Sunday, July 13, 2014

How I Spent My Summer Vacation and the French Paradox

I have just returned from a wonderful, enlightening and exhausting trip to the Brittany and Normandy regions of France.  The trip was centered on my second son’s wedding to a young woman from France.  This wedding in France included parents, relatives, friends and was carefully planned to be an amalgam of the French, American and Jewish traditions and cultures that their union represents.  The outdoor farmhouse setting in the French countryside, an hour from Nantes in the Brittany region on the border of the Loire Valley was extremely French as was the meal.  The marriage under the Chuppah, the traditional Jewish wedding canopy and the Jewish wedding vows were very Jewish.   The music incorporated a Klezmer band and a DJ playing standard American selections as well as French music.  It was a fascinating weekend and a very successful meeting of the different peoples and cultures. 

The wedding meal especially, was fascinating to me, as someone who cares about nutrition, health risks, and the cultural aspects of health.  It was eight courses (and please don’t ask me to remember and describe each course as the wine with the courses make that sort of memory impossible) and lasted six hours.  For those six hours, the music did not play and the focus was on eating, talking and enjoying each other’s company only interrupted by the occasional toast and the videos of the bride’s and the groom’s childhoods.  The French guests enjoyed every minute savoring each bit of food and the American guests couldn’t quite figure out what was going on.  The American mind set and frame of reference was one of eating rapidly and eating a large amount at times of joy, while the French mind set was one of savoring each bite, taking time with each course, and generally focusing on the taste of each unique food that was part of the admittedly small portions of each course by American standards but totally generous meal when measured in its entirety.  For the French, any one course that was too large would only hurt the enjoyment of the next course. 

While this meal was unique as a wedding meal should be, the manner in which it was eaten was fairly typical of what I observed during the rest of my and my wife’s travels through the villages, towns and cities of Brittany and Normandy.  A meal in any of these locations was an event to be savored, and enjoyed over time.  It was noticeable that this held true for everyone, not only the tourists and vacationers.  In most villages, stores would close for two hours in the middle of the day so that the storekeepers could take their lunch in the “correct” French way, slowly and focused on the quality of the meal that was being eaten.
The manner in which food is approached and eaten and the significance of the meal is clearly very different in France than in the United States.  One person I met who lived in the city of Bayeux, told me that his grandmother would spend at least five hours a day on food preparation and the remainder of the family time appeared to be related to conversation about food and upcoming meals.  Traditional French food uses a great deal of butter, cream and animal fat, and would be considered by US standards to be unhealthy however it is also very tied to natural ingredients and to the use of primary sources – sourced from local farms, bakers, and other food producers. 

Considering the high fat content of the food in France, the phenomenon of the “French paradox” has been well described for many years.  In an article in 2001 by Jean Ferri√®res entitled, “The French Paradox: lessons for other countries”, the author defines the paradox as the observation that coronary heart disease death rates are low in France despite high intake of dietary cholesterol and saturated fat.  There has been a great deal written on the reason for this paradox from the high red wine intake, to the complex behavior and attitudes towards food that I observed during my travels. 

There are those who argue that the French paradox does not exist at all and the differences seen are just a statistical aberration however proof of that contention has been difficult to elucidate.  Michael Pollan, in his book “In Defense of Food” published in 2008, suggests the French paradox is due to the nutrients found in “natural” foods as opposed to “processed” foods.  Pollan advocates an approach to food in general that culturally may have more similarities to the French way of eating than to the American norm. 

There is no simple answer to the paradox and it appears that many factors, including perhaps different statistical methods, all contribute.  Whatever the reason for the statistical paradox, I believe that the traditional French way of eating, with its focus on eating slowly, focusing on the taste of each bite and on the quality of the food instead of the quantity, has some role in the lower incidence of death from heart disease.  Smaller portions are the norm, and the ability to enjoy the eating experience, I believe, is a part of the answer.  French people I spoke with fear that this cultural approach to food is on the decline as the pace of life becomes more frenzied and more Americanized.  That is reflected in recent statistics on obesity increasing in France. 

If there is a lesson to be learned, it is the lesson that how you do something, such as eating, is often as important as or even more important than what you do.  You can eat food that appears to be less healthy but if you eat more slowly, eat smaller portions, and consider food intake to have a social dimension that does not allow the “eating on the run” and the mega-portions that are part of American life you are likely to be healthier. 

That is a lesson that extends beyond diet to all aspects of life.  As we discuss health care in general, and we focus on evidence based best practice and standardized care, we must stop and think about whether a singular focus on what we do, rather than how we do it, will hurt us in the long run.  For me, I return to the United States, having eaten my way through northern France, and weighing less than I did when I left for my trip, convinced that I will try to adjust my eating to be slower and more aware of what I eat, and perhaps to drink a bit more wine as well.  I will also adjust my thinking to stay focused on the “how” as well as the “what” in all aspects of life including my professional life in health care.