Stunning: Saturated fat and the European paradox

Saturated Fat and the Pan-European Paradox

Wow. This is mindblowing.

Have you heard about the French Paradox? French people traditionally eat a lot of saturated fat, like butter – yet they generally have less heart disease than other populations. A lot of brainpower has been wasted to explain this – does perhaps the red wine protect them?

But maybe it’s not really a paradox.

That’s it’s been seen as a paradox in the past is probably because older observational studies have shown weak associations between saturated fat consumption and increased risk of heart disease. However, there are many explanations for these findings, such as “the healthy user effect.” People who adhere to other health-related behaviors are also likely to avoid saturated fat because they’ve been told it is “unhealthy.” But there’s no way to know if their good health is due to avoiding saturated fat or is the result of all of those other behaviors – or caused by something else entirely.

That’s because observational studies can only show associations; they can’t show cause-effect relationships. There may be other factors besides dietary choices or health-related behaviors that cause the outcomes seen in these older studies.

I was just shown the diagram above, recently published in the journal Nutrition. It’s based on WHO and FAO statistics over the average intake of saturated fat in 41 European countries in 1998 (the latest available data), and the age-adjusted risk of dying from heart disease. I added some explanations.

More saturated fat, less heart disease

It’s a stunner. The French paradox is actually a French-Swiss-Icelandic-Swedish-German-Austrian-etc.-paradox!

  1. France eats the most saturated fat and has the lowest rate of heart disease deaths in all of Europe.
  2. Switzerland eats second-most saturated fat and has the second-lowest mortality.
  3. The countries eating more saturated fat have less heart disease, period.

Less saturated fat, more heart disease

And the countries eating less saturated fat? Like Georgia, Moldavia, Azerbaijan etc.? Well, they seem to have the highest mortality from heart disease in Europe.

It’s a Pan-European paradox now.


No need to hold the butter?

What does it mean?

Correlations between populations, like these, are known as ecological data. It doesn’t really prove anything. In other words, the diagram above does not prove that saturated fat protects you from heart disease. There are obviously many other differences between these populations, not just the intake of saturated fat.

But a diagram like this can provide a counter-argument to the observational studies mentioned above. It’s unlikely that saturated fat would be a major cause of deaths from heart disease, when European populations stuffing themselves with it have fewer deaths from heart disease, without exception.

Can this possibly be a weird coincidence? Can saturated fat still possibly be bad? What do you say?


When I recently interviewed professor Loren Cordain about our hunter-gatherer ancestors, his guess was that they, on average, got about 15 percent of their calories from saturated fat.

If that’s true, it means that our genes should be well adapted to eating about 15 percent saturated fat. That’s more than twice as much as the maximum set in the advice from the USDA and others. Yet it is about as much as consumed by the populations in Europe today with the best heart health. Coincidence?

More: The Paleo Diet Explained


Top comments

  1. Damn those pesky low carb people. They must have sent their Swedish ninjas into my home to recalibrate my scale, change all the size labels on my clothes from 16 to 8, and exchange my mirrors to fun house mirrors. I shall head to the grocery store and buy 30 bananas and a couple loaves of whole wheat bread as soon as it opens......
    Repeat after me; The sun goes around the earth, the sun goes around the earth....
    Read more →
  2. Laura
    Jeff LOL!!!!!
    The paper you quote about increased mortality on low carb diet is actually not even worthy of the SHREDDER!! You know why? they have not checked real LCHF dieters! They have taken two existing study cohorts and based on those dreadful questionnaires extrapolated those that according to a random preset criteria ate less carbs and sub grouped them as low carbers and compared to those that were according to the same criteria as higher carbers and calculate the risk based on mortality/morbidity in the subgroups. Oh my word!!! Cannot say how bad that is!! Almsot all those people are likely to eat grains/sugar/refined starches and rubbish as well no wonder they die a little bit more!!! Bad food combinations are even worst that eliminating a whole food group!
    Here let me quote from the paper itself:

    Our study has limitations. The low-carbohydrate diet scores were not designed to mimic any particular versions of low-carbohydrate diets available in the popular literature. Therefore, the risk estimates do not directly translate to the assessment of benefit or risk associated with the popular versions of the diet.

    The authors should be sued for misinformation and scare mongerning but they put the disclaimer in so their lawyers advised well!!
    And how can you possibly have a LOW CARB vegeterina diet.!!! ALLL plant material is CARBS (unless they only ate avocados and nuts and even they pack in quite a few carbs) honestly!! The authors of that paper really need to go back to basics. !!!
    If you are happy with your diet why do you insist in writing to this blog. You seem so angry and upset by the simple principles of paleo/lchf.
    I am happy and MUCH healthier now and hope to live nad die by the paleo motto: leave well drop dead!

    Replies: #128, #174
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All comments

  1. Firebird
    The sad thing is, he is a young doctor who went to an osteopathic college. He should know more about holistic medicine than he practices.
  2. Abel
    Why would anyone use this graph as argument ? Correlation does not mean causation. And this graph is *perfect* example of that. Better food chains, more advanced food manipulation / processing, higher GDP per capita, better medical services and even different genotype. All of these would yield as nice graph as the one above.

    Finding low quallity arguments to support cause resembles blind religious worship.

    Reply: #153
  3. Zepp
    Its nice that we got our own buck shoot diagram.. like that Ancel Keys provided!

    But we know that this not prove anything.. and mayby one can make others look at the seven country digram in a the same way.. when they compare?

  4. Deb
    could it be as simple as socio-economic level? Access to more abundant healthy foods?
  5. Deb
    oh and correlation does not equal causality - first rule of research :)
  6. PhilT
    R^2 = 0.339 - doesn't this mean leave the line off and present it as a scattergram ?
  7. Magarietha
    Hi Deb, All I know for sure is being on a Keto diet normalised my cholesterol numbers. I have HFH which means in the imperial count, without drugs my cholesterol is around 400. My whole family has it. I went onto that diet 18 months ago, and use very highly saturated fats every day. The fattest chops, steaks, duck, goose, eggs, real butter (lots) and lots of eggs, olive oil and extra virgin cold pressed coconut oil. My numbers plunged and my doctors couldn't believe it. THEY told me the numbers can't lie. It's a difficult diet but for me, I feel I was thrown a life line. My arteries, too, are clean.
    Reply: #173
  8. kazy
    I am an advocate for the low carb/high fat diet but what about the Japanese Paradox? They eat high carbs/low fat and are considered the healthiest people in the world. I read the reason for that is because they have absolutely no fructose in their diet. But what about all that rice? Does that not turn to sugar? In fact how do you explain the nearly billions of Asians who have been eating rice for thousands and thousands of years, and are the leanest people in the world?
    Replies: #159, #177
  9. Zepp
    I can come up whit a better explanation.. Japan and North European contriues is the most whealty countries in the world.. and it means that there are a good healt service and moste people have afford to use it!

    They/we have altso afford to eat what we want.. so we can swith to healtyer food if we got a healt problem of any sort!

    And the main energy for Japanese is not rice.. its fish and seafood.. at least for those afford of that!

    And on top of that.. it seems that those how is eating moste fat and protein have a longer and healtyer life!

    "The present paper examines the relationship of nutritional status to further life expectancy and health status in the Japanese elderly based on 3 epidemiological studies. 1. Nutrient intakes in 94 Japanese centenarians investigated between 1972 and 1973 showed a higher proportion of animal protein to total proteins than in contemporary average Japanese. 2. High intakes of milk and fats and oils had favorable effects on 10-year (1976-1986) survivorship in 422 urban residents aged 69-71. The survivors revealed a longitudinal increase in intakes of animal foods such as eggs, milk, fish and meat over the 10 years. 3. Nutrient intakes were compared, based on 24-hour dietary records, between a sample from Okinawa Prefecture where life expectancies at birth and 65 were the longest in Japan, and a sample from Akita Prefecture where the life expectancies were much shorter. Intakes of Ca, Fe, vitamins A, B1, B2, C, and the proportion of energy from proteins and fats were significantly higher in the former than in the latter. Intakes of carbohydrates and NaCl were lower."

  10. kazy
    So it would seem according to this study that they have a very high intake of protein. I know they eat a lot of fish and get their fat from that, but that kind of fat is not considered detrimental, not even to the low fat community advocates and I guess that would certainly change to carb impact they get from rice and noodles. I was surprised to see their fat consumption from dairy, though. Who knew?
  11. Zepp
    Dont forget that Japan have more percent diabetes in there population then Sweden!

    And I dont think there rice are protecting them.

    "Results: A total of 1103 new cases of type 2 diabetes were self-reported. There was a significant association between rice intake and an increased risk of type 2 diabetes in women; the multivariate-adjusted odds ratio for the highest compared with lowest quartiles of rice intake was 1.65 (95% CI: 1.06, 2.57; P for trend = 0.005). In men, the association was unclear, although there was a suggestion of a positive association in persons who were not engaged in strenuous physical activity (P for trend = 0.08).

    Conclusions: Elevated intake of white rice is associated with an increased risk of type 2 diabetes in Japanese women. The finding that is suggestive of a positive association of rice intake in physically inactive men deserves further investigation."

    Reply: #163
  12. Robert
    I laughed when I looked at that graph. Look at the countries with the most deaths from heart disease versus the ones at the other end of the spectrum. The socio-economic status of these countries isn't taken into account. The countries on the right (high fat/low mortality from CVD) are better off economically and have excellent health care. The countries on the left (lower fat/higher mortality from CVD) are also at the opposite end of the socio-economic spectrum. It is what this graph doesn't show that is really important. Its a dishonest portrayal to say the least.
  13. kazy
    I'm curious about this study in Japan concerning their type 2 diabetes coming from rice. Is this something new or have they had it for the thousands of years they've been eating rice? What I've read is that the Japanese now have Congestive Heart Disease, something they didn't have before and it's because of the import of American foods, specifically our soft drinks and fruit juices. IOW sugar. Parents who are still eating their traditional foods are outliving their children who have heart disease who are eating more American type foods. Some say it's red meat that has caused heart failure among the Japanese but the jury is still out on that. Connecting the dots would lead you to suspect their diabetes coming from an intake of sugar that has recently entered their diet, not the rice they've eaten for thousands of years unless they've had type 2 diabetes for the many centuries they've consumed rice, which begs the question as to why they would be considered the healthiest people in the world if they've always had type 2 diabetes? Something doesn't compute with this report relating rice to type 2 diabetes in Japan.
    Reply: #164
  14. Zepp
    Its good to be curious.. becuse one can find out something thats saying something about the topic!

    And I think you are smart enough to understand what its all about?

    I can provide more such studies if you like?

    Four articles were identified that included seven distinct prospective cohort analyses in Asian and Western populations for this study. A total of 13,284 incident cases of type 2 diabetes were ascertained among 352,384 participants with follow-up periods ranging from 4 to 22 years. Asian (Chinese and Japanese) populations had much higher white rice consumption levels than did Western populations (average intake levels were three to four servings/day versus one to two servings/week). The pooled relative risk was 1.55 (95% confidence interval 1.20 to 2.01) comparing the highest with the lowest category of white rice intake in Asian populations, whereas the corresponding relative risk was 1.12 (0.94 to 1.33) in Western populations (P for interaction=0.038). In the total population, the dose-response meta-analysis indicated that for each serving per day increment of white rice intake, the relative risk of type 2 diabetes was 1.11 (1.08 to 1.14) (P for linear trend<0.001).
    Higher consumption of white rice is associated with a significantly increased risk of type 2 diabetes, especially in Asian (Chinese and Japanese) populations."

    But its all about the conclusions.. and I say its about that they (Asians) are not of a different genetic sort!

    They are not protected frome diabetes becuse rice is there staple food.. for thuosand year!

    They get diabetes and such diseases when they adapt a modern life style.. whit modern foods!

    And Robert got it right.. (I think?) its about other things.. like.. whealty countrys have free or cheap heltcare.. in whealty countrys peopel have aford to eat expensive foods.. like meat/dairys/fish/cheese.. and whit those foods comes fat!

    It was that Ancel Keys did find.. but he didnt got the right conclusions!

    And its not about fat that they think befor.. its more about a new life style.. a western life style.. cheap food.. lots of energy, sedentary life and one get old.. if one get old one often get old age related diseases!

    Those poor people in poor countryes dies earlyer of all cause illness but not old age illnes!

  15. kazy
    So what I am understanding here is that the rice is CONTRIBUTING to the diabetes due to the change in the modern Japanese diet and lifestyle? So then the conclusion is erroneous. Why didn't it correlate the introduction of modern foods, filled with all sorts of additives, preservatives, low fat foods and SUGARS, particularly FRUCTOSE as to the reason why there's now an emergence of diabetes? If the rice is the constant, yet now we see different results than it must be something else, no? Just like Hispanics and native Americans not living in the US, eating their traditional foods come to America and develop diabetes (that they never had before) while still eating their traditional food that is now made in America and to which they are also exposed to our stressful lifestyle and lousy healthcare system. The lifestyle I question though. There's no doubt the US has a very stressful lifestyle, but is it any worse than living in a poverty ridden country where you don't have enough to eat and absolutely no healthcare? And in some cases these people live in incredibly corrupt countries where they're exposed to torture by tyrannical governments. I had a friend who was a doctor who worked for the Oscar Romero Clinic in Los Angeles and she would deal with these malnourished and tortured refugees. Mostly Maya Indians. They didn't have diabetes when they came but as they continued to live here, they developed it, all the while being told it was their high fat food that was killing them. Say what?
    Reply: #166
  16. Zepp
    Yeah.. I think you are that smart person.. drawing the right conclusions.. there are no simple explanations.. no simple solutions!

    At first.. there are no questions about that high glycemic load and dependance is one (1) cause to diabetes type 2!

    The second is genetic predisposal.. and thats a flaw of being human.. one can never be to careful to choose the right parents!

    And it seems that a modern life style excacerbate the problem?

    And on top of that.. its not only about to chose what to eat.. its altso about to chose about what your food have eating!

    The food today is to cheap.. and its becuse they are grown/feed garbage.. totaly out of that nutrients you need!

    And if you have read about the new discussions about K2.. it seems that our ancestors got that frome the food.. but we are forced to by it as pills.. becuse the modern food lacks it!

    Soo.. its needed that our food is provided real food altso.. and for K2 they have to eat grass.. not soya beans!

  17. Kalpie
    So if hight fat is ok, how much fat is too much fat? Especially if I am worried about my cholesterol levels?
    Reply: #169
  18. Rob
    High fat is not ok. The people here couldn't give a rat's ass about your health.
  19. Zepp
    Its high fat as a part of your energy demand!

    Its rather normal fat.. but to day moste people is scared of fat.. then it seems high for those.

  20. 2 comments removed
  21. Zach
    It's because they eat way more chocolate, and thereby receiving more adequate magnesium levels.

    Calcium without magnesium will lead to a calcified coronary. Other health problems will occur too.

    Google "chocolate consumption per person by country" and you will see that all these countries have high chocolate consumption per capita, and thereby higher magnesium levels.

    We've been led to believe here in North America to avoid a calcium.. ahem...... dairy deficiency and thereby consume lots of dairy without a commensurate increase in magnesium, while magnesium from vegetables and seeds has been declining from depleted soils.

  22. Gareth
    And your anecdotal experience is in no way informative to the reality of the situation. There may be many other factors affecting your lifestyle that even you may not be aware of that affects things. Which is why large data sets in blinded, controlled studies are the best. The effect of a large, randomly selected group help alleviate any bias for unknown phenomena that may be affecting individuals.
  23. Gareth
    True scotsman's fallacy. Go on, keep moving those goal posts. Pretty soon you'll run out of space or be the only "real LCHF dieter" left that fits.
  24. wilbur
    You'll find some of the happiest and healthiest places eat less grains and filler and more high fat and fermented foods
  25. Lucy
    Researchers like Ancel Keyes thought Italians and Greeks ate a low fat diet. uhm no they don't. BTW he says in article that this doesn't mean saturated fat is good, what it does mean is that the saturated fat/cholesterol theory is doggie do.
  26. Leigh Ann
    "Japan's three major causes of death for years have been cancer, heart disease, and hypertension (cerebrovascular disease). However, Japan's Ministry of Health, Labor, and Welfare revealed that in 2011, pneumonia had supplanted hypertension as the third leading cause of death in the country." Nov 12, 2012
    Japan: Pneumonia Becomes Leading Cause of Death - Pacific Bridge ...

    --- the three causes of death (cancer, hypertension, heart disease) sound a lot like hyperinsulinemia. CARBS + cigarette smoking + alcoholism + environmental toxins + hyperdensity in the population are just more contributing factors to poor health

  27. Kay
    Rice would not have a negative effect on the body if eaten in small amount with a protein. I worked with Philippines natives who brought their food to work and shared it with me. If you eat too much you pay the price. If you scale down, the scale goes down. It's no great mystery. Every now and then they brought a sweet made with rice. One of them told me that she wouldn't feel right if she didn't eat rice every day. They didn't eat a large amount of food. I call it that they ate politely. And I noticed that another Philippine female who I didn't eat with because she was on another shift was heavier. I always wondered if she ate too much rice or other native food in general compared to how the others ate which I actually saw for the two years that I worked with them.
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