Debating the Health Benefits of Wine: An Update

As an informed physician, I am with the majority of health experts who are confident that wine in moderation is good for you, especially for middle-age to older people. That said, there continues to be conflicting evidence as to the health benefits of wine and other beverage alcohol as part of a healthy lifestyle leading to confusion among the public. Without scientific evidence, some have even claimed that no level of alcohol consumption is safe.

I read all of the medical literature and research on the relationship between alcohol beverages and healthy, yet I find it challenging to decipher the differing reports. The uncertainty stems primarily from the fact that all human research to date has been with cohort and case-control studies. There have been no well-executed, randomized, double-blinded, intervention trials controlled for all confounding variables. Still, although well-performed observational studies cannot completely exclude possible genetic or environmental predilections to health outcomes, criteria do exist that can establish a very high probability of causality in these data.

I last wrote about the debate as to the health benefits of wine in Volume 11, Issue 40 of the PinotFile: www.princeofpinot.com/article/2162/. This issue offers an update on studies published and the opinions of health care experts in the almost three-year interval.

As reported in the November 2021 issue of AIM Digest Online at www.aim-digest.com, the subject of “Moderate drinking - is it still a healthy lifestyle choice?”, was discussed in detail. In October 2021, the Wine Information Council held its 6th webinar on Wine & Health, presented in collaboration with the International Scientific Forum on Alcohol Research (ISFAR) and Curtis Ellison MD, Dr Creina Stockley, and Erik Skoverborg MD. This virtual round table delved into the issue of whether moderate alcohol consumption can still be seen as an acceptable element of a balanced diet and lifestyle, and if, based on recent research, the J shaped curve still exists to the association between moderate alcohol consumption and all-cause mortality as well as for other specific diseases. Since most wine consumers are unaware of this very important scientific session, I am summarizing it here. Dr Creina Stockley discussed the positive effects of 10-20 g of alcohol a day (a standard drink in the US contains about 14 g of pure alcohol which is equivalent to 5 ounces of about 12% table wine) on cardiovascular disease outcomes, but especially when combined with the other heart-healthy lifestyle elements of not smoking, eating a Mediterranean style diet, maintaining a healthy weight, and exercising moderately. Her important conclusions:

*Dr. Stockley’s review of key cohort studies found a reduced risk of cardiovascular disease and high blood pressure by about 30%, reduced risk of ischemic stroke by about 20% and a decrease in high and unbalanced cholesterol by about 10%, with the consumption of 1-2 drinks per day of alcohol compared with lifelong abstainers.

*Alcohol achieves its effect in a number of ways with polyphenols giving additional protection. The removal and transporting LDL cholesterol from the vessel walls may account for 50% of the benefit.

*The benefits are only associated with moderate consumption and higher levels of drinking are associated with higher blood pressure, atrial fibrillation and hemorrhagic stroke, for example.

Dr Skovenborg looked at the importance of the pattern of drinking and its effect on the J shaped curve. The J shaped curve has withstood the test of time after years of critique and correction of methodological flaws. However, the importance of effect-modifying factors like drinking patterns and elements of lifestyle has become increasingly clear during the last decade. His findings:

*Those who drink little and often have better disease and longevity outcomes than those who abstain or drink heavily. A large Danish study found that for the same average consumption of alcohol, a nonfrequent intake implied a higher risk of death than a frequent intake.

*Eating while drinking significantly reduces blood alcohol concentration of alcohol and is a much healthier pattern of drinking than drinking without eating. Binge drinking is particularly harmful. A large Danish study found that for the same average consumption of alcohol, a non-frequent intake implied a higher risk of death than a frequent intake.

Dr Skovenborg went on to look at the effects of alcohol on cancer risk.

*There is no question that alcohol is associated with some cancers, notably breast and cancers of the upper digestive tract. Alcohol is estimated to be linked to 3.3% of cancers. Breast cancer risk can be somewhat mitigated by adequate folate in the diet. The combination of smoking and drinking is particularly carcinogenic for cancers of the upper digestive tract.

*In terms of the risk of dying overall (all-cause mortality) than the five heart-healthy lifestyle factors are crucial leading to a 65% lower cancer mortality, for example.

Professor Ellison emphasized the importance of all-cause mortality and the significance of the pattern of drinking and adhering to other healthy lifestyle behaviors.

*Do we live longer if we enjoy a glass of an alcoholic beverage on a near-daily basis? The answer, for healthy post-menopausal women and men over 40 is still very much, ‘yes’.

*Current scientific data indicate that adults who consume alcohol regularly, with food, and without binge drinking, have a lower risk of most of the diseases of aging and tend to live longer than if they consumed no alcohol.

* The J shaped curve is relevant to late-onset diabetes with a significantly reduced risk among moderate drinkers are shown in study after study.

A large recent study supports the role of a good diet that includes wine in heart health:

*The ASPirin in Reducing Events in the Elderly (ASPREE) clinical study published in the European Journal of Preventive Cardiology focused on the lifestyle and health of healthy American and Australian adults over the age of 70. The study did not include former drinkers who may have stopped consuming alcohol for health reasons. Study participants who consumed 3.5 to 7 drinks per week were less likely to suffer cardiovascular events than those who abstained. Those who consumed moderate amounts of alcohol had lower rates of overall mortality compared to heavier drinkers. The study results only support a correlation and not causation but add more evidence supporting the health benefits of moderate consumption of alcoholic beverages.

European politicians have recently come out in support of the health benefits of moderate drinking

*The Comté Eurpéen des Entreprises Vins (CEEV) that represents the wine trade in the European Union (EU), is urging the European Parliament to reconsider the statement that there is “no safe level of alcohol consumption”, which came from an EU report in the Special Committee on Beating Cancer (BECA), a claim that was based on a flawed study. Despite the opposition, the EU report was adopted by the European Parliament. CEEV notes that the ‘no safe level’ message is counterproductive, as the moderate consumption of wine, particularly as part of the Mediterranean diet and as part of a healthy lifestyle, is associated with greater longevity and the prevention of disease. The ‘no safe level’ assumption is based on a single study - Global Burden of Diseases (GBD) study published by The Lancet in 2018 which has been severely criticized by the scientific community for its analytical flaws.

Seminar supports wine drinking in moderation:

*The results of a study called PREDIMED (Prevención con Dieta Mediterránea) looked at wine and weight management was presented at a seminar earlier this year. Glucose tolerance and triglycerides levels were measured among the 7,500 randomized participants. The results indicated that wine drinkers, particularly those having between 7 and 14 units per week, had a lower number of cardiovascular risk factors compared to non-drinkers.

A world-leading cardiologist and editor of the European Heart Journal for more than a decade, Professor Thomas Lüscher, led a team that reviewed over 3,200 submitted manuscripts from scientists and doctors and found that many were not deemed to be backed by enough solid data to be published. After resigning his role at the European Heart Journal, Dr Lüscher, weighed in on the question of whether wine, chocolate and coffee were good for the heart in the November 21, 2021, issue of The European Heart Journal. He said there were pros and cons to each, depending on how much and how often each of them was consumed, as well as by whom. He believes that coffee and chocolate (dark, bitter chocolate) are associated with a lower risk of heart disease, but alcohol overall provides little if any health protection. That said, he enjoys good red wine in moderation on weekends. This graphical abstract below summarizes his beliefs with protective effects shown in green and harmful effects in red (DCM stands for dilated cardiomyopathy).

The 2021 American Heart Association Dietary Guidance to Improve Cardiovascular Health was published in the November 2, 2021, issue of Circulation. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) maintain healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole-grain foods and products; (4) choose healthy sources of protein (mostly plants, regular intake of fish and seafood, low-fat or fat-free dairy products, and lean cuts and unprocessed forms of meat and poultry; (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; and (10) If you choose to drink alcohol, limit intake.

Elaborating more on alcohol consumption, the Dietary Guidance noted that the relationship between alcohol intake and cardiovascular disease is complex. The risk appears to differ by amount and pattern of alcohol intake, age and sex of individuals and type of cardiovascular outcome. As alcohol intake increases, so does the risk of hemorrhagic stroke and atrial fibrillation. For coronary heart disease and ischemic stroke, there is a J shaped relationship, with the lowest risk at low alcohol intake. (1 to 2 drinks per day and higher risks at no intake and higher intake).

The 2020 Dietary Guidelines Advisory Committee recently concluded that those who do drink should consume no more than 1 drink per day and should not drink alcohol in binges. In contrast, the 2020-2025 Dietary Guidelines for Americans continues to recommend no more than 1 drink per day for women and 2 drinks per day for men.