Why are the French at a lower risk for heart disease than Americans?

In most studies, the protection provided by social support is independent of other risk factors, including diet, cholesterol, smoking, genetics, and so on. For example, much has been written lately about the so-called French paradox. In France, the rate of heart disease is 30 percent lower than in the United States, even though the traditional French diet is not very low in fat. (Heart disease is still the number-one cause of death in France, but it is lower than in the United States.) I would like to believe that there is something protective about eating pâté de foie gras, or olive oil, or red wine, but I believe that the French may live longer despite their diet, not because of it.

The major difference between France and the United States is cultural. Their social support helps protect them from their diet. They eat some fatty foods, but in small portions. They tend not to eat between meals. Fresh fruits, vegetables, grains, and beans play an important role in their diet. And, perhaps most significant, meals are important occasions for being with friends and having social support. When people eat together in an unhurried fashion, they receive nourishment and sustenance for their souls, not just food for their bodies. The isolation is bridged and healed, at least for a while.

In contrast, the majority of families in the United States do not eat even one meal together. Even within France, heart disease is much lower in the southwest region, where villagers have lived in stable communities for centuries, than in the northwestern Normandy region where the divorce rate is high and the communities are more disrupted and urbanized.

I’m not arguing for a return to a mythical, Norman Rockwell-idealized view of family and community. I know how dysfunctional many families can be. But a family is a place where you can bring down your walls, at least to some extent. They know you, they know some of your secrets, and they still care about you.