The coronary heart disease prevention message in the 1970s, coming from the USA, was negative and discouraging. “Avoid cigarettes, alcohol, fatty and rich foods.” A diet containing saturated fat would lead to high blood cholesterol levels and high coronary risk. The French did not fit into this picture. Paradoxically, they appeared to enjoy rich food with wine, a high fat intake, similar cholesterol levels to Americans, and a very low coronary heart disease mortality. The review demonstrates the international statistics that underlie the “French paradox,” and then uses data from the WHO MONICA Project (World Health Organization–MONItoring of trends and determinants in CArdiovascular disease) to examine French mortality statistics. It traces the origins of the “dietheart hypothesis” through the Framingham study, the Seven Countries Study, and metabolic ward feeding experiments, to the time in the 1970s when what foods did to blood cholesterol levels was all that seemed to matter. It then follows the way in which the diet-heart hypothesis was later modified to take account of antioxidants and micronutrients and became multidimensional. Possible key contributors to the French/Mediterranean/“healthy” diet are considered, including olive oil, wine, garlic and onions, vegetables and fruit, and fish. It concludes by speculating on the future fate of the French paradox...