Q J Med 2001; 94: 173
© 2001 Association of Physicians
Correspondence |
The Mediterranean diet revisited
152 Harley Street, London
Sir,
Yarnell and Evans1 discuss the French paradox without any reference to blood flow. Changes in blood flow may be the final common pathway, to borrow a neurological term introduced by Sir Charles Sherrington, and now applicable to the mechanism by which atheroma is influenced. It has been clearly shown in the macrocirculation that increased flow is associated with a low incidence of atheroma and a reduced flow is associated with an increased risk of atheroma.2 The influence in the microcirculation is probably less important, as shown in the following example. Men with thalassaemia minor have a reduced risk of coronary heart disease, presumably due to the increased flow associated with anaemia, despite the greater difficulty regarding the passage of red cells through the capillaries. In women, this difference in the incidence of coronary heart disease between those with and without thalassaemia minor is not seen before the menopause, presumably due to the monthly reduction in the haematocrit.
Wine drinkers in any warm area such as the south of France, Spain or Italy will have the increased blood flow that reduces the incidence of atheroma. Any cold areas such as Glasgow and Finland have the highest risk of coronary heart disease in Europe. It is time that the term ‘the French paradox’ is consigned to the dustbin of history.
References
1.
Yarnell JWG, Evans AE. The Mediterranean diet revisited—towards resolving the (French) paradox. Q J Med2000; 93:783–5.
2.
Fowler PBS. The thyroid, blood flow and atheroma. Q J Med2000; 93:477–85.
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