The Man Who Ate Everything (6 page)

In the same pot, melt the butter. Pour half of it into a small bowl and set it aside. Take 2 cups of the cooked rice, mix it in a bowl with the yogurt, and spread it on the bottom of the pot over the butter. Sprinkle a layer of lentils on the rice, then a layer of raisins, dates, and onions, then another layer of rice. Continue until all the ingredients are used up, sprinkling the remaining teaspoon of Persian allspice mixture between layers. Fluff the rice as you add it. Reduce the diameter of each layer so that the ingredients taper into a pyramid in the pot.

Cover and cook over medium heat for 10 minutes so that a delicious crust will form on the bottom of the rice. Then uncover, pour the reserved melted butter over the rice, put a dish towel over the pot, cover again, and cook over low heat for 50 minutes. Remove from the heat but do not disturb the cover; place the pot on a cold, wet dish towel for 5 minutes (which is meant to help loosen the crust). Then uncover the pot and transfer the contents by the cupful to a serving platter, mounding the rice and other ingredients into a fluffy pyramid. When only the crust remains on the bottom of the pot, dislodge it with a knife and spatula, and serve in one or two pieces (if you’re lucky) on a separate plate. Surround the rice and lentils with the meat mixture and serve.

April 1993

How We Live Today

Today’s mania for take-out food and the disappearance of home cooking have two related causes—smaller households and working women. (No man ever gave up cooking because he went back to work.) Are these trends likely to continue? With the aid of a see-through plastic ruler, I have projected the past twenty-five years of U.S. Census Bureau figures into the future, and the results are chilling.

Item: By the year 2050 the average family size will have decreased to about one person. Everyone in America will be living alone.

Item: All women older than eighteen will be working outside the home.

Item: All women will be older than eighteen.

The inevitable conclusion is that by the year 2050, everybody will order take-out food at every meal.

Eating will become extremely expensive. You will need an annual income of at least $392,114 in current dollars to get by. Grazing my way from one end of Manhattan to the other, I found that a modestly upscale take-out breakfast, lunch, and dinner cost $40 plus $7 for a taxi or $54,896 a year for an average family of 3.2 persons. Department of Agriculture figures show that the average American family spends 14 percent of its income on food. Therefore, it must earn $392,114 a year.

Finding good take-out food is not easy. Searching it out will become your full-time occupation in the year 2050, more than cooking ever was. Americans will once again become a lonely race of Mesolithic hunter-gatherers prowling the darkened city streets, wallets honed and sharpened, ready to pounce on the unsuspecting pint of pasta primavera and snare the slow-footed slice of
pate de campagne.
We will scarcely have time to eat.

April 1988

Last year, while browsing through the latest government report on diet and health, I came across a graph that left me flabbergasted.

In little black bars across the page it traced the incidence of deaths from coronary heart disease in twenty-seven industrialized countries. Japan did the best, which is no surprise because the Japanese eat lots of fish, rice, and little green things. But the identity of the runner-up astonished me. Right behind Japan, with the second-lowest rate on earth—lower than Italy with its olive oil cuisine, half of Scandinavia with its high-fish diet, and a mere fraction of the United States, the most finicky country in the world about what we put in our mouths—was, incredibly,
France!

Impossible, I gasped. Everybody knows that the French wallow in butter, cream, and egg yolks; gobble pork, cheese, goose fat, and sausages; and guzzle wine like fish. If the French have the second-lowest rate of fatal coronary heart disease in the world— and the lowest in the Western world—then everything the U.S. surgeon general, her predecessor, and iheir battalions of government doctors want us to believe about saturated fats and cholesterol must be dead wrong. And if this is so, the surgeon general would have resigned in disgrace long ago, which she didn’t.

I telephoned a doctor friend of mine, an expert in nutrition who never tires of frightening people about the devastating
effects of dietary fats, and asked him the obvious question: “If you’re so smart, why aren’t the French dropping like flies?”

Maybe the French actually eat more austerely than we think, he suggested. Or maybe it’s genetic. Perhaps the French government collects health statistics differently from the way we do. He feverishly proposed every excuse that came to mind, while avoiding what for him would be an awful truth: that we may not need to give up sumptuous food to stay healthy.

The genetic argument is hopelessly feeble because the French are not a homogeneous people like the Japanese. But do the French eat as richly as tourists imagine? After only twenty telephone calls to U.N. agencies here and in Europe, I found a statistician in Rome who was willing to send me the most recent Food Balance Sheets of the Food and Agriculture Organization.

Here are the facts: the French take in about as many calories as we do in the United States, but they consume more cholesterol and saturated fats because they eat four times as much butter as we and more than twice as much cheese and lard. I made a quick calculation that the French consume more saturated fat just from the forty pounds of cheese they eat each year than the surgeon general says we should take in from all sources combined.

If the French have heard of oat bran, it does not show up in the statistics—they eat only one-fifteenth the number of oats we do. They consume less sugar and beef and less whole milk, but the rest of their diet differs from ours in unremarkable ways: slightly less meat of all types and slightly less fresh fruit, a little more seafood, twice the garlic, half the onions, rather more potatoes and bread, and the same number of eggs.

I was about to launch an arduous search for detailed health statistics comparing France and the United States when my doctor friend sent me an excellent article by Edward Dolnick called
“Le paradoxe franqais.”
It had appeared in the May/June issue of
Hippocrates
magazine, and it did all the work for me. Only 143 out of every 100,000 middle-aged French men die each year of coronary heart disease, compared with 315 among middle-aged
American men. French men live about as long as men in the United States, but French women outlive American women by at least a year and have even fewer fatal heart attacks than the Japanese—without jogging or health clubs.

Within France the lowest rate of heart disease is found in the southwest, an earthly paradise of goose and duck fat, sausages and foie gras, and very little olive oil or fish. (So much for the Mediterranean-diet hypothesis.) In Normandy, where the people swim in butter and cream, the heart disease rate is higher than in the rest of France, but it’s still lower than in the United States. The French smoke as much as we do, but wherever you go in France, heart disease kills at a lower rate than here and kills later in life. For reasons nobody understands, a Frenchman with the same cholesterol level as an American has only half the chance of suffering a heart attack. Even in France, blood cholesterol levels do count, but something else in the French diet seems to count for much more.

One possibility is that the plentiful calcium in all that cheese binds with the fat and prevents its absorption into the bloodstream, allowing it to be excreted before it kills. Another is wine. The average Frenchman drinks
ten times more wine
than the average American. Dolnick cites one study demonstrating that the more wine a nation drinks, the lower its rate of fatal heart disease. The French may die more often from cirrhosis than we do, but liver disease still accounts for only 3 percent of all deaths in France.

Could Americans cut their heart disease rate in half by switching to a high-cheese, high-wine, high-goose-fat French diet? If I were the surgeon general or head of the National Institutes of Health, I would immediately shift every available resource to answering that question. Last week, I tried unsuccessfully to reach the surgeon general to propose this idea. Then I telephoned the Centers for Disease Control in Atlanta, but nobody cared. Finally I reached Dr. Millicent Higgins, head of epidemiology at the National Heart, Lung, and Blood Institute. She
was attending some kind of heart attack conference in Houston, where I tracked her down during breakfast in her room. Intelligent and well informed, Dr. Higgins conceded that the French statistics are extremely puzzling. But she refused to drop everything and find out why. And she grew obstinate when I suggested that she send back her fresh fruit with yogurt and bring on the bacon and eggs.

When I explained the reasoning behind my high-goose-fat diet, she objected that she knew of no epidemiological research that would support the idea. Which is precisely my point.

March 1991

Author’s Note:

Edward Dolnick and I are usually given credit for having independently “discovered” the French Paradox. Which of us was first is for historians of Great Ideas of the Twentieth Century to decide. The phrase itself was coined by the eminent French doctors J. L. Richard and Serge Renaud several years earlier in a brief and amusing note in a French medical journal; this was the only other mention in print of the phenomenon.

A considerable time after both Dolnick and I had published our pieces,
le paradoxe fran
c
ais
was “discovered” by both the
New York Times
and
60 Minutes
on CBS—on the same Sunday. The
60 Minutes
piece simplistically insisted on the red wine theory, and over the succeeding month, sales of red wine in America increased by 50 percent—not, I think, because people were trying to cure their heart disease, but because they felt that permission to drink more had been granted by a higher authority.

The French Paradox is not, of course, a true paradox, but the sort of seeming contradiction between scientific theory and real-world facts that is supposed to lead to progress. Most of the American nutrition establishment behaved otherwise, because the new facts threatened to destroy the hypotheses on which many of them had built their careers—principally those regarding the
influence of dietary fat on the health of our arteries and consequently on the rate of premature cardiac deaths; and after a year or two of engaging in what was meant to pass for scientific discourse, they were happy to let the Paradox fade from the foreground.

But they never laid a glove on it. Some nutritionists were happy to believe that the French do not know how to count heart attacks. The only basis for this charge was a technical study by a statistician at the National Cancer Institute showing that in one regard the French do not “code” their death certificates as World Health Organization protocols instruct: when the French have the choice between attributing somebody’s death to cancer or to heart disease, they incorrectly favor the former. But how often do these errors occur? The answer is critically important to the WHO’s MONICA project (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease), whose purpose is to standardize and compare cardiac risk factors and fatalities across national boundaries. An emergency meeting was held, a study was performed, and a resulting MONICA report demonstrated that the French inclination to undercount heart fatalities is too small to matter. Correcting for it does not budge France from its standing right behind Japan in the coronary heart disease sweepstakes.

Just the idea that French cholesterol levels are the same as ours—while their rate of heart attacks is less than half—is enough to drive American nutritionists crazy. But not the Europeans, who, though taking cholesterol and saturated fat very seriously, assign to them only about one-sixth the influence we do here. Whether blood lipids end up as arterial plaques depends partly on whether they are oxidized; a major MONICA study, largely ignored in this country, showed that circulating levels of vitamin E, an antioxidant, statistically overwhelmed the influence of circulating levels of cholesterol in our bloodstreams. Besides, serum cholesterol may contribute to narrowing of the arteries, but for a heart attack to occur, the blood must clot—thrombosis must
occur. Fat intake seems to have no connection with thrombosis. And other blood factors, such as circulating levels of the amino acid homocysteine, are now believed to be at least as important as cholesterol; consumption of folic acid (which occurs in greatest quantity in the liver of web-footed fowl!) effectively lowers homocysteine, but whether this is an effective therapy or merely suppressing the messenger has yet to be discovered.

A large number of heart attacks appear to result from spasms of the blood vessels, or unexplained ischemia; the causes are unknown, and diet has not been implicated. Finally, a group at Harvard has recently characterized the arterial damage that can lead to a heart attack as an inflammatory disease; again, the marker for this inflammation is as highly correlated with coronary disease as is serum cholesterol. All of this may finally explain why regular intake of aspirin fights heart disease. The suspected inflammation apparently has nothing to do with diet.

The French Paradox cannot be dismissed. It should have been noticed decades ago. And its contribution is to encourage researchers to discover the many other common causes of heart disease besides the saturated fat in our diets. The French Paradox is an embarrassment only to those nutritionists and physicians who had refused to recognize the obvious. We have known for some time that half of all heart attacks occur in people with average or low cholesterol, and that half of all people with high cholesterol never have heart attacks.