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Health Paradoxes Around The World: When Nutritionists Go Wrong

November 24th, 2008 · 7 Comments

A paradox is a fact that contradicts the paradigm.

Besides probably the most known and discussed French paradox there are other paradoxes that were discovered by the researches and they are not less interesting then the French one.

1 Israeli Paradox

Have you heard of the Israeli Paradox, which is less known but may be more important?

The Israeli Paradox is the fact that Jewish Israelis have very high rates of heart disease and diabetes in spite of a diet low in total fat, saturated fat, and high in polyunsaturated fats (the supposedly “good” fats). According to the current conception, polyunsaturated fats contained in vegetable seed oils are supposed to lower the risk of heart disease. Yet, high consumption of these oils doesn’t seem to have prevented the Israelis from dying from heart attacks.

Researchers suggest that the explanation for this paradox is Israel’s high intake of omega-6 polyunsaturated fatty acids (mainly from soybean oil), the predominant essential fat in soybean, safflower, and corn oils.

Israel has one of the highest dietary polyunsaturated/saturated fat ratios in the world. The consumption of omega-6 polyunsaturated fatty acids is about 8% higher than in the USA, and 10-12% higher than in most European countries. In fact, Israeli Jews may be regarded as a population-based dietary experiment of the effect of a high omega-6 fats diet, a diet that until recently was widely recommended. Despite such national habits, there is paradoxically high prevalence of cardiovascular diseases, hypertension, type 2 diabetes and obesity[1]. There is also an increased cancer incidence and mortality rate, especially in women, compared with western countries. Thus, rather than being beneficial, high omega-6 fatty acids diet may have some long-term harmful effects.

Non-Jewish Israeli citizens have rates of heart disease and diabetes roughly half the Jewish rate. The non-Jews consume lots of olive oil (low in omega-6) rather than soybean oil.

2 Swiss Alpine Paradox

In general, cheeses are fatty foods. However, Alpine cheese is healthy for your heart! Cheese made of milk from cows grazed on alpine pastures has a more favorable fatty acid profile than all other cheese types[8]. Alpine milk and cheese contain more omega-3 fats, such as alpha linolenic acid and conjugated linoleic acid, a lower n-6:n-3 ratio, and have relatively low concentrations of saturated fats compared to other cheeses. Surprisingly, alpine cheese is even superior to cheese produced from milk of cows fed with omega-3 – rich supplements.

3 Spanish Paradox

The Spanish Paradox was brought to light in Volume 61 of the American Journal of Clinical Nutrition.

The researchers found that since 1976, there has been a decrease in cardiovascular disease deaths in both men and women in Spain. During the same period that coronary heart disease and stroke death rates fell, the national intake of meat, dairy products, fish, and fruit increased in Spain, and the intake of olive oil, sugar, and carbohydrates decreased. Hmmm, how could that be if saturated fat clogs artheries and causes heart disease?

The study[4] was published in 1995 and noted that heart disease deaths in Spain from 1966-1990 dropped by 25% for men and by 34% in women. Also the study showed that between 1964 and 1991:

  • Bread consumption fell by 55%
  • Rice consumption fell by 35%
  • Potato consumption fell by 53%.
  • Beef consumption went up 96%
  • Pork consumption went up by 382%
  • Poultry consumption went up by 312%
  • Full-cream milk consumption went up by 73%

Another team of researchers[5] found unexpectedly high numbers of plaques in young Spanish men, similar to the prevalence in populations with much higher rates of coronary heart disease. 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.”

4 Mexican Paradox

Mexican American women despite their social disadvantages (poverty and other barriers to health care) deliver significantly fewer low birth weight babies and lose fewer babies to all causes during infancy than do women of other ethnic groups[11].

The social and cultural factors that contribute to this paradox are community networks – informal systems of prenatal care that are composed of family, friends, community members; extended family ties; strong religious beliefs; up-on-a-pedestal attitude to pregnant women; limited use of cigarettes and alcohol; diet rich in protein and vitamins.

But there’s a paradox within the paradox: the advantage goes away the longer Latinos live in the U.S. Nobody knows exactly why or how that happens. But national studies show that as Latinas become Americanized, their superior pregnancy outcomes begin to diminish[12].

5 Hispanic Paradox

Paradoxically Hispanics in the U.S. tend to have significantly better health and a lower all-cause mortality rate than the average population despite their lower levels of income and education, more limited access to health care, the factors epidemiologists long have known are linked to poor health. And this advantage remains unaffected up to age 100. This phenomenon is known as the Hispanic Paradox[8-9].

What is the Latino population doing right?

Hypotheses to explain this paradox include the presence of social and cultural factors promoting health including extended families, a strong ethnic identity, religiosity, acculturation, migration effects, and misclassification bias. Studies have indicated that Hispanics drink less alcohol and smoke less than their white counterparts. However, their healthful behaviors appear to wane with greater acculturation in the United States. Several studies have found that the children and grandchildren of foreign-born Hispanics tend to smoke, drink and use illegal drugs more than their parents and grandparents.

6 Japanese Paradox

Another cultural conundrum explored recently is the “Japanese Paradox.” The Japanese have the lowest incidence of heart attacks in the world. What makes their low occurrence of heart disease a conundrum is that the Japanese have similar blood cholesterol levels, blood pressure, and type 2 diabetes rates as men in the U.S., and they are far more likely to smoke.

When Japanese men migrate to America, they develop atherosclerosis as readily or more so than their Caucasian compatriots[14].

A new study suggests that the answer may be found in the sea[13]. The extremely high intake of fish in Japan may explain the much lower rate of atherosclerosis and subsequent coronary heart disease. The Japanese diet has become increasingly westernized since the end of World War II, but fish consumption in Japan is still among the highest in the world. The average omega-3 intake in Japan of 1 gram a day is about eight times higher than the amount the typical American gets.

7 East African Masai Paradox

The East African paradox refers to the Masai tribes in Kenya, Africa. Their diets consist of full fat milk and cream, large amounts of beef, and blood from their cattle during dry season. The average daily caloric intake was estimated to be about 3,000 kcal, with 66% of the calories derived from fat. The estimated average daily cholesterol intake was from 600 to 2,000 mg per person. When Western doctors examined the Masai, they found that their blood cholesterol levels were extremely low, and autopsies of deceased Masai found almost no evidence of arterial plaques[15].

The Samburu tribe of northern Kenya, closely related to the Masai ethnologically, also live on a diet of milk and meat. However, they have higher average levels of serum cholesterol than the Masai.

8 Albanian Paradox

In 1997, an Albanian Paradox was described as a high adult life expectancy with a very-low income.

Albania is one of the poorest countries in Europe and has one of the highest infant mortality rates in Europe (that is consistent with its economic situation). By contrast, adult mortality, including mortality from cardiovascular diseases, is similar to that in other Mediterranean countries. For example, age-standardised mortality for coronary heart disease in males aged 0-64 was 41 per 100,000 in Albania in 1990, less than half the rate in the UK but similar to that in Italy. This paradox of high adult life expectancy in very-low-income country[7] can be most plausibly explained by diet – namely, low consumption of total energy, meat, and milk products but high consumption of fruits, vegetables, and carbohydrates.

9 Italian Paradox

The Italian Paradox is that a population of heavy smokers has a low incidence of cardiovascular disease[6]. The overall death rate from cardiovascular disease in Italy is relatively low.

This observation indicates that cigarette smoking is unlikely to have a direct toxic effect on the vascular endothelium and can only be an indirect cause of coronary heart disease.

Sources & References

  • 1. Yam D, Eliraz A, Berry EM. Diet and disease–the Israeli paradox: possible dangers of a high omega-6 polyunsaturated fatty acid diet. Isr J Med Sci. 1996 Nov;32(11):1134-43. PubMed
  • 2. National Center for Health Statistics FASTATS – Overweight Prevalence
  • 3. International Obesity Task Force EU Platform Briefing Paper
  • 4. Serra-Majem L, Ribas L, Tresserras R, Ngo J, Salleras L. How could changes in diet explain changes in coronary heart disease mortality in Spain? The Spanish paradox. Am J Clin Nutr. 1995 Jun;61(6 Suppl):1351S-1359S. PubMed
  • 5. Bertomeu A, Garcia-Vidal O, Farre X, Galobart A, Va’zquez M, Laguna JC, Ros E. Preclinical coronary atherosclerosis in a population with low incidence of myocardial infarction: cross sectional autopsy study. BMJ. 2003 Sep 13;327(7415):591-2.
  • 6. Grimes DS, Hindle E, Dyer T. Respiratory infection and coronary heart disease: progression of a paradigm. QJM. 2001 Mar;94(3):173-4.
  • 7. Gjonca A, Bobak M. Albanian paradox, another example of protective effect of Mediterranean lifestyle? Lancet. 1997 Dec 20-27;350(9094):1815-7. PubMed
  • 8. Hauswirth CB, Scheeder MR, Beer JH. High omega-3 fatty acid content in alpine cheese: the basis for an alpine paradox. Circulation. 2004 Jan 6;109(1):103-7. Epub 2003 Dec 15.
  • 9. Markides KS, Eschbach K. Aging, migration, and mortality: current status of research on the Hispanic paradox. J Gerontol B Psychol Sci Soc Sci. 2005 Oct;60 Spec No 2:68-75. PubMed
  • 10. Abraido-Lanza AF, Dohrenwend BP, Ng-Mak DS, Turner JB. The Latino mortality paradox: a test of the Сsalmon biasТ and healthy migrant hypotheses. Am J Public Health 1999;89:1543Ц48 PubMed
  • 11. Guendelman S, Thornton D, Gould J, Hosang N. Free in PMC Social disparities in maternal morbidity during labor and delivery between Mexican-born and US-born White Californians, 1996-1998. American Journal of Public Health
  • 12. Page RL. Positive pregnancy outcomes in Mexican immigrants: what can we learn? J Obstet Gynecol Neonatal Nurs. 2004 Nov-Dec;33(6):783-90. PubMed
  • 13. Yamagishi K, Iso H, Date C, Fukui M, Wakai K, Kikuchi S, Inaba Y, Tanabe N, Tamakoshi A; Japan Collaborative Cohort Study for Evaluation of Cancer Risk Study Group. Fish, omega-3 polyunsaturated fatty acids, and mortality from cardiovascular diseases in a nationwide community-based cohort of Japanese men and women the JACC (Japan Collaborative Cohort Study for Evaluation of Cancer Risk) Study. J Am Coll Cardiol. 2008 Sep 16;52(12):988-96. PubMed
  • 14. Sekikawa A, Curb JD, Ueshima H, El-Saed A, Kadowaki T, Abbott RD, Evans RW, Rodriguez BL, Okamura T, Sutton-Tyrrell K, Nakamura Y, Masaki K, Edmundowicz D, Kashiwagi A, Willcox BJ, Takamiya T, Mitsunami K, Seto TB, Murata K, White RL, Kuller LH; ERA JUMP (Electron-Beam Tomography, Risk Factor Assessment Among Japanese and U.S. Men in the Post-World War II Birth Cohort) Study Group. Marine-derived n-3 fatty acids and atherosclerosis in Japanese, Japanese-American, and white men: a cross-sectional study. J Am Coll Cardiol. 2008 Aug 5;52(6):417-24. PubMed
  • 15. Mann GV. Studies of a surfactant and cholesteremia in the Maasai.Am J Clin Nutr. 1974 May;27(5):464-9.

9 responses so far ↓

  • 1 Peking P // Nov 25, 2008 at 2:45 pm

    Interesting.

  • 2 Manuel Farill // Nov 25, 2008 at 3:10 pm

    That only shows how much ignorance prevails in the medical communityy and that the marketing techniques of the pharmaceutical industry are working just fine.

  • 3 Weekend Link Love | Mark's Daily Apple // Nov 30, 2008 at 12:39 pm

    [...] a world of differences in Health Assist’s post on health paradoxes around the world. Read the article and chime in with your [...]

  • 4 Ellen // Dec 1, 2008 at 5:59 am

    Interesting information.

    However, I don’t see how #2 is a paradox. Heart healthy Alpine cheese is all well and good, but how does that affect the inhabitants of the Swiss region?

  • 5 Ashley Moran // Dec 6, 2008 at 1:04 pm

    The French Paradox is not a paradox at all. Ancel Keys selected the data points he wanted to prove his point, when in fact there is just no correlation between (saturated) fat intake and heart disease. There’s nothing for the French diet to contradict.

  • 6 Jim // Jan 26, 2009 at 2:56 pm

    L-lysine is the magic panacea within the milk protein. it is the cause of the effects you call paradox.

  • 7 Walter Jeffries // Feb 14, 2009 at 5:14 pm

    There is also the factor of large degrees of genetic variance between groups to account for many of these so called paradoxes. Evolution does a remarkably good job of selecting.