PARIS — La Coupole restaurant is jammed and, what with the noise and the difficulty of troweling just the right amount of pate onto my grilled bread, I'm having a hard time making out what Dr. Jacques Richard is saying. Richard, the reigning authority on heart disease rates in France, has his own problems. He can't seem to decide whether he wants yet another bite of lardons, the fatty bacon chunks that adorn his salad, or whether he should move on to the gooey, golden yolk of his poached egg.
Contrary to appearances, this is work. I've crossed the ocean to untangle a mystery, and if anyone can help, it's Richard. The question is best put as a riddle: Of the Western world's industrialized countries, which has the lowest rate of death from heart disease?
Oui. C'est la France. The United States isn't even close. In France each year, 143 of every 100,000 middle-aged men die of heart disease, according to the World Health Organization. In the United States, that figure is more than twice as high: 315. French women do even better, with the world's lowest rate of death from heart disease.
If you look at all industrialized countries, only Japan beats France. Japan's good health is no surprise, since the Japanese diet is light on fat and heavy on rice and fish. But despite their bad habits the French seem to be thriving.
How could it be, I'd come to ask Richard, that while Americans are dutifully downing bran muffins and the French are happily polishing off every butter flake of their croissants, they have healthier hearts than we do? This is, after all, the country that conceived bearnaise sauce--three egg yolks and half a pound of butter--and then thought to pour it over filet mignon.
Richard, an epidemiologist, has spent 25 years compiling and verifying the figures. Their message is clear: The French should be having heart attacks everywhere you look. They're not. And French women actually outlive American women by a year.
Richard, a researcher at INSERM, the French equivalent of our National Institutes of Health, is tall and thin, friendly, in a shy way, and extravagantly polite. He speaks quietly, almost apologizing as he replies to my nasty-minded question.
Maybe the French diagnose heart disease in some funny way that pretties up their statistics? No, he says, skeptics have checked and rechecked French death certificates, reworking the figures to include all the fuzzy diagnoses that just might have been heart disease deaths, and the same picture always emerges.
Maybe some regions of France have high rates of heart disease but ride the coattails of regions that are especially healthy? I'm wondering about Normandy, famous for its butter and cream, and Richard grants me an indulgent smile.
"Yes, Normandy is doing poorly relative to France, but it's doing well"--he pauses a moment trying vainly to come up with a delicate way to frame the comparison--"but it's doing well relative to you."
Another prominent French epidemiologist, Serge Renaud, had cackled cheerfully when I'd asked him about heart disease in different parts of France. "Do you know who has the lowest rate of death from heart disease in all of France?" he had asked me. "The least heart disease is in southwest France. That's the place where they have duck fat instead of butter, where they eat foie gras. "
As I sit at dinner, sipping my vintage Sauternes, Richard gestures toward the pinkish slab of pate on my plate. "That's fat," he warns. "Not so good for you." Then, with a conspiratorial grin as he indicates my wine glass. "You'd better drink your wine for protection."
Richard may be joking, but it's not entirely a joke. One study after another has found that moderate wine drinkers--those who drink about two glasses per day--have far less heart disease than either teetotalers or heavy drinkers. Eight studies in the 1970s and 1980s, in the United States and abroad, reported that moderate drinkers had between 30% and 40% less heart disease than control subjects.
Still another study looked at 18 countries and found "a strong and specific negative association between heart disease deaths and wine consumption." A chart spelled out the message: Finland, the United States and Scotland were in a group that drank the least wine and had the most deaths from heart disease: Belgium, West Germany and Austria drank more wine and had fewer deaths; Switzerland, Italy and France drank the most wine and had the fewest deaths.
If wine should prove to have some ingredient that protects against heart disease, the authors concluded, "we consider it almost a sacrilege that this constituent should be isolated . . . the medicine is already in a highly palatable form."