “French Para­dox,” a dream that entered Amer­i­can con­scious­ness in 1991, when it was described on the tele­vi­sion pro­gram 60 Min­utes. Accord­ing to this dream, drink­ing red wine will pro­tect you from heart dis­ease, even if you eat lots of high-fat, high-cho­les­terol food. Although the risk of heart dis­ease was low­er in France than in Britain, the dif­fer­ence was not due to some mag­i­cal prop­er­ties of wine. It was due part­ly to under-report­ing of coro­nary artery dis­ease as a cause of death and part­ly due to a time-lag effect. It takes a while for a fat­ty diet to clog up your arter­ies, and the French hadn’t been eat­ing as much fat as the British had been eat­ing for as long as the British had been eat­ing it. These expla­na­tions had been pub­lished in the British Med­ical Jour­nal in 1999. You can read the arti­cle for free here.

If you want to elim­i­nate your risk of heart attack, not just decrease it a lit­tle, you’d eat a low-fat, pure­ly plant-based diet.

Alco­holic bev­er­ages, includ­ing wine, can have sev­er­al effects that influ­ence a person’s risk of dying of a heart attack. Winos who die of cir­rho­sis of the liv­er often have amaz­ing­ly clean arter­ies. That’s because their liv­er lost the abil­i­ty to make cho­les­terol. Even mod­er­ate intake of alco­holic bev­er­ages can have sev­er­al effects on coro­nary artery dis­ease. The antiox­i­dants in some alco­holic bev­er­ages, includ­ing wine, could pre­vent LDL cho­les­terol from becom­ing oxi­dized, and thus could help reduce the buildup of ath­er­o­scle­rot­ic plaque. Of course, you could get these same antiox­i­dants from plant foods that haven’t been fer­ment­ed. Alco­hol can also thin the blood, and thus help to decrease the chance of a fatal heart attack or ischemic stroke. On the oth­er hand, it would increase the risk of a fatal hem­or­rhage. I haven’t seen any con­vinc­ing evi­dence that adding any form of alco­hol to a low-fat, plant-based diet would pro­vide any health ben­e­fits.

The French para­dox turned out to be a myth. How­ev­er, there are some Japan­ese para­dox­es that are real. One involves cig­a­rette smok­ing. The oth­er involves obe­si­ty and dia­betes.

Japan­ese smok­ers are less like­ly than Amer­i­can smok­ers to get lung can­cer. This is called the Japan­ese Smok­ing Para­dox. Some peo­ple think that it’s because Japan­ese are smok­ing safer cig­a­rettes or have some mag­i­cal pro­tec­tive genes. The more ratio­nal expla­na­tion is that the Japan­ese have been eat­ing less fat and ani­mal pro­tein and more veg­eta­bles than Amer­i­cans have been eat­ing. Eat­ing the tra­di­tion­al Japan­ese diet, as opposed to the stan­dard Amer­i­can diet, helps to pro­tect peo­ple against many kinds of can­cer, not just lung can­cer.

Anoth­er para­dox involves Japan­ese chil­dren. Over the past few decades, Japan­ese chil­dren have been get­ting fat­ter, and the inci­dence of type 2 dia­betes among Japan­ese chil­dren has been going up. This has been hap­pen­ing even though their calo­rie intake hasn’t increased sig­nif­i­cant­ly. They have been eat­ing a lot more fat and ani­mal pro­tein. In oth­er words, they’ve been get­ting a small­er per­cent­age of their calo­ries from car­bo­hy­drates, which were main­ly in the form of white rice. So why do the low-carb gurus keep telling me that we need to eat more fat and less car­bo­hy­drate? Is this anoth­er para­dox? If so, what should we call it?

Nonsensical Study About White Rice

So Why Is Diabetes Rare in China?

A recent study has warned us that peo­ple who eat white rice instead of brown rice are more like­ly to get dia­betes! But it leaves out a cru­cial piece of infor­ma­tion: peo­ple in Asian coun­tries whose diet is based heav­i­ly on white rice are prac­ti­cal­ly immune to type 2 dia­betes. The take-home mes­sage from this study isn’t that white rice is harm­ful, or that it would make much dif­fer­ence if you ate brown rice instead. It’s that we should be wary of researchers who fail to read the basic lit­er­a­ture on nutri­tion before they design their research.

Brown rice is the whole-grain ver­sion of rice. To make brown rice, you remove only the husk of the rice seed. To make white rice, you also grind off the bran lay­er and the germ, which is the embryo of the rice seed. In most of the areas where rice is the sta­ple of the diet, peo­ple pre­fer white rice, for two very prac­ti­cal rea­sons: brown rice goes ran­cid very eas­i­ly, and it takes a lot longer to cook.

Pol­ish­ing off the bran and germ of the rice seed removes the oils that can cause spoilage. Unfor­tu­nate­ly, it also removes most of the vit­a­min B1 (thi­amine) from the rice. Orig­i­nal­ly, white rice was an expen­sive food, reserved large­ly for rich peo­ple who could afford a var­ied diet, so the lack of vit­a­min B1 in their rice wasn’t a big deal. Unfor­tu­nate­ly, when the inven­tion of steam-pow­ered rice mills meant that lots of poor peo­ple were sub­sist­ing heav­i­ly on white rice, a debil­i­tat­ing and poten­tial­ly dead­ly defi­cien­cy dis­ease called beriberi became endem­ic in Asia. After chemists iden­ti­fied thi­amine and fig­ured out how to make it cheap­ly to “enrich” white rice, beriberi ceased to be a com­mon prob­lem. Even so, brown rice is bet­ter for you because it’s a source of fiber.

Back in the 1930s and 1940s, a Ger­man-born Amer­i­can physi­cian named Wal­ter Kemp­n­er rec­og­nized the health ben­e­fits of a plant-based diet cen­tered on rice. Kemp­n­er rec­og­nized that heart dis­ease and dia­betes were rare in Asia, where peo­ple ate a rice-based diet that was low in fat and cho­les­terol. He start­ed rec­om­mend­ing a diet based on rice, fruit, fruit juices, and sug­ar for patients with severe high blood pres­sure and kid­ney dis­ease. His spec­tac­u­lar results with these patients encour­aged him to rec­om­mend this rice-based diet for peo­ple with heart dis­ease and dia­betes. Those patients also got dra­mat­ic ben­e­fits, even though most of these patients were eat­ing white rice. So where did the authors of the study pub­lished in Archives of Inter­nal Med­i­cine get the idea that white rice might cause dia­betes?

It’s been obvi­ous since the 1870s that type 2 dia­betes is linked to obe­si­ty. We’ve known since the 1930s that the poor glu­cose tol­er­ance that under­lies it is linked to a high-fat diet and can be reversed by a switch to a starchy diet. The Chi­na-Cor­nell-Oxford Project, also known as the Chi­na Study, demon­strat­ed that peo­ple who are eat­ing a low-fat diet based heav­i­ly on white rice and veg­eta­bles stay slim and are vir­tu­al­ly immune to dia­betes. So why did the researchers just try to impli­cate white rice as a cause of dia­betes? Could it be that they have nev­er both­ered to read the his­tor­i­cal lit­er­a­ture on the sub­ject?

If you are eat­ing the stan­dard Amer­i­can diet, you are at high risk for obe­si­ty, type 2 dia­betes, var­i­ous kinds of can­cer, and a wide assort­ment of oth­er degen­er­a­tive dis­eases. That’s because those dis­eases have been linked to a high intake of ani­mal pro­tein, fat, and cho­les­terol. You can dra­mat­i­cal­ly reduce your risk of those dis­eases by switch­ing to a low-fat (<10% of calo­ries), high-fiber diet based on plant foods. As long as you get enough thi­amine and enough fiber in your diet, it doesn’t mat­ter much if the rice you eat is white.

Pho­to by sarae