The Health Benefits of Wine

We begin with a review of some of the published studies regarding the health benefits from wine and other alcoholic beverages. The following is taken mostly from the writings of Elisabeth Holmgren, director of the Department of Research and Education at the Wine Institute. Although she represents the wine industry, her writings seem to be relatively even handed. Nothing that follows is meant to obscure the fact that prolonged excessive alcohol consumption is detrimental to one’s health. Joel’s comments are in brackets [JM].

Wine’s Role in the “French Paradox” Receives Confirmation
   A new study by original “French Paradox” researcher Serge Renaud offers more evidence that moderate wine consumption is associated with a significant reduction in all-cause mortality, cardiovascular disease and cancer among men. The findings (Epidemiology, March, 1998) were based on a large cohort study [JM - cohort studies are epidemiological studies that use individuals having a statistical element in common, such as race, gender, age, etc., as opposed to a random selection of individuals. As such, the results cannot always be projected to the population as a whole.] of middle aged men in eastern France. Daily, moderate drinkers who consumed mostly wine were compared to non-drinkers and heavy drinkers.
   Renaud and colleagues from the University of Bordeaux found that moderate wine consumption (2-3 glasses a day) was associated with a 30% reduction in the death rate from all causes; a 35% percent reduction in death rates from cardiovascular disease; and an 18-24% reduction in death rates from cancer. “The results of the present study,” the researchers write, “appear to confirm the speculation that the so-called French Paradox is due, at least in part, to the regular consumption of wine. [JM - The French Paradox, of 60 minutes fame, is the observation that, although the French and Americans have similar high fat diets, the French have a much lower incidence of cardiovascular disease. Speculation was that this is due to the protective effects of wine consumption, since the French drink much more wine than we do. Of course, there are many other possible explanations.]

How Wine Works: Emerging Research on Mealtime Alcohol Consumption
   It is known that alcohol consumption reduces the risk of coronary heart disease and overall mortality. [JM - This statement is a bit strong. Statistical studies show a relationship between two variables (here, moderate alcohol consumption and reduced incidence of heart disease), but they do not establish a cause and effect relationship - “proof” that one causes the other. The recent wealth of data should give us more confidence in a cause and effect relationship, but we are not nearly to the point of “proof.” It took decades and hundreds of studies before the Surgeon General was willing to declare that smoking causes cancer.] But it has been less clear just how alcohol works to protect the body against heart disease and death.
   A new study from researchers at the University Hospital of Zurich, Switzerland. identifies a mechanism for how alcohol favorably effects arterial muscle cells. According to Wilhelm Vetter, M.D., and colleagues, alcohol, when consumed around mealtime, reduces the proliferation of smooth muscle cells (SMC) within the arteries. SMC growth is a key element in the develop-ment of atherosclerosis, which commonly leads to heart attacks and strokes.
   The study found that the ingestion of alcohol. equivalent to two glasses of wine or three beers, with a high-fat meal resulted in a 20% decrease in the growth of arterial muscle cells. Researchers suggest these results could have a profound effect on heart disease “considering the amount of time humans spend in the postprandial state during their lifetimes.”
   Other mechanisms may be at work. Several researchers have suggested that the apparent health benefits of wine ingested at mealtime may be due to the ability of alcohol and other phenolic compounds in wine to counter adverse effects of fatty foods during the critical digestive phase. Renaud has written of the positive effect of wine during meals on platelet aggregation , finding that wine “consumed with meals is absorbed more slowly, and thus has a prolonged effect on blood platelets at a time when they are under the influence of alimentary lipids known to increase their reactivity.”
   An Israeli study by Fuhrman et al, published in the American Journal of Clinical Nutrition, found that drinking red wine with meals resulted in a 20% reduction in the LDL (“bad”) cholesterol oxidation. A Dutch study, published in the British Medical Journal, found that alcohol consumed with a meal may prevent blood clotting triggered by fat.

Women Wine Drinkers Have Fewer Kidney Stones
   A new study from Harvard University researcher Gary Curhan and colleagues, using more than 81,000 women participants drawn from the Nurses’ Health Study, found that an increase in fluid intake significantly reduces risk for kidney stones and that risk reduction was greatest for wine compared with other beverages. Out of 17 beverages, including tea, coffee, fruit juices, milk and water, wine was associated with the highest reduction in risk - 59%.
   Researchers noted: “Intakes of caffeinated and decaffeinated coffee, tea and wine were associated with decreased risk.” Curhan and colleagues reported similar results for men and kidney stones in 1996. Wine consumption was associated with highest risk reduction - 39%.

Moderate wine consumption cuts stroke risk
   The moderate consumption of wine (but not beer or spirits) is associated with a reduced risk of stroke, according to a new report. The authors believe wine’s protective effects may be linked to disease-fighting compounds other than alcohol. “Intake of wine is associated with lower risk of stroke,” concludes a 16-year Danish study led by Dr. Thomas Truelsen of Copen-hagen University Hospital (Journal of the American Heart Association, December, 1998).
   Previous studies have suggested that moderate wine consumption (a glass a day, for example) may provide cardiovascular benefit. This phenomena is exemplified by what the Danish team call the ‘French paradox’ - “a low incidence of cardiovascular disease in the (wine-drinking) French population despite an unfavorable exposure to known cardiovascular factors (such as smoking).” Investigating further, the authors tracked the stroke incidence of over 13,300 Danes for 16 years.
   They report that, compared with abstainers, individuals who said they drank wine on a monthly, weekly, or daily basis had a 16%, 34%, and 32% reduced risk of stroke, respectively. The researchers found “no association between intake of beer or spirits on risk of stroke.”
   These findings suggest that other compounds in wine besides alcohol may have a positive impact on cardiovascular health. “Wine contains flavonoids and tannins,” the authors explain, “which are components presumed to prevent cardiovascular disease.” They speculate that drinking patterns specific to wine lovers may also influence cardiovascular health. Wine is more commonly consumed at mealtimes than either beer or hard liquor, and “these differences in ‘timing’ may be important,” according to the researchers. One recent study concluded that mealtime alcohol consumption reduced unhealthy alterations in blood composition that can occur after eating.
   In a press release, the American Heart Association “does not recommend that individuals start drinking to reduce their risk of heart disease and stroke.” Experts point out that excessive drinking can actually raise the likelihood of cardiovascular disease, heart attack, and stroke.

Regular, Moderate Alcohol Consumption Protects Against Atherosclerosis
   New Data from the Bruneck Study (Italy) was reported by Australian and Italian researchers in the May 1998 issue of Stroke. They conclude that light to moderate alcohol consumers faced a lower risk of atherosclerosis (early atherogenesis) than either abstainers or heavy drinkers. Arteriosclerosis, the gradual build-up of fatty deposits in the arteries, is the leading contributor to coronary heart disease and fatal heart attacks.
   Notably, alcohol consumption during meals offered advantages. “Alcohol ingestion during meals tended to offer more protection, probably due to a delayed absorption and prolonged mode of action at a time when platelet reactivity increases under the influence of alimentary lipids,” explained the researchers, led by Innsbruck University’s Stefan Kiechl, M.D.

Cohort Studies From Around the World Link Moderation to Longevity
   In recent years dozens of cohort studies from all over the world have associated moderate alcohol consumption with reduced risk for cardiovascular disease, decreased overall mortality rates and other potentially improved health conditions. This growing worldwide research consensus has resulted in certain changes in the world view of alcohol during just the last few years. In a significant departure form the past, major public health organizations and governments around the world now officially recognize that moderation can be part of a healthful diet for those who choose to drink. The World Health Organization, the United States government, the United Kingdom’s government and the American Heart Association are among the health policy leaders that recently have issued balanced alcohol statements expressing caution in terms of alcohol abuse, but highlighting scientific findings that associate cardiovascular benefits with moderate consumption.
   In varying degrees, wine, beer and spirits have been shown to confer certain health advantages for those who consume in moderation. The most recent review study on the subject of alcohol and longevity was by esteemed British epidemiologist Richard Doll, M.D. In the British Medical Journal, Doll concluded, “The consumption of small and moderate amounts of alcohol reduces mortality from vascular disease by about a third.” In his review, Doll looked over three dozen studies published over the last decade. We will discuss some of these cohort studies from around the world which are highlighted in the table below.

Alcohol and Wine’s Effects on Mortality - Findings From Around the World

Well-Established Cardiovascular Benefits of Moderation
   As early as 1980, the Honolulu Heart Study reported that moderate alcohol consumption was associated with a 50% reduction in the rate of coronary heart disease. Dozens of studies around the world have since confirmed this for both men and women. In the 1990’s, large-scale studies including the Health Professionals Follow-Up Study (over 44,000 men) and the Nurses’ Health Study of over 85,000 women have convincingly demonstrated reduced risks for heart disease. The data are so clear on this issue that leading Harvard researchers included moderate alcohol consumption as one of the best ways to cut heart attack risk. In 1996, they credited “one or two drinks of beer, wine, or liquor per day” to “a reduction in risk of 20-40%.
   The latest research has also found associations between moderation and other cardiovascular diseases. In early 1997, data was published showing that moderate alcohol con-sumers reduced their risk for stroke, angina pectoris (a painful precursor of heart attacks) and for peripheral artery disease, a condition in which internal blood clots form in the extremities.
   It was Dr. Arthur Klatsky of Kaiser Permanente Hospital in California who first noted that the association between consumption and heart disease resembled a “U” with moderate con-sumers at the lowest risk in the curve, and abstainers and abusers at higher risk. This U-shaped relationship between alcohol intake and disease continues to be seen for both cardiovascular and overall mortality studies. Moderate consumption appears to be most advantageous.

Moderation and Reduced All-Cause Mortality
   Some of the most respected population studies find that consuming wine, beer or spirits in moderation has been associated with an increased life expectancy. Researchers report that although substantial decreases in mortality risk for moderate drinkers can be attributed to reduced risk of heart disease, this factor alone does not entirely account for their favorable mortality profile. Moderate drinkers compared to abstainers, both male and female, appear to be at lower risk for all causes of death, including cancer and other chronic diseases, while heavy drinkers increase their mortality risk. This U-shaped relationship was seen in the Honolulu Heart study and subsequently in an American Cancer Society Study which found that subjects who consumed moderate amounts of alcohol (less than 3 drinks per day) were less likely to die during the research period than either abstainers or heavy drinkers. Several studies with similar findings have led the American Heart Association to state in 1996, “The lowest mortality occurs in those who consume one or two drinks per day.”
   A 13-year follow-up of a British Physician’s Study found that the overall death rate for 12,000 male doctors in middle or old age who had an average of one to two drinks per day of wine, beer, or spirits was at least 1/6 lower than that for abstainers. Investigators for the Danish government’s Copenhagen City Heart Study similarly analyzed 10-12 years of follow up data on 7234 women and 6051 men aged 30 to 79. A U-shaped curve emerged: consumers of 1-6 drinks per week had the lowest risk for all causes of mortality. A 1997 Shanghai Cohort Study, the first major Chinese study, examined 18,000 men in Shanghai and found a 19% lower mortality rate for all causes in moderate drinkers.

   The Nurses’ Health Study (1995) found a reduced overall mortality rate for light-to-moderate drinkers among 85,000 women. They concluded, “For women as a group, light to moderate alcohol consumption offers significant survival advantages. It was associated with a decreased risk of death from cardiovascular disease; heavier drinking was associated with an increased risk of death from other causes, particularly breast cancer and cirrhosis.” Benefits were most pronounced for women with risk factors for heart disease and those 50 years and older.
   Other Harvard University cohort studies, the Framingham Heart Study as well as the Kaiser Permanente Study confirm overall mortality benefits for moderate drinkers. The National Health and Nutrition Examination Survey (NHANES), the largest government survey of Americans’ health and lifestyle habits, reported that for white males, “Moderate drinking increases the time until death from any cause by about 3 percent.”
   At the same time, scientists point out that more research is needed to provide a true risk/benefit analysis for different gender and age groups that considers not only coronary heart disease and overall mortality, but also various types of cancer. In particular, some studies find a link between alcohol consumption and breast cancer in women. However, most researchers feel that the cardiovascular benefits of moderate alcohol consumption far outweigh the breast cancer risks (Cardiovascular disease is very common; breast cancer is rare in comparison).

Wine Phenolics and Disease Prevention
   While some researchers believe that all alcoholic beverages provide equal benefit, several scientists believe wine offers benefits in addition to its ethyl alcohol component. The beverage-specific data from the ongoing Copenhagen City Heart Study reported that wine drinkers were least likely to die from any cause during the 12-year study period. “Our finding, that only wine drinking clearly reduces both the risk of dying from cardiovascular and cerebrovascular disease and the risk of dying from other causes”, write researcher Morton Gronbaek and colleagues, “suggests that other more broadly acting factors in wine may be present.”
   Research programs on other factors in wine has resulted in several studies in the past few years on the antioxidant and protective effects of wine compounds. Several phenolic compounds in wine (such as quercetin, epicatechin and resveratrol) inhibit platelet aggregation and act as antioxidants to prevent the breakdown of LDL cholesterol into atherosclerotic plaque. One in vitro study even found that these compounds were more effective than vitamin E in inhibiting LDL oxidation. Since 1991 over three dozen studies have provided preliminary evidence that wine phenolics have positive health effects. However, as most of this research comes from animal studies, it has not yet been demonstrated that this is applicable to humans.

Summary Perspective
   Key recent cohort studies (Harvard’s Physician’s Health Study and the American Cancer Society’s Cancer Prevention Study II) found lower mortality profiles for moderate drinkers. The ACS study was the largest on alcohol consumption to date, with nearly half a million subjects, finding all-cause mortality risk to be reduced by approximately 20% for both men and women who consumed one drink per day. Several published reviews have pointed out that higher levels of alcohol consumption can be detrimental to health in many ways. However, as Finnish researcher Kari Poikolainen wrote in a 1995 review in the Journal of Clinical Epidemiology, “The lowest risk of death seems to be at the average intake level of one drink per day.”
   Key studies throughout the 1990’s (see Table last month) associate approx. one drink per day with increased longevity. In each study, all-cause mortality rates for moderate drinking men and women, in diverse populations such as the US, China and Australia, are significantly lower than rates for non-drinkers. Based on a decade of research findings, Richard Doll, M.D. (in the British Medical Journal) calls the evidence for alcohol’s beneficial effect “now massive. People should told the facts. These still need to be defined in detail, but in broad outline they are quite clear: In middle and old age, some amount of alcohol within the range of one to four drinks each day reduces the risk of premature death, irrespective of the medium in which it is taken.”
   The U.S. Dietary Guidelines advises moderation, which is defined as no more than two drinks per day for men and no more than one drink per day for women. Forthcoming research will continue to clarify the effects of moderate wine and alcohol consumption in healthy diets and balanced lifestyles. It is hoped that these findings will be reflected in worldwide nutrition policies like the year 2000 Dietary Guidelines for Americans.

Drinking Wine May Lower Risk for Upper Digestive Tract Cancer
   Many research studies have associated alcohol consumption with increased risk of upper digestive tract cancers. But Morton Gronbaek and colleagues at the Institute for Preventive Medicine in Copenhagen, Denmark, report just the opposite. They speculate that previous studies did not analyze data for specific types of beverages and/or did not distinguish between use and abuse. Although they acknowledge that their analysis may not be perfect, the Danish researchers tracked the 13-year incidence of mouth, throat and esophageal cancers among 28,000 Danes. They report that heavy drinkers experienced a 12-fold increase in upper digestive cancers compared with abstainers. But among moderate drinkers, those who consumed at least 30% of their alcohol intake in the form of wine were at slightly lower risk than non-drinkers for these cancers. “A moderate intake of wine probably does not increase the risk of upper digestive tract cancer.” They speculate that compounds found in wine, such as resveratrol, may exert powerful anticarcinogenic effects that protect against any cancer-causing effects of alcohol. “Wine contains several components with possible anticarcinogenic effects - these may exert their action locally in parallel with the possible effect of ethanol.”

New Research Developments of the Antioxidant Front
   The Italian National Institute of Nutrition (Rome) found that phenolic compounds in wine are absorbed in the gastrointestinal tract and “might be directly involved in the in vivo antioxi-dant defenses.” This study clearly associated non-alcoholic components in wine with increased plasma antioxidant capacity, which may lead to a reduced risk in coronary heart disease.
   A team of researchers from New York, Japan and the University of Illinois reported prelim-inary evidence that resveratrol (a compound found primarily in grapes and wine) may inhibit cancer growth in humans.

Moderate Drinkers’ Benefits Begin in Early Adulthood
   A new study from the UK, published in The Lancet, has found that among young adults, moderate drinkers are at a reduced risk of psychological distress, poor general health and long-term illness compared to abstainers and heavy drinkers. Dr. Chris Powers and associates studied 9,605 men and women at age 23 with a follow-up at 33. They found that men drinking between 11-35 units of alcohol and women drinking between 6-20 units of alcohol per week experienced fewer health-related problems than nondrinkers and heavy drinkers. One unit of alcohol was the equivalent to a half pint of beer, one measure of spirits or one glass of wine.
   Dr. Powers is from the Institute of Child Health (London) and the co-authors are from the Australian National University (Canberra). They hope to continue the research with the same subjects in order to see how they progress with age. This is one of the first studies to look at the effects of alcohol consumption in early adulthood and it’s long-term effects on health.

The information in this article is for educational purposes only. Wine should be enjoyed in a responsible manner as part of a well balanced lifestyle by healthy adults who choose to drink. “If you drink alcoholic beverages, do so in moderation, with meals, and when consumption does not put you or others at risk” ~ Advice for Today, 1995 U.S. Dietary Guidelines for Americans. Meanwhile, the research on the health benefits of wine continues!