A FRENCH LUNCH. VIVE LA FRANCE !

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A French Lunch — A Nutrition Lesson for the USA, UK, Australia, Canada, and New Zealand

For a complex mix of anthropological, historical, and geopolitical reasons, English-speaking countries and their former colonies have not fared as well as France—or many of its past and present cultural spheres—when it comes to population health.

Obesity rates (%):
USA – 42.64
New Zealand – 32.99
Mexico – 32.22
Australia – 32.05
Ireland – 30.70
Canada – 28.16
UK – 26.94
France – 10.18

Among high-income nations, only Japan has a lower rate (7.63).

Why is France the leanest country in Europe, with over 60 high-income nations recording higher obesity rates?

The answer lies, at least in part, in a deeply embedded culture of food. In France, food is not incidental—it is central. There is care in preparation, respect for ingredients, attention to presentation, moderation in portion size, and, importantly, the social ritual of eating together.

Our lunch today offered a simple illustration.

Three adolescents were spending their school holidays at their grandparents’ home; two of us joined them. The meal unfolded in the traditional French rhythm—unhurried, structured, and varied.

• Oysters, freshly harvested from the nearby bay
• Two salads: grated carrot and beetroot, both delicate and vibrant
• Chicken in a mild curry with a light cream sauce
• A mash of broccoli and potato
• Several varieties of cheese
• Dessert: fresh strawberries with Chantilly cream
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There was no frying, minimal use of oil, and an abundance of fresh vegetables. Wine, often part of dinner, was absent at this midday meal—another example of moderation.

Before this trip, I placed a continuous glucose monitoring sensor on my skin. It tracks post-meal glucose excursions alongside activity and stress—both relevant, as stress hormones can elevate blood sugar.

After this meal, my glucose peaked at 120 mg/dL, entirely within the normal range.

This is revealing.

It is not merely what is eaten, but how it is prepared, structured, and consumed. The French model—fresh ingredients, minimal processing, balanced courses, slower eating, and social context—appears to mitigate excessive glycemic spikes and, over time, the trajectory toward overweight and metabolic disease.

PS: I do not have Diabetes.

By contrast, the industrialization of food—so characteristic of the United States and widely exported to countries such as the United Kingdom, Australia, Canada, and New Zealand and the petroleum rich countries of the gulf—has been a central driver of the global obesity epidemic. Interesting to observe, in the context of politics, Iranians are leaner than the Arabs of the region.

When I am in Miami, I get very little chance to walk whereas in France, I walk with glee to do my errands, to my cafe, to the supermarche!

PS i arrived in France yesterday. I have walked more in the past 36 hours than the week prior in Miami!  

France offers not perfection, but a compelling alternative: a way of eating that is cultural, deliberate, and, above all, human.

Vive la France.

FEW HOURS AT THE FAIRCHILD BOTANIC GARDEN. MIAMI, FLORIDA

There’s something quietly radical about stepping out of the noise. Not escaping it entirely—Miami does not permit such illusions—but placing a gentle distance between oneself and its glitter, its urgency, its practiced performances. At Fairchild Tropical Botanic Garden, the mind loosens its grip.

For a few hours, thought becomes less angular. Trees soften it. Water absorbs it. Mist dissolves it.

The Japanese have a word—shinrin-yoku—forest bathing. But here, in this curated Eden, it is less a technique and more a surrender. You sit, and something ancient in you remembers how not to strive.

And then, as often happens in these states of quiet receptivity, perception sharpens rather than dulls. The trivialities of daily life—the small vanities, the rehearsed frictions of work and social theatre—return, but altered. Not diminished. Exposed. Their pettiness almost theatrical, their distortions exaggerated, as if seen through a lens that refuses to flatter.

It was in this peculiar clarity that I noticed them.

Two palms. Still. Upright. Watchful.

Sentinels.

Not merely botanical specimens, but presences. And in an instant—without hesitation, without doubt—you recognized them: Copernicia fallaensis. A recognition not of intellect, but of memory lodged somewhere deeper.

And then Cuba returned.

Camagüey—an airport once improbably new, almost untouched by the world’s traffic. The rented car. The long drive toward Minas. The finca—Perú—spoken of in low tones among those who cared about such things. And there, improbably, in the yard of a farmer bemused by decades of foreign fascination, the great palm. His yarey, your pilgrimage.

1997 A different tempo of life. A different version of yourself.

Back in Miami, you walk among companions of that memory—Coccothrinax crinita, delicate and fibrous, and Copernicia baileyana, austere and monumental. Cuba, scattered and replanted, yet still intact in essence.

And perhaps this is what such places offer—not escape, but continuity. A thread between geographies, between past and present selves.

You leave with a small decision, almost incidental, yet quietly firm. To return. Not as a visitor, but as someone who knows the path.

A short drive. A familiar table at Daily Bread. Gyro, Hummus, Taboule  conversation, the ordinary made sufficient. And the girl behind the counter, who studied dentistry in Guantanamo, Cuba. Hope the memory of her native landscape comfort her during this exile 

And somewhere within, the stillness remains—like those palms, standing, patient, untroubled by the passing theatre of human concerns.

I AM A PHYSICIAN-ANTHROPOLOGIST TO MANY INDIGENOUS TRIBES/PEOPLE AROUND THE WORLD

Psychosocial Stress, Inflammation, and Atherosclerosis: An Anthropological Reflection

That most feared of outcomes—the heart attack, or acute myocardial infarction (AMI)—rarely occurs out of the blue. From a biomedical standpoint, it is attributed to atherosclerosis: a gradual narrowing and injury of blood vessels over time. The usual culprits are well known—diabetes, hypertension, hypercholesterolemia, sedentary lifestyle, and obesity.

Yet over the decades, more than fifty “causes” have been proposed. Some, like trans fats, were once celebrated as heart-healthy before being condemned. When explanations fail, we often retreat into the vague language of “socioeconomic factors”—a polite euphemism for poverty and social instability. 

Today, biomedical thinking is increasingly centered on inflammation as both the initiating and propagating force in cardiovascular disease. Some researchers even argue that what we measure—cholesterol, for instance—may be less a cause than a downstream effect of this inflammatory state.

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The Liminal Lives of Indigenous Communities

For those of us who have worked closely with Native American communities, another layer becomes impossible to ignore: chronic psychosocial destabilization.

Anthropologists such as Victor Turner described “liminal periods”—times of transition marked by uncertainty, vulnerability, and heightened error in judgment. In most societies, these are temporary (puberty, professional initiation, migration).

But for Indigenous peoples of the Americas, one could argue that liminality has become permanent—a condition sustained since first contact. This ongoing instability shapes not only social life but also biological outcomes.

Comparable patterns are seen among Australian Aboriginal communities and the San people of the Kalahari—ancient societies navigating imposed modernity. (I am Australian, so have visited remote indigenous communities. When I was reading Anthropology in London, I did some participant observations among the San people of the Kalahari. feel lucky to have done so)

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From Stress to Biology: The Inflammatory Bridge

“Psychosocial stress” is often used loosely, but it encompasses both origins and manifestations:

• Origins: depression, hostility, poverty, perceived racism, job insecurity, loss of agency, educational barriers

• Manifestations: smoking, alcohol use, sedentary habits, and unhealthy eating patterns

These are not merely behaviors—they are expressions of distress.

We have long known that such stressors elevate inflammatory markers like CRP and IL-6. Acute emotional events—bereavement, chronic anxiety, even prolonged commuting—have measurable physiological effects, including immune suppression and increased cardiovascular risk.

A notable study in the Archives of Internal Medicine (2007) examined nearly 7,000 individuals and found that:

• Higher levels of cynical distrust correlated with higher inflammatory markers

• Chronic stress was strongly associated with elevated CRP and IL-6

• Poverty and low education were linked to depression and distrust

• Individuals with higher BMI and diabetes carried greater psychosocial burdens 

Interestingly, the effects varied across cultures—being less pronounced in Chinese participants—suggesting that cultural frameworks modulate biological stress responses.

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Beyond Measurement: Asking the Right Questions

 This leads to a critical shift in clinical thinking.

Instead of asking:

“Why does this patient drink?”

We might ask:

“What in this patient’s life makes drinking necessary?”

This reframing applies across conditions—obesity, diabetes, hypertension. Without it, we risk treating laboratory values rather than human suffering.

Prescribing statins, metformin, or antihypertensives without addressing underlying distress is akin to sweeping dust under the carpet—the room appears clean, but the problem persists.

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The Metabolic Expression of Social Instability

Among Native American communities, the most common clinical presentations include:

• Type 2 diabetes

• Obesity

• Alcohol and ultra-processed food dependence

• Behavioural and relational dysfunction

These are not isolated diseases—they are biological expressions of social and historical disruption.

There is also a physiological pathway: chronic stress activates the hypothalamic-pituitary-adrenal (HPA) axis, contributing to insulin resistance, visceral fat accumulation, and metabolic disease. When combined with modern dietary toxins—high-fructose corn syrup, processed fats—the effect is amplified.

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Disease vs. Illness: A Necessary Distinction

Anthropology reminds us:

• Disease is what physicians diagnose

• Illness is what patients experience

These are not always aligned.

Every patient carries an explanatory model shaped by culture, history, and personal experience. When these models diverge from biomedical frameworks, misunderstanding—and often non-adherence—follows.

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Curing vs. Healing

Modern medicine excels at curing—controlling glucose, lowering cholesterol, reducing blood pressure.

But healing is different.

Healing requires:

• Listening

• Contextual understanding

• Engagement with the patient’s social world

Traditional healing systems often succeed here—not because they reject biology, but because they embrace the person as a whole.

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A Global Pattern

What we observe in Indigenous communities is not isolated.

As countries industrialize—Brazil, India, China—the same pattern emerges:

• Rising diabetes

• Increasing cardiovascular mortality

• Widening inequality

These are not merely “diseases of lifestyle.” They are diseases of rapid social transformation.

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Final Reflection

I have long held that obesity and diabetes are, at their core, social illnesses with biological consequences.

No amount of biomedical intervention alone can reverse them.

But there is hope.

The gradual integration of:

• culturally grounded healing

• anthropological insight

• and modern medical care

may offer a path forward—not only for Native American communities, but for a world undergoing profound social change.

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Postscript

Curing treats the symptom. Healing addresses the suffering.

And perhaps our task, as physicians, is to learn how to do both.