Could Cheese Be the Answer to the French Paradox?

  • The “French Paradox” describes the French diet, marked by significant quantities of saturated fats from cheese and alcohol from wine, which does not seem to have resulted in a higher mortality rate due to coronary heart disease or cardiovascular disease in the French population.
  • Previous studies often focused on the antioxidant properties of components in red wine as a solution to the French Paradox.
  • More recent studies find that milk components in cheese stimulate the production of an intestinal enzyme called alkaline phosphatase, which reduces gut and systemic inflammation and may improve cardiovascular health.


There may be nothing more iconically French than the image of a luscious cheese board and bottle of aged red wine. But for those of us living in a hyper-health-conscious culture, constantly bombarded with diet and nutrition trends and fads, it would be difficult to see a wedge of Camembert and glass of Pinot Noir as anything other than an indulgence. And certainly not as a “healthy” choice. Yet decades of research show that a French diet, including a high intake of saturated fat from cheese and alcohol from wine, may lower incidence of mortality from coronary heart disease (CHD). Though researchers have long looked to the beneficial properties of antioxidants in red wine to explain this French Paradox, the benefits may actually lie with components in cheese. In particular, a recent study found that a potent intestinal enzyme, alkaline phosphatase (IAP), may be stimulated by dairy products to fight cardiovascular disease (CVD) [1].

The French Paradox was first formally identified in 1992 when cardiologists Serge Renaud and Michel De Lorgeril [2] posited that the high intake of saturated fat common in the French diet was mitigated by the average level of alcohol consumption (20–30 per day). They noted that alcohol inhibited platelet aggregation, which in turn reduced the risk of CHD. Subsequent studies supported this “red wine hypothesis” and looked further into the polyphenols, especially resveratrol, that may protect cardiovascular function and health [3-5]. Benefits of moderate consumption of red wine have been correlated to reduced CVD, type 2 diabetes, and possibly neurodegenerative diseases [4]. So by the end of the twentieth century, it seemed that the answer to the French Paradox could be found in the biochemicals of wine, and specifically in the properties of those biochemicals as they could minimize or even block the potentially negative effects of high consumption of cheese.

Yet Ivan M. Petyaev and Yuriy K. Bashmakov, both medical doctors, offered a more comprehensive solution to the French Paradox in 2012, when they noted that “multiple other factors seem to be implemented in the French paradox” [6]. “These include smaller portion size, lower number of eating occasions, regular gardening and exercise and higher intake of fruit and vegetables rich in flavonoids, phytosterols and dietary fiber.” But also, and perhaps more significantly, they argue that the French consumption of cheese, “especially of molded varieties,” may be the key to the so-called paradox. The ripening process of Roquefort, Camembert, Gorgonzola, and other varieties of molded cheeses is characterized by a more intense proteolysis than that of non-molded cheeses such as Gouda and Cheddar [6]. Ripened molded cheese contains andrastins A-D, which inhibit the cholesterol biosysnthesizing enzyme farnesyltransferase; andrastin A may also have anti-cancer potential as an antitumoral compound [7]. Petyaev and Bashmakov note that it is through the extended ripening period of molded cheeses that the most advantageous properties appear, including the anti-inflammatory and probiotic benefits to humans [6].

Most recently Jean-Paul Lallès, biochemist and Director of Research at the French National Institute for Agricultural Research in Rennes, France, further supported the “dairy products” hypothesis by suggesting that milk components, including casein, calcium, and lactose, stimulate production of the IAP [1]. IAP impacts processes in the intestine as well as beyond it and is notable for its anti-inflammatory action. As inflammation in the body is reduced, metabolism and cardiovascular health may improve. Studies involving exogenous administration of IAP show that it is effective in treating inflammation of the bowel, as well as acute or chronic kidney disease in humans and animal models [1]. Lalles notes that “both experimental and clinical observations support the notion that IAP is a key anti-inflammatory enzyme able to control both gut and systemic inflammation.”

Alkaline phosphatase is also present in non-human milk, but it is inactivated during pasteurization. “Milk-AP has long been the ‘gold standard’ marker for pasteurization,” notes Lalles, “due to its heat-sensitivity greater than that of most such pathogens” [1]. Finally, and perhaps not insignificantly, low concentrations of alcohol stimulate IAP, which may further support the role of alkaline phosphatase in the French Paradox.

When it comes to lifestyle choices and nutrition, we have often looked for particular diets and profiles that offer the best outcomes for longevity and health. The seemingly indulgent diet of wine and cheese produced a kind of nutritional mystery long dubbed the French Paradox. But as recent research continues to show, the role of dairy in cardiovascular health is significant, and for the French, the answer may lie within the cheese.


1. Lallès JP. Dairy products and the French paradox: Could alkaline phosphatases play a role?. Med Hypotheses 2016 Jul 31;92:7-11.
2. Renaud S, de Lorgeril M. Wine, alcohol, platelets, and the French paradox for coronary heart disease. Lancet 1992;339(8808):1523–6.
3. Biagi M, Bertelli AA. Wine, alcohol and pills: what future for the French paradox? Life Sci 2015;131:19–22.
4. Artero A, Artero A, Tarín JJ, Cano A. The impact of moderate wine consumption on health. Maturitas 2015;80(1):3–13.
5. Hansel B, Roussel R, Diguet V, Deplaude A, Chapman MJ, Bruckert E. Relationships between consumption of alcoholic beverages and healthy foods: the French supermarket cohort of 196,000 subjects. Eur J Prev Cardiol 2015;22(2):215–22.
6. Petyaev IM, Bashmakov YK. Could cheese be the missing piece in the French paradox puzzle? Med Hypotheses 2012;79(6):746–9.
7. Rojas-Aedo JF, Gil-Durán C, Del-Cid A, Valdés N, Álamos P, Vaca I, García-Rico RO, Levicán G, Tello M, Chávez R. The biosynthetic gene cluster for andrastin A in Penicillium roqueforti. Front Microbiol 2017 May 5;8:813.


Contributed by
Dr. Katie Rodger
Managing Editor
SPLASH® milk science update